| BackgroundAcute post streptococcal glomerulonephritis(APSGN)is one of the most common causes of acute post-infectious glomerulonephritis in children.It is acknowledged that the incidence of acute post streptococcal glomerulonephritis has decreased over the last few decades in many countries and areas.However,it is still the most common glomerulonephritis in global.Furthermore,the treatment and prognosis of this disease are relatively few in recent years.ObjectiveWe collected the clinical manifestation,lab tests,pathology results,outcome and prognosis data of children with acute post streptococcal glomerulonephritis who were admitted to the department of pediatric nephrology and rheumatism and immunology,Shandong Provincial Hospital affiliated to Shandong University in the last 11 years.We analyzed the general conditions,clinical features,laboratory examinations,treatments and outcomes of acute post streptococcal glomerulonephritis.The outcome of children with acute kidney injury,nephropathy range proteinuria were compared.We summarized the clinical prognosis change characteristics,probes into the children's long-term outcome of children with acute post streptococcal glomerulonephritis and the factors affecting the prognosis,so as to provide valuable for the region's pediatrician clinical data,for clinical early diagnosis,timely take effective measures to improve the prognosis and prognostic evaluation.MethodsA retrospective analysis was performed on 122 children with acute post streptococcal glomerulonephritis who were admitted to Pediatrics of Shandong Provincial Hospital between February 2008 to February,2019.The clinicopathological data of the children were collected through the electronic medical records system,and the data were collated and entered into the EXCEL database.Furthermore,we analyzed the general conditions,clinical features,laboratory examinations,treatments and outcomes of acute post streptococcal glomerulonephritis.According to the level of proteinuria and whether acute kidney injury occurred,the children were divided into nephropathy level proteinuria group and non-nephropathy level proteinuria group,acute kidney injury group and non-acute kidney injury group.The outcome of children with acute kidney injury,nephropathy range proteinuria were compared.Results1.General information:We admitted 122 children with acute post streptococcalglomerulonephritis(male/female 88/34,male:female=2.58:1),no loss of follow-up and missed diagnosis occurred.The age of enrollment was 8.16±2.13 years(3-13 years old).The populations with a high prevalence was school-aged children(n=61,50.0%).The incidence seasons were mostly in autumn and winter(n=69,56.6%).All children with APSGN occurred after streptococcal infection.2.Clinicopathological data and lab tests:Typical behavior in 81 cases,all patients were associated with microscopic hematuria,81 patients presented with gross hematuria,113 cases of children with different levels of proteinuria,35 of them had proteinuria in the range of nephropathy,100 patients presented with different degree of edema,57 of the children were accompanied by hypertension.There were 19 cases with atypical expression,among them 14 children had nephrotic level proteinuria combined with hypoproteinemia,presenting as nephrotic syndrome.There were 22 patients with severe manifestations,including 1 patient with hypertensive encephalopathy,21 patients with acute kidney injury,and none of the patients had severe circulatory congestion.The incidence of gross hematuria and acute kidney injury in children with nephrotic proteinuria was higher than that of non-nephrotic proteinuria group.All cases had high ASO,low complement C3.Liver and kidney function revealed that 23 cases had hypoalbuminemia,21 had elevated blood urea nitrogen,17 had hyperlipidemia.3.Pathology results:9 children underwent renal biopsy,and all the pathological results were consistent with diffuse capillary proliferative glomerulonephritis.including 2 cases with IgA nephropathy and another one case with C3 glomerulonephritis.4.Treatment:122 children were given symptomatic and supportive treatment.Only 8 children were given glucocorticoids,among which 2 patients took shock therapy of methylprednisolone for 3 courses5.Outcome:During the follow-up period of 5-132 months,the symptoms such as edema,macroscopic hematuria,renal function,blood pressure,complement returned to normal,except for persistent of the microscopic hematuria in 4 cases.The proteinuria,renal function and blood pressure of the children returned to normal during the follow-up period.The disappearance time of macroscopic and microscopic hematuria,proteinuria,edema,and the recovery time of blood pressure in the nephrotic proteinuria group were longer than that in the non-nephrotic proteinuria group,the differences between two groups were statistical significantly(P<0.05).The recovery time of edema,blood pressure,proteinuria and gross hematuria in children with AKI was longer than those without AKI,and the difference was significant statistically(P<0.05).Conclusions1.Acute post streptococcal glomerulonephritis tends to occurs in school-age boys,and the onset seasons are mainly in autumn and winter.2.All the children had a history of streptococcal infection at the beginning of the disease,and the clinical manifestations were mainly typical expression,mainly manifested as maicroscopic or microscopic hematuria,proteinuria,accompanied or not accompanied by varying degrees of edema,hypertension and acute kidney injury.The incidence of gross hematuria and acute kidney injury in children with nephrotic proteinuria was higher than that of non-nephrotic proteinuria group.3.Most children had a good prognosis,but a small number of them might had persistent microscopic hematuria.4.The clinical symptoms of them with acute kidney injury,a range of nephropathy proteinuria had a later recovery of clinical symptoms.5.For children with acute post-streptococcal glomerulonephritis with atypical clinical manifestations or laboratory examination,we should be alert to the presence of IgA nephropathy and C3 glomerulonephritis.Further follow-up studies are needed for the long-term prognosis of children with acute post-streptococcal glomerulonephritis. |
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