Pediatrik Akut Poststreptokokkal Glomerülonefritin Pandemi Öncesi ve Sonrası Dönemde Değişen Yüzü: Bir Karşılaştırma Çalışması

Year 2024, Articles Online First, 1 - 7

Bahriye Uzun Kenan , Evrim Kargın Çakıcı , Tülin Güngör , Deniz Karakaya , Evra Çelikkaya , Aysun Çaltık Yılmaz

https://doi.org/10.12956/tchd.1494473

Abstract

Amaç: Akut poststreptokokal glomerülonefrit (APSGN), çocuklarda akut glomerülonefritin önde gelen nedenidir. APSGN sıklıkla farenjit sonrasında, immün kompleks aracılı bir mekanizma ile streptokok antijenlerine karşı antikorların ve kompleman proteinlerinin aktivasyonuna bağlı olarak gelişir.

Gereç ve Yöntemler: Çalışmaya Eylül 2022 ile Mart 2023 tarihleri arasında APSGN tanısı konulan 18 yaş altı toplam 28 hasta dahil edildi ve bunlar, pandemi öncesi APSGN’li toplam 153 hastayla karşılaştırıldı.

Bulgular: Grup I’de (2010-2022) tanıda ortalama yaş 7.36±2.92 yıl, grup II’de ise 8.69±2.51 yıldı. Her iki çalışmada da hastaların dörtte üçünden fazlası [grup I/grup II; 106 (%69.3) / 21 (%71.4)] erkekti. Grup I’de en sık görülen bulgu hematüri iken, grup II’de en sık görülen bulgu hipertansiyondu. Kompleman 3 (C3) seviyeleri grup I’de önemli ölçüde daha düşüktü ve C3 iyileşme süresi grup II’de önemli ölçüde daha kısaydı. Grup I’deki hastaların yaklaşık yüzde yirmisi (%19.4) ve grup II’deki hastaların yalnızca biri hızla ilerleyen glomerülonefrite (RPGN) progrese oldu.

Sonuç: COVİD-19 salgını sonrası maske kullanımının terk edilmesiyle APSGN görülme sıklığı hızla arttı. Hastalar daha gürültülü bir klinikle prezente olsa da prognozları daha iyiydi.

Keywords

Akut, Çocuk, COVİD-19 Pandemi, Poststreptokok Glomerülonefrit

Project Number

bahriye-uzun-kenan-718088

Changing Face of Pediatric Acute Poststreptococcal Glomerulonephritis in the Pre and Post Pandemic Period: A Comparison Study

Abstract

Objective: Acute poststreptococcal glomerulonephritis (APSGN) is the leading cause of acute glomerulonephritis in children. APSGN often develops after pharyngitis due to the activation of antibodies and complement proteins to streptococcal antigens by an immune complex-mediated mechanism. In this study, we aimed to analyze APSGN patients diagnosed before and after the pandemic, with their demographic characteristics , clinical and laboratory findings.

Material and Methods: In this study, patients diagnosed with APSGN in a tertiary children’s hospital between October 2022 and March 2023 were retrospectively analyzed. The patients were compared with a large cohort followed up with the same diagnosis between 2010-2022. The patients were divided into two groups: group I (n=153, pre-pandemic) and group II (n=28, post-pandemic). Clinical, radiologic, and laboratory findings were compared between the two groups.

Results: The mean age at diagnosis in the group I (2010-2022) was 7.36±2.92 years, and in the group II 8.69±2.51 years. More than three-fourths of the cases [group I/group II; 106 (69.3%) / 21 (71.4%)] were male in both studies. As macroscopic hematuria was the most common finding in the group I, hypertension was the most common finding in group II. Complement 3 (C3) levels were significantly lower in the group I and C3 recovery time was significantly shorter in the group II. Five (19.4%) of patients in group I and only one patient in group II progressed to RPGN.

