Öz

Objective: This study aimed to evaluate the impact of clinical and laboratory findings at presentation on renal function and their predictive value for long-term complications in children diagnosed with acute post-streptococcal glomerulonephritis (APSGN).

Materials and Methods: Retrospective data of 37 APSGN patients aged 2–18 years, who were followed at the Konya City Hospital Pediatric Nephrology Clinic between January 2023 and January 2026, were analyzed. Clinical symptoms, laboratory parameters, ultrasonography findings, and treatment details were recorded.

Results: Macroscopic hematuria was present in 73% of the patients and edema in 27%; approximately 70% of cases presented during the autumn and winter seasons. Patients who developed acute kidney injury (AKI) had significantly higher levels of C-reactive protein (CRP), anti-streptolysin O (ASO) and uric acid (p=0.004, p=0.025 and p=0.035, respectively). Increased renal parenchymal echogenicity on urinary system ultrasonography was observed in all patients with AKI (p=0.012). Hemoglobin levels were significantly lower in patients with nephrotic-range proteinuria (p=0.015). A total of 70.3% of the patients required hospitalization with a mean length of stay of 7.5±3.0 days. During follow-up renal function returned to normal in all patients and proteinuria regressed to normal levels in the majority of patients.

Conclusion: Elevated inflammatory markers (CRP, ASO), high uric acid levels and increased renal parenchymal echogenicity are valuable early indicators of AKI in APSGN. Careful assessment of these non-invasive parameters at presentation is crucial for the early identification of high-risk patients and for guiding the management of potential complications.

