Investigating Crescentic Glomerulonephritis in Children: Clinical Spectrum and Predictors of Renal Survival Crescentic Glomerulonephritis
Journal of Pediatric Nephrology,
Vol. 11 No. 1 (2023),
13 September 2023
https://doi.org/10.22037/jpn.v11i1.41665
Abstract
Background and Aim: This study aims to evaluate the clinical and histopathological
profile in children with crescentic glomerulonephritis (CGN) and determine the predictors
of renal outcome.
Methods: In this retrospective study, we reviewed all native kidney biopsies performed in
patients <18 years over 9 years (2011-2019). Individuals with ≥20% crescents with follow-up
for at least 1 year were enrolled.
Results: This study included 34 patients. The most common variety was immune-complex
glomerulonephritis (GN) (type II CGN) (n=21; 62%), including patients with Henoch-
Schonlein purpura (n=6), lupus nephritis (n=6), post-infectious GN (n=3), C3GN (n=3),
and dense deposit disease (n=3). The second most common was pauci-immune GN (type
III CGN; n=12; 35%) followed by anti-glomerular basement membrane disease (type
I CGN; n=1; 3%). Hypertension (88%), hematuria (84.2%), and oliguria (64%) were the
most common presenting features. The outcome predictors for poor renal survival were
the presence of oliguria (HR-5.11, P=0.035), severe hypertension (HR-11.51, P=0.019),
estimated glomerular filtration rate <15 mL/min/1.73 m2 at presentation (HR-5.05, P=0.007),
percentage of crescents (HR-10.66, P=0.001), presence of fibrous crescents (HR-6.34,
P=0.001), and interstitial fibrosis and tubular atrophy (HR-8.88, P=0.0046). The overall
outcome of the study revealed complete recovery (n=12), partial recovery (n=6), chronic
kidney disease (n=3), and end-stage renal disease (n=13). The renal survival in patients with
≥50% crescents was poor (P=0.037) as compared to subjects with <50% crescents.
Conclusion: Renal survival can be predicted by the severity of presenting features and
histopathological markers. Two-thirds of patients had type II CGN with renal survival
outcomes similar to type III CGN. The percentage of crescents is the most important predictor
of renal survival.
- Child
- Crescentic glomerulonephritis
- End stage renal disease
- Survival
How to Cite
References
Jennette JC. Rapidly progressive crescentic glomerulonephritis.
Kidney Int. 2003; 63:1164-77. [DOI:10.1046/j.1523-
2003.00843.x] [PMID]
Bagga A, Menon B. Rapidly progressive glomerulonephritis.
In: Geary DF, Schaefer F, editors. Comprehensive pediatric
nephrology. Philadelphia: Mosby Elsevier. 2008: 319-327.
[DOI:10.1016/B978-0-323-04883-5.50027-1]
Jardim HM, Leake J, Risdon RA, Barratt TM, Dillon MJ.
Crescentic glomerulonephritis in children. Pediatr Nephrol.
; 6(3):231-5. [DOI:10.1007/BF00878354] [PMID]
Dewan D, Gulati S, Sharma RK, Prasad N, Jain M, Gupta
A, et al. Clinical spectrum and outcome of crescentic glomerulonephritis
in children in developing countries. Pediatr
Nephrol. 2008; 23(3):389-94. [DOI:10.1007/s00467-007-0647-3]
[PMID]
Özlü SG, Çaltık A, Aydoğ Ö, Bülbül M, Demircin G, Çakıcı
E, et al. Crescentic glomerulonephritis in children: A single
centre experience. World J Pediatr. 2016; 12(2):225-30.
[DOI:10.1007/s12519-015-0036-0] [PMID]
Sinha A, Puri K, Hari P, Dinda AK, Bagga A. Etiology and
outcome of crescentic glomerulonephritis. Indian Pediatr.
; 50(3):283-8. [DOI:10.1007/s13312-013-0095-z] [PMID]
BaggaA. Crescentic glomerulonephritis CH 34. In: Avner
E, Harmon W, Niaudet P, Yoshikawa N, editors. Pediatric
Nephrology. Berlin: Springer Science & Business Media; 2009.
[Link]
Rianthavorn P, Chacranon M. Long-term renal outcome in
pediatric glomerulonephritis associated with crescent formation.
