Glomerulonephritis In Children Research Articles

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

IntroductionAcute 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).

[Study on biomarkers of acteoside in treating puromycin aminonucleoside nephropathy in young rats based on non-targeted urine metabolomics technology].

This study aims to reveal the endogenous metabolic characteristics of acteoside in the young rat model of purinomycin aminonucleoside nephropathy(PAN) by non-targeted urine metabolomics and decipher the potential mechanism of action. Biochemical indicators in the urine of rats from each group were determined by an automatic biochemical analyzer. The potential biomarkers and related core metabolic pathways were identified by ultra-high performance liquid chromatography coupled with linear ion trap-Orbitrap mass spectrometry(UHPLC-LTQ-Orbitrap MS) combined with principal component analysis(PCA) and orthogonal partial least squares-discriminant analysis(OPLS-DA). MetaboAnalyst 5.0 was used to establish the receiver operating characteristic(ROC) curve for evaluating the clinical diagnostic performance of core metabolites. The results showed that acteoside significantly decreased urinary protein-to-creatinine ratio in PAN young rats. A total of 17 differential metabolites were screened out by non-targeted urine metabolomics in PAN young rats and they were involved in phenylalanine metabolism and phenylalanine, tyrosine and tryptophan biosynthesis. Thirtten differential metabolites were screened by acteoside intervention in PAN young rats, and they were involved in phenylalanine metabolism and arginine and proline metabolism. Among them, leucylproline and acetophenone were the differential metabolites that were significantly recovered after acteoside treatment. These pathways suggest that acteoside treats PAN in young rats by regulating amino acid metabolism. The area under the curve of two core biomarkers, leucylproline and acetophenone, were both greater than 0.9. In summary, acteoside may restore amino acid metabolism by regulating endogenous differential metabolites in PAN young rats, which will help to clarify the mechanism of acteoside in treating chronic glomerulonephritis in children. The characteristic biomarkers screened out have a high diagnostic value for evaluating the treatment of chronic glomerulonephritis in children with acteoside.

Crescentic glomerulonephritis in children: short-term follow-up predicts long-term outcome.

Crescentic glomerulonephritis (CrGN) is a relatively rare but severe condition in childhood with the clinical feature of rapidly progressive glomerulonephritis (RPGN). The aim of this study is to investigate the clinicopathological features and prognosis of CrGN in children. We retrospectively analyzed the clinical and laboratory data, renal pathological results, treatment, and outcome of 147 CrGN in two Chinese pediatric nephrology centers. Among the 147 children, there were 22 cases of type I (15.0%), 69 cases of type II (46.9%), and 56 cases of type III (38.1%). The mean percentages of crescents in CrGN I, II, and III were 85.3%, 68.7%, and 73.6%, respectively. The children with type I CrGN presented with more severe clinical manifestations and pathological lesions. The 3-month cumulative renal survival rates of types I, II, and III CrGN were 66.3%, 93.6%, and 75.6%, respectively. The 1-year cumulative renal survival rates of types I, II, and III CrGN were 56.9%, 85.3%, and 73.1%, respectively, and the 5-year cumulative renal survival rates of types I, II, and III CrGN were 33.8%, 73.5%, and 47.1%, respectively. The Kappa Consistency Test between the 3-month and 1-year total renal survival (82.1% vs. 74.7%) of the children was 0.683 (P < 0.001), and between the 1-year and 5-year total renal-free survival (78.3% vs. 69.1%) of the children was 0.476 (P < 0.001). The Bowman's Capsule Rupture (BCR), crescent, interstitial inflammation, and interstitial fibrosis/tubular atrophy (IF/TA) score were predictors of end-stage kidney disease (ESKD) risk but BCR showed better predictive value for ESKD than interstitial inflammation score (P = 0.027) and IF/TA score (P = 0.047). Patients with type I tended to have the worst renal survival rates. The three-month renal prognosis could partially reflect the 1-year renal prognosis, and the 1-year mortality rate could partially reflect the 5-year mortality rate of children with CrGN.

CLINICAL FUNCTIONAL CHARACTERISTICS OF SICK CHILDREN WITH GLOMERULONEPHRITIS WITH INCREASED THYROID FUNCTION

Abstract: To date, there have been few works on a comprehensive study of the functional state of the thyroid gland in glomerulo- and pyelonephritis in children, but there is no consensus on the nature of these relationships (12,13,14). Purpose of the work: to study the clinical and functional characteristics of sick children with glomerulonephritis with increased thyroid function. Material and methods of research: The work is based on clinical observations, examination and treatment of 22 children with glomerulonephritis with hyperfunction of the thyroid gland aged 5 to 17 years, who were hospitalized in the neurological department. Conclusions: characterizing the features of the clinical course of glomerulonephritis in children with increased activity of the thyroid system, one should first of all note the presence of 2 clinical variants of the disease: acute glomerulonephritis with nephritic syndrome, which was characterized by an acute onset with symptoms of general intoxication, early appearance of renal symptoms, and the presence of mixed polymorphic urinary syndrome , pronounced edema, a variety of extrarenal changes.

Risk factors associated with short- and long-term kidney injury in children with post infectious glomerulonephritis.

