Acute Postinfectious Glomerulonephritis Research Articles

C3 glomerulopathy is highly prevalent in French Polynesia

ObjectiveTo compare the natural history of C3 glomerulopathy (C3G) to acute post-infectious glomerulonephritis (APIGN) in a cohort of patients with a relative homogeneity of environment conditions and genetic background. MethodsWe retrospectively reviewed the characteristics of all patients with biopsy proven C3G or APIGN referred in 2013–2019 to the only renal unit in French Polynesia. ResultsPoint prevalence of C3G is ∼23 cases per 100,000 inhabitants. A recurrent variation of CFI (p.Arg406His) was identified at the heterozygous state in 4/8 (50 %) patients with C3G but its pathogenicity remain elusive. Characteristics at presentation and kidney outcomes were roughly similar between C3G (n = 16) and APIGN (n = 20), excepted for the presence of humps on kidney biopsy. ConclusionsC3G is highly prevalent in French Polynesia suggesting specific genetic or environmental susceptibility factors. Systematic diagnosis workflow should be proposed to all patients with C3 predominant glomerulonephritis.

Acute Post-infectious Glomerulonephritis in Children Admitted to a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Post infectious glomerulonephritis remains the most common cause leading to the majority of hospital admissions in children of developing countries like ours. The aim of ourstudy was to find the prevalence of post infectious glomerulonephritis, study the clinical profile, biochemical changes and its complication in children admitted in a tertiary care hospital of Nepal. Methods: This descriptive cross-sectional study of children admitted at a tertiary care hospital was done from May 2020 till May 2023. A census sampling method was used and sample of 1554 children was taken. Detailed socio demographic data, clinical findings and laboratory investigations were done. Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages. Results: Among 1554 patients, the prevalence of acute post-infectious glomerulonephritis was found to be 63 (4.05%) (3.07-5.03 at 95% Confidence Interval). The mean age of the patients was 9.06±3.48 years. Antistreptolysin O titer was raised in 34 (54%) patients, while low serum C3 was observed in 39 (61.90%) patients with acute post-infectious glomerulonephritis. Conclusions: Acute post-infectious glomerulonephritis (APIGN) remains a notable health concern in children, particularly in developing countries like Nepal. This highlights the need for ongoing surveillance, prevention strategies, and effective management protocols to address this burden effectively.

Allelic Variants of the Complement Genes in Acute Postinfectious Glomerulonephritis.

Acute postinfectious glomerulonephritis (APIGN) is one of the most common causes of acute glomerulonephritis in children. It may lead to inflammation and proliferation of glomerular tissue through immunologic mechanisms (Balasubramanian R, Paediatr Int Child Health 2017;37:240-247).

Clinical pattern and outcome of hematuria in children – A prospective follow-up study from South India

Background: Hematuria is defined by the presence of an increased number of red blood cells (RBCs) in the urine. It can be visible or apparent only on microscopic analysis of urine which many times is an incidental finding. The prevalence of microscopic hematuria is 4–5% in routine clinical practice in children of 6–12 years of age. The pediatrician is the first person who comes in contact with children having microscopic or gross hematuria. Updated knowledge of clinical patterns and their outcomes will help improve the management of children with hematuria. Aim and Objective: The aim and objectives are to study the outcome of hematuria in children attending SAT Hospital, Government Medical College, Thiruvananthapuram. Materials and Methods: This is a prospective follow-up study of 100 children admitted with hematuria in our hospital whose ages were between 1 month and 12 years. A preformed and piloted questionnaire was used. Clinical history and examinations were done. Relevant investigations and follow-up assessments were done for 1 year. Biopsy was done for 35 patients by an experienced pediatric nephrologist. Results: Among the 100 children presented with hematuria, 24 had prior renal disease whereas 76 children did not have any pre-existing renal disease. Both were followed up for 1 year. 80% (45) of those without prior renal involvement cleared of hematuria by 1 year and 20% had persistent renal impairment. In the other group with prior renal problems, 75% (15) showed persistent renal problems. School-going children (57%) were mostly affected with female preponderance (30%). The most common etiology was acute post-infectious glomerulonephritis (60%), and the next most common seems to be IgA nephropathy (23%) followed by SLE (17%) Conclusion: Eighty percent of hematuria was found to be resolved completely after 1 year. The remaining 20% has to be carefully evaluated including renal biopsy when indicated. This will help the clinician to provide better care for sick babies with hematuria.

