Skip to main content

Advertisement

SpringerLink
Log in

Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated inflammatory respsonse in the kidneys caused by nephritogenic strains of group A β-hemolytic streptococcus (GAS). The present study aimed to present a large patient cohort of APSGN patients to determine the factors that can be used for predicting the prognosis and progression to rapidly progressive glomerulonephritis (RPGN).

Methods

The study included 153 children with APSGN that were seen between January 2010 and January 2022. Inclusion criteria were age 1–18 years and follow-up of ≥ 1 years. Patients with a diagnosis that could not be clearly proven clinically or via biopsy and with prior clinical or histological evidence of underlying kidney disease or chronic kidney disease (CKD) were excluded from the study.

Results

Mean age was 7.36 ± 2.92 years, and 30.7% of the group was female. Among the 153 patients, 19 (12.4%) progressed to RPGN. The complement factor 3 and albumin levels were significantly low in the patients who had RPGN (P = 0.019). Inflammatory parameters, such as C-reactive protein (CRP), platelet-to-lymphocyte ratio, CRP/albumin ratio, and the erythrocyte sedimentation rate level at presentation were significantly higher in the patients with RPGN (P < 0.05). Additionally, there was a significant correlation between nephrotic range proteinuria and the course of RPGN (P = 0.024).

Conclusions

We suggest the possibility that RPGN can be predicted in APSGN with clinical and laboratory findings.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Rodriguez-Iturbe B, Musser JM (2008) The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 19:1855–1864

    Article  PubMed  Google Scholar 

  2. Rawla P, Padala SA, Ludhwani D (2022) Poststreptococcal Glomerulonephritis. In: StatPearls. StatPearls Publishing, Treasure Island, FL. https://www.ncbi.nlm.nih.gov/books/NBK538255/

  3. Chugh KS, Malhotra HS, Sakhuja V, Bhusnurmath S, Singhal PC, Unni VN, Singh N, Pirzada R, Kapoor MM (1987) Progression to end stage kidney disease in post-streptococcal glomerulonephritis. Int J Artif Organs 10:189–194

    Article  CAS  PubMed  Google Scholar 

  4. Moorani KN, Aziz M, Amanullah F (2022) Rapidly progressive glomerulonephritis in children Pak. J Med Sci 38:417–425

    Google Scholar 

  5. Rodriguez-Iturbe B, Najafian B, Silva AE, Alpers C (2016) Acute postinfectious glomerulonephritis in children. In: Avner ED (ed) Pediatric Nephrology, 7th edn. Springer, London, pp 959–969

    Chapter  Google Scholar 

  6. Marcdante KJ, Kleigman RM (2006) Nephrology and urology. In: Robert M (ed) Nelson Essentials of Pediatrics, 5th edn. Elsevier, Philadelphia, pp 751–770

    Google Scholar 

  7. Marshall CS, Cheng AC, Markey PG, Towers RJ, Richardson LJ, Fagan PK, Scott L, Krause VL, Currie BJ (2011) Acute poststreptococcal glomerulonephritis in the Northern Territory of Australia: a review of 16 years data and comparison with the literature. Am J Trop Med Hyg 85:703–710

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ong LT (2022) Management and outcomes of acute post-streptococcal glomerulonephritis in children World. J Nephrol 11:139–145

    Google Scholar 

  9. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904

    Article  Google Scholar 

  10. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady AB, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed  PubMed Central  Google Scholar 

  11. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147

    Article  PubMed  Google Scholar 

  12. Becquet O, Pasche J, Gatti H, Chenel C, Abély M, Morville P, Pietrementet C (2010) Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study. Pediatr Nephrol 25:275–280

    Article  PubMed  Google Scholar 

  13. Coulthard M, Isaacs D (1991) Retropharyngeal abscess. Arch Dis Child 66:1227–1230

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Bingler MA, Ellis D, Moritz ML (2007) Acute post-streptococcal glomerulonephritis in a 14-month-old boy: Why is this uncommon? Pediatr Nephrol 22:448–450

