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Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care
Insights
Quintuple therapy did not improve outcomes for children with severe crescentic glomerulonephritis following streptococcal infection. Supportive care alone demonstrated comparable results in managing this kidney condition.
Area of Science:
- Pediatric Nephrology
- Immunology
- Infectious Diseases
Background:
- Crescentic glomerulonephritis (CGN) is a severe kidney disease often triggered by infections.
- Post-streptococcal glomerulonephritis is a common cause of CGN in children.
- Severe CGN with reduced creatinine clearance (CCr) necessitates effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of quintuple therapy compared to supportive care for severe CGN in children.
- To assess the long-term clinical and histological outcomes in treated and untreated groups.
Main Methods:
- A comparative study involving two groups of children with CGN and CCr < 30 ml/minute/1.73 m2.
- Group A received supportive care plus three months of quintuple therapy (prednisone, azathioprine, cyclophosphamide, dipyridamole, heparin/warfarin).
- Group B received supportive care alone. Both groups had confirmed recent streptococcal infections.
Main Results:
- Histological crescent formation was similar in both groups (Group A: 69.8%, Group B: 64.4%).
- Clinical outcomes, including proteinuria and CCr, showed no significant advantage for quintuple therapy.
- One patient in Group A died from pulmonary hemorrhage; one in Group B had persistent hypertension.
Conclusions:
- Quintuple therapy offers no discernible benefit over supportive care for severe post-streptococcal CGN in children.
- Supportive care alone appears adequate for managing this condition, given the similar outcomes observed.
- Further research may explore targeted immunomodulatory approaches for specific pediatric kidney diseases.
Abstract:
Crescenteric glomerulonephritis preceded by a streptococcal infection with creatinine clearance CCr of less than 30 ml/minute/1.73 m2 was treated by supportive care plus three months of quintuple therapy (prednisone, azathioprine, cyclophosphamide, dipyridamole, and heparin followed by warfarin) in five children (Group A) or by supportive care alone in five others (Group B). Of the glomeruli examined, 69.8 +/- 11.7% (mean +/- SE) in Group A and 64.4 +/- 10.6% in Group B had crescents which involved 54.0 +/- 10.8% and 60.0 +/- 10.5% of glomerular circumference, respectively. Clinical and histologic findings supported a recent streptococcal infection in every patient. Two patients from Group A had mild proteinuria and normal CCr at 12 months; one died abruptly of pulmonary hemorrhage after maintaining a normal CCr for 25 months. Following a second episode of poststreptococcal acute glomerulonephritis seven months after the first, one patient from Group B had persistent mild proteinuria for 41 months and hypertension through 56 months of follow-up. Nine surviving patients have maintained normal CCr for eight to 60 months (mean 29.5 months). The findings of this study suggest that this quintuple therapy offers no advantage over supportive care in the clinical management and outcome of children with severe crescenteric glomerulonephritis when an antecedent streptococcal infection is confirmed by serologic and histopathologic criteria.