Glomerulonefritis aguda posinfecciosa causada por virus de la gripe B y entero rinovirus

Acute post-infectious glomerulonephritis (APIGN) is an inflammatory lesion with main involvement of the glomerulus triggered by an extrarenal infection. Its pathogenesis is immune, triggered by a wide variety of germs: bacteria, viruses and fungi. The most common cause is poststreptococcal glomerulonephritis (PSAGN). The case that we present was caused by influenza B and enterovirus, etiological agents of infrequent presentation, with clinical manifestations similar to post-streptococcal glomerulonephritis. We conclude that, when faced with a nephritic syndrome clinic, the viral history should be taken into account to make an early diagnosis.

Coexistence of cryoglobulinemia and ANCA-associated vasculitis in a chronic brucellosis patient -a case report and literature review

BackgroundThe renal involvement of brucellosis is not common. Here we reported a rare case of chronic brucellosis accompanied by nephritic syndrome, acute kidney injury, the coexistence of cryoglobulinemia and antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV) superimposed on iliac aortic stent implantation. The diagnosis and treatment of the case are instructive.Case presentationA 49-year-old man with hypertension and iliac aortic stent implantation was admitted for unexplained renal failure with signs of nephritic syndrome, congestive heart failure, moderate anemia and livedoid change in the left sole with pain. His past history included chronic brucellosis and he just underwent the recurrence and completed the 6 weeks of antibiotics treatment. He demonstrated positive cytoplasmic/proteinase 3 ANCA, mixed type cryoglobulinemia and decreased C3. The kidney biopsy revealed endocapillary proliferative glomerulonephritis with a small amount of crescent formation. Immunofluorescence staining revealed only C3-positive staining. In accordance with clinical and laboratory findings, post-infective acute glomerulonephritis superimposed with AAV was diagnosed. The patient was treated with corticosteroids and antibiotics and sustained alleviation of renal function and brucellosis was achieved during the course of a 3-month follow-up.ConclusionsHere we describe the diagnostic and treatment challenge in a patient with chronic brucellosis related glomerulonephritis accompanied by the coexistence of AAV and cryoglobulinemia. Renal biopsy confirmed the diagnosis of postinfectious acute glomerulonephritis overlapping with ANCA related crescentic glomerulonephritis, which was not ever reported in the literature. The patient showed a good response to steroid treatment which indicated the immunity-induced kidney injury. Meanwhile, it is essential to recognize and actively treat the coexisting brucellosis even when there are no clinical signs of the active stage of infection. This is the critical point for a salutary patient outcome for brucellosis associated renal complications.

Glomerulonefritis agudas y rápidamente progresivas, glomerulonefritis proliferativa endocapilar y glomerulonefritis proliferativa extracapilar

Acute (post-infectious) glomerulonephritis presents rapidly with hematuria (microscopic or causes), proteinuria, a decrease in glomerular filtration rate, and sodium and water retention that usually cause an increase in blood pressure and edema. In addition, various types of chronic glomerulonephritis may present as acute nephrotic syndrome and can be clinically indistinguishable from the onset of acute abnormalities. Rapidly progressive glomerulonephritis (RPGN) represents a clinical-pathological syndrome characterized by a rapid decline in renal function (weeks to months); proteinuria generally in a subnephrotic range; and the presence of fibrous, cellular crescents in the glomerular area. Its causes can be primary or secondary. Its classification depends on clinical, serological, and histological findings; they are divided into 3 types: 1, associated with anti-glomerular basement membrane antibodies; 2, associated with immune complexes; 3 pauci-immune (ANCA-associated), or 4, a combination of types 1 and 3. Diagnosis and treatment must be early. High-dose immunosuppressants and, sometimes, plasmapheresis can be used for the purpose of restoring renal function and avoiding rapid progression to advanced or end-stage chronic kidney disease. In cases with very high clinical suspicion, performing a renal biopsy must not delay starting immunosuppressive therapy.

