ESPN 50th Annual Meeting

ESPN 2017


 
Assessment of the etiologies and ‎renal outcomes of rapidly progressive ‎glomerulonephritis in pediatric ‎patients at King Abdulaziz University ‎Hospital
OSAMA SAFDAR FAISAL MOSAAD 1 KHALID AL-QARN KHALID AL-QARNI 1 KHALED ALETWADY KHALED JAN JAN OMAR SAGGA RAKAN AL-HARBI

1- KING ABDULAZIZ UNIVERSITY
 
Introduction:

Background Rapidly progressive glomerulonephritis (RPGN), also known as crescentic glomerulonephritis, is an uncommon ‎but serious syndrome in pediatric patients. RPGN is characterized by a rapid deterioration in renal function, and eventually progress to end stage renal disease (ESRD). Etiologies that could lead ‎to RPGN differ regionally; along with early possible intervention, different outcomes are suspected. The aim of this ‎study was to investigate the etiologies and renal outcomes of RPGN in pediatric patients at King Abdulaziz University ‎Hospital (KAUH) in Jeddah.‎

Material and methods:

A retrospective study was conducted of 19 pediatric patients who were diagnosed with RPGN, between 2006 and 2016, at ‎the department of pediatric medicine at KAUH. Relevant data were extracted from medical records. Associations between variables were evaluated using independent t-test, one-way analysis of variance (ANOVA) and chi-squared tests, as appropriate for the dataset.

Results:

The majority of patients were males, 13 (68.42%), with a mean (standard deviation) age at diagnosis of 8.52 (3.15) years. The most common underlying etiologies ‎were post-infectious glomerulonephritis (63.2%) and lupus nephritis ‎‎(21.1%). Macroscopic hematuria and edema were identified in 89.5% of cases, with macroscopic hematuria being the main presenting symptom in patients with post-infectious glomerulonephritis (P=0.026). The mean serum creatinine level at presentation was 327.15 μmol/L, decreasing to 217.66 μmol/L at the last ‎follow-up. Serum creatinine levels at the last follow-up were predictive of clinical outcomes (ANOVA, P=0.019). Thirteen patients exhibited a good clinical prognosis (68.43%), with 6 exhibiting a poor prognosis (31.57%), 4 of whom progressed to ESRD, one experiencing a relapse and one developing chronic kidney disease. Post-infectious glomerulonephritis as the etiology of RPGN was associated with the best clinical outcomes, overall. More than half of the patients received a ‎combination therapy of corticosteroids and immunosuppressive therapy (52.6%), with other patients receiving ‎corticosteroids only. Treatment was implemented early in all patients and continued for 3 months.

Conclusions:

Post-infectious glomerulonephritis was the most common etiology of RPGN, with these patients achieving a good clinical prognosis overall. Early identification and treatment of RPGN is important to preserve renal function, which is a key factor for achieving a good prognosis.