Background: Rapidly Progressive Glomerulonephritis (RPGN) is a rare condition in children and the incidence remains unknown. Systemic lupus erythematosus (SLE) is one of the etiologies, usually presented as lupus nephritis. RPGN causes fast deterioration of renal function and requires timely intervention to preserve it. RPGN can lead to acute renal failure, which management requires emergency dialysis as Renal Replacement Therapy (RRT). This case study aims to evaluate the effectiveness of SLED in a critically ill child with RPGN.
Case Presentation: A 16-year-old girl with a 10-day history of worsening dyspnea with edema anasarca, frothy sputum, and oliguria. Laboratory findings revealed anemia, leukocytosis with lymphopenia, thrombocytopenia, high procalcitonin, decreased glomerular filtration rate with uremia, hyperkalemia, increased anion gap metabolic acidosis, low C3 complement, haematuria, and proteinuria. Chest X-Ray showed pulmonary edema, pneumonia, and pleural effusion, while a CT scan revealed hydronephrosis, proximal ureter ectasis, hepatomegaly, and ascites. According to the 2015 American College of Rheumatology (ACR)/ Systemic Lupus International Collaborating Clinics (SLICC) criteria, her score was 6. She was diagnosed with RPGN due to SLE, acute kidney injury stage failure, acute respiratory distress syndrome, community-acquired pneumonia, and septic shock. The patient received SLED as a mode of dialysis due to her unstable hemodynamics. Other management included high-dose methylprednisolone pulses, antibiotics, and epinephrine drip. Her condition improved significantly both clinically and metabolic after receiving SLED.
Conclusion: SLED can be the choice of dialysis mode as emergency renal replacement therapy in hemodynamically unstable children with acute renal failure due to RPGN.