Glomerulonephritis in Children: Epidemiological, Clinical, Paraclinical and Therapeutic Profile

Background: Glomerulonephritis (GN) is a rare kidney disease that causes significant morbidity and mortality. They are frequently difficult to treat, and in some cases, no treatment is available, and they can progress to chronic kidney disease (CKD) and end stage renal disease (ESKD). Kidney biopsy is the preferred diagnostic method because it helps determine the precise specific diagnosis, assesses the level of disease activity and severity, and thus aids in proper therapy and prognosis prediction. Methods: Retrospective review of 40 children under the age of 15 with GN diagnosed between 2019 and 2022. Nephrotic syndrome, sub-nephrotic proteinuria, nephrotic syndrome (NS) with acute kidney injury (AKI), subnephrotic proteinuria plus AKI, isolated hematuria, and unexplained renal impairment were the six clinical syndromes for which a kidney biopsy was performed in 25 patients. Hospital admission records, progression notes, and outpatient follow up were used to collect data. Results: Acute glomerulonephritis (AGN) with nephritic syndrome (NS) affected 53% of the patients. Patients with AGN-NS were more likely to develop hypertension (48.0% vs. 15.7%) and acute renal damage (32% vs. 10%). 48% of the patients had Acute Postinfectious Glomerulonephritis. 5% of the patients had membranoproliferative glomerulonephritis. 2.5% of patients with ANCA-negative rapidly progressive glomerulonephritis had extramembranous glomerulonephritis, and 2.5% had extracapillary glomerulonephritis. The kidneys of 24 people were biopsied. The most common reason for a kidney biopsy was rapidly progressing glomerulonephritis. Conclusion: Acute postinfectious glomerulonephritis has been the most common glomerulonephritis in our study over the last three years in our Marrakech department. It manifested as a rapidly progressive glomerulonephritis in twelve of the cases.

Seasonal variations in renal biopsy numbers and primary glomerular disease features based on the Japan renal biopsy registry

We analyzed the seasonal variations in the number of renal biopsies and clinical characteristics of primary glomerular disease in Japan using the Japan Renal Biopsy Registry (J-RBR). We retrospectively collected clinical and pathological data of patients with primary glomerular disease who were registered in the J-RBR between 2007 and 2018. Immunoglobulin A nephropathy (IgAN), minimal change nephrotic syndrome (MCNS), membranous nephropathy (MN), and postinfectious acute glomerulonephritis (PIAGN) constituted the four major glomerular disorders included in this study (total, 13,989; IgAN, 9121; MCNS, 2298; MN, 2447; and PIAGN, 123). The number of patients with IgAN or MCNS was higher during summer. However, no overt seasonal variations were observed in patients with MN or PIAGN. Subgroup analyses suggested that in the patients with IgAN, more renal biopsies of severe cases were performed during winter, probably owing to age and blood pressure. Furthermore, more renal biopsies of severe cases were performed during spring and winter in patients with MCNS even after adjusting for the abovementioned host factors. This study suggests that seasonal factors influence the decision to perform renal biopsy as well as the pathogenesis of primary glomerular disease. Thus, our findings may provide important insights regarding the pathophysiology of primary glomerular disease.

Clinical Manifestations, Pathological Correlations, Prognostic Factors, and Outcomes of Severe Acute Postinfectious Glomerulonephritis with Rapidly Progressive Glomerulonephritis in Children

Objective: To describe clinical spectrum, as well as biochemical and histological factors that could predict severe presentations and renal outcomes among children with rapidly progressive glomerulonephritis (RPGN) due to postinfectious glomerulonephritis (PIGN). Material and Methods: A retrospective cohort study was conducted at Chiang Mai University Hospital, Thailand between February 2008 and January 2018. Ninety-six pediatric patients with PIGN were recruited. Clinical presentations, disease courses, laboratory data, renal histopathology, treatment, and outcomes were analyzed. Compare clinical manifestation and outcome between the two groups. Results: The median age (interquartile range, IQR) was 11 (8 to 13) years with a male-to-female ratio of 1.8:1. RPGN was identified in 51.04% (49/96 patients). PIGN children with RPGN exhibited a higher prevalence of nephrotic range proteinuria (69.4% versus 53.2%, p=0.04), nephrotic syndrome (46.9% versus 17%, p=0.002), and hypoalbuminemia (81.3% versus 53.8%, p<0.0001) compared with those without RPGN. Multivariate analysis revealed that anuria, and hypoalbuminemia were predicting factors of RPGN [odd ratios 0.07 (95% CI 0.01 to 0.77), p=0.03 and 0.23 (95% CI 0.08 to 0.69), p=0.006, respectively]. Follow-up data were available among 78 patients (81.3%) with a median follow-up time of 762 (256.3 to 1,293) days. Complete remission was identified in all of PIGN without RPGN but only 71.4% in the RPGN group. Kaplan-Meier analysis revealed that patients with RPGN had a longer recovery time of generalized edema at 14 days (95% CI 12 to 15.9) versus 9 days (95% CI 7 to 12), p=0.023; proteinuria at 16 weeks (95% CI 11 to 20.8) versus 8 weeks (95% CI 4.25 to 15.75), p<0.0001; and impaired glomerular filtration rate (GFR) of nine weeks (95% CI 4.8 to 13.2) versus two weeks (95% CI 1 to 8), p=0.003. Subgroup analysis of prognostic factors of PIGN with RPGN revealed that high BMI z-score and kidney replacement therapy (KRT) requirement were associated with poor renal outcomes. Conclusion: Hypoalbuminemia and anuria were predictive factors of RPGN in PIGN. High BMI z-score and low GFR required acute KRT were predictive factors of poor renal outcomes. Keywords: Postinfectious glomerulonephritis; Acute post streptococcal glomerulonephritis; Rapidly progressive glomerulonephritis; Children