Post infectious glomerulonephritis (PIGN) is the most common form of acute glomerulonephritis in children. The objective of this study was to evaluate the risk factors for kidney injury in children with PIGN referred to a tertiary care center. This was a retrospective cohort study. The primary outcome was acute kidney injury (AKI) at initial presentation; secondary outcome was composite kidney injury, defined as reduced estimated glomerular filtration rate (eGFR), proteinuria, or hypertension at last follow-up. Binary logistic regression defined risk factors associated with the primary and secondary outcomes. We identified 125 PIGN cases with a mean age of 8.3±3.5years at presentation and 252 ± 501days of follow-up. Sixty-six percent (79/119) presented with AKI and 57% (71/125) were admitted to hospital. Shorter time to seeing a nephrologist (OR 6.7, 95%CI 1.8-24.6), nadir C3 < 0.12g/L (OR 10.2, 95%CI 1.9-53.7), starting an antihypertensive medication (OR 7.6, 95%CI 1.8-31.3), and nephrotic range proteinuria (OR 3.8, 95%CI 1.2-12.4) were independent risk factors for AKI when adjusted for each other. At last follow-up 35% (44/125) of the cohort had the composite outcome, with older age at presentation (OR 1.2, 95%CI 1.04-1.4) and nadir C3 < 0.17g/L (OR 2.6, 95%CI 1.04-6.7) being independent risk factors when adjusted for AKI. PIGN is an important cause of AKI in children and adolescents. The severity of initial illness is associated with the extent of kidney injury in both the short- and longer-term. Findings will help identify cases requiring lengthier surveillance. 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

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&gt;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.

CLINICAL APPEARANCE AND TREATMENT TACTICS OF HERPESVIRUS ASSOCIATED NEPROPATHIES IN CHILDREN

To date, among the etiological causes of chronic glomerulonephritis in children, the percentage of streptococcal infection has decreased, and at the same time, there are many records of nephropathies of viral etiology. 68 children were examined. Of these, 32 (47%) were children with chronic glomerulonephritis and 36 (53%) with nephrotic syndrome. All sick children underwent clinical, biochemical studies, as well as ELISA and PCR for the diagnosis of herpes infection.Conducted immunoserological studies in the group of children with chronic glomerulonephritis showed the detection of mono-CMV infection in 6.3%, HSV 1/2 +CMV infection in 6.3%, HSV 1/2 +CMV+HHV type 8 in 37.5% of children. In the group of patients with nephrotic syndrome, 10.1% had HSV 1/2 monoinfection, 8.3% had mono-CMV infection, 41.6% had HSV1/2+CMV, and 8.3% had HSV1/2+CMV+HHV 6 type, in 33.3% of HSV1/2+CMV+HHV type 8 mixed infection.

Gut Microbiota Alterations and Primary Glomerulonephritis in Children: A Review.

The article summarizes the current evidence on the impact of microbiota alterations on immune-mediated primary glomerulonephritis in children. In particular, the focus is on the link between dysbiosis and the onset or recurrence of idiopathic nephrotic syndrome, immunoglobulin A nephropathy, and membranous nephropathy. The aim is to describe possible pathomechanisms, differences in gut microbiota composition between pediatric patients and healthy controls, and possible usage of microbiota manipulations in supportive therapy. On this basis, we attempt to indicate directions for further research in that field.

Management and outcomes of acute post-streptococcal glomerulonephritis in children.

Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in low- and middle-income countries. APSGN commonly occurs following pharyngitis due to the activation of antibodies and complements proteins against streptococcal antigens through the immune-complex-mediated mechanism. APSGN can be presented as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. The management of APSGN is mainly supportive in nature with fluid restriction, anti-hypertensives, diuretics, and renal replacement therapy with dialysis, when necessary, as the disease is self-limiting. Congestive heart failure, pulmonary edema, and severe hypertension-induced encephalopathy might occur during the acute phase of APSGN due to hypervolemia. APSGN generally has a favorable prognosis with only a small percentage of patients with persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. Decreased complement levels, increased C-reactive protein, and hypoalbuminemia are associated with disease severity. Crescent formations on renal biopsy and renal insufficiency on presentation may be the predictors of disease severity and poor outcomes in APSGN in children.

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

ACUTE GLOMERULONEPHRITIS IN CHILDREN: A HOSPITAL-BASED STUDY IN A TERTIARY CARE CENTRE IN NEPAL

Background: Acute glomerulonephritis is a common pediatric kidney disease which places a huge burden in developing countries. This study aimed to evaluate causes, clinical manifestations, laboratory findings and complications of acute glomerulonephritis in children presented to a tertiary care center of Nepal. Methods: This was a retrospective review of records of children admitted with acute glomerulonephritis at Chitwan Medical College from April 2018 to February 2021. Socio-demographic data, clinic-laboratory profile and outcomes were obtained from medical records and descriptive analysis was carried out. Results: Among 48 recruited children with acute glomerulonephritis, 60.4% were male and the mean age was 9.5 ± 3.7 years. Post infectious glomerulonephritis including post streptococcal glomerulonephritis (48%) was the main cause of acute glomerulonephritis. The major clinical features were edema (81.3%), hypertension (72.9%), dyspnea (29.2%) and hematuria (25%). ASO titer was positive in 45.8%. The complications noted were acute kidney injury (6.3%), hypertensive emergency (6.3%) and congestive cardiac failure (2.1%). Conclusions: Most of the patients were above 5 years of age and presented most commonly during autumn and summer season.  The complications of acute glomerulonephritis were acute kidney injury, hypertensive emergency and congestive cardiac failure.

Rapidly progressive glomerulonephritis in children.

