Prognostic Significance of Nephrotic-Range Proteinuria in Paediatric Acute Glomerulonephritis

Acute glomerulonephritis (AGN) in paediatric patients typically presents with haematuria, oedema, hypertension, oliguria, and a decline in renal function attributable to immune‑mediated glomerular injury. A subset of patients presents with nephrotic-range proteinuria at onset, termed nephritic-nephrotic syndrome, the prognostic implications of which remain underexplored.

A prospective observational study was conducted in the departments of paediatrics and paediatric nephrology at a tertiary care centre in Odisha over two years. Children aged 1-14 years with a clinical diagnosis of AGN were enrolled and evaluated for demographic, clinical, and laboratory parameters. Patients with nephrotic-range proteinuria at presentation were analysed as a distinct subgroup. Clinical course, complications, and outcomes were compared between nephritic-nephrotic and classical nephritic presentations.

Seventy children were included (53 males, 17 females); the majority were aged 5-10 years. Facial puffiness (100%), haematuria (68.6%), and pedal oedema (64.3%) were the most frequent presenting features. A preceding infection was documented in 85.7%, commonly pharyngitis (58.6%) or skin infection (27.1%). Nephrotic-range proteinuria was observed in 15 patients (21%). Complications on admission were more frequent in this subgroup, including hypertensive encephalopathy (60% vs. 9.1%), congestive cardiac failure (60% vs. 16.4%), and acute kidney injury (60%% vs. 21.8%). There were many signs and symptoms overlapping in both hypertensive encephalopathy and congestive cardiac failure in nephrotic-range proteinuria patients. At the three-month follow-up, children with nephrotic-range proteinuria were found to develop persistent hypertension.

Paediatric AGN with nephrotic-range proteinuria represents a high-risk phenotype associated with a more severe clinical course, greater complication rates, and may have adverse long-term renal outcomes. Early recognition and close follow-up of this subgroup are essential for timely intervention and improved prognosis.