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

Bobbity Deepthi1, Sriram Krishnamurthy2, Rajesh Nachiappa Ganesh3

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

Indian Pediatrics
|October 11, 2023
PubMed

Insights

Lupus nephritis is the most common cause of rapidly progressive glomerulonephritis (RPGN) in children. Kidney recovery in pediatric RPGN depends on symptom duration and crescent characteristics.

Area of Science:

  • Pediatric Nephrology
  • Glomerular Diseases
  • Autoimmune Disorders

Background:

  • Rapidly progressive glomerulonephritis (RPGN) is a severe kidney disease in children.
  • Understanding the causes and outcomes of pediatric RPGN is crucial for effective management.

Purpose of the Study:

  • To investigate the clinical and etiological spectrum of RPGN in children.
  • To determine the kidney outcomes and factors influencing survival in pediatric RPGN patients.

Main Methods:

  • Retrospective cohort study of pediatric patients (<18 years) diagnosed with RPGN between 2014 and 2022.
  • Analysis of patient demographics, clinical presentation, etiology, treatment, and kidney outcomes.
  • Evaluation of factors predicting kidney survival, including symptom duration and histopathological findings.

Main Results:

  • Lupus nephritis (33.8%), C3 glomerulopathy (30.9%), and infection-related glomerulonephritis (22.1%) were the leading causes of RPGN in children.
  • At presentation, significant proportions of patients experienced pulmonary edema (26.4%), hypertensive emergency (29.4%), and required dialysis (32.4%).
  • At last follow-up, 57.3% achieved complete renal recovery, 19.1% partial recovery, and 23.5% progressed to chronic kidney disease (CKD) stage 2 or beyond, with a 7.7% prevalence of end-stage kidney disease (ESKD).

Conclusions:

  • Lupus nephritis is the predominant etiology of RPGN in the pediatric population.
  • Early symptom recognition (≥7 days), lower crescent percentage (≥37.5%), and absence of fibrous crescents/segmental sclerosis are associated with better kidney survival in pediatric RPGN.
Abstract

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