    Article  PubMed  Google Scholar 

  15. Rodriguez-Iturbe B, Mezzano S (2009) Acute postinfectious glomerulonephritis. In: Avner E (ed) Pediatric Nephrology, 6th edn, Springer, Berlin and Heidelberg, pp 744–55

  16. Eison TM, Ault BH, Jones DP, Chesney RW, Wyattet RJ (2011) Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol 26:165–180

    Article  PubMed  Google Scholar 

  17. Wong W, Lennon DR, Crone S, Neutze JM, Reed PW (2013) Prospective population-based study on the burden of disease from post-streptococcal glomerulonephritis of hospitalized children in New Zealand: Epidemiology, clinical features, and complications. J Paediatr Child Health 49:850–855

    Article  PubMed  Google Scholar 

  18. Roy S III, Stapleton FB (1990) Changing perspectives in children hospitalized with poststreptococcal acute glomerulonephritis. Pediatr Nephrol 4:585–588

    Article  PubMed  Google Scholar 

  19. Sanjad S, Tolaymat A, Whitworth J, Levin S (1977) Acute glomerulonephritis in children: A review of 153 cases. South Med J 70:1202–1206

    Article  CAS  PubMed  Google Scholar 

  20. Lewis EJ, Carpenter CB, Schur PH (1971) Serum complement component levels in human glomerulonephritis. Ann Intern Med 75:555–560

    Article  CAS  PubMed  Google Scholar 

  21. Cameron JS, Vick RM, Ogg CS, Seymour WM, Chantler C, Turner DR (1973) Plasma C3 and C4 Concentrations in Management of Glomerulonephritis. Br Med J 3:668–672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Wyatt RJ, Forristal J, West CD, Sugimoto S, Curd JG (1988) Complement profiles in acute post-streptococcal glomerulonephritis. Pediatr Nephrol 2:219–223

    Article  CAS  PubMed  Google Scholar 

  23. Ayoob RM, Schwaderer AL (2016) Acute Kidney Injury and Atypical Features during Pediatric Poststreptococcal Glomerulonephritis. Int J Nephrol 2016:5163065

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hart DH, Scheinkestel C, Whitworth JA, Kincaid-Smith P (1985) Acute post streptococcal glomerulonephritis without proteinuria. J R Soc Med 78:842–843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bircan Z, Tugay S, Usluer H (2005) Poststreptococcal glomerulonephritis with pulmonary edema and microscopic hematuria. Pediatr Nephrol 20:1204

    Article  PubMed  Google Scholar 

  26. Wong W, Morris MC, Zwi J (2009) Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol 24:1021–1026

    Article  PubMed  Google Scholar 

  27. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S (2012) Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 5:2

    Article  PubMed  PubMed Central  Google Scholar 

  28. Makay B, AltugGucenmez O, Duman M, Unsal E (2014) The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch-Schonlein purpura. Rheumatol Int 34:1323–1327

    Article  CAS  PubMed  Google Scholar 

  29. Toraman A, Neşe N, Özyurt BC, Kürşat S (2019) Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritis. Indian J Med Res 150:399

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kılıc BD, Kara MA, Buyukcelik M, Balat A (2018) Pediatric post-streptococcal glomerulonephritis: Clinical and laboratory data. Pediatr Int 60:645–650

    Article  Google Scholar 

  31. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD (2019) The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med 39:345–357

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Fernandes B, Hamaguchi Y (2007) Automated enumeration of immature granulocytes. Am J Clin Pathol 128:454–463

    Article  PubMed  Google Scholar 

  33. Kim S, McClave SA, Martindale RG, Miller KR, Hurt RT (2017) Hypoalbuminemia and clinical outcomes: What is the mechanism behind the relationship? Am Surg 83:1220–1227

