Dhakal Ajaya Kumar, Shrestha Devendra, Kc Divya, Yadav Shankar Prasad
Department of Paediatrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal.
Department of Paediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
BMC Nephrol. 2025 Mar 21;26(1):142. doi: 10.1186/s12882-025-04073-8.
Acute post-streptococcal glomerulonephritis (APSGN) is the primary cause of acute glomerulonephritis in children in Nepal and contributes significantly to paediatric hospitalisations in the country. This review discusses the current status of streptococcal infections, epidemiological trends, and the challenges in diagnosing and managing APSGN in Nepalese children. This study aimed to develop local data on acute post-streptococcal glomerulonephritis to help compare epidemiological trends and patterns with regions where this disease is less prevalent.
A targeted literature review was conducted in PubMed, Google Scholar, and Nepal Journals Online (a local database) to identify relevant literature published between 1 January 2000 and 31 December 2024. Additional searches of conference abstracts and reviews were performed using Google. The collected literature was analysed to determine the kidney disease patterns, current status of Group A Streptococcal infection, epidemiological trends, clinical manifestations, management, and outcomes of APSGN in Nepali children aged < 16 years.
Thirty-four articles were selected for in-depth review. A synthesis of local hospital studies revealed significant differences in the application of diagnostic criteria for APSGN owing to the inaccessibility of serological tests and complement testing. Children over five years of age, particularly those aged 8 to 11 years and predominantly male, were more severely affected. The disease was present year-round, with pyoderma identified as the main route of preceding streptococcal infection rather than throat infection, particularly affecting economically disadvantaged children. The classical manifestations were oedema, hypertension, gross haematuria, and oliguria, whereas complications included acute kidney injury, rapidly progressive glomerulonephritis, hypertensive emergency, congestive cardiac failure, and the need for kidney replacement therapy. The anti-streptolysin O titre was positive in 34-72.7% of patients, while complement C3 levels were depressed in 61.9-100% of cases. Urinalysis showed haematuria in 67-100% of patients and pyuria in 7.9-37%. Kidney ultrasonography indicated increased echogenicity in 37-78% of the cases. Most patients were managed conservatively with diuretics and anti-hypertensives. Atypical cases and those with a progressive disease course were further managed with steroids, kidney biopsies, or kidney replacement therapy. Most patients exhibited favourable short-term kidney outcomes. There was low mortality among patients with rapidly progressive glomerulonephritis and those who required kidney replacement therapy.
This review highlights that acute post-streptococcal glomerulonephritis remains a common cause of hospitalisation in Nepal. It remains a diagnostic difficulty owing to the inaccessibility of serological and complement tests. The disease has distinct clinical manifestations, demographic patterns, histological findings and outcomes in Nepali children.
急性链球菌感染后肾小球肾炎（APSGN）是尼泊尔儿童急性肾小球肾炎的主要病因，在该国儿童住院病例中占很大比例。本综述讨论了尼泊尔儿童链球菌感染的现状、流行病学趋势以及APSGN诊断和管理面临的挑战。本研究旨在收集有关急性链球菌感染后肾小球肾炎的本地数据，以帮助与该病发病率较低地区比较流行病学趋势和模式。
在PubMed、谷歌学术和尼泊尔在线期刊（一个本地数据库）上进行了针对性的文献综述，以识别2000年1月1日至2024年12月31日期间发表的相关文献。还使用谷歌对会议摘要和综述进行了额外搜索。对收集到的文献进行分析，以确定16岁以下尼泊尔儿童的肾脏疾病模式、A组链球菌感染现状、流行病学趋势、临床表现、管理和APSGN的结局。
34篇文章被选作深入综述。综合本地医院研究发现，由于血清学检测和补体检测难以获得，APSGN诊断标准的应用存在显著差异。五岁以上儿童，尤其是8至11岁且以男性为主的儿童受影响更严重。该病全年都有发生，脓疱病被确定为先前链球菌感染的主要途径，而非咽喉感染，尤其影响经济条件较差的儿童。典型表现为水肿、高血压、肉眼血尿和少尿，而并发症包括急性肾损伤、快速进展性肾小球肾炎、高血压急症、充血性心力衰竭以及需要肾脏替代治疗。34%至72.7%的患者抗链球菌溶血素O滴度呈阳性，61.9%至100%的病例补体C3水平降低。尿液分析显示67%至100%的患者有血尿，7.9%至37%的患者有脓尿。肾脏超声检查显示37%至78%的病例回声增强。大多数患者采用利尿剂和抗高血压药物进行保守治疗。非典型病例和病情进展的病例进一步采用类固醇、肾脏活检或肾脏替代治疗。大多数患者短期肾脏结局良好。快速进展性肾小球肾炎患者和需要肾脏替代治疗的患者死亡率较低。
本综述强调，急性链球菌感染后肾小球肾炎仍是尼泊尔住院的常见原因。由于血清学和补体检测难以获得，其诊断仍然存在困难。该病在尼泊尔儿童中具有独特的临床表现、人口统计学模式、组织学发现和结局。
