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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 571-574
Outcome of Iranian children with mild post streptococcal glomerulonephritis


1 Pediatric Nephrology Department, St. Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Pediatrics Department, St. Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
3 Radiology Department, St. Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

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Date of Web Publication26-Apr-2010
 

   Abstract 

We studied the long-term outcome of children with mild acute post streptococcal glomerulonephritis (APSGN) APSGN hospitalized at St Al Zahra hospital, Isfahan, Iran from 1993-1998. The patients were subdivided into two groups according to the duration of follow-up. Group A consisted of 15 patients and group B consisted of 12 patients, followed up for 4 and 8 years, respectively. The male to female ratio was 1.45/1. The mean GFR in group A and B was 127.7 ± 26 mL/min/1.73 m2; and 128.57 ± 7 mL/min/1.73 m2, respectively. There was no statis­tically significant difference between GFRs in two groups. Comparing the mean systolic blood pressure in two groups did not demonstrate a significant difference; 95.33 ± 7.1 mmHg in group A and 102.5 ± 14.06 mmHg in group B. However the mean diastolic blood pressure in group B was significantly higher than group A; 65.4 ± 11.71 mmHg vs 61.33 ± 3.51 mmHg. Our study found that even mild APSGN may lead to some degree of renal impairment, and rising diastolic blood pressure maybe an early clinical sign of renal impairment in APSGN.

How to cite this article:
Gheissari A, Adjodani TS, Hashemi M, Mokhtarian A, Sirous M. Outcome of Iranian children with mild post streptococcal glomerulonephritis. Saudi J Kidney Dis Transpl 2010;21:571-4

How to cite this URL:
Gheissari A, Adjodani TS, Hashemi M, Mokhtarian A, Sirous M. Outcome of Iranian children with mild post streptococcal glomerulonephritis. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Oct 27];21:571-4. Available from: https://www.sjkdt.org/text.asp?2010/21/3/571/62731

   Introduction Top


Acute post streptococcal glomerulonephritis (APSGN) is one of the common clinical com­plications that follows infection with beta he­molytic streptococci. [1] For many years, APSGN was believed to have a good outcome in chil­dren. [2],[3],[4] However, a small percentage of these patients will rapidly progress to renal failure during the acute phase of the disease. [4],[5] APSGN is usually followed by clinical recovery over several days to weeks, and accordingly the risk of rapid progression to renal impairment dec­reases. [5],[8] However, recent studies questioned the favorable long-term outcome of these pa­tients; [3] most of these studies were on patients with different severity of APSGN.

We aim in this study to determine the long­term outcome of the mild form of the APSGN in children and the risk renal dysfunction.


   Materials and Methods Top


We studied 27 children with mild APSGN who were under 15 years at the onset of di­sease. They were subdivided into two groups according to the duration of follow-up. Group A (15 patients; 11 boys) and group B (12 pa­tients; 5 boys) who had been followed up for 4 and 8 years after onset of disease, respectively; the male to female ratio was 1.45/1.

We included in the study all children with a history of mild APSGN, which is a duration of an acute phase of disease less than 7 days with­out anuria or necessity for dialysis during the acute phase in addition to normal blood pre­ssure after resolving the acute phase of disease, absence of glomerular range proteinuria after 4 week, and GFR > 50 mL/min/1.73m2; that re­turns to normal after recovery of acute phase.

We excluded from the analysis the patients with persistently low level of C3 or evidence of other glomerulonephritis.

We followed up blood pressure by the same observer, height and weight by the same scale, serum creatinine by the same lab method, and urine microalbumin on spot fasting urine (by electrophoresis method since the chip electro­phoresis identified higher microalbuminuria con­centrations in urine samples. [7] Urine microal­bumin/creatinine more than 30 was considered as abnormal amount.

To calculate glomerular filtration rate (GFR) we used the Schwartz formula:

GFR (mL/min/1.73 m2) = k* Height (cm)/ serum creatinine (mg/dL), (k = Constant, k = 0.33 in preemie infants. k = 0.45 in term infants to 1 year old, k = 0.55 in children upto 13 years, k = 0.65 in adolescent males and 0.55 in females).


