Crescentic glomerulonephritis in children: a retrospective review of data at Chris Hani Baragwanath Academic Hospital
Date
2020
Authors
Mansoor, Sajeda
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Abstract
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.
Description
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