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Wong W, Prestidge C, Zwi J, Han DY. Biomarkers of histologic severity in children with severe or atypical acute post-streptococcal glomerulonephritis. Pediatr Nephrol 2024; 39:1801-1808. [PMID: 38117311 DOI: 10.1007/s00467-023-06249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute kidney injury (AKI) in children; however, in a small subgroup, the presentation is one of rapidly progressive glomerulonephritis (RPGN) deteriorating kidney function associated with severe oligo-anuria or a mixed nephritic-nephrotic picture. This study reviewed potential clinical and laboratory factors which may assist the treating clinician to identify patients at high risk of severe disease. METHODS All kidney biopsies for APSGN performed between 1996 and 2020 were obtained from a departmental biopsy database. Clinical and laboratory data were extracted from the patients' clinical records. Kidney biopsies were reviewed and scored independently by a renal histopathologist. RESULTS Thirty of 53 (56.6%) patients had stage 3 AKI at initial presentation with a median estimated glomerular filtration rate (eGFR) 27 (IQR 11-41), falling to 20 ml/min/1.73 m2 (IQR 13.3-43) at time of biopsy. Patients who had either a pre-biopsy eGFR < 35 ml/min/1.73 m2 or a ≥ 25% fall in eGFR between admission and biopsy were more likely to have glomerular crescents (p = 0.004). Multivariate regression analysis and receiver operating curve showed the pre-biopsy eGFR most accurately predicted glomerular crescents (p = 0.047, ROC 0.757). There were no significant predictors of nephrotic proteinuria or nephrotic syndrome during the acute phase. CONCLUSIONS Severe APSGN is associated with a pronounced reduction in eGFR. Calculation of eGFR in this small group of patients may assist in identifying which patient should have an urgent kidney biopsy to facilitate a more accurate clinical diagnosis and management plan.
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Affiliation(s)
- William Wong
- Department of Paediatric Nephrology, Starship Children's Hospital, 3 Park Road, Grafton, Auckland, New Zealand.
| | - Chanel Prestidge
- Department of Paediatric Nephrology, Starship Children's Hospital, 3 Park Road, Grafton, Auckland, New Zealand
| | - Jonathan Zwi
- Department of Anatomic Pathology, LabPlus, Auckland City Hospital, 3 Park Road, Grafton, Auckland, New Zealand
| | - Dug Yeo Han
- Starship Research and Innovation, Starship Children's Hospital, 160 Grafton Road, Grafton, Auckland, New Zealand
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Zhang P, Yang X, Gao CL, Wu W, Xia ZK. Crescentic glomerulonephritis in children: short-term follow-up predicts long-term outcome. Front Pediatr 2023; 11:1206168. [PMID: 37691769 PMCID: PMC10485554 DOI: 10.3389/fped.2023.1206168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023] Open
Abstract
Background Crescentic glomerulonephritis (CrGN) is a relatively rare but severe condition in childhood with the clinical feature of rapidly progressive glomerulonephritis (RPGN). The aim of this study is to investigate the clinicopathological features and prognosis of CrGN in children. Methods We retrospectively analyzed the clinical and laboratory data, renal pathological results, treatment, and outcome of 147 CrGN in two Chinese pediatric nephrology centers. Results Among the 147 children, there were 22 cases of type I (15.0%), 69 cases of type II (46.9%), and 56 cases of type III (38.1%). The mean percentages of crescents in CrGN I, II, and III were 85.3%, 68.7%, and 73.6%, respectively. The children with type I CrGN presented with more severe clinical manifestations and pathological lesions. The 3-month cumulative renal survival rates of types I, II, and III CrGN were 66.3%, 93.6%, and 75.6%, respectively. The 1-year cumulative renal survival rates of types I, II, and III CrGN were 56.9%, 85.3%, and 73.1%, respectively, and the 5-year cumulative renal survival rates of types I, II, and III CrGN were 33.8%, 73.5%, and 47.1%, respectively. The Kappa Consistency Test between the 3-month and 1-year total renal survival (82.1% vs. 74.7%) of the children was 0.683 (P < 0.001), and between the 1-year and 5-year total renal-free survival (78.3% vs. 69.1%) of the children was 0.476 (P < 0.001). The Bowman's Capsule Rupture (BCR), crescent, interstitial inflammation, and interstitial fibrosis/tubular atrophy (IF/TA) score were predictors of end-stage kidney disease (ESKD) risk but BCR showed better predictive value for ESKD than interstitial inflammation score (P = 0.027) and IF/TA score (P = 0.047). Conclusion Patients with type I tended to have the worst renal survival rates. The three-month renal prognosis could partially reflect the 1-year renal prognosis, and the 1-year mortality rate could partially reflect the 5-year mortality rate of children with CrGN.