   Statistical Analysis Top


The significance of differences was calcula­ted using the paired t-test for paired data and the unpaired t-test for unpaired data. P value < 0.05 was considered significant.


   Results Top


There was no statistically significant diffe­rence in the mean GFR in group A and B, which was 127.7 ± 26 mL/min/1.73 m 2 and 128.58 ± 7 mL/min/1.73 m 2 , respectively. In addition comparing the mean GFR according to gender did not show a significant difference between both subgroups [Table 1].

The means systolic and diastolic blood pres­sure are depicted in [Table 2]. Diastolic blood pressure was significantly higher in group B compared to group A, P=0.04. Only two pa­tients in group B had urinary microalbumin/ Creatinine more than 30μg/gm. Data analysis did not show a significant difference between the mean urine microalbumin to creatinine ra­tio in both groups.


   Discussion Top


The results of our study did not show a dif­ference in the function of the kidneys in the children with mild APSGN including the GFR and albuminuria. Only the elevated blood pres­sure was significantly more in the group with extended time follow-up.

In contrast to our study, recent studies re­vealed some degrees of renal impairment after long term follow-up. Bladwin et al reported some degrees of urinary abnormalities, hyper­tension, proteinuria and azotemia in up to 60 % of patient with APSGN 2-17 years after onset of disease. [3] Another study by Lewy et al demonstrated renal impairment in patients with more severe forms of disease. [14] Furthermore, in a prospective study by Dodge et al found that up to 11% of patients after 3 years did not achieve complete renal recovery. [13] Finally, a large follow-up study on 472 Australian abo­riginals after two epidemic attacks of APSGN demonstrated that APSGN resulted in hema­turia and microalbuminuria as markers of ch­ronic renal disease. [10]

Comparable to our findings of hypertension associated with PSGN, Pinto et al found that patients who developed microalbuminuria had higher diastolic blood pressure than those who did not. [9],[15] Furthermore, increased incidence of hypertension after 11-12 years following APSGN was described in another study on 71 patients by Garcia et al. [16] The increased dias­tolic blood pressure in comparison with sys­tolic blood pressure suggests the importance of follow-up the children even with mild form of disease by checking blood pressure serially.

In contrast to our findings of no significant incidence of persistent microalbuminuria, as­sociated with PSGN, Pinto et al reported mi­croalbuminuria in 34% of patients. [15] moreover, the Venezuelan study found 11.2 % incidence of proteinuria in patients during 11 years of follow-up [16],[17] and the Italian study that showed microalbuminuria in 46% of patients 3-24 years after the onset of the disease. [8],[18]

However, White et al reported in the study of 427 people with epidemic attack of PSGN no significant difference between the control group and the PSGN group in blood pressure, and GFR. [10] In addition, a Japanese study on 138 children could not demonstrate urinary abnor­malities or significant renal impairment after at least 2 years of follow-up. [4] In our study micro­albuminuria was observed in only two patients after 8 years of follow- up. Owing to the fact that the duration of our study was not long enough and also we selected patients with mild presentation of disease, the incidence of mi­croalbuminuria was low. However, our study was limited by the small number of our pa­tients, the short duration of follow- up, and the mildness of the disease may explain our results.

We conclude that children with mild forms of PSGN require long-term follow-up. More stu­dies may determine the most sensitive clinical and laboratory parameters that may help in the follow-up of these patients

