Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 2022; 11(5): 139-145 [PMID: 36187464 DOI: 10.5527/wjn.v11.i5.139]
Corresponding Author of This Article
Leong Tung Ong, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. leotungong@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Sep 25, 2022; 11(5): 139-145 Published online Sep 25, 2022. doi: 10.5527/wjn.v11.i5.139
Management and outcomes of acute post-streptococcal glomerulonephritis in children
Leong Tung Ong
Leong Tung Ong, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Author contributions: Ong LT designed and performed the search, analyzed the data, wrote the paper, and approved the final manuscript.
Conflict-of-interest statement: The author reports no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leong Tung Ong, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. leotungong@gmail.com
Received: January 14, 2022 Peer-review started: January 14, 2022 First decision: April 13, 2022 Revised: April 24, 2022 Accepted: July 24, 2022 Article in press: July 24, 2022 Published online: September 25, 2022 Processing time: 250 Days and 17.4 Hours
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.
Core Tip: Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in the low- and middle-income countries. The clinical spectrum of APSGN can vary as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. APSGN is generally self-limiting and has a good long-term prognosis. However, a small percentage of patients may have persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. This review discusses the management, prognosis, and outcomes of APSGN.
