Biomarkers of histologic severity in children with severe or atypical acute post-streptococcal glomerulonephritis.
Kidney biopsy
Post streptococcus glomerulonephritis
Severe post
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
20 Dec 2023
20 Dec 2023
Historique:
received:
17
09
2023
accepted:
27
11
2023
revised:
27
10
2023
medline:
20
12
2023
pubmed:
20
12
2023
entrez:
20
12
2023
Statut:
aheadofprint
Résumé
Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute kidney injury (AKI) in children; however, in a small subgroup, the presentation is one of rapidly progressive glomerulonephritis (RPGN) deteriorating kidney function associated with severe oligo-anuria or a mixed nephritic-nephrotic picture. This study reviewed potential clinical and laboratory factors which may assist the treating clinician to identify patients at high risk of severe disease. All kidney biopsies for APSGN performed between 1996 and 2020 were obtained from a departmental biopsy database. Clinical and laboratory data were extracted from the patients' clinical records. Kidney biopsies were reviewed and scored independently by a renal histopathologist. Thirty of 53 (56.6%) patients had stage 3 AKI at initial presentation with a median estimated glomerular filtration rate (eGFR) 27 (IQR 11-41), falling to 20 ml/min/1.73 m Severe APSGN is associated with a pronounced reduction in eGFR. Calculation of eGFR in this small group of patients may assist in identifying which patient should have an urgent kidney biopsy to facilitate a more accurate clinical diagnosis and management plan. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
BACKGROUND
Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute kidney injury (AKI) in children; however, in a small subgroup, the presentation is one of rapidly progressive glomerulonephritis (RPGN) deteriorating kidney function associated with severe oligo-anuria or a mixed nephritic-nephrotic picture. This study reviewed potential clinical and laboratory factors which may assist the treating clinician to identify patients at high risk of severe disease.
METHODS
METHODS
All kidney biopsies for APSGN performed between 1996 and 2020 were obtained from a departmental biopsy database. Clinical and laboratory data were extracted from the patients' clinical records. Kidney biopsies were reviewed and scored independently by a renal histopathologist.
RESULTS
RESULTS
Thirty of 53 (56.6%) patients had stage 3 AKI at initial presentation with a median estimated glomerular filtration rate (eGFR) 27 (IQR 11-41), falling to 20 ml/min/1.73 m
CONCLUSIONS
CONCLUSIONS
Severe APSGN is associated with a pronounced reduction in eGFR. Calculation of eGFR in this small group of patients may assist in identifying which patient should have an urgent kidney biopsy to facilitate a more accurate clinical diagnosis and management plan. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 38117311
doi: 10.1007/s00467-023-06249-6
pii: 10.1007/s00467-023-06249-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.
Références
Kanjanabuch T, Kittikowit W, Eiam-Ong S (2009) An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol 5:259–269
doi: 10.1038/nrneph.2009.44
pubmed: 19384327
Rodriguez-Iturbe B, Musser JM (2008) The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 19:1855–1864
doi: 10.1681/ASN.2008010092
pubmed: 18667731
Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ (2011) Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol 26:165–180
doi: 10.1007/s00467-010-1554-6
pubmed: 20652330
Zaffanello M, Cataldi L, Franchini M, Fanos V (2010) Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children. Med Sci Monit 16:RA79-84
pubmed: 20357732
Ong LT (2022) Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 11:139–145
doi: 10.5527/wjn.v11.i5.139
pubmed: 36187464
pmcid: 9521512
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 hospitalised children in New Zealand: epidemiology, clinical features and complications. J Paediatr Child Health 49:850–855
