Renal outcome and risk factors for end‐stage renal disease in pediatric rapidly progressive glomerulonephritis

Background Rapidly progressive glomerulonephritis ( RPGN ), defined as acute nephritic syndrome with dramatic loss of renal function within a few months, is associated with crescentic glomerulonephritis (Cres GN ), which requires ≥50% crescents on pathology. The disease characteristics and renal outcome in children with RPGN , however, will differ according to the percentage of crescents. Methods To evaluate the renal outcomes and factors associated with end‐stage renal disease ( ESRD ), this retrospective cohort study assessed children aged ≤15 years with RPGN at a tertiary medical center. Results Of 67 patients with RPGN , 32 (47.8%) were male; mean age was 10.6 ± 3.0 years; median follow up was 1.1 years (range, 0.02–9.17 years) and 24 (35.8%) progressed to ESRD . Post‐infectious glomerulonephritis was the most frequent cause of RPGN (50.7%). The incidence of ESRD was significantly higher in patients with ≥50% than <50% crescents (57.9% vs 28.6%, P = 0.029). On Cox regression analysis, disease etiology, serum creatinine >3 mg/dL, need for acute dialysis, ≥80% crescents and ≥20% tubular atrophy and interstitial fibrosis ( TA / IF ) were associated with ESRD . On multivariate analysis, need for acute dialysis ( HR , 2.8; 95% CI: 1.1–7.3, P = 0.041) and ≥20% TA / IF ( HR , 4.8; 95% CI: 1.4–16.1, P = 0.011) were independent risk factors for the development of ESRD . Conclusions Approximately one‐third of children with RPGN developed ESRD ; and need for acute dialysis and TA / IF ≥20% were independent risk factors for ESRD .