Crescentic glomerulonephritis in children: A retrospective review of data from Chris Hani Baragwanath Academic Hospital

Background. Crescentic glomerulonephritis (CGN) as a cause of progressive renal failure is rare. Crescent formation on kidney biopsyrepresents a response to injury of the glomerular capillary walls. There are limited published reports on paediatric CGN in Africa.Objectives. To describe the clinical presentation and outcome of children with CGN in Soweto, South Africa, over a 22-year period.Methods. A retrospective study was conducted at the Paediatric Renal Unit at Chris Hani Baragwanath Academic Hospital. Childrenyounger than 14 years with crescent formation in more than 50% of glomeruli on renal biopsy were included in the study. Kidney biopsy specimens were examined by light microscopy, immunofluorescence and electron microscopy. Demographic and clinical data were extracted from the patient files.Results. During the study period, 961 kidney biopsies were performed. Fourteen patients (1.5%) met inclusion criteria of crescents in>50% of glomeruli. Common clinical findings were oedema (n=13; 93%), microscopic haematuria (n=12; 86%), hypertension (n=11; 79%)and proteinuria (n=10; 71%). The median estimated glomerular filtration rate (eGFR) at presentation was 23.9 mL/min/1.73m2. Thirteen patients (93%) had immune-complex-mediated glomerulonephritis. The underlying cause was acute post-infectious glomerulonephritis in 9 patients (64%), membranoproliferative glomerulonephritis and IgA nephropathy in 2 patients each (14%) and global sclerosis in 1 patient (7%). Prolonged duration of symptoms resulted in a lower eGFR at follow-up. Treatment included peritoneal dialysis, methylprednisolone and cyclophosphamide. Seven (54%) patients had a normal eGFR at a median (range) follow-up of 36.7 (4.5 - 61.5) months. Six (46%) patients had progressed to chronic kidney disease stages 2 - 5. One patient was followed up for less than 3 months, and therefore was not included in the follow-up results.Conclusion. Poor outcomes were observed in patients who presented late. The clinical findings of haematuria, hypertension and acutekidney injury warrant early referral and kidney biopsy to determine management.

POS-038 EPIDEMIOLOGICAL, CLINICAL AND PROGNOSTIC ASPECTS OF ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS FROM JUNE 2014 TO JUNE 2018: A SINGLE HAITIAN HOSPITAL-BASED STUDY

Acute post-infectious glomerulonephritis (APIGN) is one of the main causes of glomerulonephritis in children with a clear male predominance. It is more common in countries with limited resources and is associated with high morbidity and mortality. Through this study, we wanted to evaluate the burden of this glomerulopathy in children admitted at the only pediatric hospital in Haiti by reviewing its epidemiological, clinical, and prognostic characteristics

Prevalence of Renal Failure in Children and the Need for Dialysis in Paediatric Nephrology in a Developing Country

