Acute Poststreptococcal Glomerulonephritis Research Articles

Reduction in Acute Post-Streptococcal Glomerulonephritis Incidence in Counties Manukau, New Zealand, after the COVID-19 Pandemic.

The COVID-19 pandemic has altered the epidemiology of many common childhood infections, including Group A streptococcal (GAS) disease. Acute post-streptococcal glomerulonephritis (APSGN) is a nonsuppurative complication of GAS pharyngitis and pyoderma. It remains the most common cause of pediatric acute glomerulonephritis globally. In Counties Manukau, New Zealand, APSGN rates have previously been shown to be the highest in the country, with marked ethnic and socioeconomic disparities. We performed a retrospective review of children aged 0-14 years who were discharged from Kidz First Hospital, Counties Manukau, between 2015 and 2023 and met the Strep A Vaccine Global Consortium consensus definition of APSGN. We describe a marked, sustained reduction in APSGN hospitalizations, temporally associated with the COVID-19 pandemic. This ongoing reduction in APSGN incidence is notable in light of contrasting reports of increasing incidence of rheumatic fever in New Zealand and invasive GAS disease internationally.

An unusual etiology in an 8-year-old girl with chest pain and elevated troponin-I.

Acute post-streptococcal glomerulonephritis (APSGN) is the most common glomerulonephritis of childhood, and clinical presentation can vary widely. This case report presents an atypical manifestation of APSGN in an 8-year-old female patient with pleuritic chest pain and elevated troponin-I, despite lacking classical kidney symptoms. Imaging studies showed cardiomegaly and interstitial lung opacities. Further investigations revealed hematuria and proteinuria, and the diagnosis was confirmed through elevated antistreptolysin-O (ASO) titers and low complement 3 (C3) levels. The patient was successfully managed with fluid restriction, diuretics, and antihypertensives, resulting in the resolution of symptoms and normalization of laboratory values. This case highlights the significance of recognizing atypical manifestations of APSGN for ensuring prompt diagnosis and proper management in the pediatric population.

Predictive factors of progression to chronic glomerulonephritis in pediatric patients with post streptococcal acute glomerulonephritis

BackgroundPost streptococcal acute glomerulonephritis (PSAGN) patients have favorable prognosis, in which most patients showed full recovery in terms of kidney function. However, there is a slight chance ranging from 3 to 6% that PSAGN patients develop chronic kidney diseasewhich may progress into end-stage kidney disease in later life. It is important to identify the factors that can predict the development of chronic glomerulonephritis following PSAGN. Therefore, early intervention can be performed to halt the progression of chronic kidney disease. This study aimed to determine the predictive factors of chronic glomerulonephritis in pediatric patients with PSAGN. MethodsThis study was an analytical observational study with retrospective cohort design. The accessible population was children within the age of 2–18 years old who were admitted with PSAGN between January 2015 and December 2020 in Dr. Sardjito General Hospital Yogyakarta. All anonymized patient data were evaluated for demographic variables, clinical features, laboratory profiles and outcome. Multivariate analysis was performed with multivariate logistic regression method. ResultsA total of 124 patients with PSAGN were obtained from medical record data. There were 65 patients (52.4%) with chronic glomerulonephritis. Bivariate analysis was performed on assumed predictive factors with the results indicating massive proteinuria with hypoalbuminemia (OR 1.670, 95%CI 1.199–2.326; p = 0.003), oliguria (OR 1.517, 95%CI 1.101–2.089; p = 0.028) and macroscopic hematuria (OR 1.647, 95%CI:1.061–2.555; p = 0.013) were significantly higher in the PSAGN group with chronic glomerulonephritis compared to those without. Results of the multivariate logistic regression analysis showed massive proteinuria with hypoalbuminemia (OR 2.896, 95%CI 1.177–7.123, p = 0.021) and macroscopic hematuria (OR 2.457, 95%CI ,1.018–5.933, p = 0.046) would highly predict chronic glomerulonephritis in subjects with PSAGN. ConclusionWe concluded that massive proteinuria with hypoalbuminemia and macroscopic hematuria are the predictive factors which highly predict chronic glomerulonephritis in PSAGN.

