Skip to main content

Advertisement

SpringerLink
Log in

Post-streptococcal acute glomerulonephritis in Chile—20 years of experience

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

Abstract

In order to characterize the epidemiological and clinical picture of post-streptococcal acute glomerulonephritis (PSAGN), a prospective study was designed to investigate all admissions to a general hospital of a local health service in Chile. The protocol included the investigation of previous streptococcal infections (SI), clinical symptoms and signs, socioeconomic situation (SES), throat and skin swabs for the isolation of group A beta-hemolytic streptococci, sequential determination of serum antistreptolysin O (ASO) titer, anti-DNAase B antibodies, and C3. During the 20 years studied, 926 cases were admitted (56% males). Incidence showed an endemic period (EP) 1980–1983, an epidemic outbreak (EO) 1984–1989, and a late period (LP) 1990–1999, with a rate per 100,000 inhabitants of 6.2, 13.2, and 1.7, respectively. The clinical picture was similar in the three periods. SES was homogeneous, with 80% of the population in low and middle-low categories. The average size of the family was 6.9 compared with 4.8 in the general population. Pyoderma was more frequent than pharyngeal infection, and more so during the EO. The isolation rate of group A beta-hemolytic streptococci from the pharynx was 20% compared with 60% from skin swabs. During EP, the most prevalent serotypes were T14-M0 and T1-M1 from the pharynx and TImp19-M0 from the skin. During EO, T14-M0 was more prevalent (30%). M or T classification was possible in EP and EO in 80%–85% of all strains isolated from the two locations. Significant titers for ASO and anti-DNAase B were found on admission: 55% and 75%, respectively. Both tests allowed identification of 100% of previous SI. In conclusion, the incidence of PSAGN had an uneven trend during the observed period. EO was mainly due to skin infection and a predominance of one serotype, T14-MO, was observed. After the EO, the yearly rate gradually decreased from 13.2 in 1988 to 0.0 in 1999, a rate similar to that of industrialized nations.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bright R (1836) Cases and observations, illustration of renal disease accompanied with secretion of albuminous urine. Guys Hosp Rep 1:338–379

    Google Scholar 

  2. Schick B (1907) Die Nachkrankheiten des Scharlachs. Jahrb Kinderheilkd 65 [Suppl]:132–173

    Google Scholar 

  3. Rammelkamp CH, Weaver RS (1953) Acute glomerulonephritis. The significance of the variations in the incidence of the disease. J Clin Invest 32:345–358

    PubMed  Google Scholar 

  4. Stollerman GH (1969) Nephritogenic and rheumatogenic group A streptococci. J Infect Dis 120:258–263

    CAS  PubMed  Google Scholar 

  5. Dillon HC (1967) Pyoderma and nephritis. Ann Rev Med 18:207–218

    Article  PubMed  Google Scholar 

  6. Bisno AL, Pearce IA, Wall HP, Moody MD, Stollerman GM (1970) Contrasting epidemiology of acute rheumatic fever and acute glomerulonephritis: nature of the antecedent streptococcal infection. N Engl J Med 283:561–565

    CAS  PubMed  Google Scholar 

  7. Wannamaker LW (1970) Differences between streptococcal infections of the throat and of the skin. N Engl J Med 202:78–85

    Google Scholar 

  8. Brouhard BH, Travis LB (1992) Acute post infectious glomerulonephritis. In: Edelman CM (ed) Pediatric kidney disease, vol 2. Little Brown, Boston, pp 1199–1221

  9. Soto HM, Parra G, Rodríguez-Iturbe B (1997) Circulating levels of cytokines in post streptococcal glomerulonephritis. Clin Nephrol 47:6-12

    CAS  PubMed  Google Scholar 

  10. Ardiles LG, Valderrama G, Moya P, Mezzano SA (1997) Incidence and studies on antigenic specificities of antineutrophil-cytoplasmic auto antibodies (ANCA) in post-streptococcal glomerulonephritis. Clin Nephrol 47:1–5

