Long-Term Prognosis for Endocapillary Glomerulonephritis of Poststreptococcal Type in Children and Adults

Abstract

The long-term clinical course of sporadic, acute endocapillary glomerulonephritis of poststreptococcal type is reported. In all cases, the diagnosis was established by renal biopsies and in most cases by clinical tests. The study is based on retrospective/prospective data from 36 children and 101 adults in the Federal Republic of Germany, Luxemburg, and Austria. In 72 patients (21 children, 51 adults) the disease course was clinically followed over periods of 2–13 years (clinical features: blood pressure, serum creatinine, proteinuria, hematuria). In this group, the number of clinical recoveries (i.e., all features within strictly defined normal ranges) increased with increasing length of observation. Children showed more rapid clinical recovery. 29% of the children and 41% of the adults showed no clinical recovery. Out of all 137 patients, 3 progressed to chronic renal failure, and 4 other patients died. Cases with an initial nephrotic syndrome had a significantly poorer long-term prognosis (p < 0.005). Initial elevation of serum creatinine concentration due to acute renal failure did not influence the long-term prognosis. Our results indicate that the acute endocapillary glomerulonephritis of poststreptococcal type has a slow tendency towards clinical recovery under good hygienic conditions and if unaccompanied by nephrotic syndrome in the initial phase.

The Current State of Poststreptococcal Glomerulonephritis

“…A group of patients with especially poor long-term prognosis are elderly patients who develop persistent proteinuria in the nephrotic range; 77% of these patients develop chronic renal failure. 97 For children, the prognosis of PSGN may be significantly worse in specific communities in which other risk factors for chronic renal failure are common. This is the case in Australian Aboriginal communities, where low birth weight (resulting in the endowment of a low nephron number), diabetes, and metabolic syndrome are prevalent.…”

Proteinuria and Progression in Human Glomerular Diseases

“…Table 1 lists some of the conditions in which either the presence of proteinuria in predominantly haematuric illnesses or its magnitude in proteinuric illnesses has been associated with a poorer prognosis [2][3][4][5][6][7][8][9], Conversely, if proteinuria diminishes and disappears, progression is virtually never seen [10]. Only in lupus nephritis is there controversy whether those patients with a greater amount of protein in their urine at onset [11], and especially when this state persits, may have a poorer prognosis than those with modest proteinuria.…”

A rare adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess

“…In regard to the long-term prognosis of PSAGN, the incidence of ESRD in studies with 15 years of follow-up is less than 1%, with the exception being that long-term prognosis is poor in elderly patients who develop persistent proteinuria in the nephrotic range; 77% of these patients develop chronic renal failure [14,17,20,21]. The present case developed nephrotic syndrome, but fortunately recovered.…”