Acute Post-streptococcal Glomerulonephritis in a Pediatric Population: A Five-Year Retrospective Study.

Post-streptococcal glomerulonephritis is a kidney disease that occurs after infection with a certain strain of streptococcal bacteria. It has a high hospitalization rate, especially in developing countries. It is characterized by the sudden appearance of edema, hematuria, proteinuria, and hypertension. The objective of this retrospective descriptive study conducted at James L. Gordon Memorial Hospital in Olongapo, Zambales, Philippines, is to analyze the demographic distribution, clinical presentation, complication, and outcome of acute post-streptococcal glomerulonephritis (APSGN) in a pediatric population. Methods: A retrospective descriptive study was done in patients (below 18 years of age) admitted with the diagnosis of post-streptococcal glomerulonephritis during a five-year period in the pediatric ward of a tertiary hospital in the Philippines. All patients underwent detailed clinical history and examination and were closely monitored during treatment. The course of disease progression was closely monitored and recorded. Seventy-seven children were treated for APSGN with a mean age of 7.8 years and with standard deviation of 3.85. Edema and gross hematuria were noted in 53 (68.8%) and 24 (31.1%) cases, respectively. Hypertension was present in 54 patients (70.1%). Among those 54 patients, 49 (63.6%) patients developed acute renal injury (based on normal creatinine for age), three cases (3.8%) had pleural effusion, and two patients (2.5%) developed hypertensive encephalopathy. All patients underwent KUB (kidneys, ureters, and bladder) ultrasound, among which 13 (16.88%) had diffuse parenchymal swelling which improved and eventually were discharged. Increased blood urea nitrogen (BUN) was noted in 60-65% of patients. Hypoalbuminemia and lower hemoglobin were also quite common. There was no mortality during treatment and hospital stay. APSGN remains one of the most common causes of glomerulonephritis in the region. Edema, hypertension, and hematuria were the most common presenting features. Early identification and comprehensive monitoring and management are required to prevent morbidity and mortality. The prognosis is generally good if early treatment is done.

Group A Streptococcus Infections.

Group A Streptococcus causes a variety of clinical manifestations, including pharyngitis and skin and soft tissue infections as well as more invasive disease. There are also multiple nonsuppurative complications of group A Streptococcus infection, including acute rheumatic fever and poststreptococcal glomerulonephritis. Pediatricians should be able to diagnose and treat the various presentations of the infection.

Myocardial dysfunction and thrombocytopenia, rare manifestations of acute post-streptococcal glomerulonephritis: case report

In this case report, we present two rare cases of acute post-streptococcal glomerulonephritis with unusual manifestations in the form of myocardial dysfunction and thrombocytopenia. APSGN typically follows Streptococcal infections and is characterized by inflammation of glomeruli. These cases, however, exhibited additional complexities. The first case involved a 12-year-old male with fever, shortness of breath, and cough. He presented with pedal edema, pallor, and hypertension. Laboratory findings revealed thrombocytopenia, anemia, and decreased C3 levels, while echocardiography indicated grade-3 diastolic dysfunction. The second case featured a 5-year-old female with icterus, fever, and body swelling. She had a palpable liver, pleural effusion, and thrombocytopenia. Both cases were diagnosed with APSGN, congestive heart failure, and thrombocytopenia. Thrombocytopenia is a rare finding in APSGN, and its etiology remains debated. Treatment included decongestive therapy and antihypertensive medication. Notably, thrombocytopenia in both cases improved without specific intervention, challenging the necessity of steroids or IVIg therapy. This report illuminates on the atypical presentation of APSGN, highlighting the potential coexistence of glomerulonephritis and thrombocytopenia. It underscores the need for further research to better understand this association and determine appropriate treatment protocols. These cases emphasize the importance of considering diverse clinical manifestations in the context of APSGN, calling for a broader understanding of this condition.