 
   References Top

1.Geetha D. Glomerulonephritis, Post streptoco-ccal. Updated 2006 December [cited 2008 November 30] . Available from: http:// www.emedicine.com/med/topic889.htm .  Back to cited text no. 1      
2.Clark G, White RH. Glasgow EF, et al. Post streptococcal glomerulonephritis in children: Clinicopathological correlations and long term prognosis. Pediatr Nephrol 1988;2:381-8.  Back to cited text no. 2      
3.Herthelius M, Berg U. Renal Function reserve after APSGN. Pediatr Nephrol 1999;13:907--11.  Back to cited text no. 3      
4.Kasahara T, Hukyakawa H, Okubo S, et al. Prognosis of APSGN is excellent in children, when adequately diagnosed. Pediatr Int 2001; 43:364-7.  Back to cited text no. 4      
5.Clepter R, Davidovitz M, Halevi R, Eisenstein B. Renal function reserve after APSGN. Pediatr Nephrol 1997;11:473-6.  Back to cited text no. 5      
6.Cole BR, Salinas-Madrigal L, Acute Prolifera-tive glomerulonephritis and crescentic glome-rulonephritis. In: Barrat TM, Averner ED, Harman WE (Eds) Pediatric Nephrology: Philadelphia, Lippincott Williams and Wilkins, 1999: 669-678.  Back to cited text no. 6      
7.Kasiske BL, Williams F, Keane MM. Laboratory assessment of renal disease. In: Brenner and Rector. The Kidney. W.B. Saunders Company, 2000:1148.  Back to cited text no. 7      
8.Treser G, Ehrenreich T, Ores R, Sagel I, Was-serman E, Lange K. Natural history of appa-rently healed acute post streptoccoal glome-rulonephritis in children. Pediatrics 1969;43: 1005-17.  Back to cited text no. 8      
9.Berrios X. Quesney G, Morales A, Blazquez J, Lagomarsino E, Bisno AL. Acute rheumatic fever and post streptococcal glomerulonephritis in an open population: comparative studies of epidemiology and bacteriology. J Lab Clin Med 1986;108:535-42.  Back to cited text no. 9      
10.White AV, Hoy WE, McCredie DA. Child-hood poststreptococcal glomerulonephritis as a risk factor for chronic renal disease in later life. Med J Aust.2001;174:492-6.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Singhal PC, Malik GH, Narayan G, et al. Prog-nosis of post streptococcal glomerulonephritis: Chandigarah study. Ann Acad Med Singapore 1982;5:36-41.  Back to cited text no. 11      
12.Wilson CB. Antibody reactions with native or planted glomerular antigens producing nephri-togenic immune deposits or selective glome-rular cell injury. In: Wilson CB, Brenner BM, Stein JH, eds. Immunopathology of renal Di-sease. New York: Churchill Livingstone, 1988:1--34.  Back to cited text no. 12      
13.Dodge WF, Spargo BH, Travis LR, et al. Post streptococcal glomerulonephritis. A prospec-tive study in children. N Engl J Med 1990; 286:273-8.  Back to cited text no. 13      
14.Lewy, JF, Salinas-Madrigal L, Herdson, PB, Pirani CL, Metcoff J. Clinico pathologic corre-lations in acute poststreptococcal glomerulo-nephritis: A correlation between renal func-tions, morphologic damage, and clinical course of 46 children with acute poststreptococcal glo-merulonephritis. Medicine (Baltimore) 1971;50: 453.  Back to cited text no. 14      
15.Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM. Follow up of patients with epidemic poststreptococcal glomerulonephritis. Am J Kidney Dis 2001:38(2):249-55.  Back to cited text no. 15      
16.Garcia R, Rubio L, Rodriguez-Iturbe B. Long-term prognosis of epidemic post-streptococcal glomerulonephritis in Maracibo: Follow up studies 11-12 years after the acute episode. Clin Nephrol 1981;15:291-8.  Back to cited text no. 16      
17.Rodriguez-Iturbe B, Garcia R, Rubio L, Cuenca L, Treser G, Lange K. Epidemic Glomerulo-nephritis in Maracaibo. Evidence for progre-ssion to chronicity. Clin Nephrol 1976;5:197--205  Back to cited text no. 17      
18.Buzio C Allegri L, Mutti A, Perazzoli F, Bergamaschi E. Significance of albuminuria in the follow-up of acute post streptococcal glomerulonephritis. Clin Nephrol 1994;41:259--64.  Back to cited text no. 18      

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Correspondence Address:
Alaleh Gheissari
Pediatric Nephrology Department, St. Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan
Iran
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PMID: 20427896

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