doi: 10.1111/jpc.12295
pubmed: 23782011
Wong W, Morris MC, Zwi J (2009) Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol 24:1021–1026
doi: 10.1007/s00467-008-1086-5
pubmed: 19096879
Clark G, White RHR, Glasgow EF, Chantler C, Cameron JS, Gill D, Comley LA (1998) Poststreptococcal glomerulonephritis in children: clinicopathological correlations and long term prognosis. Pediatr Nephrol 2:381–388
doi: 10.1007/BF00853424
Markowitz GS, Radhakrishnan J, D’Agati VD (2004) An overlapping etiology of rapidly progressive glomerulonephritis. Am J Kidney Dis 43:388–393
doi: 10.1053/j.ajkd.2003.06.005
pubmed: 14750107
Hogg RJ (1985) A clinico-pathologic study of crescentic glomerulonephritis in 50 children. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int 27:450–458
Pottel H, Hoste L, Martens F (2012) A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol 27:973–979
doi: 10.1007/s00467-011-2081-9
pubmed: 22252520
Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1-138
Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S, Wetzels J, Alhasan K, Banerjee S, Bhimma R, Bonilla-Felix M, Cano F, Christian M, Hahn D, Kang HG, Nakanishi K, Safouh H, Trachtman H, Xu H, Cook W, Vivarelli M, Haffner D (2023) International Pediatric Nephrology Association. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol 38:877–919
doi: 10.1007/s00467-022-05739-3
pubmed: 36269406
Jennette JC (2003) Rapidly progressive crescentic glomerulonephritis. Kidney Int 63:1164–1177
doi: 10.1046/j.1523-1755.2003.00843.x
pubmed: 12631105
GraphPad Instat 3.1 Graphpad software San Diego, CA 92108 USA
Mayer U, Schmitz J, Bräsen JH, Pape L (2020) Crescentic glomerulonephritis in children. Pediatr Nephrol 35(5):829–842
doi: 10.1007/s00467-019-04436-y
pubmed: 32052153
pmcid: 7096391
Moroni G, Ponticelli C (2014) Rapidly progressive crescentic glomerulonephritis: early treatment is a must. Autoimmun Rev 13:723–729
doi: 10.1016/j.autrev.2014.02.007
pubmed: 24657897
Grant AM, Gordon FK, Ferguson EL, Williams SM, Henry TE, Toafa VM, Guthrie BE, Goulding A (2005) Do young New Zealand Pacific Island and European children differ in bone size or bone mineral? Calcif Tissue Int 76:397–403
doi: 10.1007/s00223-004-0156-3
pubmed: 15895283
Roy S 3rd, Murphy WM, Arant BS Jr (1981) Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care. J Pediatr 98:403–410
doi: 10.1016/S0022-3476(81)80703-2
pubmed: 7205449
Piyaphanee N, Ananboontarick C, Supavekin S, Sumboonnanonda A (2017) Renal outcome and risk factors for end-stage renal disease in pediatric rapidly progressive glomerulonephritis. Pediatr Int 59:334–341
doi: 10.1111/ped.13140
pubmed: 27542664
Dagan R, Cleper R, Davidovits M, Sinai-Trieman L, Krause I( 2016) Post-infectious glomerulonephritis in pediatric patients over two decades: severity-associated features. Isr Med Assoc J 18:336–340
Fogo AB, Lusco MA, Najafian B, Alpers CE (2015) AJKD Atlas of renal pathology: postinfectious glomerulonephritis. Am J Kidney Dis 66:e31–e32
doi: 10.1053/j.ajkd.2015.08.005
pubmed: 26408244
Sorger K, Gessler U, Hübner FK, Köhler H, Schulz W, Stühlinger W, Thoenes GH, Thoenes W (1982) Subtypes of acute postinfectious glomerulonephritis. Synopsis of clinical and pathological features. Clin Nephrol 17:114–128
pubmed: 7067173
Lewy JE, Salinas-Madrigal L, Herdson PB, Pirani CL, Metcoff J (1971) Clinico-pathologic correlations in acute poststreptococcal glomerulonephritis. A correlation between renal functions, morphologic damage and clinical course of 46 children with acute poststreptococcal glomerulonephritis. Medicine (Baltimore) 50:453–501
doi: 10.1097/00005792-197111000-00001
pubmed: 4942418
Vogel AM, Lennon DR, van der Werf B, Diack M, Neutze JM, Horsfall M, Emery D, Wong W (2019) Post-streptococcal glomerulonephritis: some reduction in a disease of disparities. J Paediat Child Health 55:652–658
doi: 10.1111/jpc.14263