Outcome and Clinical Spectrum of Post-streptococcal Glomerulonephritis in Children in Developing Countries
DOI:
https://doi.org/10.24203/ajas.v5i2.4689Keywords:
Crescentic glomerulonephritis, post streptococcal glomerulo-nephritis chronic kidney diseases proteinuria, rapidly progressive glomerulonephritis, immune-complex disease.Abstract
Background: Post streptococcal glomerulonephritis with crescentic glomerulonephritis is an uncommon outcome in children. This study was done to evaluate the clinical spectrum and outcome in children with crescentic glomerulonephritis following acute post-streptococal glomerulonephritis. The diagnosis of underlying renal disease was based on various criteria, including the clinical picture, serology and histopathology. The patients received treatment in the form of intravenous methyl prednisolone, oral steroid treatment, and oral cyclophosphamide .
Objective: to evaluate the clinical spectrum and outcome of the pediatric patients with post-streptococal crescentic glomerulonephritis admitted or referred in Zagazig general hospital in nephrology unit.
 Study design: The study included ( 20 ) children patients with biopsy proven crescentic golmerulonephritis following APSGN admitted or referred from other hospitals to the nephrology unit in Zagazig general hospital between Marsh 2010 to May 2016 These patients were subjected to detailed clinical and biochemical examinations including urine analysis ,U&E ,serum albumin, ASOT ,anti- DNase-B test, complements ( C3 and C4), ANA, ANCAs ,anti- DNA antibodies; anti-(GBM) antibodies . The diagnosis of underlying renal disease was based on various criteria, including the clinical picture, serology and histopathology by light immunofluorescence and electron microscopy and all patients were taken immunosuppressive treatment.
Results: 20 patients with poststreptococcal crescentic glomerulonephritis (12 males and 8 females). The mean age of patients at the time of presentation was (7.5) years with range of 5 to 12 years. All were having gross hematuria ,progressive rise of serum creatinine, mean creatinine was 571.5 umol/l with range of (413umol/- 822umol/1) ,low complement C3, 16 patients were having hypertension (80%),10 patients (50%) had nephrotic range of proteinuria and remaining were having moderate range. Renal biopsy which revealed more than 50% crescents in all biopsies with mean of 62.5% and ranging between 50-90%. 4 patients had fibrocellular crescents (20%) and 16 had cellular crescents (80%). the mean follow up duration in months was 25 mo ranging between 22-28 months after immunosuppression,16 patients regained their normal kidney functions (80%) with mean creatinine 47 umol/l ranging between (40-68) P-value <0.001**.4 patients (20%) had residual renal impairment, these 4 patients had fibro cellular crescents in renal biopsy. 8 patients regained their normal blood pressure at last follow up (80%) P-value <0.001**.
Conclusion: the overall outcome of 20 patients with post streptococcal crescentic glomerulonephritis was accepted & excellent, 16 patients out of 20 (80%) regained their normal kidney functions. Due to the limited number of our patients , large multi-center study is needed to prove this result.
References
- Palmer A, Villips J, Baliga R . Glomerulonephritis associated with acute pneumococcal pneumonia: a case report. Pediatr Nephrol 2005 20(10):1494–1495
Porcella SF, Beres SB, Sesso R, Pinto SWL, Hoe NP, DeLeo FR, Musser JM .Genome sequence of a lancefield group C Streptococcus zooepidermicus strain causing epidemic nephritis: new information about an old disease. PLoS One 2008 21(3):e3026
Steer AC, Danchin MH, Carapetis JR. Group A streptococcal infections in children. J Paediatr Child Health 2007 43(4):203–213
- Rodriguez-Iturbe,B,Musser,JM.The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol; 2008 19:1855
- Morris MC, Wong W, Zwi J. Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. 2009;24(5):1021-
- Sobin LH ,Chaerge . Renal disease:classification and atlas of glomerular disease.
