title: Post-Infectious Glomerulonephritis in Pediatric Patients over Two Decades: Severity-Associated Features.
abstract: BACKGROUND
  The incidence of post-infectious glomerulonephritis (PIGN) has decreased over the last decades. As a result, recent epidemiological data from industrialized countries are scarce.
  
  
  OBJECTIVE
  To evaluate patterns of PIGN in children and detect possible predictors of disease severity.
  
  
  METHODS
  We collected clinical and laboratory data of patients with PIGN admitted to Schneider Children's Medical Center during 1994-2011. Diagnostic criteria included presence of hematuria with/without other features of nephritic syndrome along with hypocomplementemia and/or microbiological/serological evidence of streptococcal infection. Patients with other diseases (systemic lupus erythematosus, vasculitis, etc.) were excluded from the study.
  
  
  RESULTS
  A total of 125 patients with a mean age of 5.8 ± 3.3 years (range 1.5-17.6), of whom 16% were < 3 years, matched the study criteria. Presenting features included hypertension in 103 (82.4%) patients, azotemia in 87 (70.2%), fever in 49 (40/6), and elevated C-reactive protein in 75 (81.5%). Isolated macrohematuria was found in 21 (16%). Full-blown nephritic syndrome was diagnosed in 51 patients (41.1%) and 28 (22.9%) had nephritic syndrome with nephrotic-range proteinuria. Depressed C3 complement levels were associated with the presence of nephritic syndrome (OR 0.73, 95% CI 0.60-0.88, P = 0.001) as well as older age (OR 1.24, Cl 1.08-1.43, P = 0.001). At last follow-up (mean 42 months) all examined patients (100 of 125) had normal renal function, 6 had hypertension, and 1 had proteinuria.
  
  
  CONCLUSIONS
  PIGN remains an important cause of glomerular disease in children and may affect very young patients. Nephrotic-range proteinuria with hypoalbuminemia seems to be more frequent than previously reported. Hypocomplementemia is associated with a more severe disease course, namely, azotemia and nephritic syndrome.
authors.forename: Rona
authors.initials: R
authors.lastname: Dagan
authors.forename: Roxana
authors.initials: R
authors.lastname: Cleper
authors.forename: Miriam
authors.initials: M
authors.lastname: Davidovits
authors.forename: Levana
authors.initials: L
authors.lastname: Sinai-Trieman
authors.forename: Irit
authors.initials: I
authors.lastname: Krause
mesh_terms: D002648:Child; D002675:Child, Preschool; D003165:Complement System Proteins / Q000032:analysis; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D006801:Humans; D034141:Hypoalbuminemia / Q000175:diagnosis / Q000209:etiology; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012698:Serologic Tests; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis
chemical_list: D003165:Complement System Proteins