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Risk factors associated with short- and long-term kidney injury in children with post infectious glomerulonephritis

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Abstract

Background

Post infectious glomerulonephritis (PIGN) is the most common form of acute glomerulonephritis in children. The objective of this study was to evaluate the risk factors for kidney injury in children with PIGN referred to a tertiary care center.

Methods

This was a retrospective cohort study. The primary outcome was acute kidney injury (AKI) at initial presentation; secondary outcome was composite kidney injury, defined as reduced estimated glomerular filtration rate (eGFR), proteinuria, or hypertension at last follow-up. Binary logistic regression defined risk factors associated with the primary and secondary outcomes.

Results

We identified 125 PIGN cases with a mean age of 8.3±3.5 years at presentation and 252 ± 501 days of follow-up. Sixty-six percent (79/119) presented with AKI and 57% (71/125) were admitted to hospital. Shorter time to seeing a nephrologist (OR 6.7, 95%CI 1.8–24.6), nadir C3 < 0.12 g/L (OR 10.2, 95%CI 1.9–53.7), starting an antihypertensive medication (OR 7.6, 95%CI 1.8–31.3), and nephrotic range proteinuria (OR 3.8, 95%CI 1.2–12.4) were independent risk factors for AKI when adjusted for each other. At last follow-up 35% (44/125) of the cohort had the composite outcome, with older age at presentation (OR 1.2, 95%CI 1.04–1.4) and nadir C3 < 0.17 g/L (OR 2.6, 95%CI 1.04–6.7) being independent risk factors when adjusted for AKI.

Conclusion

PIGN is an important cause of AKI in children and adolescents. The severity of initial illness is associated with the extent of kidney injury in both the short- and longer-term. Findings will help identify cases requiring lengthier surveillance.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and confidentiality and are available from the corresponding author upon reasonable request.

References

  1. Kanjanabuch T, Kittikowit W, Eiam-Ong S (2009) An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol 5:259–269

    Article  PubMed  Google Scholar 

  2. Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5:685–694

    Article  PubMed  Google Scholar 

  3. Van De Voorde RG 3rd (2015) Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis. Pediatr Rev 36:3–12

  4. Roy S 3rd, Stapleton FB (1990) Changing perspectives in children hospitalized with poststreptococcal acute glomerulonephritis. Pediatr Nephrol 4:585–588

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Yap HK, Chia KS, Murugasu B, Saw AH, Tay JS, Ikshuvanam M, Tan KW, Cheng HK, Tan CL, Lim CH (1990) Acute glomerulonephritis–changing patterns in Singapore children. Pediatr Nephrol 4:482–484

    Article  CAS  PubMed  Google Scholar 

  7. Ilyas M, Tolaymat A (2008) Changing epidemiology of acute post-streptococcal glomerulonephritis in Northeast Florida: a comparative study. Pediatr Nephrol 23:1101–1106

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Rodriguez-Iturbe B, Musser JM (2008) The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 19:1855–1864

    Article  PubMed  Google Scholar 

  10. Hoy WE, White AV, Dowling A, Sharma SK, Bloomfield H, Tipiloura BT, Swanson CE, Mathews JD, McCredie DA (2012) Post-streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life. Kidney Int 81:1026–1032

    Article  CAS  PubMed  Google Scholar 

  11. Garg AX, Suri RS, Barrowman N, Rehman F, Matsell D, Rosas-Arellano MP, Salvadori M, Haynes RB, Clark WF (2003) Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA 290:1360–1370

    Article  CAS  PubMed  Google Scholar 

  12. Davin JC, Coppo R (2014) Henoch-Schonlein purpura nephritis in children. Nat Rev Nephrol 10:563–573

    Article  CAS  PubMed  Google Scholar 

  13. Coppo R, Andrulli S, Amore A, Gianoglio B, Conti G, Peruzzi L, Locatelli F, Cagnoli L (2006) Predictors of outcome in Henoch-Schonlein nephritis in children and adults. Am J Kidney Dis 47:993–1003

    Article  PubMed  Google Scholar 

  14. Pottel H, Vrydags N, Mahieu B, Vandewynckele E, Croes K, Martens F (2008) Establishing age/sex related serum creatinine reference intervals from hospital laboratory data based on different statistical methods. Clin Chim Acta 396:49–55

