POS-157 ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN CHILDREN: ABOUT A SERIES OF 83 CASES

Abstract

Post-infectious acute glomerulonephritis (PI-AGN) is very common among Moroccan children. IT can be defined as an acute, non-suppurative, diffuse, generalized inflammation of the glomeruli of both kidneys. It occurs after an infection (of the skin or the upper respiratory tract). Group A beta-hemolytic (GABH) streptococcus is the most incriminated infectious agent. PI-AGN prognosis depends on the severity of renal involvement, with the possibility of chronic renal disease in the worst cases. The aim of our study is to determine the epidemiological, clinical, histological, and evolutive features of PI-AGN in children treated in our center. For that reason, we gathered retrospective data of 83 children. The study took place from January 2016 to June 2020. The median of age was 9 years. Distribution by sex was in favor of males with 65%. Most cases (91%) were seen in winter. The most involved infectious sites were the upper respiratory tract (74%), and the skin (24%). The infection was still active at diagnosis in 30% of cases, while the remaining cases had it at least one week before. Microscopic hematuria and proteinuria were always present. Gross hematuria, generalized edema, and hypertension were also very common (seen respectively in 77%, 82%, and 65% of the cases). Other symptoms reported at diagnosis of PI-AGN were abdominal pain and vomiting (71%), convulsions (17%), and oliguria (13.3%). Acute kidney failure was found at onset in 25 children, from whom two had dialysis. The C3 complement fraction was low in 68 patients, and the ASLO titers were high in 53% of cases. All patients were under water and salt restriction. Furosemide was the first-line treatment of hypertension and oliguria patients, and nicardipine was added when blood pressure targets were not achieved. Renal biopsy was performed on 14 children. The main indications were nephrotic syndrome, persistent proteinuria, rapidly progressive glomerulonephritis (respectively in 22, eight, four, and two patients). The renal biopsy findings were as follows: endocapillary GN with C3 deposits in 14 children, minimal change disease in four children, membranous GN in one patient, crescent GN in two children, and glomerulosclerosis with C3 deposits in one child. Oral steroids (nephrosis regiment) were prescribed in 40%. Meanwhile, intravenous methylprednisolone (1g/1.73m2 three days in a row) and cyclophosphamide (500 mg/m2/month for six months) was indicated in severe cases (respectively 23% and 9.6% of cases). All our 83 children had a good prognosis, and no cases of chronic kidney disease were noted at follow-up. PI-AGN is still very common in Morocco, mainly because GABH-streptococcus upper respiratory tract infections are still frequent in our children. However, the prognosis remains good if the appropriate management is started early.