A 6-year review of acute post-streptococcal glomerulonephritis at a public children’s hospital in Cape Town, South Africa

BackgroundAcute post-streptococcal glomerulonephritis (APSGN) is the most common cause of acute nephritis in children globally and, in some cases, may be associated with progressive kidney injury and failure, cumulating in the need for long-term dialysis and/or kidney transplantation.MethodsOur retrospective study describes the occurrence of APSGN among children (< 14 years) admitted to a tertiary children’s hospital in Cape Town, South Africa, from January 2015 to December 2020.ResultsOf 161 children who presented with acute nephritis (haematuria, oedema, oliguria, and hypertension), 100 met the inclusion criteria. Demographic, clinical features, laboratory findings, management, and outcome data were collected. APSGN was defined by the clinical presentation of at least two clinical signs of acute nephritis, and low serum complement 3 (C3) level or evidence of a recent streptococcal infection. Most cases of APSGN were associated with streptococcal skin infections: 55/100 (55%); 10/100 (10%) children presented with hypertensive seizures; C3 levels were low in 86/92 (93.5%) children; 94/94 (100%) children had elevated anti-deoxyribonuclease-B (anti-DNase-B) levels; and 80/94 (85%) also had elevated anti-streptolysin O titre (ASOT) at presentation. Eleven (11%) children had a percutaneous kidney biopsy; 4/11 (36%) showed histological features of post-infectious nephritis, and 7/11(64%) also had crescentic glomerulonephritis with immune complex deposits. Sixty-two (62%) children confirmed recovered, and five (5%) progressed to kidney failure, but 29 presumed recovered as they did not return for follow-up to our institution.ConclusionsChildhood APSGN remains an important health problem in South Africa (SA) with favourable outcomes in most, apart from those with crescentic glomerulonephritis who progressed to kidney failure.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Biomarkers of histologic severity in children with severe or atypical acute post-streptococcal glomerulonephritis.

Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute kidney injury (AKI) in children; however, in a small subgroup, the presentation is one of rapidly progressive glomerulonephritis (RPGN) deteriorating kidney function associated with severe oligo-anuria or a mixed nephritic-nephrotic picture. This study reviewed potential clinical and laboratory factors which may assist the treating clinician to identify patients at high risk of severe disease. All kidney biopsies for APSGN performed between 1996 and 2020 were obtained from a departmental biopsy database. Clinical and laboratory data were extracted from the patients' clinical records. Kidney biopsies were reviewed and scored independently by a renal histopathologist. Thirty of 53 (56.6%) patients had stage 3 AKI at initial presentation with a median estimated glomerular filtration rate (eGFR) 27 (IQR 11-41), falling to 20ml/min/1.73 m2 (IQR 13.3-43) at time of biopsy. Patients who had either a pre-biopsy eGFR < 35ml/min/1.73 m2 or a ≥ 25% fall in eGFR between admission and biopsy were more likely to have glomerular crescents (p = 0.004). Multivariate regression analysis and receiver operating curve showed the pre-biopsy eGFR most accurately predicted glomerular crescents (p = 0.047, ROC 0.757). There were no significant predictors of nephrotic proteinuria or nephrotic syndrome during the acute phase. Severe APSGN is associated with a pronounced reduction in eGFR. Calculation of eGFR in this small group of patients may assist in identifying which patient should have an urgent kidney biopsy to facilitate a more accurate clinical diagnosis and management plan.

Hepatorenal and renocardial syndrome in young patients with acute glomerulonephritis

