Overview on Acute Poststreptococcal Glomerulonephritis in Pediatrics: A Review

Acute poststreptococcal glomerulonephritis (APSGN) is the most common kind of post-infectious glomerulonephritis and is caused by group A streptococcus (Streptococcus pyogenes). Although the prevalence of PSGN has decreased in affluent nations, non-streptococcal species are becoming more common. and it is still the major cause of glomerulonephritis in children. APSGN can manifest itself in epidemic outbreaks or clusters of instances, as well as in single persons. Epidemic outbreaks have previously been documented as a result of upper respiratory or cutaneous streptococcal infections in various parts of the world. In developed nations, APSGN is now mostly a disease of the elderly, who are more likely to have disabling illnesses such as cancer, alcoholism, or diabetes. Children between the ages of 3 and 12 (with a peak incidence between the ages of 5 and 6 years) and seniors over the age of 60 are the most commonly affected. The pathophysiology of APSGN is complicated by inflammation. (APSGN) often occurs one to two weeks after a throat infection and three to five weeks after a skin infection. Hematuria, edoema, azotemia, and hypertension are the most common clinical signs. Loop or thiazide diuretics, are the most effective therapy for hypertension and edoema in PSGN. In this review we’ll be looking at the disease causes, epidemiology, presentation and treatment.

FACTORS ASSOCIATED WITH HAEMATURIA IN CHILDREN IN AGE GROUP OF 1 TO 14 YEARS

BACKGROUND: Haematuria is the most common urinary finding that bring children to the attention of the paediatric nephrologists. It can be caused by glomerular & non-glomerular diseases. The main causes of Haematuria are urinary tract infections, trauma to abdomen, acute post streptococcal glomerulonephritis and congenital hydronephrosis. OBJECTIVE: The objective of this study was to identify the distribution of factors in children with haematuria in age group of 1 to 14 years METHODS: A total of 84 admitted patients of haematuria, who fulfill the inclusive criteria,were enrolled in this study after consent from their parents. Each patient was evaluated through history, examination and investigated. Urine sample of each patient was analyzed for a microscopic examination. Investigations / imaging were performed in clinical laboratory of LGH / PGMI, Lahore. The collected information was entered into SPSS version 20, and analyzed. RESULTS: There were 47(44.05%) male and 37(55.95%) female patients in this study. The mean age of patients was 8.69 ± 3.63 years.We found 14 patients (16.66%) has urological anomalies,6 boys have posterior urethral valves.2 girls and one boy has vesicoureteral reflux.One boy and one girl has ureterovesical junction obstruction,one boy has hypospadias and 2 girls , ureteropelvic junction obstruction.History of recent bladder catheterization was seen in 5(5.59%), urinary tract infection 17(20.23%) and 14 patients has urological anomalies(16.66%). CONCLUSION: According to this study ,most common factors causing haematuria was urinary tract infection 17(20.23%) , acute poststreptococcal glomerulonephritis 16(19.04%) and congenital urological anomalies 14(16.66%).Renal stones were found in 10(11.90%).

Scabies in remote Aboriginal and Torres Strait Islander populations in Australia: A narrative review

Scabies has recently gained international attention, with the World Health Organization (WHO) recognizing it as a neglected tropical disease. The International Alliance for the Control of Scabies recently formed as a partnership of more than 15 different countries, with an aim to lead a consistent and collaborative approach to preventing and controlling scabies globally. Scabies is most prevalent in low-resource and low socioeconomic areas that experience overcrowding and has a particularly high prevalence in children, with an estimated 5% to 10% in endemic countries. Scabies is widespread in remote Aboriginal and Torres Strait Islander communities in Australia with the prevalence of scabies in Aboriginal and Torres Strait Islander children in remote communities estimated to be as high as 33%, making it the region with the third highest prevalence in the world. This population group also have very high rates of secondary complications of scabies such as impetigo, poststreptococcal glomerulonephritis (PSGN), and rheumatic heart disease (RHD). This article is a narrative review of scabies in remote Aboriginal and Torres Strait Islander populations in Australia, including clinical manifestations of disease and current treatment options and guidelines. We discuss traditional approaches to prevention and control as well as suggestions for future interventions including revising Australian treatment guidelines to widen the use of oral ivermectin in high-risk groups or as a first-line treatment.

