Post-streptococcal glomerulonephritis in Sydney: A 16-year retrospective review

Authors

  • Christopher C Blyth,

    Corresponding author
    1. Department of Immunology and Infectious Diseases and
    2. School of Women’s and Children’s Health, University of New South Wales, Kensington, New South Wales, Australia
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  • Peter W Robertson,

    1. Department of Microbiology, South-Eastern Area Laboratory Service, Prince of Wales Hospital, Randwick and
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  • Andrew R Rosenberg

    1. Nephrology, Sydney Children’s Hospital,
    2. School of Women’s and Children’s Health, University of New South Wales, Kensington, New South Wales, Australia
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Dr Christopher Blyth, Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia. Fax: + 61 2 9382 1580; email: christopher.blyth@sesiahs.health.nsw.gov.au

Abstract

Aim:  Post-streptococcal glomerulonephritis (PSGN) is a frequent cause of acute nephritis in children. Numerous studies have described PSGN in high-risk populations yet few data describing PSGN in a low-incidence population exist. This study aimed to describe the epidemiology, clinical manifestations, diagnosis, complications and outcomes of PSGN in an urban Australian population.

Methods:  A 16-year retrospective review of case notes and laboratory data was conducted at a tertiary Sydney paediatric hospital.

Results:  Thirty-seven children were treated for PSGN with a mean age of 8.1 years (range 2.6–14.1 years). Twenty-eight subjects (75.7%) had a history of a recent upper respiratory tract or skin infection. Hypertension and/or oedema was present in 29 subjects (78.4%). Streptococcal pharyngitis was identified as the likely source in 17 subjects (45.9%). Skin infections occurred less frequently. Antibodies against streptolysin O, streptokinase or deoxyribonuclease B were elevated when a single titre was measured in 35 subjects (94.6%). Thirty subjects (81.1%) developed renal impairment (median peak creatinine, 95 µmol/L, range 39–880 µmol/L). No correlation was demonstrated between peak creatinine, age, ethnicity, streptococcal titres and serum complement levels. The mean length of admission was 8.2 days. Seven subjects (18.9%) had a complicated course with three subjects requiring dialysis. Only one subject has ongoing renal dysfunction.

Conclusion:  Significant differences are seen in a low-incidence urban Australian population with PSGN when compared with endemic or epidemic disease in high-risk populations. The higher rates of complications that were seen compared with previously studied populations need further clarification.

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