背景:急性链球菌后肾小球肾炎(APSGN)是全球儿童急性肾炎的最常见原因,在某些情况下,可能与进行性肾损伤和衰竭有关,累积在需要长期透析和/或肾移植。
方法:我们的回顾性研究描述了在开普敦三级儿童医院住院的儿童(<14岁)中发生APSGN的情况。南非,2015年1月至2020年12月。
结果:161名患有急性肾炎的儿童(血尿,水肿,少尿,和高血压),100人符合纳入标准。人口统计,临床特征,实验室发现,管理,并收集结果数据。APSGN由急性肾炎的至少两种临床体征的临床表现定义。和低血清补体3(C3)水平或近期链球菌感染的证据。大多数APSGN病例与链球菌皮肤感染有关:55/100(55%);10/100(10%)儿童出现高血压性癫痫发作;86/92(93.5%)儿童的C3水平较低;94/94(100%)儿童的抗脱氧核糖核酸酶B(抗DNase-B)水平升高;80/94(85%)的抗链球菌表达(AStolysO)升高。11例(11%)儿童进行了经皮肾活检;4/11(36%)显示感染后肾炎的组织学特征,7/11(64%)还患有新月体肾小球肾炎,并伴有免疫复合物沉积。62名(62%)儿童确认康复,5人(5%)进展为肾衰竭,但29人被推定为康复,因为他们没有返回我们的机构接受后续行动。
结论:儿童APSGN在南非(SA)仍然是一个重要的健康问题,在大多数情况下,除了那些进展为肾衰竭的新月体肾小球肾炎。更高分辨率版本的图形摘要可作为补充信息。
BACKGROUND: Acute post-streptococcal
glomerulonephritis (APSGN) is the most common cause of acute nephritis in children globally and, in some cases, may be associated with progressive kidney injury and failure, cumulating in the need for long-term dialysis and/or kidney transplantation.
METHODS: Our retrospective study describes the occurrence of APSGN among children (< 14 years) admitted to a tertiary children\'s hospital in Cape Town, South Africa, from January 2015 to December 2020.
RESULTS: Of 161 children who presented with acute nephritis (haematuria, oedema, oliguria, and hypertension), 100 met the inclusion criteria. Demographic, clinical features, laboratory findings, management, and outcome data were collected. APSGN was defined by the clinical presentation of at least two clinical signs of acute nephritis, and low serum complement 3 (C3) level or evidence of a recent streptococcal infection. Most cases of APSGN were associated with streptococcal skin infections: 55/100 (55%); 10/100 (10%) children presented with hypertensive seizures; C3 levels were low in 86/92 (93.5%) children; 94/94 (100%) children had elevated anti-deoxyribonuclease-B (anti-DNase-B) levels; and 80/94 (85%) also had elevated anti-streptolysin O titre (ASOT) at presentation. Eleven (11%) children had a percutaneous kidney biopsy; 4/11 (36%) showed histological features of post-infectious nephritis, and 7/11(64%) also had crescentic
glomerulonephritis with immune complex deposits. Sixty-two (62%) children confirmed recovered, and five (5%) progressed to kidney failure, but 29 presumed recovered as they did not return for follow-up to our institution.
CONCLUSIONS: Childhood APSGN remains an important health problem in South Africa (SA) with favourable outcomes in most, apart from those with crescentic
glomerulonephritis who progressed to kidney failure.