A brief review on Group A Streptococcus pathogenesis and vaccine development

Streptococcus pyogenes , also known as Group A Streptococcus (GAS), is a Gram-positive human-exclusive pathogen, responsible for more than 500 000 deaths annually worldwide. Upon infection, GAS commonly triggers mild symptoms such as pharyngitis, pyoderma and fever. However, recurrent infections or prolonged exposure to GAS might lead to life-threatening conditions. Necrotizing fasciitis, streptococcal toxic shock syndrome and post-immune mediated diseases, such as poststreptococcal glomerulonephritis, acute rheumatic fever and rheumatic heart disease, contribute to very high mortality rates in non-industrialized countries. Though an initial reduction in GAS infections was observed in high-income countries, global outbreaks of GAS, causing rheumatic fever and acute poststreptococcal glomerulonephritis, have been reported over the last decade. At the same time, our understanding of GAS pathogenesis and transmission has vastly increased, with detailed insight into the various stages of infection, beginning with adhesion, colonization and evasion of the host immune system. Despite deeper knowledge of the impact of GAS on the human body, the development of a successful vaccine for prophylaxis of GAS remains outstanding. In this review, we discuss the challenges involved in identifying a universal GAS vaccine and describe several potential vaccine candidates that we believe warrant pursuit.

Poststreptococcal Glomerulonephritis without Hypertension in a Patient with Concealed Skin Lesions

Poststreptococcal Glomerulonephritis (PSGN) is an acute inflammation of renal glomerular parenchyma and is sequelae of pharyngitis or skin infection caused by nephritogenic strains of group A beta-Haemolytic Streptococcus. PSGN is conventionally diagnosed based upon clinical findings and demonstration of recent streptococcal infection by a positive skin/throat culture or serologic tests. Hereby, authors present a case of PSGN in an 18-year-old normotensive male is reported who presented with anasarca. On evaluation, the patient had subnephrotic range proteinuria without haematuria and normal serum creatinine. Concealed healing skin lesions in the gluteal region, suggestive of impetigo were noted and hence, arrived at the diagnosis of PSGN. He was treated with intravenous antibiotics, following which symptoms improved. Young patients with acute presentation of oedema or proteinuria with possible renal cause warrants thorough head to foot examination for unseen skin lesions in otherwise overlooked areas. PSGN responds promptly with early antibiotic therapy.

Análise do perfil clínico e sociodemográfico dos pacientes pediátricos diagnosticados com glomerulonefrite difusa aguda em hospital no Sertão de Pernambuco, Brasil

