ESPN 51th Annual Meeting

ESPN 2018


 
FINDING OF CRESCENTS ON KIDNEY BIOPSY AND THE OUTCOME
VALBONA STAVILECI 1 DIAMANT SHTIZA 2 IRENA PALLOSHI 2 KJELL TULLUS 1

1- UNIVERSITY CLINICAL CENTER OF KOSOVA, PEDIATRIC CLINIC
2- HOSPITAL CENTER OF TIRANA, PEDIATRIC CLNIC
 
Introduction:

What would suggest us for crescent nature of the disease.  Do we need to treat with more aggressive treatment in order to preserve the kidney function?

Material and methods:

We evaluated biopsy results, done in the Great Ormond Street Hospital to 2010, 82 of which resulted with Crescents. Age of manifestation was find from 2 years to 17teen. Clinical and laboratory parameters were retrieved along with the therapeutic approach and clinical outcome, wherever available. This is our interest to identify.

Results:

Of all biopsies, Female were 44 and male 38 cases. Biopsies had from 5% to 100% crescents: <=10% crescents had 9 biopsies, <=20% had  6, <=30%  had 8, <=40% had 3, <=50% had 10, <=60% had 6, <=70% had 4, <=80% had 14, <=90% had 6, <=100%crescents had 16 biopsies.

79% of these cases had ultrasound evaluation. 40% had enlarged kidneys, 92% had hyperechogenic structure and 16.9% had normal size and echostructure. As is seen increased echogenity is a high indicator of the presence of the crescents. From all the diseases found, HSP was most frequent reason of the crescents in 21.9% of all cases, and the most of the cases were with >=50% crescents. LES followed with 18.2% of cases, but with <=50%.crescents. Post infectious GN were in 17% of cases, and with >=50% crescents. Postinfectious GN found on 10.9% cases. And with <6% were found Wegner, MPGN, Good pasture, Nephrotic syndrome, HUS. Immunologic tests were done in most of the cases. And findings were different, not always connected with the percentage of crescents. Age of manifestation was find from 2 years to 17teen.

Treatment in almost all cases was with Pulse methyl prednisolon and oral steroids. Also CYC was the first immunosuppressive drug. Followed by MMF, AZA, Rituximab. Combined with anticoagulants and supportive treatment. Plasma Exchange was reserved for cases with >50 of crescents. None has died, 13.4 % ended with RRT (transplanted,HD, CAPD). Other improved with no changes in kidney function, and  a few ended up with CKD.

 

Conclusions:

Starting treatment with Pulse Methyl Pred should not be delayed when suspected for crescents. And Ultrasound examination gives a lot information also.