Analysis of Childhood Rapidly Progressive Glomerulonephritis

ABSTRACT

PURPOSE:Rapidly progressive glomerulonephritis (RPGN) is characterized by the rapid increase in serum creatitnin and crescents formation involving more than 50% of glomeruli. 10 patients who had been treated for RPGN were studied retrospectively for thier underlying diseases and clinical features. METHOD: Cilinical review was performed on 10 children who were diagnosed with RPGN by clinical features and renal biopsy and followed up at department of pediatrics during the last 10 years, from May 1990 to May 2000. RESULT: There were 6 males and 4 females between the ages of 2.1 and 14.3 years (mean 10.9+/-.8). 3 had Henoch-Sch nlein purpura nephritis; 2, idiopathic rapidly progressive glomerulonephritis; 2, lupus nephritis; 1, hemolytic uremic syndrome; 1, membranous glomerulonephritis and 1, microscopic polyangiitis. The most common chief complaints were gross hematuria and oliguria. Initial clinical features included proteinuria, edema, hypertension, nausea and arthralgia. Mean serum BUN was 74.2+/-39.1 mg/dL; mean serum creatinin, 3.2+/-1.8 mg/dL and mean creatinin clearance, 26.5+/-13.2 mL/min/1.73m2. Antineutrophil cytoplasmic antibody was positive only in microscopic polyangiitis. ANA and Anti-DNA antibody were positive in two lupus nephritis patients. Serum complements were decreased in 4 patients. All patients except Hemolytic uremic syndrome received steroid pulse therapy and immunosupressive agents. 3 patients were performed acute peritoneal dialysis and 2 patients were given plasmapheresis. At the last follow up, 1 patient was dead, 4 patients had elevated serum creatinin, 2 of these 4 patients were on chronic ambulatory peritoneal dialysis and 6 patients had normal renal function. CONCLUSION: Rapidly progressive glomerulonephritis is a medical emergency that requires very rapid diagnosis, classification, and therapy. Appropriate therapy selected on the basis of underlying disease mechanism can substantially improve renal survival.