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Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiao Yang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chun-lin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei Wu
- Department of Pediatrics, Longgang District Center Hospital of Shenzhen, Shenzhen, China
| | - Zheng-kun Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Ruas AFL, Lébeis GM, de Castro NB, Palmeira VA, Costa LB, Lanza K, Simões E Silva AC. Acute kidney injury in pediatrics: an overview focusing on pathophysiology. Pediatr Nephrol 2022; 37:2037-2052. [PMID: 34845510 DOI: 10.1007/s00467-021-05346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/12/2023]
Abstract
Acute kidney injury (AKI) is defined as an abrupt decline in glomerular filtration rate, with increased serum creatinine and nitrogenous waste products due to several possible etiologies. Incidence in the pediatric population is estimated to be 3.9 per 1,000 hospitalizations, and prevalence among children admitted to intensive care units is 26.9%. Despite being a condition with important incidence and morbimortality, further evidence on pathophysiology and management among the pediatric population is still lacking. This narrative review aimed to summarize and discuss current data on AKI pathophysiology in the pediatric population, considering all the physiological particularities of this age range and common etiologies. Additionally, we reported current diagnostic tools, novel biomarkers, and newly proposed medications that have been studied with the aim of early diagnosis and appropriate treatment of AKI in the future.
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Affiliation(s)
- Ana Flávia Lima Ruas
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Gabriel Malheiros Lébeis
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Nicholas Bianco de Castro
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Vitória Andrade Palmeira
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Larissa Braga Costa
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Katharina Lanza
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil.
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Gureck A, McSweeney Z, Ziadie M, Casey RJ, Constantinescu AR. Acute Kidney Injury in a 17-Year-Old Male With a History of Autoimmune Hemolytic Anemia. Clin Pediatr (Phila) 2020; 59:1209-1213. [PMID: 32674588 DOI: 10.1177/0009922820941639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Mandolin Ziadie
- Florida Atlantic University, Boca Raton, FL, USA.,Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Takahashi-Kobayashi M, Usui J, Kaneko S, Sugiyama H, Nitta K, Wada T, Muso E, Arimura Y, Makino H, Matsuo S, Yamagata K. Age-dependent survival in rapidly progressive glomerulonephritis: A nationwide questionnaire survey from children to the elderly. PLoS One 2020; 15:e0236017. [PMID: 32658915 PMCID: PMC7357754 DOI: 10.1371/journal.pone.0236017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background Rapidly progressive glomerulonephritis (RPGN) has been known to have a poor prognosis. Although evidence across adult RPGN cases has accumulated over many years, the number of case series in adolescents and young adults has been limited, requiring further studies. Methods A total of 1,766 cases from 1989 to 2007 were included in this nationwide questionnaire survey, led by Intractable (former name, Progressive) Renal Diseases Research, Research on intractable disease, from the Ministry of Health, Labour and Welfare of Japan. To elucidate age-related differences in 2-year patient and renal survival rates, the cases were divided into the following four groups: children (0–18 years), young adults (19–39 years), the middle-aged (40–64 years), and the elderly (over 65 years). Results Of the 1,766 total RPGN cases, antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis comprised 1,128 cases (63.9% of all RPGN cases), showing a tendency to increase with age. Two-year patient survival for RPGN was 93.9% among children, 92.6% in young adults, 83.2% in the middle-aged, and 68.8% in the elderly. The younger group (children plus young adults) showed a clearly higher survival rate compared to the older group (middle-aged plus elderly) (p<0.05). ANCA-associated glomerulonephritis also showed similar age-related results with all RPGN cases. The comparison of renal prognosis showed no statistically significant differences both in RPGN and in ANCA-associated GN. Conclusion The present study described the age-dependent characteristics of the classification of RPGN, especially focusing on a better prognosis of the younger group in patient survival both in RPGN and in ANCA-associated GN.
