Prognosis of acute post-streptococcal glomerulonephritis in Sudanese children.

INTRODUCTION: Acute post streptococcal glomerulo-nephritis (APSGN) is a form of acute nephritic syndrome characterized by edema, hematuria, proteinuria, and hypertension. The immediate prognosis of acute post-streptococcal glomerulonephritis in children is usually excellent, however, the long-term prognosis has been a subject of debate.

METHODS: This is a retrospective and prospective cohort study of Sudanese children with APSGN followed in a tertiary care hospital between 2006 and 2010. Patients who presented for follow-up 1-5 years after initial diagnosis were assessed for proteinuria, hematuria, urinary albumin to creatinine ratio (ACR), hypertension, and glomerular filtration rate (GFR).

RESULTS: Data of 69 children (46 males; 66.7%) was analyzed. At presentation, 29% had severe acute disease requiring dialysis. On discharge, 60 children (87%) recovered their renal function, seven children (10.1%) showed no recovery and two children (2.9%) died. Forty out of 69 children presented to follow-up 1-5 years after initial diagnosis. Thirty-four of these children (85%) had normal blood pressure and GFR while six children (15%) progressed to chronic kidney disease (CKD); three of whom died. Among children with normal GFR, eight (23.5%) had microalbuminuria plus hematuria and four (11.7%) had hematuria. Persistence of proteinuria and/or hematuria was universal among the 14 children with normal GFR who continued follow-up more than three years after initial presentation.

CONCLUSION: APSGN in this group of Sudanese children had a less favorable prognosis. This reflects the tertiary care set-up of this study. Persistence of hematuria and/or proteinuria was common on follow-up.