Rapidly progressive glomerulonephritis undetected by routine school urinalysis: a case report

A twelve year old girl with rapidly progressive glomerulonephritis (RPGN) is reported. First symptoms of renal failure developed in August 1987 just five months after a routine school urinalysis which detected no abnormalities. The patient developed end stage renal failure within 2 months of onset. Continuous ambulatory peritoneal dialysis (CAPD) was introduced to manage the renal failure, and open renal biopsy was performed simultaneously in order to elucidate the underlying renal disease in this patient. Microscopic examination of the biopsy specimen demonstrated marked formation of crescents in about 90% of the glomeruli, and some of the glomeruli were already sclerotic. Granular depositions of IgG(trace), IgA(1+), IgM(3+), properdine(3+), Clq(3+) and C3(3+) were observed by immunofluorescence staining. A definite diagnosis of rapidly progressive glomerulonephritis was made as the cause of renal failure in this patient. It was suggested that open renal biopsy is useful in diagnosing the underlying kidney disease of end stage renal failure in cases where the clinical course is relatively short.