    Article  PubMed  Google Scholar 

  34. Stetson CA, Rammelkamp CH, Krause RM, Kohen RJ, Perry WD (1995) Epidemic acute nephritis: studies on etiology, natural history and prevention. Medicine 34:431–450

    Article  Google Scholar 

  35. Lasch EE, Frankel V, Vardy PA, Rabinowitz SB, Ofek I, Rabinowitz K (1971) Epidemic glomerulonephritis in Israel. J Infect Dis 124:141–147

    Article  CAS  PubMed  Google Scholar 

  36. Bateman E, Mansour S, Okafor E, Arrington K, Hong BY, Cervantes J (2022) Examining the Efficacy of Antimicrobial Therapy in Preventing the Development of Postinfectious Glomerulonephritis: A Systematic Review and Meta-Analysis. Infect Dis Rep 14:176–183

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ahn SY, Ingulli E (2008) Acute poststreptococcal glomerulonephritis: an update. Curr Opin Pediatr 20:157–162

    Article  PubMed  Google Scholar 

  38. Kasahara T, Hayakawa H, Okubo S, Okugawa T, Kabuki N, Tomizawa S, Uchiyama M (2001) Prognosis of acute poststreptococcal glomerulonephritis is excellent in children, when adequately diagnosed. Pediatr Int 43:364–367

    Article  CAS  PubMed  Google Scholar 

  39. Sepahi MA, Shajari A, Shakiba M, Shooshtary FK, Salimi MH (2011) Acute Glomerulonephritis: A 7 Year Follow up of Children in Center of Iran. Acta Med Iran 49:375–378

    PubMed  Google Scholar 

  40. Baikunje S, Vankalakunti M, Nikith A, Srivatsa A, Alva S, Kamath J (2016) Post-infectious glomerulonephritis with crescents in adults: a retrospective study. Clin Kidney J 9:222–226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Blyth CC, Robertson PW, Rosenberg AR (2007) Post-streptococcal glomerulonephritis in Sydney: A 16-year retrospective review. J Paediatr Child Health 43:446–450

    Article  PubMed  Google Scholar 

  42. Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5:685–694

    Article  PubMed  Google Scholar 

  43. Kasiske BL, Wheeler DC (2012) Chapter 9: Infection-releated glomerulonephritis. Kidney Int Suppl 2:200–208

    Article  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge Mr. Scott Evans for English language editing.

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey

    Deniz Karakaya, Tülin Güngör, Evrim Kargın Çakıcı, Fatma Yazılıtaş, Evra Çelikkaya & Mehmet Bülbül

  2. Faculty of Engineering, Çanakkale Onsekiz Mart University, Çanakkale, Turkey

    Sait Can Yücebaş

Authors
  1. Deniz Karakaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tülin Güngör
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evrim Kargın Çakıcı
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatma Yazılıtaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evra Çelikkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sait Can Yücebaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Bülbül
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Deniz Karakaya, Evrim Kargın Çakıcı, and Mehmet Bülbül. Analysis and interpretation of data: Deniz Karakaya, Tülin Güngör, Fatma Yazılıtaş, and Sait Can Yücebaş. Drafting of the manuscript: Deniz Karakaya, Tülin Güngör, and Evra Çelikkaya. Critical revision of the manuscript for important intellectual content: Deniz Karakaya and Evrim Kargın Çakıcı.

Corresponding author

Correspondence to Deniz Karakaya.

Ethics declarations

We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. All authors accept the copyright of the journal.

Ethics approval

The study protocol was approved by the Dr. Sami Ulus Training and Research Hospital Ethics Committee.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Conflicts of interest

The authors declare that they have no conflicts of interest to disclose.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Graphical Abstract (PPTX 42 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karakaya, D., Güngör, T., Çakıcı, E.K. et al. Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis. Pediatr Nephrol 38, 3027–3033 (2023). https://doi.org/10.1007/s00467-023-05935-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-023-05935-9

Keywords

Search

Navigation