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Etiology and Outcomes of Rapidly Progressive Glomerulonephritis in Children: A Retrospective Cohort Study

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Abstract

Objective

To study the clinico-etiological spectrum and outcomes of children with rapidly progressive glomerulonephritis (RPGN).

Methods

This retrospective cohort study evaluated patients <18 years with RPGN, over an 8-year period (2014–2022), for etiology and kidney outcomes.

Results

Among 68 RPGN cases [median age 10 (7,12) years], 23 (33.8%) had lupus nephritis, 21 (30.9%) C3 glomerulopathy, and 15 (22.1%) infection-related glomerulonephritis (IRGN). At presen-tation, 18 (26.4%) patients had pulmonary edema, 20 (29.4%) had hypertensive emergency and 22 (32.4%) required dialysis. Median (IQR) follow-up duration was 24.5 (12,48) months. The median (IQR) admission eGFR was 19 (10.93, 38.60) mL/min/1.73 m2, which increased to 126 (102.7,142) mL/min/1.73m2 at the last follow-up. At the last follow-up, 39 (57.3%) and 13 (19.1%) patients attained complete and partial renal recovery, respectively; while 16 (23.5%) progressed to CKD stage 2 and beyond. The prevalence of end stage kidney disease (ESKD) was 7.3% at 1-year and 7.7% at the last follow-up. Factors predicting kidney survival were duration of symptoms prior to presentation ≥7 days, crescents ≥37.5%, and presence of fibrous crescents/segmental sclerosis.

Conclusion

Lupus nephritis, was the commonest etiology of RPGN in children. Renal outcomes were determined by pre-admission symptoms, and percentage and stage of crescents.

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Funding

Funding: None

Author information

Authors and Affiliations

  1. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Bobbity Deepthi,  Sriram Krishnamurthy, Amar Murdeshwar, Sudarsan Krishnasamy & Pediredla Karunakar

  2. Department of Pathology, JIPMER, Puducherry, India

    Rajesh Nachiappa Ganesh

  3. Department of Biostatistics, JIPMER, Puducherry, India

    Sachit Ganapathy

Authors
  1. Bobbity Deepthi
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  2. Sriram Krishnamurthy
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  3. Rajesh Nachiappa Ganesh
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  4. Amar Murdeshwar
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  5. Sachit Ganapathy
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  6. Sudarsan Krishnasamy
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  7. Pediredla Karunakar
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Contributions

Contributors: BD, SK, AM, PK, SuK: managed the patients. BD conceptualized the study design and participated in study protocol preparations, recruited patients, participated in data analysis, and drafted the first version of the manuscript. SK conceptualized the study design and critically revised the manuscript. RNG interpreted the histopathology findings. SG helped in statistical analysis. All authors contributed to drafting of the manuscript and approved the final version.

Corresponding author

Correspondence to Sriram Krishnamurthy.

Ethics declarations

Ethics approval: Approved by the Ethics Committee of the institute; No. JIP/IEC/2022/0117 dated May 11, 2022.

Competing interests: None stated.

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Deepthi, B., Krishnamurthy, S., Ganesh, R.N. et al. Etiology and Outcomes of Rapidly Progressive Glomerulonephritis in Children: A Retrospective Cohort Study. Indian Pediatr 60, 816–821 (2023). https://doi.org/10.1007/s13312-023-3011-1

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  • DOI: https://doi.org/10.1007/s13312-023-3011-1

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