Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVI/273: 115-121

SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Increased frequency of acute poststreptococcal glomerulonephritis in the first half of 2018 – single-center experience

Leszczyńska A1, Skrzypczyk P2, Leszczyńska B2, Kuźma-Mroczkowska E2, Brzewski M3, Pańczyk-Tomaszewska M2.

Medical University of Warsaw: 1Student Scientific Group at the Department of Pediatrics and Nephrology; 2Department of Pediatrics and Nephrology; 3Department of Pediatric Radiology

Acute poststreptococcal glomerulonephritis (APSGN) is a complication of infection with group A beta-hemolytic streptococcus. The disease manifests as microscopic/gross hematuria, arterial hypertension, edema, and acute kidney injury and has most commonly self-limiting course.
The aim of study was the analysis of clinical course of APSGN in period of increased incidence in the first half of 2018.
Material and methods. We analyzed following parameters in children hospitalized due to APSGN in January-June 2018: age, sex, anthropometric parameters, preceding infection, clinical signs, renal function, biochemical and immunological tests (including antristreptolysins (ASO) and complement), urinalysis, renal ultrasonography, and treatment. The incidence of APSGN in years 2007-2018 was analyzed.
Results. We found 11 children (6 boys, 5 girls) aged 5.01±2.44 years. The disease was preceded by pharyngitis in 8, skin infection in 1 with latent period 16.40±5.77 days. Clinical symptoms were: gross hematuria in 8, edema in 6, hypertension in 5, renal function impairment 6, and hyperkalemia in 5; all patients had lowered C3 complement factor; ASO was elevated in all patients except for a boy with skin infection. During hospitalization clinical symptoms resolved in all children; significant elevation in GFR (p=0.018) and C3 (p=0.034), and decrease in proteinuria (p=0.039) were observed. Four patients with abnormal ultrasonographic kidney image were characterized by worse kidney function (p=0.018), higher potassium concentration (p=0.052), higher proteinuria (p=0.073) and erythrocyturia (p=0.015) than remaining children. In follow-up (after 142,00±89,20days) all children had normal renal function and blood pressure, 1 patient had proteinuria, and 4 had erythrocyturia.
Conclusions. In most cases APSGN is characterized by rapid resolution of symptoms and good prognosis, but patients require periodic follow-up visits. Abnormal initial ultrasonographic kidney image may be a marker of worse clinical course of APSGN.

Key words: acute poststreptococcal glomerulonephritis, nephritic syndrome, Streptococcus pyogenes, children

Pol Med J, 2019; XLVI (273); 115–121