Introdução: A glomerulonefrite difusa aguda é uma glomerulopatia decorrente do dano inflamatório dos componentes glomerulares, comumente encontrada em pacientes pediátricos, com padrão e prevalência variáveis de acordo com idade, sexo, fatores socioeconômicos e geográficos (principalmente nas glomerulonefrites infecciosas ou pós-infecciosas), sendo a causa mais comum de acometimento renal após os seis anos de idade. Porém, faltam dados mundiais precisos sobre a prevalência da síndrome. Objetivo: Traçar o perfil sociodemográfico e clínico dos pacientes pediátricos diagnosticados com esta glomerulonefrite no Hospital Regional Professor Agamenon Magalhães, localizado no município de Serra Talhada, Pernambuco. Material e método: Trata-se de um estudo retrospectivo e descritivo de corte transversal. A coleta de dados foi realizada entre agosto de 2018 a junho de 2019, através da análise dos prontuários dos pacientes pediátricos que foram diagnosticados com glomerulonefrite difusa aguda. Resultados: 29 prontuários foram analisados, correspondendo aos anos 2015 a 2018, sendo 51,72% do sexo masculino, residente em Serra Talhada e em zona rural, com idade média 7,7 anos, todos de etnia parda. Em admissão para atendimento hospitalar 75,86% da amostra apresentou estado geral regular, e apenas 3,45% grave. 34,48% da população estudada apresentou oligúria, 89,66% edema generalizado, 58,62% hipertensão arterial durante admissão, 27,59% cefaleia e 55,17% febre. Conclusão: Os resultados obtidos através da pesquisa destacam a importância de traçar o perfil para guiar os profissionais do serviço na assistência aos pacientes pediátricos acometidos pela patologia abordada. Descritores: Glomerulonefrite; Glomérulos Renais; Pediatria. Referências Costa DMN, Valente LM, Gouveia PAC, Sarinho FW, Fernandes GV, Cavalcante MAGM, et al. Análise comparativa de glomerulopatias primária e secundária no nordeste do Brasil: dados do Registro Pernambucano de Glomerulopatias - REPEG. J. Bras. Nefrol. 2017; 39(1): 29-35. Sim JJ, Batech M, Hever A, Harrison TN, Avelar T, Kanter MH, et al. Distribution of biopsy-proven presumed primary glomerulonephropathies in 2000-2011 among a racially and ethnically diverse US population. Am J Kidney Dis. 2016; 68(4): 533-544. Crensiglova C, Rehme BB, Kinasz LRS, Chula DC, Do Nascimento MM, Soares MFS. Frequência e avaliação clínico-histológica das doenças glomerulares em um hospital terciário da região Sul do Brasil. J Bras Nefrol. 2016; 38(1): 42-48. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Manual de Medicina de Harisson. 19. ed. Porto Alegre: Mc Graw Hill/ Artmed; 2017. Couser WG. Patogênese e tratamento da glomerulonefrite, uma atualização. J Bras Nefrol. 2016; 38(1): 107-122. Figueira F, Alves JGB, Ferreira OS, Maggi RRS, Correia JB. Pediatria. 4ª edição. Rio de Janeiro: MedBook; 2011. Moorani KN, Sherali AR. Histopathological pattern in childhood glomerulonephritis. J Pak Med Assoc. 2010; 60(12): 1006. Rocha LP, Carminati CR, Machado JR, Laterza VL, Reis MA, Corrêa RRM. Prevalence of nephropathies in children and adolescents and alterations in renal biopsies in Minas Gerais, Brazil, from 1996 to 2010. Ann Diagn Pathol. 2017; 17(1): 22-27. Silva VS, Hagemann R, Viero RM. Glomerulonefrites primárias. In: Riella MC. Princípios de Nefrologia e Distúrbios Hidroeletrolíticos. Rio de Janeiro: Guanabara Koogan; 2018. Bertola EA, Simonetti GD, Del Giorno R, Giannini O, Fossali EF, Meoli M, et al. Extrarenal Immune-mediated disorders linked with acute poststreptococcal glomerulonephritis: a systematic review. Clinic Rev Allerg Immunol. 2019;57(2): 294-302. Sethi S, Fervenza FC. Standardized classification and reporting of glomerulonephritis. Nephrol Dial Transplant. 2018;34(2):193-99. Kılıc BD, Akbalık MK, Buyukcelik M, Balat A. Pediatric post-streptococcal glomerulonephritis: Clinical and laboratory data. Pediatr Int. 2018; 60(7):645‐50. Ali el-TM, Babikir AM, El-Assad S, Abdelrahim MB. Prognosis of acute post-streptococcal glomerulonephritis in Sudanese children. Arab J Nephrol Transplant. 2014;7(2):103‐7. Gunasekaran K, Krishnamurthy S, Mahadevan S, Harish BN, Kumar AP. Clinical characteristics and outcome of post-infectious glomerulonephritis in children in Southern India: a prospective study. Indian J Pediatr. 2015;82(10):896‐903. Maia MLA, Vale MLD, Hatanaka E. Recomendações: Atualização de Condutas em Pediatria. Departamento de Nefrologia. Síndrome nefrítica. Departamentos Científicos SPSP, n. 88, p.10-14, 2019.

Infekt-assoziierte Glomerulonephritiden

Glomerulonephritis, secondary to bacterial, or, more rarely, viral or parasitic infections, is called infection-associated. The epidemiology of infection-associated glomerulonephritis has changed in recent decades. For a long time, the classic form has been acute poststreptococcal glomerulonephritis (APGN), but in developed countries its incidence has declined sharply. However, there is an increase in staphylococcal associated glomerulonephritis (SAGN). The clinical manifestations of APGN and SAGN are different: APGN typically presents with a glomerulonephritis after an infectious latency period (post-infectious), while SAGN typically shows an immune complex glomerulonephritis concomitant with infection (para-infectious). SAGN often presents with an occult infections in older patients with multiple comorbidities.

Proliferative glomerulonephritis

Proliferative glomerulonephritis describes the finding of increased cellularity of the glomerulus, which may be due to proliferation of intrinsic glomerular cells, infiltration of leucocytes, or both. This principally occurs in the context of glomerular deposition of immunoglobulins, immune complexes, or complement components. Different subtypes are described based on histological features: proliferation of mesangial cells, endocapillary proliferation, diffuse proliferation, or extracapillary proliferation (also termed crescentic glomerulonephritis). Patients will typically have haematuria, and this may be associated with proteinuria and/or impairment of excretory renal function and/or hypertension. The best characterized proliferative glomerulonephritis is poststreptococcal glomerulonephritis. This most commonly affects children, who present with nephritis about 2 weeks after pharyngitis or skin infection caused by streptococci of Lancefield group A. Treatment is directed at eradicating the infection with an appropriate antimicrobial and providing symptomatic relief. Recovery is the rule, although haematuria and proteinuria may persist.