Background: Renal failure is among the major visceral failures responsible for morbidity and mortality in children. Epidemiological data on renal failure in children are limited in sub-Saharan Africa, including Senegal. We conducted this study to assess the prevalence of renal failure (RF) and the need for dialysis in the paediatric nephrology unit. Patients and methods: This was a retrospective and descriptive study in the pediatric nephrology unit from 1st January 2020 to 30 June 2021, including children with acute or chronic RF. The need for dialysis was judged to be met by its effectiveness in face of an indication. The data collected were analysed on sphinx plus 2017 software. Results: The prevalence of RF was 60% (n/N = 132/220). RF was acute in 59% (n/N = 78/132) of cases. The mean age was 6.53 ± 4.77 years with a sex ratio of 1.8. The mean serum creatinine level was 27.22 mg/L (240.9 μmol/L) and BUN at 0.85 g/L. The aetiologies were dominated by prerenal AKI (Acute Kidney Injury) complicating nephrotic syndrome (NS) in 37.2% (n/N = 29/78) and dehydration due to stomach flu in 17.6% (n/N = 9/51). Acute post-infectious glomerulonephritis including group A streptococcus and plasmodium falciparum accounted for 16.7% (n = 13/78) of intrinsic AKI. The need for dialysis was unmet in 50% (n/N = 7/14) with a mortality of 14.1% (n/N = 11/78). The mean age of the patients with chronic RF was 8.68 ± 4.74 years with a sex ratio of 2.6. The mean serum creatinine level was 36.56 mg/L (323.5 μmol/L) and the BUN level was 0.99 g/L. Half of the children were classified as having CKD stage II (early stage). The aetiologies were dominated by primary focal and segmental glomerulosclerosis (FSGS), 53.7% (n/N = 29/54), renal hypoplasia, 22.2% (n/N = 12/54) and reflux nephropathy, 29.4% (n/N = 5/17). The need for dialysis was unmet in 46.1% (n/N = 6/13). The overall mortality of chronic kidney disease (CKD) with RF was 29.6% (n/N = 8/27). Conclusion: The prevalence of RF was high in the unit. Most aetiologies of AKI were accessible to prevention. Only half of the children had access to free dialysis, hence the need for a dedicated pilot dialysis centre.

Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review

BackgroundKidney diseases are a recognized cause of posterior reversible leukoencephalopathy syndrome, usually abbreviated as PRES. The purpose of this review was to systematically address the association between acute postinfectious glomerulonephritis and PRES.MethodsWe performed a systematic review of the literature on acute postinfectious glomerulonephritis associated with PRES. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Systematic Reviews and Meta-analyses were used. Databases searched included Excerpta Medica, US National Library of Medicine, and Web of Science.ResultsFor the final analysis, we evaluated 47 reports describing 52 cases (32 males and 20 females). Fifty patients were ≤ 18 years of age. Blood pressure was classified as follows: normal-elevated (n = 3), stage 1 hypertension (n = 3), stage 2 hypertension (n = 5), and severe hypertension (n = 41). Acute kidney injury was classified as stage 1 in 32, stage 2 in 16, and stage 3 in four cases. Neuroimaging studies disclosed a classic posterior PRES pattern in 28 cases, a diffuse PRES pattern in 23 cases, and a brainstem-cerebellum PRES pattern in the remaining case. Antihypertensive drugs were prescribed in all cases and antiepileptic drugs in cases presenting with seizures. A resolution of clinical findings and neuroimaging lesions was documented in all cases with information about follow-up.ConclusionsThe main factor associated with PRES in acute postinfectious glomerulonephritis is severe hypertension. Prompt clinical suspicion, rapid evaluation, and management of hypertension are crucial.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Гострий гломерулонефрит: особливості перебігу та патоморфологічної картини (власне спостереження)

Наведено клінічний випадок з особливостями морфологічної картини гострого гломерулонефриту, що перебігав на фоні попередньо існуючої патології канальцевого апарату нирок — мікрополікістозу некласифікованого. Хворому Х., 20 років, була проведена патогенетична терапія гострого гломерулонефриту глюкокортикоїдами та цитостатиками. Однак, незважаючи на застосовані терапевтичні засоби, симптоми гломерулонефриту продовжували наростати, розвинувся нефротичний синдром, що призвело до критичної втрати білків плазми крові, розладів коагуляції у вигляді ДВЗ-синдрому та подальшого приєднання уремії. Імовірно, резистентність до лікування пов’язана з попередньо існуючою патологією канальців нирок, функція яких була скомпрометована, та, можливо, генетично детермінованою резистентністю до патогенетичної терапії.