Conclusion: The incidence of APSGN increased rapidly after the Covid-19 pandemic when the use of face masks was discontinued. Although the patients presented with a serious clinic, their prognosis was better.

Keywords

Acute, Child, Covid-19, Pandemic, Poststreptecoccal glomerulonephritis

Ethical Statement

WE HAVE NO CONFLİCT OF İNTEREST TO DİSCLOSE.

Supporting Institution

ANKARA ETLİK CİTY HOSPİTAL,ANKARA,TURKEY

Project Number

bahriye-uzun-kenan-718088

References

• Blyth CC, Robertson PW, Rosenberg AR. Post-streptococcal glomerulonephritis in Sydney: a 16-year retrospective review. J Paediatr Child Health 2007;43:446-50.
• Sagel I, Treser G, Ty A, Yoshizawa N, Kleinberger H, Yuceoglu AM, et al. Occurrence and nature of glomerular lesions after group A streptococci infections in children. Ann Intern Med 1973;79:492-9.
• Rodríguez-Iturbe B. Epidemic poststreptococcal glomerulonephritis. Kidney Int 1984;25:129-36.
• Moorani KN, Aziz M, Amanullah F. Rapidly progressive glomerulonephritis in children Pak. J Med Sci 2022;38:417–25.
• Orlando C, Milani GP, Simonetti GD, Simonetti BG, Lava SAG, Wyttenbach R, et al. Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review. Pediatr Nephrol 2022; 37:833-41.
• Fux CA, Bianchetti MG, Jakob SM, Remonda L. Reversible encephalopathy complicating post-streptococcal glomerulonephritis. Pediatr Infect Dis J 2006; 25:85-7.
• Kanjanabuch T, Kittikowit W, Eiam-Ong S. An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol 2009;5:259-69.
• Balasubramanian R, Marks SD. Post-infectious glomerulonephritis.Paediatr Int Child Health 2017;37:240-7.
• Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol 2011;26:165-80.
• Oda T, Yamakami K, Omasu F, Suzuki S, Miura S, Sugisaki T, et al. Glomerular plasmin-like activity in relation to nephritis-associated plasmin receptor in acute poststreptococcal glomerulonephritis. J Am Soc Nephrol 2005;16:247-54
• Han KH, Lee KH, Park SJ, Yu R, Kim SH, Lee IR, et al. Hypocomplementemia (C3) as an independent predictor for children with acute post-streptococcal glomerulonephritis:a long-term observation. Eur Rev Med Pharmacol Sci 2021;25:5674–83.
• Rodriguez-Iturbe B, Musser JM.The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol 2008;19:1855–64.
• Lewy JE, Salinas-Madrigal L, Herdson PB, Pirani CL, Metcoff J. Clinico-pathologic correlations in acute poststreptococcal glomerulonephritis. A correlation between renal functions, morphologic damage and clinical course of 46 children with acute poststreptococcal glomerulonephritis. Medicine (Baltimore) 1971; 50:453-501.
• Rodriguez-Iturbe B, Najafan B, Silva AE, Alpers C.Acute postinfectious glomerulonephritis in children. In: Avner ED (ed) Pediatric Nephrology, 7th ed. Springer, London 2016;959–69.
• Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 2022;11:139-45.
• Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140:e20171904.
• Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629-37.
• Marcdante KJ, Kleigman RM.Nephrology and urology.In: Robert M (ed) Nelson Essentials of Pediatrics, 5th edn. Elsevier, Philadelphia 2006:751–70.
• Demircioglu Kılıc B, Akbalık Kara M, Buyukcelik M, Balat A. Pediatric post-streptococcal glomerulonephritis: Clinical and laboratory data. Pediatr Int 2018;60:645-50.
• Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect 2005;5: 685–94.