In: World Health Organization (WHO) (ed) Monograph1981,New York, Igaku-Shoin Medical Publishers, Tokyo, pp 3–9
- Southwest Pediatric Nephrology Study Group .A clinico-pathologic study of crescentic glomerulonephritis in 50 children. A report by the Southwest Pediatric Nephrology Study Group. Kidney Int 1985 27:450–458
- Risdon A, Jardim HMPF, Leake J, Barratt TM, Dillon MJ.Crescentic glomerulonephritis in children.Pediatr Nephrol 1992;6:231–235
- Sulyok A . Acute proliferative glomerulonephritis.In Avner, E D.; Harmon, W E.; Niaudet, P,(eds):Pediatric nephrology,5th ed ,Philadelphia,2004 Lippincott Williams & Wilkins:601-13.
- Kohler PF, Ten Bensel R (1969) Serial complement component alterations in acute glomerulonephritis and systemic lupus erythematosus. Clin Exp Immunol 4:191–202PubMedGoogle ScholarW, Eiam-Ong, SAn update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol; 2009 5:259
Lavjay Butani. Prolonged hypocomplementaemia after post-streptococcal glomerulonephritis. Nephrol Dial Transplant 2001 16: 869,
- Pinto, SW, Sesso, R, Vasconcelos, E. Follow-up of patients with epidemic poststreptococcal glomerulonephritis. Am J Kidney Dis; 2001 38:2
- El-Agroudy A.E., El-Husseini A.A., Moustafa F.E.,M.A., Fouda M.A.& Sobh M.A. Impact of clinical and histopathological factors on outcome of Egyptianpatients with crescentic glomerulonephritis.International Urology and Nephrology 2003 35: 543–551.
- Sharma R, Dewan D, Prasad N, JainM, Gupta A and Kumar A. Clinical spectrum and outcome of crescentic glomerulonephritis in children in developing countries. Pediatr Nephrol 2008 23:389–394
- Vasudev AS, Srivastava RN, Moudgil A, Bagga A, Bhuyan UN, Sundraem KR . Crescentic glomerulonephritis in children: a review of 43 cases. Am J Nephrol 1992 12:155–161
- Steele BT ,Miller MN, Baumal R, Poucell S. Incidence and prognostic importance of glomerular crescents in renal disease of childhood. Am J Nephrol 1984 4:244–247
- Murphy WM, Roy S 3rd, Arant BS Jr . Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care. J Pediatr 1981 98:403–41
- Herdson PB, Lewy JE, Salinas-Madrigal L, Pirani CL, Metcoff J . Clinico-pathologic correlations in acute poststreptococcal glomerulonephritis. A correlation between renal functions, morphologic damage and clinical course of 46 children with acute poststreptococcal glomerulonephritis. Medicine (Baltimore) 1971 50:453–501
- Stollerman GH (1971) Rheumatogenic and nephritogenic streptococci. Circulation 43:915–921PubMedGoogle Scholar
- Fuentes F, Morales R , Martinez J , Mompean EO Acute post-estreptoccocal glomerulonephritis in the elderly Nefrologia 2008 28(1):113-114 | Doi
- Hebert T, Raouff A, Pullma J, Coco M . Crescentic post streptococcal glomerulonephritis with nephrotic syndrome in an adult: is aggressive therapy warranted. Clin Nephrol 2005 63:375–380
- Sabry A.A., Sheashaa H.A., Moustafa F.E.,&SobhM.A.Acutepostinfectiouscrescentic glomerulonephritis:Clinicopathologic presentation and risk factors.International Urology and Nephrology 2005 37:603–609
- Kerr PG, Atkins RC, Lan HY.Rapidly progressive glomerulonephritis.In: Schrier RW, Gottschalk CW,eds. Diseases of the Kidney 1997.Boston: Little, Brown,; 1617–1644.
-Dillon HC Jr (1967) Pyoderma and nephritis. Annu Rev Med 18:207–218PubMedGoogle Scholar
- Moore MS, Updyke EL, Conroy E (1955) Provisional new type of group A streptococci associated with nephritis. Science 121:171–172PubMedGoogle Scholar
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