Rapidly progressive glomerulonephritis (RPGN), characterized by a rapid development of nephritis with loss of kidney function in days or weeks, is typically associated histologically, with crescents in most glomeruli; and is a challenging problem, particularly in low resource settings. RPGN is a diagnostic and therapeutic emergency requiring prompt evaluation and treatment to prevent poor outcomes. Histopathologically, RPGN consists of four major categories, anti-glomerular basement membrane (GBM) disease, immune complex mediated, pauci-immune disorders and idiopathic /overlap disorders. Clinical manifestations include gross hematuria, proteinuria, oliguria, hypertension and edema. Diagnostic evaluation, including renal function tests, electrolytes, urinalysis/microscopy and serology including (anti GBM antibody, antineutrophil cytoplasmic antibody (ANCA)) starts simultaneously with management. An urgent renal biopsy is required to allow specific pathologic diagnosis as well as to assess disease activity and chronicity to guide specific treatment.The current guidelines for management of pediatric RPGN are adopted from adult experience and consist of induction and maintenance therapy. Aggressive combination immunosuppression has markedly improved outcomes, however, nephrotic syndrome, severe acute kidney injury requiring dialysis, presence of fibrous crescents and chronicity are predictors of poor renal survival. RPGN associated post infectious glomerulonephritis (PIGN) usually has good prognosis in children without immunosuppression whereas immune-complex-mediated GN and lupus nephritis (LN) are associated with poor prognosis with development of end stage kidney disease (ESKD) in more than 50% and 30% respectively.Given the need for prompt diagnosis and urgent treatment to avoid devastating outcomes, we conducted a review of the latest evidence in RPGN management to help formulate clinical practice guidance for children in our setting.Information sources and search strategy: The search strategy was performed in the digital databases of PubMed, Cochrane Library, google scholar, from their inception dates to December 2020. Three investigators independently performed a systematic search using the following search terms “Rapidly progressive glomerulonephritis” “children” “crescentic glomerulonephritis” “management” at the same time, backtracking search for references of related literature.

Overview on Acute Poststreptococcal Glomerulonephritis in Pediatrics: A Review

Acute poststreptococcal glomerulonephritis (APSGN) is the most common kind of post-infectious glomerulonephritis and is caused by group A streptococcus (Streptococcus pyogenes). Although the prevalence of PSGN has decreased in affluent nations, non-streptococcal species are becoming more common. and it is still the major cause of glomerulonephritis in children. APSGN can manifest itself in epidemic outbreaks or clusters of instances, as well as in single persons. Epidemic outbreaks have previously been documented as a result of upper respiratory or cutaneous streptococcal infections in various parts of the world. In developed nations, APSGN is now mostly a disease of the elderly, who are more likely to have disabling illnesses such as cancer, alcoholism, or diabetes. Children between the ages of 3 and 12 (with a peak incidence between the ages of 5 and 6 years) and seniors over the age of 60 are the most commonly affected. The pathophysiology of APSGN is complicated by inflammation. (APSGN) often occurs one to two weeks after a throat infection and three to five weeks after a skin infection. Hematuria, edoema, azotemia, and hypertension are the most common clinical signs. Loop or thiazide diuretics, are the most effective therapy for hypertension and edoema in PSGN. In this review we’ll be looking at the disease causes, epidemiology, presentation and treatment.

Гломерулярные поражения почек у детей с ювенильным ревматоидным артритом (обзор литературы)

Обзор литературы посвящен описанию различных форм гломерулонефрита (ГН) у детей с полиартикулярной и системной формами ювенильного ревматоидного артрита (ЮРА). В доступной литературе представлен 21 клинический случай развития ГН, а именно: ANCA-ассоциированный ГН, мезангиопролиферативный ГН, в том числе IgA- и IgМ-нефропатия, мембранозная нефропатия, фокально-сегментарный гломерулосклероз, болезнь минимальных изменений, экстракапиллярный ГН. Механизм гломерулярных поражений при ЮРА объясняется гиперпродукцией провоспалительных цитокинов, а также нефротоксическим действием базисных противовоспалительных лекарственных средств. Подробно проанализированы клинические проявления и эффективность проводимой терапии каждого варианта ГН у детей с ЮРА. Больше всего публикаций посвящено ANCA-ассоциированному ГН, который развился у пациентов с торпидным течением и высокой степенью активности полиартикулярной и системной форм ЮРА. Особенностью ANCA-ассоциированного ГН явилось наличие гиперкреатининемии и практически в половине случаев— развитие терминальной почечной недостаточности, несмотря на проводимую иммунодепрессивную терапию. Единичные случаи других вариантов ГН описаны более 10 лет назад. Клинически отмечались протеинурия и реже— нефротический синдром, что стало основанием для прижизненного морфологического исследования почек. Иммунодепрессивная терапия была эффективной при мезангиопролиферативном ГН и болезни минимальных изменений. Во всех случаях при фокально-сегментарном гломерулосклерозе, экстракапиллярном ГН отмечено формирование терминальной почечной недостаточности. Благоприятный прогноз оказался у детей с мембранозной нефропатией, индуцированной препаратами, после отмены последних. Представлены публикации с положительным терапевтическим эффектом применения генно-инженерных биологических препаратов при ANCA-ассоциированном ГН, IgМ-нефропатии, гормонорезистентном варианте болезни минимальных изменений у детей с ЮРА.

