CLINICAL PROFILE AND IMMEDIATE OUTCOME OF ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN CHILDREN: A HOSPITAL-BASED STUDY

BACKGROUND Post-Infective Glomerulonephritis (PIGN) is the most common type of acute glomerulonephritis, resulting from immunological events triggered by many infective agents. MATERIALS AND METHODS All the children admitted with the diagnosis of Acute Post-Infectious Glomerulonephritis (APIGN) or Acute Post-Streptococcal Glomerulonephritis (APSGN) in last three years were included in this retrospective study. Case records were analysed to obtain data on clinical characteristics, laboratory parameters, immediate outcome and treatment received and descriptive analysis was done. RESULTS Out of 70 children with PIGN, 64 (91.4%) were from a residential tribal school; 49 (78.6%) had history of pyoderma. Facial puffiness, oliguria, pedal oedema and gross haematuria were found in 97.1%, 97.1%, 94.3% and 25.7% cases respectively. Severe hypertension was seen in 71.4% cases. Low serum C3, Anti-Streptolysin O (ASO) titer positivity and nephrotic-range proteinuria were seen in 98.6%, 78.1% and 7.1% cases respectively. The complications were hypertensive encephalopathy, acute left ventricular failure and accelerated hypertension in 7.1%, 4.3% and 1.4% cases respectively. Associated conditions included Urinary Tract Infection (UTI), throat infection by other bacteria, malaria, dengue, mumps, measles, pneumonia, cervical lymphadenitis, chronic suppurative otitis media (CSOM) and inguinal abscess; 17.1% cases needed intensive care. Convulsions (X-2 = 16.811, P = 0.000) and respiratory distress (X-2 = 22.655, P = 0.000) in the child were significantly associated with PICU admission, whereas total leukocyte count (P = 0.042) and diastolic pressure (P = 0.025) were significantly high among them. None had residual renal injury; 4 (5.7%) patients had persistent hypertension at discharge, which normalised in 2 weeks. CONCLUSION Post-Infective Glomerulonephritis (PIGN) with its varied presentation and complications is still a major cause of morbidity in children of developing countries like India.