Renal survival in children with glomerulonephritis with crescents: A pediatric nephrology research consortium cohort study

Joseph G. Maliakkal, M. John Hicks, Mini Michael, David T. Selewski, Katherine Twombley, Michelle N. Rheault, Meredith Seamon, Jason M. Misurac, Cheryl L. Tran, Loretta Reyes, Joseph T. Flynn, Ali M. Onder, Alexandru R. Constantinescu, Vaishali Singh, Cynthia Pan, Abiodun Omoloja, Qiang Wu, William E. Smoyer, Guillermo Hidalgo, Scott E. Wenderfer

Research output: Contribution to journalArticlepeer-review

Abstract

There is no evidence-based definition for diagnosing crescentic glomerulonephritis. The prognostic implications of crescentic lesions on kidney biopsy have not been quantified. Our objective was to determine risk factors for end-stage kidney disease (ESKD) in patients with glomerulonephritis and crescents on kidney biopsy. A query of the Pediatric Nephrology Research Consortium’s Pediatric Glomerulonephritis with Crescents registry identified 305 patients from 15 centers. A retrospective cohort study was performed with ESKD as the primary outcome. Median age at biopsy was 11 years (range 1–21). The percentage of crescents was 3–100% (median 20%). Etiologies included IgA nephropathy (23%), lupus (21%), IgA vasculitis (19%) and ANCA-associated GN (13%), post-infectious GN (5%), and anti-glomerular basement membrane disease (3%). The prevalence of ESKD was 12% at one year and 16% at last follow-up (median = 3 years, range1–11). MediantimetoESKDwas100days. RiskfactorsforESKDincluded%crescents,presence of fibrous crescents, estimated GFR, and hypertension at biopsy. For each 1% increase in %crescents, therewasa3%decreaseinlogoddsof1-yearrenalsurvival(p = 0.003)anda2%decreaseinlogodds of renal survivalat last follow-up(p < 0.001). Thesefindings providean evidencebase for enrollment criteria for crescentic glomerulonephritis in future clinical trials.

Original languageEnglish (US)
Article number2385
Pages (from-to)1-13
Number of pages13
JournalJournal of Clinical Medicine
Volume9
Issue number8
DOIs
StatePublished - Aug 2020

Bibliographical note

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Cellular crescents
  • Fibrous crescents
  • Glomerulonephritis
  • Immunosuppression
  • Targeted biologic therapies

PubMed: MeSH publication types

  • Journal Article

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