    Article  CAS  PubMed  Google Scholar 

  15. Levey AS, Eckardt KU, Dorman NM, Christiansen SL, Hoorn EJ, Ingelfinger JR, Inker LA, Levin A, Mehrotra R, Palevsky PM, Perazella MA, Tong A, Allison SJ, Bockenhauer D, Briggs JP, Bromberg JS, Davenport A, Feldman HI, Fouque D, Gansevoort RT, Gill JS, Greene EL, Hemmelgarn BR, Kretzler M, Lambie M, Lane PH, Laycock J, Leventhal SE, Mittelman M, Morrissey P, Ostermann M, Rees L, Ronco P, Schaefer F, St Clair Russell J, Vinck C, Walsh SB, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC (2020) Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 97:1117–1129

    Article  PubMed  Google Scholar 

  16. Falkner B, Daniels SR, Loggie JMH, Horan MJ, Prineas RJ, Rosner B, Sinaiko AR, Roccella EJ, Anderson DE (1996) Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 98:649–658

  17. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

  18. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pesce F, Stea ED, Rossini M, Fiorentino M, Piancone F, Infante B, Stallone G, Castellano G, Gesualdo L (2020) Glomerulonephritis in AKI: From Pathogenesis to Therapeutic Intervention. Front Med (Lausanne) 7:582272

    Article  PubMed  Google Scholar 

  20. Ong LT (2022) Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 11:139–145

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wan Yusof WA, Yaacob NM, Nasir A, Yusoff S, Ilias MI (2023) Clinical predictors of acute kidney injury in children with acute post-streptococcal glomerulonephritis: a tertiary centre experience. Singapore Med J. https://doi.org/10.4103/singaporemedj.SMJ-2021-092

    Article  PubMed  Google Scholar 

  22. Uber AM, Sutherland SM (2020) Acute kidney injury in hospitalized children: consequences and outcomes. Pediatr Nephrol 35:213–220

    Article  PubMed  Google Scholar 

  23. Balasubramanian R, Marks SD (2017) Post-infectious glomerulonephritis. Paediatr Int Child. Health 37:240–247

    Google Scholar 

  24. 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

    PubMed  Google Scholar 

  25. Han KH, Lee KH, Park SJ, Yu R, Kim SH, Lee IR, Han SY, Kim HS, Kronbichler A, Li H, Koyanagi A, Jacob L, Shin JI, Kim JH, Smith L (2021) Hypocomplementemia (C3) as an independent predictor for children with acute post-streptococcal glomerulonephritis: a long-term observation. Eur Rev Med Pharmacol Sci 25:5674–5683

    CAS  PubMed  Google Scholar 

  26. Rodriguez-Iturbe B (2004) Nephritis-associated streptococcal antigens: where are we now? J Am Soc Nephrol 15:1961–1962

    Article  PubMed  Google Scholar 

  27. Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, Sugisaki T, Boyle MD (2004) Nephritis-associated plasmin receptor and acute poststreptococcal glomerulonephritis: characterization of the antigen and associated immune response. J Am Soc Nephrol 15:1785–1793

    Article  CAS  PubMed  Google Scholar 

  28. Batsford SR, Mezzano S, Mihatsch M, Schiltz E, Rodriguez-Iturbe B (2005) Is the nephritogenic antigen in post-streptococcal glomerulonephritis pyrogenic exotoxin B (SPE B) or GAPDH? Kidney Int 68:1120–1129

    Article  CAS  PubMed  Google Scholar 

  29. Mezzano S, Lopez MI, Olavarria F, Ardiles L, Arriagada A, Elgueta S, Wegman ME, Fuentes C (1991) Age influence on mononuclear phagocyte system Fc-receptor function in poststreptococcal nephritis. Nephron 57:16–22

    Article  CAS  PubMed  Google Scholar 

  30. Blyth CC, Robertson PW, Rosenberg AR (2007) Post-streptococcal glomerulonephritis in Sydney: A 16-year retrospecticve review. J Paediatr Child H 43:446–450

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, British Columbia Children’s Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, K4-156, Canada

    Douglas G. Matsell, Dan Cojocaru & Marisa Catapang

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  1. Douglas G. Matsell
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Matsell, D.G., Cojocaru, D. & Catapang, M. Risk factors associated with short- and long-term kidney injury in children with post infectious glomerulonephritis. Pediatr Nephrol 38, 3309–3315 (2023). https://doi.org/10.1007/s00467-023-06000-1

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