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[Post-infection glomerulonephritis. Longitudinal study of 450 cases observed over a period of 12 years]
Insights
Acute post-infectious glomerulonephritis in children often resolves with normal kidney function. Renal biopsy findings, particularly proliferative endocapillary glomerulonephritis, predict a good prognosis, while other types indicate poorer outcomes.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Infectious Diseases
Context:
- Acute post-infectious glomerulonephritis (APIGN) is a significant renal disease in children.
- A 12-year follow-up study was conducted on 450 pediatric patients diagnosed with APIGN.
- Disease incidence peaked during 1978-1979, coinciding with a scarlet fever epidemic.
Purpose:
- To present clinical and pathological data of pediatric APIGN cases.
- To correlate histological findings from renal biopsies with long-term clinical outcomes.
- To evaluate the predictive value of renal biopsy in APIGN prognosis.
Summary:
- Histological analysis of 127 renal biopsies revealed proliferative endocapillary glomerulonephritis (PEG) in 79.5%, focal proliferative endo- and extracapillary glomerulonephritis (FPEEG) in 5.5%, diffuse proliferative endo- and extracapillary crescent-forming glomerulonephritis (DPEEG) in 11%, and membranoproliferative glomerulonephritis (MPG) in 3.9%.
- Over 12 years, 91% of patients maintained normal renal function.
- PEG demonstrated a good prognosis, whereas DPEEG and MPG were associated with poor clinical evolution.
Impact:
- Renal biopsy is a valuable tool for predicting the clinical course of pediatric post-infectious glomerulonephritis.
- Understanding histological subtypes aids in managing patient expectations and treatment strategies.
- This study reinforces the link between specific glomerular pathologies and long-term renal health in children.
Abstract:
Clinical and pathological data of 450 children ranging from 1.5 to 16 years of age with acute post-infectious glomerulonephritis observed at the Children's Hospital of Centro Médico de Occidente (IMSS), with a follow-up of 12 years are presented. The outstanding features of this review are the following: a very high incidence of the disease in 1978 and 1979, coinciding with an epidemic of scarlet fever. From 127 patients a renal biopsy was obtained; in 79.5% the histological picture srowed proliferative endocapillary glomerulonephritis (PEG), 5.5% corresponded to focal proliferative endo and extracapillary glomerulonephritis (FPEEG), 11% were diffuse proliferative endo and extracapillary crescent-forming glomerulonephritis (DPEEG) and 3.9% membranoproliferative glomerulonephriteis (MPG). On clinical basis, the evolution of the disease through a 12 years follow-up period has demonstrated normal renal function in 91% of all patients. Correlation of the results of histologic examination with the clinical course of the disease have demonstrated a good prognosis in PEG, whereas DPEEG and MPG have shown a poor evolution. The data here presented confirms the usefulness of the renal biopsy to predict the clinical evolution of post-infectious glomerulonephritis.