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Extracapillary proliferative glomerulonephritis in children
Insights
Acute extracapillary proliferative glomerulonephritis prognosis is better following streptococcal infection. Children with post-streptococcal glomerulonephritis showed better outcomes than those without.
Area of Science:
- Pediatric Nephrology
- Glomerulonephritis Research
- Renal Pathology
Background:
- Acute extracapillary proliferative glomerulonephritis (AEG) is a severe kidney disease.
- Understanding AEG's clinical course and renal pathology is crucial for patient outcomes.
- Previous studies have not fully elucidated AEG prognosis based on preceding infections.
Purpose of the Study:
- To report the clinical course and renal pathology of 17 children diagnosed with AEG.
- To compare the prognosis of AEG following streptococcal infection versus AEG without a preceding infection.
- To describe initial histopathologic changes and their progression in serial renal biopsies.
Main Methods:
- Retrospective case series of 17 pediatric patients with AEG.
- Exclusion of patients with systemic diseases causing renal involvement.
- Analysis of clinical data, renal pathology, and follow-up information, including renal biopsies and therapeutic interventions.
Main Results:
- Ten patients had AEG following streptococcal infection: 5 healed completely, 4 died, 1 received a transplant.
- Seven patients had AEG without preceding streptococcal infection: 3 had persistent hypertension, proteinuria, and reduced creatinine clearance, 2 died, 2 received transplants.
- Histopathologic changes and their progression were documented; prognosis appears better for post-streptococcal AEG.
Conclusions:
- AEG following streptococcal infection demonstrates a better prognosis compared to AEG without a preceding streptococcal infection.
- Renal pathology and its progression play a significant role in AEG outcomes.
- Further research into therapeutic agents for AEG is warranted.
Abstract:
The clinical course and renal pathology of 17 children with acute extracapillary proliferative glomerulonephritis is reported. Patients with systemic diseases associated with renal involvement were excluded. The onset followed streptococcal infection in ten; of these, four have died, one has been transplanted, and the remaining five have completely healed. The mean follow-up of the latter five patients was 32 months (range, 18 to 57 months). Of the other seven patients without evidence of precedeing streptococcal infection, two have died, two have been transplanted, and the remaining three all have hypertension, proteinuria, and reduced creatinine clearance. The mean follow-up of the latter three patients was 29 months (range, 14 to 38 months). The initial renal histopathologic changes and their progress in later renal biopsies is described. The role of various therapeutic agents is discussed. The prognosis in acute extracapillary proliferative glomerulonephritis following streptococcal infection appears to be better than in ones without preceding streptococcal infection.