Prognostic Factors Associated with Renal Survival in Children with Rapidly Progressive Glomerulonephritis

Renal Survival in Children with Rapidly Progressive Glomerulonephritis

Abstract

Rapidly progressive glomerulonephritis (RPGN) is a severe pediatric renal disorder characterized by rapid deterioration in kidney function. In low-resource settings such as Pakistan, delayed presentation and limited access to specialized nephrology services may adversely affect renal outcomes. Objectives: To identify clinical, serological, histopathological, and healthcare access–related predictors of renal survival in children diagnosed with RPGN. Methods: This prospective observational cohort study was conducted at the Department of Pediatric Nephrology, The Children's Hospital and Institute of Child Health, Multan, between 15 February 2025 and 15 October 2025. All patients were followed for three months after confirmation of diagnosis. Children aged 1–18 years diagnosed with RPGN were consecutively enrolled after informed consent. Participants were followed for three months from diagnosis or until development of end-stage kidney disease (ESKD), whichever occurred first. Multivariable logistic regression was used to identify independent predictors of ESKD. Results: Among 110 enrolled children, 78 (70.9%) achieved renal survival, while 32 (29.1%) progressed to ESKD. Patients developing ESKD had significantly lower baseline estimated glomerular filtration rate (eGFR), higher serum creatinine and urine protein-to-creatinine ratio, longer delay before nephrology consultation, and greater crescent burden on biopsy (all p≤0.006). Conclusions: Histopathological severity, impaired baseline renal function, hypertension, and treatment delay are key determinants of short-term renal survival in pediatric RPGN.