In this paper we discuss classical types of acute glomerulonephritis in young adults, when the intake of paracetamol and diclofenac led to a dysfunctional and organic liver injury, at the same time it negatively affected the course of acute glomerulonephritis. To study the characteristics of the development of acute reno-cardial syndrome (ARCS) Goal: Assessment of cause and effect relations of renal, hearts and liver injuries in young adults in acute post-streptococcal glomerulonephritis (APSG). With acute nephritic syndrome (ANS) complicated by acute kidney injury (AKI) and without it, to identify the role of the etiological factor on the course of APSG. Methods and Material: 220 male patients with APSG with ANS aged 18-20 were examined. The patients were divided into 2 groups based on the functional state of kidneys. The first group included 140 patients with APSG without ANS, the second group included 80 patients with AKI. Results: Out 66 patients had subclinical liver injury, which resulted from the effect of antipyretic hepatotoxic drugs taken in the initial stage of the disease. Due to the toxic and immunological liver injury, levels of transaminases increase, and albumin levels decrease. These changes occur along with the development of APSG and are correlated with some laboratory values. Impairment of cardiovascular function was observed in all 220 patients. ECG and Echocardiography studies conducted during the cardiac asthma attacks occurred as a decrease of voltage, broadening of the P wave, lengthening of the PQ interval, broadening of the QRS complex, dilatations of the right and left atrium. The severity of clinical manifestations of AKI and ARCS correlates with the degree of macrohematuria, GFR decrease, complement C3 fraction, monocyte. Conclusion. In APSG liver injury has a toxicoallergic character. Frequency of liver injury depends on specific features of a particular organism, it does not depend on the dose of the taken drug. In case of any type of acute glomerulonephritis it is necessary to assess the functional state of liver and after the treatment of the main disease hepatologist follow-up of patients is recommended. Thus in the development of acute reno-cardial syndrome (ARCS) the degree of manifestation of hypervolemia with hypertension, as a result of active immune inflammation of the glomerular apparatus with the development of AKI, plays the main role in the development of ARCS with APSG.. As a rule ARCS in case of APSG with ANS in young adults has a successful outcome.

An outbreak of acute rheumatic fever in a remote Aboriginal community

ObjectivesWe describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. MethodsIn August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. Results12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. ConclusionsThis outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. Implications for Public HealthOutbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.

Overview on Management of Acute Glomerulonephritis in the ED

The word "glomerulonephritis" refers to a group of kidney illnesses marked by immune-mediated destruction to the basement membrane, mesangium, or capillary endothelium, resulting in hematuria, proteinuria, and azotemia. Acute Kidney Injury episodes in glomerular disease are typically caused by rapidly progressive glomerulonephritis (RPGN). acute glomerulonephritis is caused by immunologically mediated damage caused by numerous infectious agents such as viruses, bacteria, or protozoa, as well as non-infectious causes such as Henoch–Schonlein purpura (HSP). The most prevalent infectious cause is post-streptococcal glomerulonephritis (PSGN). The emergency physician must conduct a thorough physical examination and obtain a complete medical history, including herbal agents, sports supplements, non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and calcineurin inhibitors, among other medications. In addition, the patient's blood pressure, weight, hydration status, edoema, skin manifestations, pulmonary and cardiac examinations must all be correctly monitored. Because there is no particular medication for renal illness, the treatment for acute poststreptococcal glomerulonephritis (PSGN) is mostly supportive. The underlying infections must be addressed when acute glomerulonephritis (GN) is accompanied with chronic infections. The critical care unit's expertise may be required for the treatment of individuals with hypertensive encephalopathy or pulmonary edoema. A nephrologist's consultation may be necessary. Renal function, blood pressure, edoema, serum albumin, and urine protein excretion rate should all be evaluated on an outpatient basis. In this article, we will be reviewing Acute glomerulonephritis, its evaluation as well as management.

IMPETIGO, DESCRIPTION, ETIOLOGY, EPIDEMIOLOGY, PATHOPHYSIOLOGY, EVALUATION, DIFFERENTIAL DIAGNOSIS, TREATMENT, PROGNOSIS AND COMPLICATIONS