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

Acute glomerulonephritis (GN) is an acute episode of glomerular injury accompanied by inflammation, usually characterizing by edema, hematuria, hypertension, and acute kidney injury.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar In the classification of the clinical renal presentation, acute GN (International Classification of Diseases code: N00-N01.9) (Table S1) generally includes nephritic syndrome and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar The clinical outcome of patients with acute GN depends on the disease severity and the underlying cause. Acute post-infectious glomerulonephritis is the most common form of acute GN, particularly in children. Viral, bacterial, and protozoal organisms can cause infections, with subsequent acute post-infectious glomerulonephritis.2Prasad N. Patel M.R. Infection-induced kidney diseases.Front Med. 2018; 5: 327Crossref Scopus (12) Google Scholar With the aging population growing, acute GN is increasingly common in older patients due to the increased rates of endocarditis, which is associated with the ongoing utility of intravenous drugs and cardiac devices.3Boils C.L. Nasr S.H. Walker P.D. et al.Update on endocarditis-associated glomerulonephritis.Kidney Int. 2015; 87: 1241-1249Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Thus, not only younger children but also older adults are affected by this disease. In addition to acute post-infectious glomerulonephritis, the other forms of acute GN include immunoglobulin A nephropathy and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Immunoglobulin A nephropathy is characterized by a mesangial proliferative GN. Rapidly progressive GN has the potential to destroy renal function within days. These forms of acute GN usually cannot be expected to resolve spontaneously.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Acute GN can result in acute renal failure requiring dialysis and intensive care and results in economic costs to families and the health system. Therefore, we do not turn a blind eye to the disease burden of acute GN. Previous predominantly single-center studies have described the clinical characteristics, complications, and clinical outcome of adults and children with acute GN.4Eison T.M. Ault B.H. Jones D.P. et al.Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis.Pediatr Nephrol. 2011; 26: 165-180Crossref PubMed Scopus (88) Google Scholar,5Dowler J. Wilson A. Acute post-streptococcal glomerulonephritis in Central Australia.Australian J Rural Health. 2020; 28: 74-80Crossref PubMed Scopus (2) Google Scholar However, a large-scale systematic analysis of the global disease burden of acute GN is lacking. The Global Burden of Disease (GBD) Study 2019 provides up-to-date data regarding the epidemiology of acute GN for 195 countries and territories from 1990 to 2019.6Diseases G.B.D. Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 1204-1222Abstract Full Text Full Text PDF PubMed Scopus (541) Google Scholar Using this data source, we analyzed rates in 2019, and temporal trends between 1990 and 2019, for the point prevalence, incidence, disability-adjusted life-years (DALYs), and mortality (Table S2) associated with acute GN at a global, regional, and national level. Globally, there were 48,375 point prevalent cases, 722,244 incident cases, 10,522 deaths, and 307,480 DALYs attributed to acute GN in 2019. The age-standardized rates in 2019 for prevalence per 100,000 population were 0.63 (95% uncertainty interval [UI], 0.52 to 0.76), for incidence was 9.45 (95% UI, 7.72 to 11.55), the mortality rate was 0.13 (95% UI, 0.10 to 0.16), and the DALY rate was 3.90 (95% UI, 2.57 to 4.61) (Table 1). The highest age-standardized rates were in North Korea (1.75; 95% UI, 1.27 to 2.32) for prevalence, in Vietnam (25.44; 95% UI, 19.32 to 32.90) for incidence, in China (0.40; 95% UI, 0.27 to 0.46) for mortality, and in Timor-Leste (21.70; 95% UI, 8.04 to 32.32) for DALYs (rate per 100,000 population in 2019) (Table 1, Figure 1). These rates decreased significantly from 1990 to 2019 per year. Generally, East Asia had the highest decreased trend of age-standardized prevalence and age-standardized incidence rate during 1990 to 2019, respectively. Eastern Europe had the highest decreased trend of age-standardized mortality and age-standardized DALYs over the same period. By contrast, the highest increased trend in age-standardized incidence and age-standardized prevalence rate was in South Asia. At the same time, North Africa and Middle East, High-income North America, and Central Latin America had the highest increased trends of age-standardized mortality and age-standardized DALYs from 1990 to 2019 (Table 1, Figure S1). The national age-standardized rates and trends of prevalence, incidence, mortality, and DALYs across the 195 countries and territories were seen in Table S3. Here, we found the highest disease burden in Asian countries, particularly in Brunei, Uzbekistan, Vietnam, and North Korea with the highest prevalence and incidence, and in China, Laos, Afghanistan, North Korea, and Cambodia with the highest mortality and DALYs.Table 1Numbers, age-standardized rates of prevalence, incidence, mortality, and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in the global and regional levelsVariablesPrevalenceCount (IQR)Age-standardized prevalence (95% UI)Annual percent change in rate (CI)aPercent change in