Outcome and Clinical Spectrum of Post-streptococcal Glomerulonephritis in Children in Developing Countries
Keywords:Crescentic glomerulonephritis, post streptococcal glomerulo-nephritis chronic kidney diseases proteinuria, rapidly progressive glomerulonephritis, immune-complex disease.
Background: Post streptococcal glomerulonephritis with crescentic glomerulonephritis is an uncommon outcome in children. This study was done to evaluate the clinical spectrum and outcome in children with crescentic glomerulonephritis following acute post-streptococal glomerulonephritis. The diagnosis of underlying renal disease was based on various criteria, including the clinical picture, serology and histopathology. The patients received treatment in the form of intravenous methyl prednisolone, oral steroid treatment, and oral cyclophosphamide .
Objective: to evaluate the clinical spectrum and outcome of the pediatric patients with post-streptococal crescentic glomerulonephritis admitted or referred in Zagazig general hospital in nephrology unit.
Â Study design: The study included ( 20 ) children patients with biopsy proven crescentic golmerulonephritis following APSGN admitted or referred from other hospitals to the nephrology unit in Zagazig general hospital between Marsh 2010 to May 2016 These patients were subjected to detailed clinical and biochemical examinations including urine analysis ,U&E ,serum albumin, ASOT ,anti- DNase-B test, complements ( C3 and C4), ANA, ANCAs ,anti- DNA antibodies; anti-(GBM) antibodies . The diagnosis of underlying renal disease was based on various criteria, including the clinical picture, serology and histopathology by light immunofluorescence and electron microscopy and all patients were taken immunosuppressive treatment.
Results: 20 patients with poststreptococcal crescentic glomerulonephritis (12 males and 8 females). The mean age of patients at the time of presentation was (7.5) years with range of 5 to 12 years. All were having gross hematuria ,progressive rise of serum creatinine, mean creatinine was 571.5 umol/l with range of (413umol/- 822umol/1) ,low complement C3, 16 patients were having hypertension (80%),10 patients (50%) had nephrotic range of proteinuria and remaining were having moderate range. Renal biopsy which revealed more than 50% crescents in all biopsies with mean of 62.5% and ranging between 50-90%. 4 patients had fibrocellular crescents (20%) and 16 had cellular crescents (80%). the mean follow up duration in months was 25 mo ranging between 22-28 months after immunosuppression,16 patients regained their normal kidney functions (80%) with mean creatinine 47 umol/l ranging between (40-68) P-value <0.001**.4 patients (20%) had residual renal impairment, these 4 patients had fibro cellular crescents in renal biopsy. 8 patients regained their normal blood pressure at last follow up (80%) P-value <0.001**.
Conclusion: the overall outcome of 20 patients with post streptococcal crescentic glomerulonephritis was accepted & excellent, 16 patients out of 20 (80%) regained their normal kidney functions. Due to the limited number of our patients , large multi-center study is needed to prove this result.
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