Crescentic glomerulonephritis in children: a retrospective review of data at Chris Hani Baragwanath Academic Hospital
Background Crescentic glomerulonephritis as a cause of progressive renal failure is rare. Crescent formation represent a response to injury of the glomerular capillary walls in patients with crescents on kidney biopsy. Objectives Most publications on CGN represent adult patients; with regards to paediatric patients the data is minimal, especially from our setting here in Africa. This study serves to describe the clinical presentation on children with CGN in South Africa. Methods A retrospective study was conducted at this hospital over 22 years. Children younger than 14 years with crescent formation in more than fifty percent of glomeruli on renal biopsy were included from data extracted using the renal biopsy register and files. Results Fourteen patients (1.5%) met criteria from 961 renal biopsies performed. Kidney biopsy specimens were examined by light microscopy, immunofluorescence and electron microscopy. Common findings were oedema (n=13, 92.9%), microscopic haematuria (n=12, 85.7%), hypertension (n=11, 78.6%) and proteinuria (n=10, 71.4%). The median GFR at presentation was 23.9ml/min/1.73m2. Thirteen patients (n=13, 93%) had immune-complex mediated glomerulonephritis. The underlying renal pathology was acute post-infectious glomerulonephritis in nine patients (64.3%), membranoproliferative glomerulonephritis and IgA nephropathy in two patients each (14.3%), and global sclerosis in one patient (7.1%).Treatment included peritoneal dialysis, methylprednisone and cyclophosphamide. Seven (n=7, 50%) patients had a normal GFR at a median follow-up of 36 months. Six (42.9%) patients had progressed to chronic kidney disease.
A research report submitted in partial fulfilment of the requirements for the degree of MMed Paediatrics to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020