Kaynakça

  1. Abugrain K, McCulloch MI, Muloiwa R, Luyckx VA, Buys H. A 6 year review of acute post streptococcal glomerulonephritis at a public children’s hospital in Cape Town, South Africa. Pediatr Nephrol. 2024;39:1809-16. https://doi.org/10.1007/s00467-023-06247-8
  2. Rodriguez-Iturbe B, Haas M. Post-Streptococcus pyogenes glomerulonephritis. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: basic biology to clinical manifestations [Internet]. 2nd edition. Oklahoma City, OK: University of Oklahoma Health Sciences Center. 2022.
  3. Pinheiro SVB, de Freitas VB, de Castro GV, et al. Acute post-streptococcal glomerulonephritis in children: a comprehensive review. Curr Med Chem. 2022;29(34):5543-59.https://doi.org/10.2174/0929867329666220613103316
  4. Satoskar AA, Parikh SV, Nadasdy T. Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. Nat Rev Nephrol. 2020;16(1):32-50. https://doi.org/10.1038/s41581-019-0178-8
  5. Rawla P, Ludhwani D, Padala S. Poststreptococcal glomerulonephritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 (updated 2022 Oct 9).
  6. Dhakal AK, Shrestha D, Singh SK, Acharya S. Clinical profile of children with acute post-streptococcal glomerulonephritis. Pediatr Nephrol. 2023;38:3327-36. https://doi.org/10.1007/s00467-023-05982-2
  7. Roy RR, Laila K. Acute post-streptococcal glomerulonephritis in children-a review. Bangladesh J Child Health. 2014;38:32-9.https://doi.org/10.3329/bjch.v38i1.20025
  8. Dagan R, Cleper R, Davidovits M, Sinai-Trieman L, Krause I. Post-infectious glomerulonephritis in pediatric patients over two decades: severity-associated features. Isr Med Assoc J. 2016;18(6):336-40.
  9. Leong TO. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol. 2022;11(5):139-45. https://doi.org/10.5527/wjn.v11.i5.139
  10. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S);S1-S276.
  11. Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20(3):629-37. https://doi.org/10.1681/ASN.2008030287
  12. Starr MC, Charlton JR, Guillet R, et al; Neonatal Kidney Collaborative Board. Advan-ces in neonatal acute kidney injury. Pediatrics. 2021;148(5):e2021051220. https://doi.org/10.1542/peds.2021-051220
  13. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Subcommittee on screenıng and management of high blood pressure in children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. https://doi.org/10.1542/peds.2017-3035
  14. Alhamoud MA, Salloot IZ, Mohiuddin SS, et al. A comprehensive review study on glomerulonephritis associated with poststreptococcal infection. Cureus. 2021;13:e20212. https://doi.org/10.7759/cureus.20212
  15. Tizki S, Nassih H, Elqadiry R, Abourrahouat A, Lahlou L, Aitsab I. Acute post-streptococcal glomerulonephritis in children: a moroccan experience. Cureus. 2025;17(10): e94683. https://doi.org/10.7759/cureus.94683
  16. Wan Yusof WA, Yaacob NM, Nasir A, Yusoff S, Ilias MI. Clinical predictors of acute kidney injury in children with acute post streptococcal glomerulonephritis: a tertiary centre experience. Singapore Med J. 2025;66:54-7. https://doi.org/10.4103/singaporemedj.SMJ-2021-092
  17. Korsten P, Baier E, Hakroush S, Tampe B. C-reactive protein levels are associated with complement C4 deposits and interstitial arteritis in ANCA-associated renal vasculitis. Int. J Mol Sci. 2023;24:3072. https://doi.org/10.3390/ijms24043072
  18. Li J, Chen J, Lan HY, Tang Y. Role of c-reactive protein in kidney diseases. Kidney Dis. 2023;9(2):73-81. https://doi.org/10.1159/000528693
  19. Aziz T, Chowdhury N, Hakim A, Pramanik SH, Hossain S, Islam S. Sonographically determined renal size and echogenicity as a predictor of chronic irreversible renal parenchymal disease in glomerulonephritis patients: comparison with histopathology. Arch Intern Med Res. 2024;7:230-40. https://doi.org/10.26502/aimr.0180
  20. Shrestha M, Chimoriya R, Dhungel A, Koirala S, Bhatta R, Basnet B. Acute post-infectious glomerulonephritis in children admitted to a tertiary care hospital: a descriptive cross-sectional study. J Nepal Med Assoc. 2024;62(272):264-8. https://doi.org/10.31729/jnma.8554
  21. Chong HYC, Hung TY, Hohls A, Francis JR, Chaturvedi S. Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the Top End of Australia. J Paediatr Child Health. 2023;59:735-42. https://doi.org/10.1111/jpc.16386
  22. Dhakal AK, Shrestha D, Preston R, Lennon R. Acute post-streptococcal glomerulonephritis in children-treatment standard. Nephrol Dial Transplant. 2025;40:1843-53. https://doi.org/10.1093/ndt/gfaf130
  23. Atasever Yıldırım G, Taner S. Evaluation of post-infectious glomerulonephritis: single center experience. Nam Kem Med J. 2024;12(3):198-202. https://doi.org/10.4274/nkmj.galenos.2024.59455
  24. Demircioğlu Kılıç B, Akbalık Kara M, Büyüçelik M, Balat A. Pediatric post-streptococcal glomerulonephritis: clinical and laboratory data. Pediatr Int. 2018;60(7):645-50. https://doi.org/10.1111/ped.13587
  25. Chauvet S, Berthaud R, Devriese M, et al. Anti-factor B antibodies and acute postinfectious GN in children. J Am Soc Nephrol. 2020;31:829-40. https://doi.org/10.1681/ASN.2019080851
  26. Nnadi N, Hendricks AR, Torrealba J, Drake KA, Gattineni J. C3 glomerulopathy in a patient with a history of post-infectious glomerulonephritis. Pediatr Nephrol. 2024;39(3):745-8. https://doi.org/10.1007/s00467-023-06177-5
  27. Cho MH. Association between serum uric acid and kidney disease with pediatric focus. Child Kidney Dis. 2024;28(3):106-11. https://doi.org/10.3339/ckd.24.016
  28. Mengstie LA, Tesfa T, Addisu S, Shewasinad S. Treatment outcome of post-streptococcal acute glomerulonephritis and its associated factors among children less than 15 years at the referral hospital of East Amhara, Ethiopia. BMC Res Notes. 2024;17:313. https://doi.org/10.1186/s13104-024-06971-w

Nasıl atıf yapılır

1.
Yılmaz İ, Soran M, Leventoğlu E. Clinical course and prognosis of acute post-streptococcal glomerulonephritis in children: A single-center experience. Turk J Pediatr Dis. 2026;Early View:1-7. https://doi.org/10.12956/TJPD.2026.1366