Post-streptococcal glomerulonephritis in Sydney: a 16-year retrospective review.
OBJECTIVE
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 micromol/L, range 39-880 micromol/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.


CONCLUSIONS
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.
Blyth
Christopher C
CC
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia. christopher.blyth@sesiahs.health.nsw.gov.au
Robertson
Peter W
PW
Rosenberg
Andrew R
AR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D006417:Hematuria / Q000208:ethnology*; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000150:complications / Q000208:ethnology*; D013297:Streptococcus pyogenes