P0676 - Etiology and Outcome of Crescentic Glomerulonephritis (CrGN) in Hispanic Pediatric Population

INTENDED AUDIENCE: Physicians, Health Professionals

Purpose: To determine the etiology and outcome in Hispanic children with Crescentic Glomerulonephritis (CrGN) as a single-center experience.

STUDY DESIGN: Retrospective Study in Collaboration with Multi-Center Pediatric Nephrology Research Consortium.

SETTING: Hispanic Pediatric CrGN population on the US (Texas) - Mexico Border (El Paso region).

Introduction: Crescentic Glomerulonephritis (CrGN) is defined by progressive loss of renal function due to extensive crescent formation in the kidney. Many of these patients have a relatively poor prognosis. Therefore, it is essential to diagnose and treat these patients early and appropriately to prevent renal complications. However, there is a large knowledge gap on pediatric CrGN patients in North America, especially in the Hispanic pediatric population.

Methods: Clinical records of patients younger than the age of 21 years with a renal biopsy performed after January 1, 2004, were reviewed. CrGN was defined as renal biopsy showing >1 glomerulus with crescents (cellular or fibrous). Etiology and outcome at one-year and last follow-up were determined for each patient.

Results: Seven Hispanic subjects (5 female, 2 male) ages ranging from 7- 16 years (mean 12.7) were evaluated. Four patients (57%) had Immune Complex Glomerulonephritis (GN) and three patients (43%) had Pauci-Immune GN, Antineutrophil Cytoplasmic Antibody (ANCA) Vasculitis. Etiology for Immune Complex GN included Systemic Lupus Erythematous (SLE) nephritis (29%), Henoch-Schoenlein Purpura Nephritis (HSPN) (14%) and Complement 3 Glomerulopathy (C3G) (14%). One ANCA vasculitis patient progressed to CKD Stage III (CKD III) over a 6.2-year follow-up. While one class IV Lupus Nephritis and one C3G patient progressed to End-Stage Renal Failure (ESRF) and CKD III over 2.9 years period follow up.

Conclusion: Immune Complex GN constitutes more than 50% of patients with CrGN at our center. In our study, loss of kidney function is not related to the percentage of crescents seen at the initial presentation. Two out of three patients that progressed to CKD III or ESRF did not adhere to the specified treatment regimen and follow-up due to financial burdens.

SIGNIFICANCE: Our research is the first one presenting an entirely pediatric cohort of CrGN in the US-Mexico Border (El Paso region) Hispanic population. Our study highlighted not only the importance of clinical and laboratory findings, but also the impact of socio-economic factors and the role of treatment compliance in preventing the progression of disease in minority patients.