rate refer to average annual percent changes between 1990 and 2019.Prevalence Global level48,375 (39,386, 58,295)0.63 (0.52 to 0.76)-1.92 (-2.14, -1.69) Male25,791 (21,044, 31,044)0.67 (0.55 to 0.8)-2.02 (-2.26, -1.78) Female22,583 (18,339, 27,267)0.60 (0.48 to 0.72)-1.81 (-2.02, -1.6) Regional levelLow SDI6196 (4870, 7745)0.55 (0.45 to 0.67)0.54 (0.43, 0.66)Low-middle SDI13,997 (11,377, 16,925)0.78 (0.64 to 0.93)-0.1 (-0.18, -0.02)Middle SDI15,894 (12903,19163)0.69 (0.56 to 0.83)-2.75 (-3.12, -2.37)High-middle SDI8427 (6902, 10,229)0.62 (0.5 to 0.75)-3.28 (-3.66, -2.9)High SDI3832 (3121, 4605)0.41 (0.32 to 0.5)-0.74 (-0.8, -0.68) Andean Latin America202 (154, 259)0.32 (0.24 to 0.41)0.24 (0.11, 0.37) Australasia93 (69, 120)0.35 (0.25 to 0.47)-0.02 (-0.07, 0.04) Caribbean279 (207, 363)0.6 (0.44 to 0.78)0.18 (0.15, 0.2) Central Asia1377 (1078, 1753)1.45 (1.14 to 1.84)-0.46 (-0.64, -0.28) Central Europe936 (753, 1150)0.94 (0.74 to 1.18)-0.18 (-0.28, -0.08) Central Latin America1166(904,1468)0.48 (0.37 to 0.6)-0.24 (-0.4, -0.07) Central sub-Saharan Africa590 (425, 776)0.49 (0.37 to 0.63)-0.04 (-0.1, 0.02) East Asia6805 (5516, 8513)0.53 (0.42 to 0.66)-5.34 (-6.1, -4.58) Eastern Europe2876 (2412, 3448)1.3 (1.09 to 1.55)-1.62 (-1.86, -1.38) Eastern sub-Saharan Africa2144 (1641, 2738)0.54 (0.43 to 0.67)-0.11 (-0.16, -0.05) High-income Asia Pacific1939 (1558, 2345)1.41 (1.08 to 1.80)0.27 (0.21, 0.33) High-income North America526 (457, 600)0.12 (0.10 to 0.14)-0.32 (-0.49, -0.14) North Africa and Middle East2683 (2092, 3415)0.46 (0.36 to 0.58)0.96 (0.91, 1.01) Oceania128 (91, 174)0.91 (0.67 to 1.19)0.21 (0.17, 0.25) South Asia14,564 (11,840, 17,670)0.78 (0.64 to 0.94)1.75 (1.44, 2.07) Southeast Asia6790 (5344, 8557)1.05 (0.83 to 1.34)-0.85 (-0.95, -0.74) Southern Latin America131 (97, 174)0.19 (0.14 to 0.26)0.01 (-0.13, 0.16) Southern sub-Saharan Africa398 (321, 489)0.5 (0.41 to 0.61)0.09 (0.04, 0.14) Tropical Latin America2889 (2385, 3516)1.43 (1.17 to 1.78)-1.14 (-1.32, -0.97) Western Europe682 (535, 853)0.17 (0.13 to 0.22)0.01 (-0.07, 0.1) Western sub-Saharan Africa1176 (886, 1497)0.26 (0.2 to 0.32)0.26 (0.19, 0.32)Incidence Global level722,244 (595,182, 877,834)9.45 (7.72 to 11.55)-1.84 (-2.05, -1.62) Male384,881 (317,618, 466,573)10 (8.23 to 12.16)-1.94 (-2.17,-1.71) Female337,363 (277,087, 410,579)8.91 (7.23 to 10.9)-1.72 (-1.93 ,-1.52) Regional levelLow SDI90,785 (71,609, 113,621)8.13 (6.57 to 9.93)0.53 (0.39, 0.68)Low-middle SDI209,162 (171,704, 254,192)11.71 (9.67 to 14.18)-0.04 (-0.12, 0.05)Middle SDI229,525 (188,587, 279,710)9.96 (8.15 to 12.2)-2.49 (-2.81, -2.17)High-middle SDI124,479 (102,778, 150,652)9.13 (7.41 to 11.24)-3.23 (-3.61, -2.86)High SDI56,795 (47,068, 68,265)6.00 (4.78 to 7.51)-0.75 (-0.81, -0.68) Andean Latin America3034 (2312, 3921)4.79 (3.65 to 6.18)0.25 (0.12, 0.38) Australasia1368 (1037, 1770)5.15 (3.79 to 6.85)-0.03 (-0.09, 0.03) Caribbean4196 (3119, 5510)9.01 (6.67 to 11.88)0.16 (0.14, 0.19) Central Asia20,600 (16,148, 26,447)21.67 (16.95 to 27.73)-0.39 (-0.55, -0.23) Central Europe13,940 (11,329, 17,197)13.98 (11.1 to 17.69)-0.18 (-0.27, -0.08) Central Latin America17,472 (13,693, 22,068)7.17 (5.63 to 9.05)-0.27 (-0.43, -0.11) Central sub-Saharan Africa8854 (6432, 11,696)7.46 (5.69 to 9.59)0 (-0.06, 0.05) East Asia97,614 (79,539, 119,180)7.65 (6.16 to 9.4)-5.34 (-6.1, -4.57) Eastern Europe43,027 (36,442, 51,278)19.53 (16.55 to 23.27)-1.5 (-1.73, -1.27) Eastern sub-Saharan Africa32,783 (25,239, 41,795)8.31 (6.66 to 10.38)-0.12 (-0.17, -0.06) High-income Asia Pacific28,660 (23,389, 34,876)20.76 (16.04 to 26.93)0.26 (0.2, 0.32) High-income North America7723 (6781, 8749)1.76 (1.56 to 2)-0.36 (-0.53, -0.2) North Africa and Middle East39,991 (31,202, 51,879)6.88 (5.4 to 8.72)0.92 (0.87, 0.96) Oceania1938 (1400, 2654)13.73 (10.09 to 18.28)0.2 (0.16, 0.24) South Asia220,143 (180,802, 265,753)11.86 (9.88 to 14.25)1.72 (1.4, 2.04) Southeast Asia101,025 (79,100, 129,176)15.73 (12.31 to 20.21)-0.82 (-0.92, -0.72) Southern Latin America1969 (1479, 2559)2.87 (2.15 to 3.79)0 (-0.15, 0.15) Southern sub-Saharan Africa6005 (4851, 7402)7.56 (6.2 to 9.27)0.1 (0.05, 0.15) Tropical Latin America43,849 (36,483, 52,981)21.8 (17.88 to 26.71)-1.11 (-1.28, -0.93) Western Europe10,091 (8034, 12,503)2.55 (1.99 to 3.28)0 (-0.09, 0.08) Western sub-Saharan Africa17,961 (13,753, 22,763)3.93 (3.11 to 4.9)0.23 (0.17, 0.29)Mortality Global level10,522 (7199, 12,200)0.13 (0.09 to 0.15)-2.89 (-3.15, -2.63) Male5670 (2969, 6847)0.16 (0.08 to 0.19)-2.67 (-2.96, -2.38) Female4853 (3784, 5980)0.11 (0.09 to 0.14)-3.17 (-3.4, -2.94) Regional levelLow SDI548 (153, 1053)0.08 (0.02 to 0.18)-2.1 (-2.19, -2.02)Low-middle SDI1971 (1010, 2297)0.15 (0.08 to 0.18)-2.86 (-3.01, -2.7)Middle SDI5502 (3660, 6453)0.24 (0.17 to 0.29)-2.86 (-3.18, -2.55)High-middle SDI1945 (1539, 2256)0.1 (0.08 to 0.12)-4.07 (-4.37, -3.77)High SDI554 (476, 606)0.03 (0.02 to 0.03)-0.02 (-1.15, 1.1) Andean Latin America8 (6, 11)0.02 (0.01 to 0.02)-5.41 (-6.06, -4.75) Australasia7 (6, 9)0.01 (0.01 to 0.02)-0.65 (-3.21, 1.91) Caribbean17 (10, 27)0.04 (0.02 to 0.06)-1.42 (-1.99, -0.85) Central Asia110 (93, 134)0.12 (0.1 to 0.15)-3.79 (-4.55, -3.03) Central Europe41 (35, 47)0.02 (0.02 to 0.02)-5.18 (-6.2, -4.16) Central Latin America281 (242, 320)0.12 (0.11 to 0.14)3.2 (0.57, 5.84) Central sub-Saharan Africa110 (30, 221)0.18 (0.04,0.41)-1.33 (-1.62, -1.05) East Asia7175 (4789, 8407)0.39 (0.27 to 0.45)-3.24 (-3.5, -2.97) Eastern Europe156 (132, 182)0.05 (0.05 to 0.06)-7.86 (-8.72, -7) Eastern sub-Saharan Africa317 (76, 761)0.15 (0.03 to 0.41)-2.74 (-2.83, -2.65) High-income Asia Pacific151 (119, 172)0.03 (0.02 to 0.03)-1.52 (-1.75, -1.29) High-income North America269(236,297)0.04 (0.04 to 0.04)2.99 (0.25, 5.73) North Africa and Middle East424 (58, 528)0.1 (0.02 to 0.12)3.17 (2.66, 3.69) Oceania4 (1, 8)0.04 (0.01 to 0.08)0.04 (-0.18, 0.25) South Asia171 (124, 226)0.01 (0.01 to 0.02)-3.9 (-4.06, -3.74) Southeast Asia1060 (311, 1464)0.19 (0.06 to 0.26)-3.17 (-3.28, -3.05) Southern Latin America3 (2, 3)0.003 (0.0029 to 0.004)-3.56 (-4.75, -2.38) Southern sub-Saharan Africa35 (30, 41)0.06 (0.05 to 0.06)-0.69 (-0.98, -0.39) Tropical Latin America58 (53, 63)0.03 (0.02 to 0.03)-6.15 (-6.71, -5.59) Western Europe92 (80, 101)0.0087 (0.008 to 0.009)-1.18 (-3, 0.65) Western sub-Saharan Africa34 (12, 63)0.01 (0 to 0.02)-1.94 (-2.13, -1.75)DALYs Global level307,480 (204,185, 362,573)3.90 (2.57 to 4.61)-3.89 (-4.08, -3.7) Male168,933 (84,118, 207,613)4.39 (2.18 to 5.36)-3.59 (-3.81, -3.36) Female138,547 (94,777, 178,442)3.46 (2.29 to 4.5)-4.24 (-4.38, -4.09) Regional levelLow SDI27,352 (8248, 47,095)2.67 (0.77 to 5.1)-2.7 (-2.77, -2.63)Low-middle SDI62,601 (31,604, 74,473)4.05 (2.05 to 4.79)-3.96 (-4.09, -3.83)Middle SDI158,186 (102,853, 185,699)6.61 (4.28 to 7.72)-3.77 (-4.05, -3.49)High-middle SDI50,545 (41,348, 58,939)2.86 (2.32 to 3.33)-5.02 (-5.29, -4.75)High SDI8668 (7820, 9364)0.52 (0.48 to 0.56)-0.78 (-1.77, 0.21) Andean Latin America241 (162, 333)0.4 (0.28 to 0.56)-7.11 (-7.79, -6.44) Australasia123 (101, 148)0.28 (0.23 to 0.33)-1.06 (-3.2, 1.09) Caribbean782 (423, 1369)1.73 (0.92 to 3.08)-1.58 (-2.04, -1.11) Central Asia4728 (3952, 5765)4.99 (4.20 to 6.04)-3.82 (-4.57, -3.07) Central Europe1012 (871, 1163)0.65 (0.56 to 0.75)-5.72 (-6.68, -4.76) Central Latin America6802 (5875, 7754)2.84 (2.45 to 3.23)2.1 (-0.38, 4.58) Central sub-Saharan Africa5067 (1465, 10,186)4.98 (1.38 to 10.05)-2.17 (-2.48, -1.86) East Asia183,639 (125,297, 217,608)10.17 (7.02 to 11.93)-4.18 (-4.41, -3.95) Eastern Europe5495 (4680, 6414)2.14 (1.83 to 2.5)-7.96 (-8.81, -7.11) Eastern sub-Saharan Africa15,382 (4016, 31,248)4.49 (1.09 to 10.97)-3.55 (-3.65, -3.45) High-income Asia Pacific2029 (1723, 2241)0.51 (0.45 to 0.56)-1.48 (-1.71, -1.26) High-income North America4107 (3772, 4440)0.71 (0.66 to 0.76)2.65 (0.02, 5.27) North Africa and Middle East16,079 (2321, 20,747)2.97 (0.44 to 3.79)2.74 (2.25, 3.24) Oceania190 (44, 428)1.51 (0.36 to 3.22)0.17 (-0.08, 0.43) South Asia6692 (4863, 8314)0.41 (0.3 to 0.51)-3.94 (-4.04, -3.84) Southeast Asia47,484 (11,297, 64,070)7.66 (1.88 to 10.42)-3.7 (-3.85, -3.56) Southern Latin America73 (62, 87)0.10 (0.09 to 0.13)-3.65 (-4.52, -2.78) Southern sub-Saharan Africa1510 (1279, 1824)2.01 (1.72 to 2.41)-1.63 (-1.95, -1.31) Tropical Latin America2410 (2181, 2656)1.19 (1.06 to 1.33)-6.9 (-7.35, -6.44) Western Europe1311 (1182, 1418)0.17 (0.15 to 0.18)-1.67 (-3.2, -0.15) Western sub-Saharan Africa2323 (695, 4595)0.41 (0.15 to 0.76)-2.06 (-2.27, -1.84)CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval.a Percent change in rate refer to average annual percent changes between 1990 and 2019. Open table in a new tab CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval. Notably, acute GN most often results from a soft tissue infection such as beta-hemolytic streptococci pharyngitis in children, namely acute post-streptococcal GN.7Balasubramanian R. Marks S.D. Post-infectious glomerulonephritis.Paediatr Int Child Health. 2017; 37: 240-247Crossref PubMed Scopus (15) Google Scholar Consistent with the previous studies, we found that the highest rate of prevalence and incidence occurred in children. As shown in Figure S2, the initial increased peak in the age-standardized prevalence and incidence was, respectively, in the 10 to 14 age group, followed by a decline in younger adults, and accompanied by a small wave with some fluctuations in the older population. Acute GN can also occur in adults. Most previous studies about acute GN were limited to children with acute post-streptococcal GN. Therefore, studies involving adults are needed. Different forms of acute GN occur in elderly people, especially those who are immunocompromised with health conditions such as diabetes. For example, protozoal and viral infections in the skin occur more frequently than streptococcal pharyngeal infections as a cause of acute GN in elderly patients.8Hamouda M. Mrabet I. Dhia N.B. et al.Acute post-infectious glomerulonephritis in adults: a single center report.Saudi J Didney Dis Transpl. 2014; 25: 567-571Crossref PubMed Scopus (5) Google Scholar Also, immunoglobulin A nephropathy and membranoproliferative GN can result in acute GN8Hamouda M. Mrabet I. Dhia N.B. et al.Acute post-infectious glomerulonephritis in adults: a single center report.Saudi J Didney Dis Transpl. 