Introduction: Impetigo is a common infection of the superficial layers of the epidermis that is highly contagious and usually originated by gram-positive bacteria, this disease manifests with the presence of erythematous plaques with a yellow crust, which may become itchy or painful. Diagnosis is usually based on signs and symptoms alone. Treatment involves topical and oral antibiotics and symptomatic care. Objective: to detail current information related to impetigo, description, etiology, epidemiology, pathophysiology, evaluation, differential diagnosis, treatment, prognosis and complications. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 28 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: impetigo, cutaneous bacterial infection, S. aureus, streptococcal, bullous impetigo. Results: Impetigo accounts for approximately 10% of skin complaints in the pediatric population and the main pathogens involved include Staphylococcus aureus and Streptococcus pyogenes. There are two common variants of impetigo: non-blistering (70%) and blistering (30%)Streptococcus pyogenes (group A streptococcus) is one of the most important bacterial causes of skin and soft tissue infections (STBI) worldwide. Impetigo is a non-life-threatening infection, but can lead to acute post-streptococcal glomerulonephritis. Conclusions: Impetigo is a common disease in early life, especially in warm and humid climates. The infection can be blistering or non-blistering and is usually caused by Staphylococcus aureus and Streptococcus pyogenes. The infection usually affects the face, but can occur anywhere else on the body with a laceration, abrasion, insect bite, or other trauma. History and physical examination are paramount for diagnosis, which is usually based on symptoms and clinical manifestations alone. Treatment strategies for impetigo differ, depending on whether the condition is localized or generalized, as well as resistance patterns to the causative agents and current guidelines. Topical antibiotics alone or in combination with systemic antibiotics are most frequently used for treatment. The prognosis is usually good and complications are rare. KEY WORDS: impetigo, S. aureus, blistering, cutaneous, skin.

Anti-factor H antibody-positive C3 glomerulonephritis secondary to poststreptococcal acute glomerulonephritis with diabetic nephropathy

Poststreptococcal acute kidney glomerulonephritis (PSAGN) has been seen in adults in recent years, especially in patients with type 2 diabetes mellitus, and the renal prognosis has not always been good. There have been cases of PSAGN in which complete remission was not achieved and hematuria and proteinuria persisted, leading to end-stage renal disease. Previous reports showed that the patients subjected to PSAGN have an underlying defect in regulating the alternative pathway of complement, and they identified that antibodies to the C3 convertase, C3 nephritic factors (C3NeF), are involved. C3NeF stabilizes C3 convertase, sustains C3 activation, and causes C3 glomerulonephritis (C3GN). On the other hand, factor H is a glycoprotein that suppresses the overactivation of the alternative pathway by decaying the C3 convertase. Anti-factor H (aFH) antibodies interfere with factor H and cause the same activation of the alternative pathway as C3NeF. However, a limited number of reports describe the clinical course of C3GN with aFH antibodies. We encountered a 49-year-old Japanese man with type 2 diabetes mellitus. He was referred to our hospital because of his elevated serum creatinine, proteinuria, hematuria, and developed edema on both legs. He was diagnosed as PSAGN at the first kidney biopsy, and his renal function improved and edema and hematuria disappeared, but proteinuria persisted after 5 months. He was diagnosed as C3GN at the second kidney biopsy. In our case, no C3NeF was detected. However, a high titer of aFH antibodies was detected in stored serum from the initial presentation, providing a unified diagnosis of aFH antibody-positive C3GN secondary to PSAGN. He progressed to end-stage renal disease (ESRD) and hemodialysis was started. The persistence of high levels of aFH autoantibodies may have caused C3GN secondary to PSAGN due to activating the alternative complement pathway, which eventually worsened the nephropathy and led to ESRD.

Autoimmune streptococcal glomerulonephritis: the problem of nephritogenicity of &lt;i&gt;Streptococcus pyogenes&lt;/i&gt;

