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Poststreptococcal glomerulonephritis in children: clinicopathological correlations and long-term prognosis
G Clark1, R H White, E F Glasgow
1Evelina Children's Department, Guy's Hospital, London, UK.
Insights
Long-term follow-up of childhood poststreptococcal glomerulonephritis (PSGN) shows an excellent prognosis. Most children recover fully, with minimal long-term urinary abnormalities or impaired renal function, indicating a favorable outcome for PSGN patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Pathology
Background:
- Poststreptococcal glomerulonephritis (PSGN) is a common kidney disease in children.
- Histological grading of PSGN at diagnosis can inform prognosis.
- Long-term outcomes and recovery patterns in pediatric PSGN require further elucidation.
Purpose of the Study:
- To assess the long-term renal outcomes in children diagnosed with acute poststreptococcal glomerulonephritis (PSGN).
- To correlate initial histological biopsy findings with long-term clinical outcomes.
- To evaluate the prevalence of persistent renal abnormalities after PSGN.
Main Methods:
- Prospective follow-up study of 36 children with biopsy-proven PSGN (1962-1970).
- Initial biopsies classified into four histological grades.
- Long-term follow-up assessments at mean intervals of 9.5 and 19.0 years.
Main Results:
- Initial biopsy grade correlated significantly with heavy proteinuria.
- Two children with grade-4 biopsies died from rapidly progressive glomerulonephritis.
- At long-term follow-up (mean 19 years), no survivors had abnormal plasma creatinine; only one patient was hypertensive.
- Persistent microscopic haematuria or proteinuria was uncommon (20% of subjects).
Conclusions:
- The long-term prognosis for children with poststreptococcal glomerulonephritis is excellent.
- Initial histological severity, particularly grade-4, is associated with poor outcomes.
- Most children achieve complete renal recovery, with minimal long-term sequelae.
Abstract:
Between 1962 and 1970, 36 children with acute biopsy-proven poststreptococcal glomerulonephritis (PSGN) entered a prospective long-term follow-up study. The initial biopsies were scored into four histological grades using criteria based on endocapillary proliferation, leucocyte infiltration, epithelial "hump" and crescent formation; 5 patients had grade-1 (least severe), 14 grade-2, 15 grade-3 and 2 grade-4 biopsies. Two children died from rapidly progressive glomerulonephritis; both had grade-4 biopsies. Early repeat biopsy in 12 patients showed improvement in all but one patient who progressed from grade 2 to type 2 mesangiocapillary glomerulonephritis (MCGN). The initial biopsy grade correlated significantly with heavy proteinuria (chi2 = 9.73, P less than 0.01) but not with hypertension, haematuria or renal functional impairment. Follow-up observations were made after mean periods of 9.5 years (range 5.4-12.4 years; 32 subjects) and 19.0 years (range 14.6-22 years; 30 subjects). None of the survivors had an abnormal plasma creatinine. Only one patient (grade-3 biopsy), a female with a subsequent history of recurrent pyelonephritis, was hypertensive. Isolated microscopic haematuria persisted in 1 grade-2 and 2 grade-3 subjects. One grade-2 subject had proteinuria secondary to MCGN and one grade-3 subject had mild proteinuria and borderline hypertension. Although 20% of subjects had urinary abnormalities, we conclude that the long-term outcome of PSGN in children is excellent.