Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis

Eison, T. Matthew; Ault, Bettina H.; Jones, Deborah; Chesney, Russell W.; Wyatt, Robert

doi:10.1007/s00467-010-1554-6

Cited by 165 publications

(195 citation statements)

References 157 publications

(166 reference statements)

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“…22 The long-term implications of APSGN are less clear with studies reporting mixed outcomes. 23 Although many studies have reported favorable outcomes, some are less reassuring, especially in the Indigenous Australian population. A recent study has found significantly higher rates of albuminuria in Indigenous Australians with previous APSGN compared with controls.…”

Section: Discussionmentioning

confidence: 99%

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

Marshall¹,

Cheng²,

Markey³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Data relating to acute post-streptococcal glomerulonephritis (APSGN) from the notifiable diseases surveillance system in the Northern Territory of Australia was extracted and analyzed. Isolates of Streptococcus pyogenes from confirmed cases were emm sequence typed. From 1991 to July 2008, there were 415 confirmed cases and 23 probable cases of APSGN notified. Four hundred fifteen (94.7%) of these were Indigenous Australians and 428 (97.7%) were people living in remote or very remote locations. The median age of cases was 7 years (range 0–54). The incidence of confirmed cases was 12.5/100,000 person-years, with an incidence in Indigenous Australian children younger than 15 years of age of 94.3 cases/100,000 person-years. The overall rate ratio of confirmed cases in Indigenous Australians to non-Indigenous Australians was 53.6 (95% confidence interval 32.6–94.8). Outbreaks of disease across multiple communities occurred in 1995 (N = 68), 2000 (N = 55), and 2005 (N = 87 [confirmed cases]). Various emm types of S. pyogenes were isolated from cases of APSGN including some types not previously recognized to be nephritogenic. The widespread outbreak in 2005 was caused by emm55.0 S. pyogenes. Acute post-streptococcal glomerulonephritis continues to occur in remote Indigenous communities in Australia at rates comparable to or higher than those estimated in developing countries. Improvements in preventative and outbreak control strategies are needed.

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Section: Discussionmentioning

confidence: 99%

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

Marshall¹,

Cheng²,

Markey³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…Postinfectious GN is a form of GN that develops after an infection; it is especially common in children and in the elderly (1)(2)(3)(4). Often the infection is minor (e.g., pharyngitis) and has usually resolved by the time clinical evidence of an ongoing GN is manifested.…”

Section: Discussion Of Questionmentioning

confidence: 99%

“…Nevertheless, it has been proposed that the initial phase of the process is characterized by deposition of bacterial antigens (e.g., streptococcal) in the glomeruli (planted). This phase is followed by production of antibodies that interact in situ with the planted antigens (2,9). Antigens that enter the circulation after the antibody response is fully underway form immune complexes in circulation.…”

Section: Discussion Of Questionmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2012

Fervenza

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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SummaryPresentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience-that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.Clin J Am Soc Nephrol 8: 1460-1465, 2013. doi: 10.2215/CJN.00440113 GN Case 1A 20-year-old woman was referred for evaluation of persistent hematuria and proteinuria. She had a history of fever and sore throat lasting 1 week that occurred 6 months earlier and were associated with abdominal pain and dark urine. She did not receive any antimicrobial agents. Significant findings on physical examination at that time included a BP of 140/90 mmHg and 2+ edema. Laboratory evaluation showed a serum creatinine value of 1.4 mg/dl, urinalysis with 2+ protein and 3+ blood, and a 24-hour urinary protein excretion of 680 mg. The C3 level was 46 mg/dl (reference range, 75-175 mg/dl) and the C4 level was 23 mg/dl (reference range, 14-40 mg/dl). A throat culture was negative for b-hemolytic streptococci, and an antistreptolysin O titer was 200 IU/ml (upper limit of normal, 200 IU/ml). The serum albumin concentration was 3.6 g/dl.A renal biopsy was performed and showed a pattern of membranoproliferative GN on light microscopy. No crescents were observed. Immunofluorescence microscopy showed bright (3+) mesangial and capillary wall C3 staining. Electron microscopy showed mesangial, intramembranous, and subendothelial deposits, as well as a few subepithelial hump-like deposits. Postinfectious GN and type III membranoproliferative GN were diagnosed. The patient was treated symptomatically, but proteinuria and hematuria persisted. Current evaluation shows a hemoglobin level of 11.8 g/dl, a serum creatinine concentration of 1.3 mg/dl, urinalysis with 3+ blood and 3+ protein, quantitative proteinuria of 2.2 g/24 hours, C3 concentration of 44 mg/dl, and C4 concentration of 22 mg/dl. Question 1 (see Figure 1 for responses of program directors and attendees)To further evaluate this patient, you would now order:A. Antinuclear antibodies B. Hepatitis B and C serology C. Anti-deoxyribonuclease (DNase) antibody titers D. Serum C1q level E. Antibodies to complement-regulating ...

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“…Anemia is common in APSGN and traditionally it has been attributed solely to volume overload (Eison et al, 2011). However, autoimmune hemolytic anemia (AIHA) has recently been reported in patients with APSGN.…”

Section: Autoimmune Hemolytic Anemiamentioning

confidence: 99%

Atypical Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis

Watanabe¹

2011

An Update on Glomerulopathies - Clinical and Treatment Aspects

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Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis

Cited by 165 publications

References 157 publications

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

American Society of Nephrology Quiz and Questionnaire 2012

Atypical Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis

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