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Published on: June 18, 2020
Changing epidemiology of acute post-streptococcal glomerulonephritis in Northeast Florida: a comparative study
Mohammad Ilyas1, Asad Tolaymat
1Pediatric Nephrology, University of Florida/Jacksonville, Jacksonville, FL, USA. mohammad.ilyas@jax.ufl.edu
Insights
Acute post-streptococcal glomerulonephritis (APSGN) incidence and severity have declined in children. Pharyngitis is now the main cause, replacing impetigo, impacting disease patterns.
Area of Science:
- Pediatric Nephrology
- Infectious Disease Epidemiology
- Public Health
Background:
- Acute post-streptococcal glomerulonephritis (APSGN) is a significant post-infectious kidney disease in children.
- Understanding epidemiological shifts in APSGN is crucial for public health and clinical management.
- Previous studies highlighted impetigo as a primary driver of APSGN in pediatric populations.
Purpose of the Study:
- To review and compare the epidemiological patterns of pediatric APSGN over several decades.
- To analyze changes in incidence, clinical presentation, and outcomes of APSGN.
- To identify shifts in the predominant antecedent infection and its impact on APSGN characteristics.
Main Methods:
- Retrospective review of medical records for pediatric APSGN patients admitted between 1999-2006 (recent cohort).
- Comparison of the recent cohort with a previously reported cohort admitted between 1957-1973 (earlier cohort).
- Analysis of incidence, demographics, antecedent infections, seasonality, clinical presentation, and outcomes.
Main Results:
- Incidence decreased from 10.9 to 6.4 patients per year; median age increased from 4.25 to 7 years.
- Recent cohort predominantly White-American (62%) with antecedent pharyngitis (64%); earlier cohort predominantly African American (87%) with antecedent pyoderma (66%).
- Milder symptoms and full recovery observed in the recent cohort, contrasting with 1.3% mortality in the earlier cohort; seasonal variation shifted from summer/fall to a broader distribution.
Conclusions:
- A significant decline in APSGN incidence and severity has occurred in pediatric populations over recent decades.
- Pharyngitis has emerged as the primary antecedent infection, replacing pyoderma as the leading cause of APSGN.
- Changes in etiological agents for infections have influenced APSGN's incidence, racial distribution, seasonality, and severity.
Abstract:
The objective of this study was to review the epidemiological patterns of acute post-streptococcal glomerulonephritis (APSGN) in a pediatric population. We compared incidence, pathogenesis, clinical presentation and outcomes in two APSGN pediatric patient cohorts in northeastern Florida. Retrospective medical records were reviewed of children who were admitted to our institution with a diagnosis of APSGN. Patients admitted between 1999 and 2006 (recent cohort) were compared with a previously reported cohort of patients admitted between 1957 and 1973 (earlier cohort). The recent cohort comprised 45 children with APSGN of whom 87% were male and 13% were female; the median age was 7 years, and there was an average incidence of 6.4 patients per year. The earlier cohort comprised 153 children with APSGN of whom 62% were male and 38% were female; the median age 4.25 years, and there was an average incidence of 10.9 patients per year. The recent cohort was predominantly White-American (62%) and the earlier cohort predominately African American (87%). In the recent cohort, 64% of patients had antecedent pharyngitis, and in the earlier cohort, 66% of patients had antecedent pyoderma. In the recent cohort, 11% of APSGN cases occurred between August to October, and in the earlier cohort, 50% occurred during these months. In the recent cohort, symptoms of APSGN at presentation were milder and all cases recovered, but in the earlier cohort two deaths (1.3% mortality) were reported. In conclusion, there has been a decline in the incidence and severity of APSGN at our institute in recent decades. Pharyngitis has replaced impetigo as the predominant cause of APSGN. The etiological agent for impetigo has changed over the last decade, which has impacted the incidence, racial distribution, seasonal variation and severity of APSGN.
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