• Van DeVoorde RG. 3rd. Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis. Pediatr Rev 2015;36:3-13.
• Karakaya D, Güngör T, Çakıcı EK, Yazılıtaş F, Çelikkaya E, Yücebaş SC, et al. Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis. Pediatr Nephrol 2023;38:3027-33.
• Shafer F, Greenbaum LA. Pediatric Kidney Disease, 3rd ed. Switzerland, Springer 2023;19:562.
• Becquet O, Pasche J, Gatti H, Chenel C, Abely M, Morville P, et al. Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study. Pediatr Nephrol 2010;25:275–80.
• 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;82:896-903.
• Bingler MA, Ellis D, Moritz ML. Acute post-streptococcal glomerulonephritis in a 14-month-old boy: why is this uncommon?.Pediatr Nephrol 2007;22:448-50.
• Rodriguez-Iturbe B, Mezzano S.Acute postinfectious glomerulonephritis. in: Avner E (ed) Pediatric Nephrology, 6th edn, Springer, Berlin and Heidelberg 2009;744–55.
• Stetson CA, Rammelkamp CH, Krause RM, Kohen RJ, Perry WD. Epidemic acute nephritis: studies on etiology, natural history and prevention. Medicine1995;34:431–50.
• Lasch EE, Frankel V, Vardy PA, Rabinowitz SB, Ofek I, Rabinowitz K. Epidemic glomerulonephritis in Israel. J Infect Dis1971;124:141–7.
• Bateman E, Mansour S, Okafor E, Arrington K, Hong BY, Cervantes J.Examining the Efficacy of Antimicrobial Therapy in Preventing the Development of Postinfectious Glomerulonephritis: A Systematic Review and Meta-Analysis. Infect Dis Rep 2022:176–83.
• Rajajee S. Post-streptococcal acute glomerulonephritis: a clinical, bacteriological and serological study. Indian J Pediatr 1990;57:775–80.
• Shafer F,Greenbaum LA. Pediatric Kidney Disease, 3th ed ,Springer, Switzerland 2023;19:553.
• Gallo G, Calvez V, Savoia C. Hypertension and COVID-19: Current Evidence and Perspectives. High Blood Press Cardiovasc Prev 2022;29:115–23.
• Karmouty-Quintana H, Thandavarayan RA, Keller SP, Sahay S, Pandit LM, Akkanti B. Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets. Int J Mol Sci 2020;21:8081.
• Mizuiri S, Ohashi Y. ACE and ACE2 in kidney disease. World J Nephrol 2015;4:74-82.
• Wong W, Morris MC, Zwi J. Outcome of severe acute poststreptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol 2009;24:1021–6.
• Kasahara T, Hayakawa H, Okubo S, Okugawa T, Kabuki N, Tomizawa S, et al. Prognosis of acute poststreptococcal glomerulonephritis (APSGN) is excellent in children, when adequately diagnosed. Pediatr Int 2001;43:364-367.
• El-Husseini AA, Sheashaa HA, Sabry AA, Moustafa FE, Sobh MA. Acute postinfectious crescentic glomerulonephritis: clinicopathologic presentation and risk factors. Int Urol Nephrol 2005;37:603–9.
• Hunt EAK, Somers MJG. Infection-Related Glomerulonephritis. Pediatr Clin North Am 2019; 66: 59-72.
• Bircan Z, Tugay S, Usluer H.Poststreptococcal glomerulonephritis with pulmonary edema and microscopic hematuria. Pediatr Nephrol 2005;20:1204.
• Ahn SY, Ingulli E. Acute poststreptococcal glomerulonephritis: an update. Curr Opin Pediatr 2008; 20:157–62.
• Sepahi MA, Shajari A, Shakiba M, Shooshtary FK, Salimi MH. Acute Glomerulonephritis: A 7 Year Follow up of Children in Center of Iran. Acta Med Iran 2011; 49:375–8.
• Baikunje S, Vankalakunti M, Nikith A, Srivatsa A, Alva S, Kamath J. Post-infectious glomerulonephritis with crescents in adults: a retrospective study. Clin Kidney J 2016;9:222–6.