Acute Post-streptococcal Glomerulonephritis in Children: A Moroccan Experience

Acute post-streptococcal glomerulonephritis (APSGN) is the most prevalent form of glomerulonephritis in children. It is caused by an immune-mediated glomerular injury, most commonly secondary to Group A β-hemolytic streptococcus. This study aims to describe the characteristics and outcomes of hospitalized children with APSGN.

This was a retrospective descriptive study of 83 pediatric patients (<15 years) admitted to the pediatric nephrology department in the Mohamed VI Hospital in Marrakech with APSGN between January 2019 and December 2023, with a follow-up of one year. Children with acute glomerulonephritis not related to APSGN were excluded.

The mean age was 8.34 ± 3.58, and 69.9% (n = 58) were male. Among the 83 APSGN patients, 17 (20.4%) progressed to rapidly progressive glomerulonephritis (RPGN). The most often given presentations were hematuria (90.3%, n=75), edema (77.1%, n=64), hypertension (66.3%, n=55), and oliguria (12%, n=10). 15.6% (n=13) of the patients had an acute kidney injury (AKI). Nephrotic syndrome was found in 33.7% (n=28) of children, reduced C3 level in 84.3% (n=70), and elevated antistreptolysin O titer (ASOT) in 69.9% (n=58). Kidney biopsy was performed in 50.6% of children (n=42). 38.6% (n=32) of our patients required two anti‑hypertensives such as furosemide and nicardipine. Kidney replacement therapy was required for 6% (n=5) of patients, antibiotics for 36.1% (n=30), methylprednisolone pulses for 56.6% (n=47), and cyclophosphamide pulses for 20.4% (n=16). The outcome was favorable for all children, except for one girl with RPGN who developed a chronic kidney disease.

APSGN is still one of the most frequent causes of glomerulonephritis in Morocco. The main presenting features were hematuria and hypertension. Although the outcome of APSGN is good, sequential follow-up is necessary to detect long-term complications and prevent morbidity and mortality.