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Etiology and outcome of crescentic glomerulonephritis

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Abstract

Objective

To determine the etiology, course and predictors of outcome in children with crescentic glomerulonephritis (GN).

Study design

Retrospective, descriptive study. Setting: Pediatric Nephrology Clinic at a referral center in Northern India.

Methods: Clinic records of patients aged <18 year with crescentic GN diagnosed from 2001–2010 and followed at least 12-months were reviewed. Crescentic GN, defined as crescents in >-50% glomeruli, was classified based on immunofluorescence findings and serology. Risk factors for renal loss (chronic kidney disease stage 4–5) were determined

Results

Of 36 patients, (median age 10 yr) 17 had immune complex GN and 19 had pauci-immune crescentic GN. The etiologies of the former were lupus nephritis (n=4), postinfectious GN (3), and IgA nephropathy, Henoch Schonlein purpura and membranoproliferative GN type II (2 each). Three patients with pauci-immune GN showed antineutrophil cytoplasmic antibodies (ANCA). Rapidly progressive GN was present in 33 patients, and required dialysis in 12. At median 34 (19–72) months, 2 patients with immune complex GN and 8 with pauci-immune GN showed renal loss. Renal survival was 94.1% at 3 yr, and 75.3% at 8 yr in immune complex GN; in pauci-immune GN survival was 63.2% and 54.1%, respectively (P=0.054). Risk factors for renal loss were oliguria at presentation (hazards ratio, HR 10.50; P=0.037) and need for dialysis (HR 6.33; P=0.024); there was inverse association with proportion of normal glomeruli (HR 0.91; P=0.042).

Conclusions

Pauci-immune GN constitutes one-half of patients with crescentic GN at this center. Patients with pauci-immune GN, chiefly ANCA negative, show higher risk of disease progression. Renal loss is related to severity of initial presentation and extent of glomerular involvement.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Aditi Sinha, Kriti Puri, Pankaj Hari & Arvind Bagga

  2. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Amit Kumar Dinda

  3. Division of Nephrology, Department of Pediatrics, Teaching Block, All India Institute of Medical Sciences, 3053, New Delhi, India

    Arvind Bagga

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  1. Aditi Sinha
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  2. Kriti Puri
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  3. Pankaj Hari
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  4. Amit Kumar Dinda
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  5. Arvind Bagga
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Correspondence to Arvind Bagga.

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Sinha, A., Puri, K., Hari, P. et al. Etiology and outcome of crescentic glomerulonephritis. Indian Pediatr 50, 283–288 (2013). https://doi.org/10.1007/s13312-013-0095-z

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  • DOI: https://doi.org/10.1007/s13312-013-0095-z

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