    CAS  PubMed  Google Scholar 

  11. Savil J (2001) Apoptosis in post-streptococcal glomerulonephritis. Kidney Int 60:1203–1214

    Article  PubMed  Google Scholar 

  12. Oda T, Yoshizawa N, Takeuchi A, Nakabayashi I, Nishiyama J, Ishida A, Tazawa K, Murayama M, Hotta O, Taguma Y (1997) Glomerular proliferating cell kinetics in acute post streptococcal glomerulonephritis (APSGN). J Pathol 183:359–368

    Article  CAS  PubMed  Google Scholar 

  13. Dillon HC (1972) Streptococcal infection of the skin and its complication impetigo and nephritis. In: Wannamaker LW, Masten P (eds) Streptococci and streptococcal diseases. New York Academy Press, New York, pp 571–575

  14. Instituto Nacional de Estadísticas (1992) XVI Censo Nacional de Población y IV de Vivienda. Ministerio de Economía, Fomento y Reconstrucción

  15. Berríos X, Lagomarsino E, Morales A, Guzmán B, Rodríguez C, Bisno A, Quesney F (1986) Incidencia de glomérulonefritis aguda post estreptocóccica en un Hospital de Santiago, Chile, durante el período 1980–1989. Informe preliminar. Bol Of Sanit Panam 100:684–688

    Google Scholar 

  16. Swift HF, Wilson A, Lancefield RC (1943) Typing group A hemolytic streptococci by M precipitin reactions in capillary pipettes. J Exp Med 78:127–133

    Google Scholar 

  17. Moody MD, Padula J, Lizana D, Hall CT (1965) Epidemiological characterization of group A streptococci by T-agglutination and M-precipitation tests in public health laboratory. Health Lab Sci: 2149–2162

    Google Scholar 

  18. Top FH Jr, Wannamaker LW (1968) The serum opacity reaction of Streptococcus pyogenes: frequency of production of streptococcal lipoproteins by strains of different serological types and the relationship to M protein production. J Hyg 66:49–58

    Google Scholar 

  19. Puentes R (1992) Situación de salud infantil. Winter A, Puentes R, Medicina infantil MCD. Publicaciones, Santiago, Chile, pp 7–16

  20. Morales A, Berríos X, Lagomarsino E, Guzmán B Rodríguez C, Quesney F (1988) Estudio de los contactos familiares de casos de glomérulonefritis aguda post estreptocócica. Rev Chil Pediatr 59:289–294

    CAS  PubMed  Google Scholar 

  21. Ministerio de Salud. Anuario de Enfermedades de Declaración Obligatoria. 1971–1982

  22. Berríos X (1990) Reflexiones sobre un brote epidémico de glomérulonefritis aguda post estreptocócica. Rev Chil Pediatr 61:109–112

    PubMed  Google Scholar 

  23. Berríos X (1985) Epidemia de Glomérulonefritis aguda. Investigación epidemiológica. Bol Vigilancia Epidemiológica 12:3–5

  24. Tejani A,Ingulli E (1990) Post-streptococcal glomerulonephritis. Current clinical and pathological concepts. Nephron 55:1–5

    CAS  Google Scholar 

  25. Anthony BF, Kaplan EL, Wannamaker LW (1969) Attack rates of acute nephritis after type 49 streptococcal infections of the skin and of the respiratory tract. J Clin Invest 48:1697–1701

    CAS  PubMed  Google Scholar 

  26. Dillon HC (1979) Post streptococcal glomerulonephritis following pyoderma. Rev Infect Dis 6:935–942

    Google Scholar 

  27. Zimmerman RA, Cross M, Miller BS (1966) A streptococcal epidemic in an isolated civilian population with institution of mass prophylaxis. J Pediatr 69:40

    CAS  PubMed  Google Scholar 

  28. Rodríguez-Iturbe B, Garcia R (1987) Acute glomerulonephritis. In: Holliday MA, Barrat MT, Vernon RL (eds) Pediatric nephrology. Williams and Wilkins, Baltimore, pp 407–419

