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Clinical Characteristics and Outcome of Post-Infectious Glomerulonephritis in Children in Southern India: A Prospective Study

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Abstract

Objectives

To evaluate the clinical characteristics, complications and outcome of post-infectious glomerulonephritis (PIGN).

Methods

This prospective observational study was conducted from January 2013 through July 2014 at a tertiary care hospital in south India. Post-streptococcal glomerulonephritis (PSGN) was diagnosed in the presence of: a) Hematuria and proteinuria b) Clinico-serological evidence of recent streptococcal infection [recent pyodermas or pharyngitis; positive antistreptolysin-O (ASO) titres, anti-DNAse B titres or throat swab positivity for Group A streptococcus], and c) Low serum C3 levels, with normalization on 8 wk follow up. PIGN included PSGN and other infectious etiologies. AKI was classified as per Acute Kidney Injury Network (AKIN) criteria. Clinical features, biochemical and serological investigations in the study subjects were recorded.

Results

Among 83 children with acute nephritic syndrome (ANS) recruited, 72 (86.7 %) had PIGN. PSGN was the most common etiology [65(90.3 %)] among the PIGN cases. Pyodermas, upper respiratory infections and varicella preceded hematuria in 58 (80.6 %), 4 (5.6 %) and 2 (2.8 %) cases respectively. Pneumonia, mumps and liver abscess caused PIGN in 7 (9.7 %) cases. Complications included AKI in 15 (20.8 %), hypertensive emergency in 14 (19.4 %), cardiac failure in 8 (11.1 %), encephalopathy in 3 (4.2 %) cases and retinopathy in 1 (1.4 %) case. Among the AKI patients, 3(20 %) were in AKI stage 3, while 1 child required hemodialysis. Twenty three cases (31.9 %) had evidence of residual renal injury at discharge. Renal biopsy showed diffuse proliferative glomerulonephritis in 4 and crescentic glomerulonephritis in one case of PIGN. At 6 mo follow up, one patient continued to have microalbuminuria.

Conclusions

PIGN (including PSGN) remains a significant contributor to morbidity in children with ANS. The study is notable for high incidence of hypertensive emergency and AKI, that often required intensive care management.

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Contributions

KG, SK and SM were involved in management of the patients. KG collected the data, reviewed the literature and drafted the manuscript. SK conceptualized the study, reviewed the literature and critically reviewed the manuscript. SM critically revised the manuscript. BNH supervised the laboratory tests. APK performed the statistical analysis. All authors contributed to writing the paper and approved the final version of the manuscript. SK shall act as guarantor of the paper.

Conflict of Interest

None.

Source of Funding

The study was supported by an intramural grant from the authors’ institution for estimation of serum anti-DNAse B and C3 levels, which is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India

    Kuralvanan Gunasekaran, Sriram Krishnamurthy & Subramanian Mahadevan

  2. Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India

    B. N. Harish

  3. Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India

    Ajith Prabhu Kumar

Authors
  1. Kuralvanan Gunasekaran
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  2. Sriram Krishnamurthy
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  3. Subramanian Mahadevan
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  4. B. N. Harish
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  5. Ajith Prabhu Kumar
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Corresponding author

Correspondence to Sriram Krishnamurthy.

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Gunasekaran, K., Krishnamurthy, S., Mahadevan, S. et al. Clinical Characteristics and Outcome of Post-Infectious Glomerulonephritis in Children in Southern India: A Prospective Study. Indian J Pediatr 82, 896–903 (2015). https://doi.org/10.1007/s12098-015-1752-0

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