Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 661–667 | Cite as

Long-term renal outcome in pediatric glomerulonephritis associated with crescent formation

Original article

Abstract

Background

Information on long-term renal outcome of pediatric glomerulonephritis associated with crescent formation is limited. A single center retrospective study was conducted to assess long-term renal survival and to determine whether the 2010 classification for antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis can predict renal outcome in pediatric glomerulonephritis associated with crescent formation.

Methods

Biopsy and clinical data of children, aged ≤ 18 years with ≥ 10 glomeruli and ≥ 10% crescentic glomeruli during January 1998 to December 2015, were reviewed. Biopsies were classified according to the 2010 classification into focal, crescentic, mixed, and sclerotic classes. The clinical endpoint was end-stage renal disease (ESRD).

Results

Of 72 children, 14 patients (19.4%) had positive ANCA. The biopsy indication was rapidly progressive glomerulonephritis in 38 patients (52.8%) and 22 patients (30.6%) required dialysis at onset. Lupus nephritis was the most common diagnosis (43.1%), followed by IgA nephropathy/Henoch–Schoenlein purpura (HSP) (22.2%). ESRD occurred in 18 patients (25%) and the risk of ESRD differed among the histological classifications (p < 0.001). Dialysis at onset and sclerotic class was independent predictors of ESRD in an adjusted model. The risk of ESRD was four-fold higher in patients requiring dialysis at onset and 7.7-fold higher in sclerotic patients than in crescentic patients.

Conclusions

The probability of ESRD was substantial in pediatric glomerulonephritis associated with crescent formation. The 2010 classification is useful for establishing long-term renal prognosis. Future research is required to validate whether histological classification could be a determinant in therapeutic guideline modification, since long-term renal prognosis is different in each class.

Keywords

Children Glomerulonephritis Kidney failure Outcome 

Notes

Acknowledgements

The authors gratefully acknowledge Kevin P. Jones for English editing and Stephen J. Kerr, PhD for assistance with statistical analysis.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 811/2016) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Due to the policy of the institutional ethical committee, formal written informed consent was not required for this type of study. However, patient anonymity was preserved.

Funding

This was an unfunded study.

