The following is a summary of “Biomarkers of histologic severity in children with severe or atypical acute post-streptococcal glomerulonephritis,” published in the December 2023 issue of Nephrology by Wong et al.
Though acute post-streptococcal glomerulonephritis (APSGN) typically causes Acute Kidney Injury (AKI) in children, a rare subgroup presents with rapidly worsening kidney function (RPGN), manifesting as severe urine reduction or a combined inflammatory and protein-leakage syndrome (nephritic-nephrotic picture).
Researchers started a retrospective study to identify clinical and laboratory factors that could help doctors predict children with APSGN at risk for severe, rapidly progressing kidney disease.
They obtained all kidney biopsies for APSGN performed (1996 and 2020) from a departmental biopsy database. Clinical and laboratory data from the patient’s clinical records were extracted, and a renal histopathologist independently reviewed and scored kidney biopsies.
The results showed that at initial presentation, 56.6% (30) of 53 patients had stage 3 AKI with a median estimated glomerular filtration rate (eGFR) of 27 (IQR 11–41), decreasing to 20 ml/min/1.73 m2 (IQR 13.3–43) at the time of biopsy. Patients with either a pre-biopsy eGFR < 35 ml/min/1.73 m2 or a ≥ 25% fall in eGFR between admission and biopsy were more likely to have glomerular crescents (P=0.004). Pre-biopsy eGFR was identified as the most accurate predictor of glomerular crescents through multivariate regression analysis and receiver operating curve analysis (P=0.047, ROC 0.757). No significant predictors were found for nephrotic proteinuria of nephrotic syndrome during the acute phase.
They concluded that falling eGFR in severe childhood kidney disease suggests urgent biopsy for better diagnosis and care.
Source: link.springer.com/article/10.1007/s00467-023-06249-6
