Rapidly progressive glomerulonephritis in two Zambian children: a case report

Abstract

Rapidly progressive glomerulonephritis (RPGN) is a rare syndrome which is marked by a sudden rise in serum creatinine and the presence of crescents on renal biopsy. If appropriate and timely treatment is not instituted, as many as 90% of affected patients may develop End Stage Renal Disease (ESRD). There is only limited access to renal replacement therapy in many low resource countries, thus it is important that awareness of this entity is raised. We narrate the clinical course of two children who were admitted with rising serum creatinine, hypertension and haematuria and who were subsequently diagnosed with crescentic glomerulonephritis on biopsy. Despite having received immunosuppressive therapy, both children had a poor renal outcome, perhaps due to delays in institution of appropriate treatment. It is imperative that all clinicians who manage children are made aware of this clinical syndrome so that timely referrals to nephrology are done. This will help to improve renal outcomes.

Keywords: Acute kidney injury; case report; crescentic glomerulonephritis; rapidly progressive glomerulonephritis; renal disease.

Figure 1

needle biopsy of the kidney demonstrating: A) (x400 hematoxylin and eosin stain); B) (x400 periodic acid Schiff stain); A) fibro-cellular crescent; B) glomerulus with a capillary tuft that is collapsed crescent; B) glomerulus with a capillary tuft that is collapsed