References

  1. 1.
    Noone DG, Twilt M, Hayes WN, Thorner PS, Benseler S, Laxer RM, et al. The new histopathologic classification of ANCA-associated GN and its association with renal outcomes in childhood. Clin J Am Soc Nephrol. 2014;9(10):1684–91.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Piyaphanee N, Ananboontarick C, Supavekin S, Sumboonnanonda A. Renal outcomes and risk factors for ESRD in children with rapidly progressive glomerulonephritis. Pediatr Int. 2016;59(3):334–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Li X, Liang S, Zheng C, Zeng C, Zhang H, Hu W, et al. Clinicopathological characteristics and outcomes of pediatric patients with systemic small blood vessel vasculitis. Pediatr Nephrol. 2014;29(12):2365–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Sinha A, Puri K, Hari P, Dinda AK, Bagga A. Etiology and outcome of crescentic glomerulonephritis. Indian Pediatr. 2013;50(3):283–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Ozlu SG, Caltik A, Aydog O, Bulbul M, Demircin G, Cakici E, et al. Crescentic glomerulonephritis in children: a single centre experience. World J Pediatr. 2016;12(2):225–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Alsaad K, Oudah N, Al Ameer A, Fakeeh K, Al Jomaih A, Al Sayyari A. Glomerulonephritis with crescents in children: etiology and predictors of renal outcome. ISRN Pediatr. 2011;2011:507298.  https://doi.org/10.5402/2011/507298.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, et al. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010;21(10):1628–36.CrossRefPubMedGoogle Scholar
  8. 8.
    Bjorneklett R, Sriskandarajah S, Bostad L. Prognostic value of histologic classification of ANCA-associated glomerulonephritis. Clin J Am Soc Nephrol. 2016;11(12):2159–67.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chang DY, Wu LH, Liu G, Chen M, Kallenberg CG, Zhao MH. Re-evaluation of the histopathologic classification of ANCA-associated glomerulonephritis: a study of 121 patients in a single center. Nephrol Dial Transplant. 2012;27(6):2343–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Muso E, Endo T, Itabashi M, Kakita H, Iwasaki Y, Tateishi Y, et al. Evaluation of the newly proposed simplified histological classification in Japanese cohorts of myeloperoxidase-anti-neutrophil cytoplasmic antibody-associated glomerulonephritis in comparison with other Asian and European cohorts. Clin Exp Nephrol. 2013;17(5):659–62.CrossRefPubMedGoogle Scholar
  11. 11.
    Nohr E, Girard L, James M, Benediktsson H. Validation of a histopathologic classification scheme for antineutrophil cytoplasmic antibody-associated glomerulonephritis. Hum Pathol. 2014;45(7):1423–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Ellis CL, Manno RL, Havill JP, Racusen LC, Geetha D. Validation of the new classification of pauci-immune glomerulonephritis in a United States cohort and its correlation with renal outcome. BMC Nephrol. 2013;14:210.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hilhorst M, Wilde B, van Breda Vriesman P, van Paassen P, Cohen Tervaert JW. Estimating renal survival using the ANCA-associated GN classification. J Am Soc Nephrol. 2013;24(9):1371–5.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Iwakiri T, Fujimoto S, Kitagawa K, Furuichi K, Yamahana J, Matsuura Y, et al. Validation of a newly proposed histopathological classification in Japanese patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis. BMC Nephrol. 2013;14:125.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Unlu M, Kiremitci S, Ensari A, Ozluk Y, Kilicaslan I, Ozdemir BH, et al. Pauci-immune necrotizing crescentic glomerulonephritis with crescentic and full moon extracapillary proliferation: clinico-pathologic correlation and follow-up study. Pathol Res Pract. 2013;209(2):75–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Tanna A, Guarino L, Tam FW, Rodriquez-Cubillo B, Levy JB, Cairns TD, et al. Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors. Nephrol Dial Transplant. 2015;30(7):1185–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Togashi M, Komatsuda A, Nara M, Omokawa A, Okuyama S, Sawada K, et al. Validation of the 2010 histopathological classification of ANCA-associated glomerulonephritis in a Japanese single-center cohort. Mod Rheumatol. 2014;24(2):300–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Ford SL, Polkinghorne KR, Longano A, Dowling J, Dayan S, Kerr PG, et al. Histopathologic and clinical predictors of kidney outcomes in ANCA-associated vasculitis. Am J Kidney Dis. 2014;63(2):227–35.CrossRefPubMedGoogle Scholar
  19. 19.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.Google Scholar
  20. 20.
    Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20(3):629–37.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Koyama A, Yamagata K, Makino H, Arimura Y, Wada T, Nitta K, et al. A nationwide survey of rapidly progressive glomerulonephritis in Japan: etiology, prognosis and treatment diversity. Clin Exp Nephrol. 2009;13(6):633–50.CrossRefPubMedGoogle Scholar
  22. 22.
    Dewan D, Gulati S, Sharma RK, Prasad N, Jain M, Gupta A, et al. Clinical spectrum and outcome of crescentic glomerulonephritis in children in developing countries. Pediatr Nephrol. 2008;23(3):389–94.CrossRefPubMedGoogle Scholar
  23. 23.
    A clinico-pathologic study of crescentic glomerulonephritis in 50 children. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int. 1985;27(2):450–8.Google Scholar
  24. 24.
    Bajema IM, Hagen EC, Hansen BE, Hermans J, Noel LH, Waldherr R, et al. The renal histopathology in systemic vasculitis: an international survey study of inter- and intra-observer agreement. Nephrol Dial Transplant. 1996;11(10):1989–95.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand

Personalised recommendations