Циліопатії, роль Wnt-сигнального шляху в перебігу гострого (постінфекційного) гломерулонефриту: огляд літератури та власне спостереження

Первинні війки — це субклітинні органели, що є похідними цитоплазматичної мембрани клітин майже будь-якого типу. Вони відіграють роль у сприйнятті та передачі механічних та хімічних сигналів із поверхні клітин, орієнтації площини поділу клітини, органогенезі тощо. Зазначені функції реалізуються завдяки великій кількості білків, рецепторів, сигнальних шляхів. Мутації та дерегуляція даних компонентів можуть мати широкий спектр фенотипових наслідків, що об’єднуються спільною назвою — циліопатії, до яких, зокрема, належать і кістозні ураження паренхіми нирок. Серед інших сигнальних каскадів, пов’язаних з первинними війками, Wnt-сигнальний шлях є відповідальним за нефрогенез та відповідь нирок на ушкоджуючі фактори. Описано клінічний випадок гострого (постінфекційного) гломерулонефриту в пацієнта Х., 20 років, із кістозним розширенням ниркових канальців, що було діагностовано гістологічно. У поданій статті, базуючись на останніх дослідженнях у галузі циліопатій, ми припускаємо ймовірні молекулярні механізми, відповідальні як за формування кіст у канальцевій системі нирок, так і за прогресуючий фатальний перебіг гломерулонефриту в даному випадку.

Eculizumab as a New Treatment for Severe Acute Post-infectious Glomerulonephritis: Two Case Reports

Acute post-infections glomerulonephritis (APIGN) is a frequent cause of glomerulonephritis and represents the most common cause of acute glomerulonephritis in children. It can evolve to severe acute renal failure and chronic kidney disease or even end-stage kidney disease. The precise pathophysiological mechanisms of APIGN are still incompletely understood. The implication of the alternative complement pathway and the potential benefits of C5 blockade have been recently highlighted, in particular in the presence of a C3 Nephritic Factor (C3Nef), anti-Factor B or H autoantibodies. We report two children with severe APIGN, successfully treated with eculizumab. The first patient presented a severe form of APIGN with advanced renal failure and anuria, associated with a decreased level of C3 and an increased level of soluble C5b-9, in the presence of a C3NeF autoantibody. The second case had a severe oliguric APIGN associated with low C3 level. Kidney biopsy confirmed the diagnosis of APIGN in both cases. Eculizumab allowed full renal function recovery and the avoidance of dialysis in both cases. In conclusion, the alternative and terminal complement pathways activation might be common in PIGN, and in severe cases, eculizumab might help.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Acute Kidney Injury in a Patient with Trisomy 21.

1. Hannah S. Kim, MD* 2. Francesca Costigliolo, MD† 3. Serena Bagnasco, MD† 4. Jeffrey Fadrowski, MD, MHS* 5. Rebecca L. Ruebner, MD, MSCE* 1. *Division of Pediatric Nephrology and 2. †Division of Pathology, Johns Hopkins University, Baltimore, MD A 5-year-old former 34-week girl with trisomy 21, hypothyroidism, and obstructive sleep apnea presents to the emergency department with a chief complaint of fever. She initially presented to her pediatrician 3 weeks earlier with sore throat and was diagnosed as having group A streptococcal pharyngitis. She completed 10 days of amoxicillin with resolution of sore throat. Now for the past 3 days she has had fever, chest pain, decreased enteral intake, and emesis. Review of systems is negative for diarrhea, gross hematuria, dysuria, polyuria, polydipsia, edema, weight loss, rash, arthralgia, arthritis, oral ulcers, epistaxis, and hemoptysis. She has had normal growth. She takes levothyroxine and took several doses of ibuprofen for fever over the past several weeks. There is no family history of kidney disease. She had no recent travel or sick contacts. On physical examination her weight is 45.2 lb (20.5 kg) (65th percentile); height, 46.1 in (117 cm) (62% percentile); temperature, 100.8°F (38.2°C); heart rate, 110 beats/min; respiratory rate, 24 breaths/min; oxygen saturation, 100% on room air; and blood pressure, 92/42 mm Hg (systolic 31st and diastolic 9th percentiles for age and sex). There is no pharyngeal injection or exudate. She appears well-hydrated, including moist mucous membranes. Lungs are clear to auscultation. Her abdomen is soft, nontender, and nondistended. There is no edema, and she has brisk capillary refill. She has no rash or joint swelling, erythema, or warmth. Laboratory evaluation includes a white blood cell count of 15,310/µL (15.31×109/L) with 83.6% neutrophils and 0.8% bands; hemoglobin …

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

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.