PROGNOSIS

After the initial episode resolves, about one third experience bouts of disease recurrence, which are usually mild and occur during the first several months after presentation. Patients should thus receive careful follow-up during this period.

Most children have normal long-term renal function, with a small fraction experiencing persistent sediment abnormalities and even fewer experiencing renal insufficiency. In contrast, adults appear to have a worse renal prognosis, with a large series finding that 15% experienced ongoing moderate insufficiency, 13% developed advanced chronic kidney disease, and 10% progressed to ESRD. Worse prognoses are more likely in those who develop more severe renal symptoms and are found to have markers of more significant inflammation, such as cellular crescents, on renal biopsy.

Renal transplantation can be performed on those who have progressed to ESRD. Disease recurrence, however, occurs in up to 25% of patients at 5 years. Although overall graft and patient survival are similar, recurrence can be associated with graft loss, especially in patients with necrotizing or crescentic lesions in their native kidneys.