title: Etiology and outcome of crescentic glomerulonephritis.
abstract: OBJECTIVE
  To determine the etiology, course and predictors of outcome in children with crescentic glomerulonephritis (GN).
  
  
  METHODS
  Retrospective, descriptive study.
  
  
  METHODS
  Pediatric Nephrology Clinic at a referral center in Northern India.
  
  
  METHODS
  Clinic records of patients aged <18 year with crescentic GN diagnosed from 2001 - 2010 and followed at least 12 months were reviewed. Crescentic GN, defined as crescents in ≥50% glomeruli, was classified based on immunofluorescence findings and serology. Risk factors for renal loss (chronic kidney disease stage 4-5) were determined.
  
  
  RESULTS
  Of 36 patients, (median age 10 yr) 17 had immune complex GN and 19 had pauci-immune crescentic GN. The etiologies of the former were lupus nephritis (n=4), postinfectious GN (3), and IgA nephropathy, Henoch Schonlein purpura and membranoproliferative GN type II (2 each). Three patients with pauciimmune GN showed antineutrophil cytoplasmic antibodies (ANCA). Rapidly progressive GN was present in 33 patients, and required dialysis in 12. At median 34 (19-72) months, 2 patients with immune complex GN and 8 with pauciimmune GN showed renal loss. Renal survival was 94.1% at 3 yr, and 75.3% at 8 yr in immune complex GN; in pauciimmune GN survival was 63.2% and 54.1%, respectively (P=0.054). Risk factors for renal loss were oliguria at presentation (hazards ratio, HR 10.50; P=0.037) and need for dialysis (HR 6.33; P=0.024); there was inverse association with proportion of normal glomeruli (HR 0.91; P=0.042).
  
  
  CONCLUSIONS
  Pauci-immune GN constitutes one-half of patients with crescentic GN at this center. Patients with pauciimmune GN, chiefly ANCA negative, show higher risk of disease progression. Renal loss is related to severity of initial presentation and extent of glomerular involvement.
authors.affiliation: Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Sinha
authors.forename: Kriti
authors.initials: K
authors.lastname: Puri
authors.forename: Pankaj
authors.initials: P
authors.lastname: Hari
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Dinda
authors.forename: Arvind
authors.initials: A
authors.lastname: Bagga
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000209:etiology / Q000473:pathology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D002648:Child; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D012189:Retrospective Studies
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic