Outcome of Post-Streptococcal Crescentic Glomerulonephritis in Children

Background: Crescentic glomerulonephritis (CGN) is a relatively rare but severe condition in childhood. It is characterised by the presence of extensive crescents in renal biopsy, and clinically by a progressive decline in renal function.
Objective: In this study we aim to look at the outcome of pediatric patients admitted or referred to us diagnosed as post streptococcal rapidly progressively glomerulonephritis
Methods: Ten pediatric patients with crescentic glomerulonephritis following APSGN admitted or referred from other hospitals to our unit (in King Abdulaziz University Hospital, Jeddah, KSA) between January 2003 to May 2009, all patients were evaluated clinically and were assessed by laboratory tests including urine analysis, U&E, s. albumin, ASOT, anti-DNAse-B test, complement (C3 and C4), ANA, ANCAs anti-DNA antibodies; anti-(GBM) antibodies. Histopathologic assessment by light. IF and electron microscopy was done and immunosuppressive therapy was given to all patients
Results: Ten patients with poststreptococcal crescentic glomerulonephritis, 6 males and 4 females. The mean age at the time of presentation was 8.4 years with range of 4 to 11 years. All were having gross hematuria, progressive rise of serum creatinine. Mean creatinine was 563 mmo1/1 with range of (396-870), low comple-ment C3, 8 patients were having hypertension (80%), 5 patients (50%) were having nephrotic range of proteinuria and remaining were having moderate range. Renal biopsy revealed > 50% crescents in all biopsies with mean of 62.5% and ranging between 50-88%. Two patients had fibrocellular crescents (20%) and 8 had cellular crescents (80%). The mean follow up duration in months was 26 months, ranging between 18-36 months, after immunosuppressant Eight patients regained their normal kidney functions (80%) with mean creatinine 46 mmoVl (ranging between 39 — 66 mmo1/1), p value < 0.001. Two patients (20%) had residual renal 'impairment; these 2 patients had fibro cellular crescents in renal biopsy. Eight patients regained their normal blood pressure at last follow up (80%), p value < 0.001.
Conclusion: The overall outcome of our 10 patients with poststreptococcal crescentic glomerulonephritis was excellent, 8 patients out of 10 i.e. (80%) regained their normal kidney functions. Due to the limited number of our patients, a large multi-centre study is needed to prove this result