title: Clinical Characteristics and Outcome of Post-Infectious Glomerulonephritis in Children in Southern India: A Prospective Study.
abstract: OBJECTIVE
  To evaluate the clinical characteristics, complications and outcome of post-infectious glomerulonephritis (PIGN).
  
  
  METHODS
  This prospective observational study was conducted from January 2013 through July 2014 at a tertiary care hospital in south India. Post-streptococcal glomerulonephritis (PSGN) was diagnosed in the presence of: a) Hematuria and proteinuria b) Clinico-serological evidence of recent streptococcal infection [recent pyodermas or pharyngitis; positive antistreptolysin-O (ASO) titres, anti-DNAse B titres or throat swab positivity for Group A streptococcus], and c) Low serum C3 levels, with normalization on 8 wk follow up. PIGN included PSGN and other infectious etiologies. AKI was classified as per Acute Kidney Injury Network (AKIN) criteria. Clinical features, biochemical and serological investigations in the study subjects were recorded.
  
  
  RESULTS
  Among 83 children with acute nephritic syndrome (ANS) recruited, 72 (86.7 %) had PIGN. PSGN was the most common etiology [65(90.3 %)] among the PIGN cases. Pyodermas, upper respiratory infections and varicella preceded hematuria in 58 (80.6 %), 4 (5.6 %) and 2 (2.8 %) cases respectively. Pneumonia, mumps and liver abscess caused PIGN in 7 (9.7 %) cases. Complications included AKI in 15 (20.8 %), hypertensive emergency in 14 (19.4 %), cardiac failure in 8 (11.1 %), encephalopathy in 3 (4.2 %) cases and retinopathy in 1 (1.4 %) case. Among the AKI patients, 3(20 %) were in AKI stage 3, while 1 child required hemodialysis. Twenty three cases (31.9 %) had evidence of residual renal injury at discharge. Renal biopsy showed diffuse proliferative glomerulonephritis in 4 and crescentic glomerulonephritis in one case of PIGN. At 6 mo follow up, one patient continued to have microalbuminuria.
  
  
  CONCLUSIONS
  PIGN (including PSGN) remains a significant contributor to morbidity in children with ANS. The study is notable for high incidence of hypertensive emergency and AKI, that often required intensive care management.
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
authors.forename: Kuralvanan
authors.initials: K
authors.lastname: Gunasekaran
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India. drsriramk@yahoo.com.
authors.forename: Sriram
authors.initials: S
authors.lastname: Krishnamurthy
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Mahadevan
authors.affiliation: Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Harish
authors.affiliation: Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Ajith Prabhu
authors.initials: AP
authors.lastname: Kumar
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000382:microbiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000382:microbiology; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D007194:India; D007223:Infant; D007668:Kidney / Q000473:pathology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D063128:Tertiary Health Care
keywords: Acute nephritic syndrome; Post infectious glomerulonephritis; Post streptococcal glomerulonephritis