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[Anemia associated with acute post streptococcal glomerulonephritis]
1Departamento de Pediatría, Hospital Sótero del Río, Santiago, Chile.
Insights
Post-streptococcal acute glomerulonephritis causes anemia in children, often due to hemodilution and bone marrow depression. Some cases suggest additional pathogenic factors contributing to persistent anemia.
Area of Science:
- Pediatric Nephrology
- Hematology
Context:
- Post-streptococcal acute glomerulonephritis (PSAGN) is a common childhood illness.
- Anemia is frequently observed in children diagnosed with PSAGN.
Purpose:
- To prospectively investigate the causes and recovery patterns of anemia in children with PSAGN.
- To differentiate between hemodilution, bone marrow depression, and other factors contributing to anemia in PSAGN.
Summary:
- Thirty-three children with PSAGN were studied. Most presented with low hematocrit (Hct) and anemia. While hemodilution was common, bone marrow depression (indicated by low reticulocyte index) was evident in some. A subset exhibited severe anemia suggesting additional pathogenic factors beyond hemodilution and marrow suppression.
- Hematocrit levels improved over time, but a significant percentage remained anemic at discharge. Three distinct recovery groups were identified, highlighting varied responses and recovery durations.
Impact:
- This study differentiates anemia causes in PSAGN, identifying hemodilution, bone marrow depression, and potentially other factors.
- Findings aid in understanding anemia pathophysiology in PSAGN, guiding further research into persistent anemia mechanisms and management.
Abstract:
Thirty-three children with post-streptococcal acute glomerulonephritis, age mean: 8.3 years (range: 6 - 12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6% with 90% showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was < 0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentage of transferrin saturation were normal for this age group although 75% of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1% but 44% still had anemia. Hct increased spontaneously for 105 days stabilizing at 38%. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p < 0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group III, suggests other pathogenic factors.