Clin Exp Nephrol. 2018; 22(3):661-7. [DOI:10.1007/
s10157-017-1498-2] [PMID]
Alsaad K, Oudah N, Al Ameer A, Fakeeh K, Al Jomaih A,
Al Sayyari A. Glomerulonephritis with crescents in children:
Etiology and predictors of renal outcome. ISRN Pediatr. 2011;
:507298. [DOI:10.5402/2011/507298] [PMID] [PMCID]
Mayer U, Schmitz J, Bräsen JH, Pape L. Crescentic glomerulonephritis
in children. Pediatr Nephrol. 2020; 35(5):829-42.
[DOI:10.1007/s00467-019-04436-y] [PMID] [PMCID]
Jennette JC, Thomas DB. Crescentic glomerulonephritis.
Nephrol Dial Transplant. 2001;16 Suppl 6:80-82.
[DOI:10.1093/ndt/16.suppl_6.80] [PMID]
Tao J, Wang H, Wang SX, Yu F, Zhao MH. The predictive
value of crescents in the disease progression of lupus nephritis
based on the 2018 International society of nephrology/renal
pathology society revision system: A large cohort study
from China. Ren Fail. 2020; 42(1):166-72. [DOI:10.1080/088602
X.2020.1726385] [PMID] [PMCID]
Lee MJ, Kim SJ, Oh HJ, Ko KI, Koo HM, Kim CH, et al.
Clinical implication of crescentic lesions in immunoglobulin
A nephropathy. Nephrol Dial Transplant. 2014; 29(2):356-64.
[DOI:10.1093/ndt/gft398] [PMID]
Baikunje S, Vankalakunti M, Nikith A, Srivatsa A, Alva S,
Kamath J. Post-infectious glomerulonephritis with crescents
in adults: A retrospective study. Clin Kidney J. 2016; 9(2):222-
[DOI:10.1093/ckj/sfv147] [PMID] [PMCID]
Flynn J. T., Kaelber D. C., Baker-Smith C. M., Blowery D.,
Carroll A. E., Daniels S. R., et al. Clinical Practice Guideline
for Screening and Management of High Blood Pressure in
Children and Adolescents. Pediatrics. 2017; 140:pii: e20171904
[DOI:10.1542/peds.2017-3035] [PMID]
Rampelli SK, Rajesh NG, Srinivas BH, Harichandra Kumar
KT, Swaminathan RP, Priyamvada PS. Clinical spectrum and
outcomes of crescentic glomerulonephritis: A single center experience.
Indian J Nephrol. 2016; 26(4):252-6. [PMID] [PMCID]
Quiroga B, Vega A, Rivera F, López-Gómez JM; Spanish
Registry of Glomerulonephritis. Crescentic glomerulonephritis:
Data from the Spanish glomerulonephritis registry. Intern
Med J. 2015; 45(5):557-62. [DOI:10.1111/imj.12725] [PMID]
El-Husseini AA, El-Agroudy AE, Moustafa FE, Fouda MA,
Sobh MA. Impact of clinical and histopathological factors on
outcome of Egyptian patients with crescentic glomerulonephritis.
Int Urol Nephrol. 2003; 35(4):543-51. [DOI:10.1023/
B:UROL.0000025607.41722.aa] [PMID]
No author. A clinico-pathologic study of crescentic glomerulonephritis
in 50 children. A report of the southwest pediatric
nephrology study group. Kidney Int. 1985; 27(2):450-8.
[DOI:10.1038/ki.1985.30] [PMID]
Maliakkal JG, Hicks MJ, Michael M, Selewski DT, Twombley
K, Rheault MN et al. Renal Survival in children with
glomerulonephritis with crescents: A pediatric nephrology
research consortium cohort study. J Clin Med. 2020; 9(8):2385.
[DOI:10.3390/jcm9082385] [PMID] [PMCID]
Alexander S, Yusuf S, Rajan G, Elias John E, Roy S, Annamalai
VC, et al. Crescentic glomerulonephritis: What's different
in South Asia? A single center observational cohort study.
Wellcome Open Res. 2020; 5:164. [DOI:10.12688/wellcomeopenres.
1] [PMID] [PMCID]
Williamson SR, Phillips CL, Andreoli SP, Nailescu C.
A 25-year experience with pediatric anti-glomerular basement
membrane disease. Pediatr Nephrol. 2011; 26(1):85-91.
[DOI:10.1007/s00467-010-1663-2] [PMID]
Chauhan R, Betts G, Long EL, et al. Anti-Gbm disease in
children: Outcomes and association with systemic vasculitis.
Rheumatol. 2017; 56(6):1-4. [DOI:10.1093/rheumatology/
kex356.046]
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