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Affiliation(s)
| | - Joichi Usui
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Shuzo Kaneko
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Eri Muso
- Department of Nephrology and dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yoshihiro Arimura
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
- Kichijoji Asahi Hospital, Tokyo, Japan
| | | | | | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Piyaphanee N, Chaiyaumporn S, Phumeetham S, Lomjansook K, Sumboonnanonda A. Acute kidney injury without previous renal disease in critical care unit. Pediatr Int 2020; 62:810-815. [PMID: 32145130 DOI: 10.1111/ped.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized and critically ill children. Apart from primary kidney disease, etiologies of AKI are usually related to systemic disease and nephrotoxic insult. This study examines the incidence, characteristics, and mortality risks of AKI in critically ill children without primary renal disease or previously known chronic kidney disease. METHODS A retrospective cohort study was conducted of patients aged 1-18 years, diagnosed with AKI (excluding severe glomerulonephritis and previously known chronic kidney disease) in pediatric intensive care units between 2013 and 2016. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes classifications. Cox proportional hazards regression analysis was employed to assess the relationship between the risk factors and mortality. RESULTS Of 1,377 pediatric intensive care unit patients, 253 (18.4%) developed AKI and only 169 (12.3%) who did not have previously known renal disease were included. Of these 169 AKI patients, the mean age was 8.1 ± 4.7 years; 88 (52.1%) patients were male; and 60 (35.5%) patients had AKI stage 3. The most common etiologies of AKI were sepsis (76.9%) and shock (64.5%). Fifty-three (31.4%) of those patients died during admission. The risk factors for death were the need for mechanical ventilation (adjusted hazard ratio, 17.82; 95% CI, 2.41-132.06) and AKI stage 3 (adjusted hazard ratio, 2.32; 95% CI, 1.07-5.00). CONCLUSIONS Acute kidney injury in critically ill children without previously known renal disease was approximately two-thirds of the overall incidence. The risk factors of in-hospital death were the use of mechanical ventilation, and AKI stage 3.
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Affiliation(s)
- Nuntawan Piyaphanee
- Divisions of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sivaporn Chaiyaumporn
- Divisions of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwannee Phumeetham
- Divisions of Intensive Care, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kraisoon Lomjansook
- Divisions of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Achra Sumboonnanonda
- Divisions of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Kasinath V, Yilmam OA, Uehara M, Jiang L, Ordikhani F, Li X, Salant DJ, Abdi R. Activation of fibroblastic reticular cells in kidney lymph node during crescentic glomerulonephritis. Kidney Int 2019; 95:310-320. [PMID: 30522766 PMCID: PMC6342621 DOI: 10.1016/j.kint.2018.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 01/02/2023]
Abstract
Crescentic glomerulonephritis is an inflammatory condition characterized by rapid deterioration of kidney function. Previous studies of crescentic glomerulonephritis have focused on immune activation in the kidney. However, the role of fibroblastic reticular cells, which reside in the stromal compartment of the kidney lymph node, has not been studied in this condition. We investigated the activation of kidney lymph node-resident fibroblastic reticular cells in nephrotoxic serum nephritis, a classic murine model of crescentic glomerulonephritis. We found that increased deposition of extracellular matrix fibers by fibroblastic reticular cells in the kidney lymph node was associated with the propagation of high endothelial venules, specialized blood vessels through which lymphocytes enter the lymph node, as well as with expansion of the lymphatic vasculature. The kidney lymph node also contained an expanding population of pro-inflammatory T cells. Removal of the kidney lymph node, depletion of fibroblastic reticular cells, and treatment with anti-podoplanin antibody each resulted in reduction of kidney injury. Our findings suggest that modulating the activity of fibroblastic reticular cells may be a novel therapeutic approach in crescentic glomerulonephritis.
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Affiliation(s)
- Vivek Kasinath
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Osman A Yilmam
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mayuko Uehara
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Liwei Jiang
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Farideh Ordikhani
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xiaofei Li
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David J Salant
- Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
| | - Reza Abdi
- Transplantation Research Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Falix FA, Oosterveld MJS, Florquin S, Groothoff JW, Bouts AHM. Diagnostic dilemmas in a girl with acute glomerulonephritis: Answers. Pediatr Nephrol 2018; 33:65-69. [PMID: 28280937 PMCID: PMC5700220 DOI: 10.1007/s00467-017-3626-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Farah A Falix
- Pediatric Nephrology Department of the Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands.
| | - Michiel J S Oosterveld
- Pediatric Nephrology Department of the Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Sandrine Florquin
- Pathology Department, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Jaap W Groothoff
- Pediatric Nephrology Department of the Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Antonia H M Bouts
- Pediatric Nephrology Department of the Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
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Long-term renal outcome in pediatric glomerulonephritis associated with crescent formation. Clin Exp Nephrol 2017; 22:661-667. [PMID: 29101552 DOI: 10.1007/s10157-017-1498-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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.
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