2014; 25: 567-571Crossref PubMed Scopus (5) Google Scholar; membranous GN is the underlying cause of acute GN in the elderly due to a variety of malignancies including carcinoma of the lung, stomach, breast, and colon. Rapidly progressive GN can result in acute kidney injury requiring dialysis, and become a major contributor to morbidity and disability within the growing aging population. In this study, we found that the age-standardized rates of mortality and DALYs increased with age, and peaked in the 80- to 85-year-old age groups in 2019 (Figure S2). These rates were slightly higher in males than in females, although no statistically significant differences were observed. Distributions of these rates were similar to those of case numbers of prevalence, incidence, mortality, and DALYs in 2019 (Figure S3). Thus, policymakers should take the elderly population into account when deciding on approaches to reducing the disease burden of acute GN in the future. In this study, no association was found between age-standardized incidence, age-standardized prevalence rates or sociodemographic index (SDI) in 2019 regionally and nationally (Figure S4 and S5). However, a negative association between SDI and age-standardized mortality as well as DALYs was observed. Similar results were also seen in expected age-standardized rates based on their own SDI values in 21 regions (Figure S6–S9). Notably, East Asia and Southeast Asia had a higher observed burden than expected to mortality and disability from 1990 to 2019 (Figure S8 and S9). Likewise, countries and territories such as China, Myanmar, Timor-Leste, Cambodia, Laos, and North Korea had much higher observed age-standardized mortality and DALYs than expected in 2019 (Figure S10 and S11). These results indicated that the burden of acute GN may be generally higher at lower socioeconomic levels of development possible due to the higher frequency of acute post-infectious glomerulonephritis. The underlying reason may be explained by the hygiene hypothesis, namely, early and frequent exposure to bacterial antigens is more common in developing countries than in industrialized nations, which had fewer infections due to better public hygiene.9Hurtado A. Johnson R.J. Hygiene hypothesis and prevalence of glomerulonephritis.Kidney Int Suppl. 2005; : S62-S67Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Thus, increasing population awareness about these relations is warranted to reduce the future burden of acute GN, particularly in the Asia region. In conclusion, the prevalence, incidence, mortality, and disability related to acute GN have decreased globally. But a high disease burden remains in children and elderly people, particularly in some Asian regions. Increasing awareness about acute GN in these populations is warranted to reduce the future burden of acute GN. This work is supported by Zhejiang Provincial Natural Science Foundation of China (LY19H080009). The funders had no role in study design, data collection, data analysis, interpretation, writing of this report. The authors thank the GBD collaborator and the IHME leaders who provided the methodologies and datasets in GBD studies; and Yansmin Elhajmoussa at City of Hope/Biomedical Research Center (BRC) at Gehr Leukemia Center for polishing the language of the article. QG and SW contributed equally. The GBD study 2019, conducted by Institute of Health Metrics and Evaluation (IHME), provides the available datasets. IHME uses de-identified and aggregated data, so informed consent is not applicable to the GBD study. This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee. Download .pdf (2.29 MB) Help with pdf files Supplementary File (PDF) Table S1. International Classification of Diseases code (N00-N01.9) as reference to diagnosis acute GN in this study. Table S2. Definitions of measure metrics in GDB 2019. Table S3.Numbers, age-standardized rates of prevalence, incidence, mortality and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in GBD study in the national levels. Figure S1. Annual percentage changes of prevalence, incidence, mortality, and disability-adjusted life years for 21 regions in 2019. APCpre, APCinc, APCmort, and APCdaly represent annual percent changes of prevalence, incidence, mortality, and disability-adjusted life years, respectively. Figure S2. Age-standardized point prevalence (A), incidence (B), mortality (C) and disability-adjusted life years (D) for acute glomerulonephritis per 100,000 population by sex and age in 2019. Red and green lines represent females and males, respectively. Figure S3. Global number of prevalent cases (A), incident cases (B), mortality cases (C), and DALYs cases (D) by sex and age in 2019. Figure S4. Correlation relationship among sociodemographic index (SDI) and age-standardized rates of prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) in 21 regions in 2019. Figure S5. Correlation relationship among sociodemographic index (SDI) and age-standardized rates of prevalence (Pre), incidence (Inc), mortality (Mort), and disability-adjusted life years (DALYs) in 195 countries in 2019. Figure S6. The estimated relation between SDI and expected age-standardized prevalence from 1900 to 2019 in 21 regions. Figure S7. The estimated relation between SDI and expected age-standardized incidence (ASIR) from 1900 to 2019 in 21 regions. Figure S8. The estimated relation between SDI and expected age-standardized mortality (ASMR) from 1900 to 2019 in 21 regions. Figure S9. The estimated relation between SDI and expected age-standardized disability-adjusted life years (DALYs) from 1900 to 2019 in 21 regions. Figure S10. Age-standardized DALYs rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic index in 2019. Figure S11. Age-standardized mortality rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic index in 2019. Gray ribbon represents expected disease rates based on sociodemographic index in all countries. Points are plotted for the observed age-standardized mortality rate in each country.

