Acute Post-Streptococcal Glomerulonephritis in Children: A Comprehensive Review

Abstract

Background: Acute post-streptococcal glomerulonephritis (APSGN) is an immune-complex (ICs) mediated glomerular disease triggered by group A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes infections. APSGN represents a major cause of acquired kidney injury in children. Methods: This non-systematic review summarizes recent evidence on APSGN. We discuss the epidemiology, pathogenesis, clinical and laboratory findings, histopathology, treatment and prognosis of the disease. Results: The median APSGN incidence in children in developing countries is estimated at 24.3/100,000 per year, compared with 6.2/100,000 per year in developed countries. Nephritis-associated plasmin receptor, identified as glyceraldehyde-3-phosphate dehydrogenase, and the cationic cysteine proteinase streptococcal pyrogenic exotoxin B are thought to be two leading streptococcal antigens involved in the pathogenesis of APSGN, which activate the complement system, mainly via the alternative but also the lectin pathway. This process is critical for the generation of inflammation by the ICs deposited in the glomerulus. The classic phenotype is an acute diffuse proliferative glomerulonephritis leading to features of the nephritic syndrome including hematuria, oliguria, hypertension and edema. The histopathology shows that the glomeruli are diffused affected, mostly presenting enlarged glomerular tuffs due to hypercellularity. Proliferative endothelial and mesangial cells and inflammation are also observed. APSGN frequently has spontaneous recovery. There is no specific therapy, but its morbidity and mortality are drastically reduced by the prevention and/or treatment of complications. Conclusion: Despite recent advances, the pathogenesis of APSGN is not fully understood. There is no specific treatment for APSGN. The prognosis is generally good. However some cases may evolve to chronic kidney disease.

Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen

“…Hypertension is a common accompaniment to APSGN and may contribute to the progression of renal damage. APSGN is characterized histologically by diffuse proliferative glomerulonephritis with hypercellularity, "lumpy-bumpy" immunofluorescence deposits, and subepithelial humps on electron microscopy, indicative of immune complex deposition involving both streptococcal antigens and components of the glomerular basement membrane [26,33].…”

“…The diagnosis of post-streptococcal diseases is based on clinical history and findings compatible with the specific illness associated with the evidence of a preceding group A strep infection, including the isolation of GAS from the throat/skin or the detection of certain streptococcal antibodies (anti-streptolysin O and anti-DNase B). A four-fold increase in titer is considered the proof of antecedent streptococcal infection [27,29,33,[42][43][44].…”

Design of 3D Environment Combining Digital Image Processing Technology and Convolutional Neural Network

“…(1) EMD EMD is defined as the minimum sum of the distances between elements u in the set and all elements in the set S an . Its expression is shown in Formula (14).…”

“…IoU represents the intersection ratio between the 3D voxel shape of the network reconstruction and the shape of the true solid element. Here, the same voxel generation method as literature [14] is adopted. CD and EMD represent the difference between two point clouds.…”

“…The depth map fusion method used in literatures [12,13] is also effective in restoring high-precision dense point clouds in the scene. Literature [14] proposed a 3D model reconstruction method based on point cloud, which achieved better reconstruction accuracy by defining loss functions such as chamfering distance and spatial distance. Literature [15] classifies internal points and external points based on fusion features and proposes a point cloud sampling optimization strategy.…”