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Predictive factors of progression to chronic glomerulonephritis in pediatric patients with post streptococcal acute
Ida Ayu Laksmi Arnita Utari1, Surya Adhi2, Kristia Hermawan3
1Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Master Program of Clinical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Insights
Massive proteinuria with hypoalbuminemia and macroscopic hematuria are key indicators for predicting chronic kidney disease in children with post-streptococcal acute glomerulonephritis (PSAGN). Early identification aids in managing potential long-term kidney damage.
Area of Science:
- Pediatric Nephrology
- Glomerular Diseases
- Streptococcal Infections
Background:
- Post-streptococcal acute glomerulonephritis (PSAGN) typically resolves, but a small percentage of pediatric patients develop chronic kidney disease.
- Identifying early predictors of chronic glomerulonephritis in PSAGN is crucial for timely intervention and preventing disease progression.
Purpose of the Study:
- To determine the predictive factors for the development of chronic glomerulonephritis in pediatric patients diagnosed with PSAGN.
Main Methods:
- Retrospective cohort study involving 124 pediatric patients (ages 2-18) with PSAGN.
- Data collected included demographics, clinical features, laboratory results, and outcomes.
- Multivariate logistic regression analysis was used to identify predictive factors.
Main Results:
- 52.4% of patients developed chronic glomerulonephritis.
- Massive proteinuria with hypoalbuminemia and macroscopic hematuria were significantly associated with chronic glomerulonephritis in bivariate analysis.
- Multivariate analysis confirmed massive proteinuria with hypoalbuminemia (OR 2.896) and macroscopic hematuria (OR 2.457) as strong predictors.
Conclusions:
- Massive proteinuria with hypoalbuminemia and macroscopic hematuria are significant predictors of chronic glomerulonephritis in pediatric PSAGN patients.
- These findings can guide early intervention strategies to mitigate long-term kidney disease progression.
Background:
Post streptococcal acute glomerulonephritis (PSAGN) patients have favorable prognosis, in which most patients showed full recovery in terms of kidney function. However, there is a slight chance ranging from 3 to 6% that PSAGN patients develop chronic kidney diseasewhich may progress into end-stage kidney disease in later life. It is important to identify the factors that can predict the development of chronic glomerulonephritis following PSAGN. Therefore, early intervention can be performed to halt the progression of chronic kidney disease. This study aimed to determine the predictive factors of chronic glomerulonephritis in pediatric patients with PSAGN.
Methods:
This study was an analytical observational study with retrospective cohort design. The accessible population was children within the age of 2-18 years old who were admitted with PSAGN between January 2015 and December 2020 in Dr. Sardjito General Hospital Yogyakarta. All anonymized patient data were evaluated for demographic variables, clinical features, laboratory profiles and outcome. Multivariate analysis was performed with multivariate logistic regression method.
Results:
A total of 124 patients with PSAGN were obtained from medical record data. There were 65 patients (52.4%) with chronic glomerulonephritis. Bivariate analysis was performed on assumed predictive factors with the results indicating massive proteinuria with hypoalbuminemia (OR 1.670, 95%CI 1.199-2.326; p = 0.003), oliguria (OR 1.517, 95%CI 1.101-2.089; p = 0.028) and macroscopic hematuria (OR 1.647, 95%CI:1.061-2.555; p = 0.013) were significantly higher in the PSAGN group with chronic glomerulonephritis compared to those without. Results of the multivariate logistic regression analysis showed massive proteinuria with hypoalbuminemia (OR 2.896, 95%CI 1.177-7.123, p = 0.021) and macroscopic hematuria (OR 2.457, 95%CI ,1.018-5.933, p = 0.046) would highly predict chronic glomerulonephritis in subjects with PSAGN.
Conclusion:
We concluded that massive proteinuria with hypoalbuminemia and macroscopic hematuria are the predictive factors which highly predict chronic glomerulonephritis in PSAGN.
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