Management and outcomes of acute post-streptococcal glomerulonephritis in children

Abstract

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.

Clinical picture of acute post-streptococcal glomerulonephritis in children at Ruteng hospital

“…Treatment of acute PSGN patients includes fluid restriction, antihypertensive administration, diuretics, and renal replacement therapy (hemodialysis), if needed. 3 The use of antibiotics in group A beta hemolytic infections did not show significant results on the incidence of acute PSGN. Giving antibiotics will only prevent the spread of infection, but will not prevent the progression of the disease to acute PSGN.…”

Rare Post Streptococcal Glomerulonephritis presentations include back pain and constipation

“…After receiving full treatment, hypertension may recur in 3 to 6% of PSGN patients. [7,8] Children with PSGN involvement may exhibit abnormal neurological symptoms like generalized seizures because of severe hypertension, which affects about 30 to 35 percent of children with PSGN. [4,9] Additionally, hypertension can result from PRES, a term for hypertensive encephalopathy that was first used in 1996 and PRES causes seizures in patients.…”

Case report: A pediatric case of MPO-ANCA-associated granulomatosis with polyangiitis superimposed on post-streptococcal acute glomerulonephritis

“…In general, PSAGN patients had a good prognosis in the absence of immunosuppressive therapy. Crescent formation is not rare in PSAGN and are a predictor of poor long-term prognosis ( 19 ). In New Zealand children, 41% (11 of 27) of patients with crescentic PSAGN had higher serum creatinine levels, requiring acute dialysis ( 20 ).…”

“…In New Zealand children, 41% (11 of 27) of patients with crescentic PSAGN had higher serum creatinine levels, requiring acute dialysis ( 20 ). In addition, PSAGN can be associated with many other diseases, such as atypical hemolytic uremic syndrome (aHUS) ( 21 ), arthritis ( 19 ), IgAN ( 22 ), membranous nephropathy ( 23 ), and Alport syndrome ( 22 ). The co-occurrence of PSAGN and AAV is relatively rare ( 24 , 25 ).…”