Acute post-streptococcal glomerulonephritis usually occurs as a complication after a streptococcal infection due to untimely or inadequate antibiotic therapy. The etiology of post-streptococcal glomerulonephritis has been studied rather comprehensively. Today, both clinicians and microbiologists do not deny the dominant role of Streptococcus pyogenes (streptococcus attributed to serological group A, GAS). Usually, emergence of acute post-streptococcal glomerulonephritis (APSGN) is associated with the so-called GAS-related "nephritogenicity" often judged by appearance and accumulation of antibodies to the antigens and extracellular products of streptococcal cells in patient blood. This interpretation is quite loose and most likely evidence about a link to the bacterial strain, rather than its nephritogenicity. Many studies refer and still attribute a leading role of "nephritogenic" factors to various streptococcal antigens and related biologically active products. Streptococcal nephritogenic factors include cross-reacting antigens, streptokinase, cysteine proteinase, endostreptosin a GAS cell membrane protein as well as plasmin-tropic enzyme glyceraldehyde-3-phosphate dehydrogenase. Nephritogenicity of all such streptococcal products is suspected to result from the fact that they are found in renal biopsies like specific patient blood serum antibodies. Regarding a term of nephritogenicity, it has been evidenced that it cannot be attributed to any specific streptococcal cell product. This review attempted to analyze a number of bacterial products as starting factors triggering this process. APSGN can be reproduced experimentally in rabbits by intravenous administration of a heat-killed Streptococcus pyogenes culture. In our experiments, strains of serotypes 1, 4, 12, 15, 22 were used. They produced M-proteins and had the ability to bind human and rabbit immunoglobulin G by interacting with the Fc part of the IgG molecule. In numerous series of experiments, evidence was obtained regarding the initiating role of GAS IgGFc-receptor proteins in developing APSGN. Recent studies confirmed the role of streptococcal IgGFc-binding proteins in the initiation of glomerulonephritis after animals were inoculated with temperature-killed IgGFc-positive GAS. This approach excluded a large group of bacterial extracellular agents from the list of APSGN-initiating candidates. An unconventional view on the pathogenesis of GAS-infection-coupled complications may allow approaching their prevention or new treatment strategies.

Reversible Posterior Encephalopathy Syndrome Secondary to Post-Streptococcal Acute Glomerulonephritis in a Child: About an Unusual Case Report and Review of Literature Oumou Maïga, Marwa El Massi, Moussa Coulibaly, Soumia Mghar, Karima El Fakiri, Nouredine Rada, Ghizlane Draiss, Dounia Basraoui, Mohamed Bouskraoui Published: May 6, 2023 | 7 5 DOI: 10.36347/sasjm.2023.v09i05.007 Pages: 434-426 Downloads Abstract Reversible posterior encephalopathy (PRES) is a

Reversible posterior encephalopathy (PRES) is a clinico-radiological syndrome, which manifests as headaches, confusion, visual disturbances, convulsive seizures and radiological abnormalities of the white substance suggesting oedema of the posterior parieto occipital brain regions. It is a poorly known and very rare disease in children. In a 10-year-old boy with an untreated 15-day history of angina, he presents for headaches, associated with vomiting, or even photophobia-type visual disorders and earache-type otalgia and phonophobia, a disorder of conscience of more than 24 hours without the notion of convulsions and a hematuria in broth dirty. All associated with functional impotent of the lower limbs and meningeal syndrome. Cerebral MRI showed a signal abnormality in cortical subcortical range visible in bilateral parieto-occipital, T2 hypersignal and flair with discrete under cortical restriction of diffusion and not raised after injection. We are bringing a case of reversible posterior encephalopathy secondary to acute glomerulonephritis post-streptococcal associated with a meningeal syndrome that could likely be related to germless bacterial meningitis or meningeal hemorrhage. Early detection and prompt treatment are important measures to reduce morbidity and mortality.

Clinical profile of children with acute post-streptococcal glomerulonephritis.

