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Published on: February 2, 2021
Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis
Rose M Ayoob1, Andrew L Schwaderer1
1Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Post-streptococcal glomerulonephritis (PSGN) is common in children, but this study found a higher rate of severe cases. Some children presented with acute kidney injury and hematological anomalies, mimicking lupus nephritis.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Immunology
Background:
- Post-streptococcal glomerulonephritis (PSGN) is the most frequent cause of acute glomerulonephritis in children.
- Typical PSGN presents with hypertension and gross hematuria, usually in children aged 3-12 years.
- While generally mild, PSGN can rarely lead to severe complications like rapidly progressive glomerulonephritis or hypertensive encephalopathy.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric patients with PSGN.
- To identify the frequency of severe presentations and atypical features of PSGN in a tertiary care setting.
- To explore associations between PSGN and autoimmune markers or hematological abnormalities.
Main Methods:
- Retrospective analysis of 17 pediatric patients diagnosed with PSGN over a 12-month period.
- Inclusion of patients treated at a pediatric tertiary care center.
- Review of clinical data including presenting symptoms, laboratory findings (BUN, GFR, ANA, ANCA), and treatment requirements.
Main Results:
- Ninety-four percent of patients exhibited elevated serum BUN and decreased GFR, indicating acute kidney injury (AKI).
- Fifty-three percent had low serum albumin, and 18% presented with thrombocytopenia.
- Four patients (23.5%) had atypical PSGN with complex presentations including AKI, positive ANA or ANCA, and hematological anomalies, resembling lupus nephritis.
Conclusions:
- PSGN can present with severe nephritis, contrary to its typical mild course.
- A subset of pediatric PSGN cases may exhibit features similar to Systemic Lupus Erythematosus (SLE) nephritis, including AKI, positive ANA, and hematological anomalies.
- Close monitoring and further investigation are warranted for children with atypical PSGN presentations.
Abstract:
The most common acute glomerulonephritis in children is poststreptococcal glomerulonephritis (PSGN) usually occurring between 3 and 12 years old. Hypertension and gross hematuria are common presenting symptoms. Most PSGN patients do not experience complications, but rapidly progressive glomerulonephritis and hypertensive encephalopathy have been reported. This paper reports 17 patients seen in 1 year for PSGN including 4 with atypical PSGN, at a pediatric tertiary care center. Seventeen children (11 males), mean age of 8 years, were analyzed. Ninety-four percent had elevated serum BUN levels and decreased GFR. Four of the hospitalized patients had complex presentations that included AKI along with positive ANA or ANCAs. Three patients required renal replacement therapy and two were thrombocytopenic. PSGN usually does not occur as a severe nephritis. Over the 12-month study period, 17 cases associated with low serum albumin in 53%, acute kidney injury in 94%, and thrombocytopenia in 18% were treated. The presentation of PSGN may be severe and in a small subset have associations similar to SLE nephritis findings including AKI, positive ANA, and hematological anomalies.
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