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[Outcome of rapidly progressive glomerulonephritis post-streptococcal disease in children]

Manel Jellouli1, Sondos Maghraoui1, Kamel Abidi1

  • 1Service de pédiatrie, hôpital Charles-Nicolle, 2037 Tunis, Tunisie.

Nephrologie & Therapeutique
|July 25, 2015
PubMed

Insights

Severe post-streptococcal glomerulonephritis in children can lead to kidney failure. Supportive dialysis was the key factor for renal survival in this study of rapidly progressive glomerulonephritis.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Glomerular Diseases

Background:

  • Rapidly progressive glomerulonephritis (RPGN) is a rare, severe form of postinfectious glomerulonephritis.
  • Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritis in children.
  • This study focuses on severe PSGN presenting as RPGN.

Purpose of the Study:

  • To describe the clinical outcomes of children with severe post-streptococcal glomerulonephritis.
  • To identify factors influencing renal survival in pediatric RPGN secondary to streptococcal infection.

Main Methods:

  • A retrospective study of pediatric patients diagnosed with severe PSGN between 1997 and 2009.
  • Analysis of clinical presentation, renal biopsy findings, treatment modalities, and long-term renal function.
  • Included 27 children with a mean age of 8.7 years, all presenting with renal failure.

Main Results:

  • All 27 children presented with renal failure; 6 had nephrotic syndrome.
  • Renal biopsies revealed crescents in 24 cases, indicating severe glomerular damage.
  • While 66.6% received corticosteroids and 22% received corticosteroids with cyclophosphamide, only supportive dialysis (required by 11 patients) significantly improved renal survival (P=0.015).
  • At follow-up, 81.5% achieved normal kidney function, but 3 progressed to end-stage renal disease.

Conclusions:

  • Severe post-streptococcal glomerulonephritis, presenting as RPGN, is uncommon but carries a significant risk of poor renal outcomes.
  • Despite advancements in supportive care, outcomes remain challenging.
  • Supportive dialysis emerged as a critical factor for preserving kidney function in this cohort.
Abstract

Keywords:
Biopsie rénaleChildrenEnfantGlomérulonéphrite aiguëInfection streptococciqueInsuffisance rénalePostinfectious glomerulonephritisRenal biopsyRenal failure

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