  29. Kaplan EL, Wannamaker LW (1973) Suppression of host response to streptolysin O by skin lipids and its clinical implication. Pediatr Res 7:375–381

    Google Scholar 

  30. Roy S, Pitcock JA, Etteldorf JN (1976) Prognosis of acute post streptococcal glomerulonephritis in childhood: prospective study and review of the literature. Adv Pediatr 23:35–69

    PubMed  Google Scholar 

  31. Lagomarsino E, Valenzuela A, Cavagnaro F, Solar E (1999) Chronic renal failure in pediatrics—Chilean survey, 1996. Pediatr Nephrol 13:288–291

    PubMed  Google Scholar 

  32. West CD, McAdams AJ (1987) Membrane-proliferative glomerulonephritis. In: Halliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology, 2nd edn. Williams and Wilkins, Baltimore, pp 420–431

  33. Rodríguez-Iturbe B, Rubio L, García R (1981) Attack rate of post-streptococcal nephritis in families. Lancet I:401–403

    Article  Google Scholar 

  34. Nissenson AR, Baraf LJ, Fine RN, Knutson DW (1979) Post-streptococcal acute glomerulonephritis. Facts and controversy. Ann Intern Med 91:76–86

    CAS  PubMed  Google Scholar 

  35. Belani K, Schlievert PM, Kaplan EL, Ferrieri P (1991) Association of exotoxin producing group A streptococci and severe disease in children. Pediatr Infect Dis J 10:351–354

    CAS  PubMed  Google Scholar 

  36. Barnett BO, Frieden IJ (1992) Streptococcal skin diseases in children. Semin Dermatol 11:3–10

    CAS  PubMed  Google Scholar 

  37. Berríos X, Bedregal P, Ramírez G, Riedel I (1984) Infección por estreptococo grupo A invasor. Caracterización bacteriológica. Rev Chil Infect 11:26–34

    Google Scholar 

  38. Pichichero M, Disney F, Green J (1992) Comparative reliability of clinical, culture and antigen detection methods for the diagnosis of group A beta-hemolytic streptococcal tonsillo-pharyngitis. Pediatr Ann 21:798–805

    CAS  PubMed  Google Scholar 

  39. Berríos X, Quesney F, Morales A, Blázquez J, Lagomarsino E (1986) Acute rheumatic fever and post streptococcal glomerulonephritis in an open population. Comparative studies of epidemiology and bacteriology. J Lab Clin Med 108:421–427

    Google Scholar 

  40. Denny FW (1986) The mystery of acute rheumatic fever and post-streptococcal glomerulonephritis. J Lab Clin Med 108:523–524

    Google Scholar 

Download references

Acknowledgements

This study was supported by Catholic University Research grants 11/80 and 98/82,and also by The American Heart Association grant 809/91. We acknowledge the collaboration of Richard Facklam, MD, from the Centers for Disease Control and Prevention, Atlanta, Georgia, USA, Alan Bisno, MD, from the College of Medicine, University of Tennessee, Memphis, Tennessee, USA, and Edward Kaplan, MD, from the Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Author information

Authors and Affiliations

  1. Department of Public Health, Catholic University, Santiago, Chile

    Ximena Berríos, Beatriz Guzmán & Ingrid Riedel

  2. Department of Pediatrics, Catholic University, Santiago, Chile

    Edda Lagomarsino

  3. Pediatric Service, Hospital Sótero del Río, Santiago, Chile

    Eric Solar & Gloria Sandoval

  4. Lira 85—5th Floor, Santiago, Chile

    Edda Lagomarsino

Authors
  1. Ximena Berríos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edda Lagomarsino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Solar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gloria Sandoval
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Beatriz Guzmán
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingrid Riedel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edda Lagomarsino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Berríos, X., Lagomarsino, E., Solar, E. et al. Post-streptococcal acute glomerulonephritis in Chile—20 years of experience. Pediatr Nephrol 19, 306–312 (2004). https://doi.org/10.1007/s00467-003-1340-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-003-1340-9

Keywords

Search

Navigation