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BACKGROUND: Crescentic glomerulonephritis, if not managed promptly, is associated with unsatisfactory outcomes. There are limited studies reporting the outcomes of crescentic glomerulonephritis in children. OBJECTIVES: This systematic review is aimed at synthesizing the data on etiology, clinical profile, and outcomes of crescentic glomerulonephritis in children. DATA SOURCES: We performed a literature search using PubMed, Embase, and Web of Science from inception to January 2024 without language or geographic restrictions. STUDY ELIGIBILITY CRITERIA: Cohort and cross-sectional studies with at least 10 participants reporting etiology, clinical features, and outcomes on crescentic glomerulonephritis in children were considered eligible. PARTICIPANTS AND INTERVENTIONS: Children aged less than 18 years with crescentic glomerulonephritis. STUDY APPRAISAL AND SYNTHESIS METHODS: We used a tool by Hoy et al. for assessing the quality of studies. We calculated pooled estimates using random effect meta-analyses. Primary outcome was the pooled proportion of patients progressing to kidney failure. RESULTS: From 1706 records, we included 36 studies (1548 participants) from 16 countries. Etiology was immune-complex glomerulonephritis in 76% (95% CI 67 to 85), pauci-immune in 19% (13 to 25), and anti-GBM disease in 5% (3 to 7) of patients. Gross hematuria, oliguria, edema, and hypertension were observed in 63% (41 to 82), 57% (34 to 79), 79% (65 to 90), and 64% (49 to 77), respectively. In-hospital mortality, reported in 11 studies, was 7% (4 to 11). Progression to kidney failure and chronic kidney disease was reported in 27% (21 to 33) and 50% (29 to 71) of patients, respectively. Risk factors for kidney failure included oliguria, dialysis requirement at onset, estimated GFR, proportion of fibrous crescents, and pauci-immune glomerulonephritis as the underlying etiology. LIMITATIONS: High heterogeneity in pooled estimates of the outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Immune-complex glomerulonephritis is the most common etiology in children, with edema, hypertension, gross hematuria, and oliguria being the chief presenting manifestations. Almost one in every four patients with crescentic glomerulonephritis progressed to kidney failure. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO registration number CRD42024500515.
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PURPOSE: To assess whether medical undergraduates can be trained to effectively screen diabetic retinopathy (DR) by statistical comparison with a retina specialist at a tertiary eye care center in India. METHODS: Three final-year undergraduate medical students, having completed ophthalmology department rotation, received training from a retina specialist for grading DR, following which they were asked to grade a set of 50 fundus photographs centered on the macula with a view of 50° as sight-threatening DR (STDR), diabetic macular edema, and grade of DR. Agreement among the undergraduates and retina specialist was determined with the help of Cohen's Kappa coefficient. RESULTS: Kappa coefficient between undergraduates for detection of STDR ranged from 0.695 to 0.817 and between each student and the retina specialist ranged from 0.663 to 0.712. The sensitivity and specificity for undergraduates' and retina specialist's detection of STDR were 93.93%-96.96% and 60%, respectively. CONCLUSION: There was substantial agreement among the undergraduates as well as between the undergraduates and the retina specialist for the detection of STDR. Undergraduates also detected STDR with a high sensitivity. This study outlines the feasibility of training undergraduate students for screening DR.