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Extrarenal Immune-Mediated Disorders Linked with Acute Poststreptococcal Glomerulonephritis: a Systematic Review

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Abstract

Streptococcus A infections have been associated with immune-mediated sequelae including acute glomerulonephritis, acute rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein purpura, arthritis, uveitis, guttate psoriasis, and erythema nodosum. Available reviews do not report the occurrence of acute poststreptococcal glomerulonephritis in association with one of the mentioned conditions. We performed a systematic review of the literature on extrarenal immune-mediated disorders associated with acute poststreptococcal glomerulonephritis. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Meta-Analyses and Systematic Reviews were used. We identified 41 original articles, published after 1965, which reported on 52 patients (34 males and 18 females aged from 1.7 to 57 years, median 9) affected by acute poststreptococcal glomerulonephritis associated with a further poststreptococcal disease: 29 cases with rheumatic fever (17 males and 12 females aged 3.0 to 57, median 17 years), 16 with hematologic diseases such as thrombocytopenia or hemolytic anemia (13 males and 3 females aged 1.8 to 13, median 6.0 years) and seven with Henoch-Schönlein syndrome, reactive arthritis or uveitis (4 males and 3 females aged 1.7 to 14, median 7.0 years). Patients affected by acute poststreptococcal glomerulonephritis associated with acute rheumatic fever were on the average older (P < 0.05) than patients with acute poststreptococcal glomerulonephritis associated with thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis or uveitis. Five large case series describing 2058 patients affected by acute poststreptococcal glomerulonephritis did not mention its occurrence in association with further immune-mediated disorders. This systematic review points out that acute poststreptococcal glomerulonephritis can be associated, albeit rarely, with rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis, or uveitis.

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Abbreviations

APSGN:

acute poststreptococcal glomerulonephritis

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Authors and Affiliations

  1. Università della Svizzera Italiana, Lugano, Switzerland

    Elena A. Bertola, Giacomo D. Simonetti, Martina Meoli & Mario G. Bianchetti

  2. Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland

    Giacomo D. Simonetti & Mario G. Bianchetti

  3. Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Rosaria Del Giorno

  4. Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland

    Olivier Giannini

  5. Pediatric Emergency Department, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Emilio F. Fossali

  6. Epatocentro Ticino, Via Soldino 5, 6900, Lugano, Switzerland

    Benedetta Terziroli Beretta-Piccoli

  7. Institute of Liver Studies, Mowat Labs, King’s College Hospital, London, UK

    Benedetta Terziroli Beretta-Piccoli

  8. Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Gregorio P. Milani

  9. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Gregorio P. Milani

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  1. Elena A. Bertola
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Bertola, E.A., Simonetti, G.D., Del Giorno, R. et al. Extrarenal Immune-Mediated Disorders Linked with Acute Poststreptococcal Glomerulonephritis: a Systematic Review. Clinic Rev Allerg Immunol 57, 294–302 (2019). https://doi.org/10.1007/s12016-019-08761-w

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