The role of cell signaling molecules in the pathogenesis of glomerulonephritis in children

Background: Cytokines are functional class of tiny proteins and glycoprotein and fundamentally they are monomers that function as soluble mediators in an autocrine or paracrine manner. Cytokines are produced by a number of cell types, predominantly leukocytes, and their targets implicate both immune and non-immune cells. Material and methods: This study was performed on 75 children with glomerulonephritis (GN), aged from 2 up to 17 years. There were 20 children with steroid-sensitive nephrotic syndrome (SSNS), 15 children with steroid-resistant nephrotic syndrome (SRNS), 20 children with chronic glomerulonephritis (CGN) nephrotic form and 20 children with CGN mixed form. This study was performed on patients experiencing disease relapse and clinical remission. The control group consisted of 20 healthy children. Results: The results of this study demonstrated increased levels of cell signaling molecules (IL-8, TNF-α, MCP-1, MIP-1α) in the urine during clinical manifestations, valuable result due to their major role in the immunopathogenic mechanism of proteinuria in nephrotic syndrome. Conclusions: Determination of urinary concentrations of cellular signaling molecules may be useful as a predictive non-invasive method for estimating disease activity, monitoring disease progression, differentiating steroid-sensitive nephrotic syndrome from steroid-resistant nephrotic syndrome, and assessing the effectiveness of treatment in children with different variants of GN

Renal Lesions of Juvenile Idiopathic Arthritis in Children: A Literature Review

The literature review presents current data on the frequency, mechanisms of development, clinical manifestations, diagnosis and treatment of renal AA-amyloidosis and describes different forms of glomerulonephritis (GN) in children with juvenile idiopathic arthritis (JIA). The frequency of AA renal amyloidosis in JIA in children ranges from 0.8% to 2%, in adults with JIA duration of 28.3 years - 8.9%. In recent years, against the background of immunobiological therapy, the incidence of AA-amyloidosis of the kidneys in adults has decreased to 2%. AA-amyloidosis of the kidneys most often develops in children with the systemic form, in adults - with systemic and polyarticular forms of JIA. The first symptom of AA-amyloidosis of the kidneys is isolated proteinuria, which transforms into nephrotic syndrome. The peculiarity of the nephrotic syndrome is the absence of hypercholesterolemia in most cases, combined in some patients with arterial hypertension, hematuria, and impaired renal function. The available literature presents clinical cases of renal GN in children with JIA, viz: ANCA-associated GN, mesangioproliferative GN, including IgA- and IgM-nephropathy, membranous nephropathy, focal-segmental glomerulosclerosis, minimal change disease, extracapillary GN. Most publications are devoted to ANCA-associated HN, which developed in patients with a torpid course and a high degree of activity of polyarticular and systemic forms of JIA. The peculiarity of ANCA-associated HN was the presence of hypercreatininemia and, in almost half of cases, the development of terminal renal failure, despite the ongoing immunosuppressive therapy. The main method confirming the diagnosis of AA-amyloidosis and renal HN is the intravital renal morphological study. The use of immunobiological drugs in renal AA-amyloidosis and HN in children with JIA has therapeutic efficacy.