Acute post-streptococcal glomerulonephritis (APSGN) is common in developing countries with a high hospitalization rate. Most patients have acute nephritic syndrome features, although some occasionally present with unusual clinical features. This study aims to describe and analyze clinical features, complications, and laboratory parameters in children diagnosed with APSGN at presentation, 4 and 12weeks later, in a resource-limited setting. This cross-sectional study was conducted among children < 16years with APSGN between January 2015 and July 2022. Hospital medical records and outpatient cards were reviewed for clinical findings, laboratory parameters, and kidney biopsy results. Descriptive analysis of multiple categorical variables was performed using SPSS version 16.0 and presented as frequencies and percentages. The study included 77 patients. Most (94.8%) were older than five years, and age group 5-12years had highest prevalence (72.7%). Boys were affected more frequently than girls (66.2% vs. 33.8%). Edema (93.5%), hypertension (87%), and gross hematuria (67.5%) were the most frequent presenting symptoms, and pulmonary edema (23.4%) was the most common severe complication. Anti-DNase B and anti-streptolysin O titers were positive in 86.9% and 72.7%, respectively, and 96.1% had C3 hypocomplementemia. Most clinical features resolved in three months. However, at 3months, 6.5% of patients had persistent hypertension, impaired kidney function, and proteinuria alone or in combination. Most patients (84.4%) had an uncomplicated course; 12 underwent kidney biopsy, 9 required corticosteroids, and 1 required kidney replacement therapy. There was no mortality during the study period. Generalized swelling, hypertension, and hematuria were most common presenting features. Persistent hypertension, impaired kidney function, and proteinuria persisted in a small proportion who had a significant clinical course and required kidney biopsy. A higher resolution version of the Graphical abstract is available as Supplementary information.

Improving public health surveillance systems for acute post-streptococcal glomerulonephritis in Far North Queensland, Australia

Improving public health surveillance systems for acute post-streptococcal glomerulonephritis in Far North Queensland, Australia

Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the Top End of Australia.

Despite the declining incidence of acute post-streptococcal glomerulonephritis (APSGN) in Australia, there is still a significant burden of disease amongst Aboriginal and Torres Strait Islander people in the Northern Territory. Childhood APSGN has been highlighted as a predictor of chronic kidney disease in this population. We aimed to describe clinical characteristics and outcomes of hospitalised children with APSGN in the Northern Territory. Single-centre, retrospective cohort study of children (<18 years) with APSGN admitted to a tertiary hospital in the Top End of the Northern Territory between January 2012 and December 2017. Cases were confirmed using the Centre for Disease Control case definition guidelines. Data were extracted from the case notes and electronic medical records. There were 96 cases of APSGN with median age of 7.1 years (interquartile range (IQR) 6.7-11.4). Majority were Aboriginal and Torres Strait Islander (90.6%) and from rural and remote areas (82.3%). Preceding skin infections were identified in 65.5% and sore throat in 27.1%. Severe complications included hypertensive emergencies (37.4%), acute kidney injury (43.8%) and nephrotic-range proteinuria (57.7%). All children improved from their acute illness with supportive medical therapy; however, only 55 out of 96 (57.3%) children were followed up within 12 months of their acute illness. APSGN disproportionately affects Aboriginal and Torres Strait Islander children and highlights the need for continued and improved public health response. There is room for significant improvement in the medium- and long-term follow-up of affected children.

Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis.

Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated inflammatory respsonse in the kidneys caused by nephritogenic strains of group A β-hemolytic streptococcus (GAS). The present study aimed to present a large patient cohort of APSGN patients to determine the factors that can be used for predicting the prognosis and progression to rapidly progressive glomerulonephritis (RPGN). The study included 153 children with APSGN that were seen between January 2010 and January 2022. Inclusion criteria were age 1-18years and follow-up of ≥ 1years. Patients with a diagnosis that could not be clearly proven clinically or via biopsy and with prior clinical or histological evidence of underlying kidney disease or chronic kidney disease (CKD) were excluded from the study. Mean age was 7.36 ± 2.92years, and 30.7% of the group was female. Among the 153 patients, 19 (12.4%) progressed to RPGN. The complement factor 3 and albumin levels were significantly low in the patients who had RPGN (P = 0.019). Inflammatory parameters, such as C-reactive protein (CRP), platelet-to-lymphocyte ratio, CRP/albumin ratio, and the erythrocyte sedimentation rate level at presentation were significantly higher in the patients with RPGN (P < 0.05). Additionally, there was a significant correlation between nephrotic range proteinuria and the course of RPGN (P = 0.024). We suggest the possibility that RPGN can be predicted in APSGN with clinical and laboratory findings. A higher resolution version of the Graphical abstract is available as Supplementary information.

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&lt;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&lt;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