Factors Affecting Glomerular Filtration Rate and Length of Hospitalization in Pediatric Acute Poststreptococcal Glomerulonephritis: A Decade-Long Observational Study

Abstract

Introduction: Acute poststreptococcal glomerulonephritis (APSGN) remains a significant public health concern, especially in pediatric populations. This decadelong observational study aims to provide a comprehensive exploration of pediatric APSGN, emphasizing on factors those influencing glomerular filtration rate (GFR) and also contributing to prolonged hospitalization. Materials and Methods: The single-center, observational, retrospective study was conducted from January 2010 to December 2020 and included children aged 3-18 years diagnosed with APSGN. Diagnostic criteria included hematuria, decreased serum complement-3 levels, and evidence of recent streptococcal infection. Data extracted from medical records encompassed demographic details, clinical features, and a range of laboratory parameters. Results: Forty-four patients with APSGN were included (mean age: 8.65±3.31 years), 54.55% of whom were male. Hematuria was present in all cases (macroscopic hematuria in 77.27% of patients), edema in 63.64% of cases, and hypertension in 50.00% of cases. There was a negative correlation between inflammatory markers (C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio) and GFR (r: -0.511, r: -0.302, r: -0.380; p :< 0.05 respectively). Decreased GFR, albumin, and complement-3 levels (r: -0.361, r: -0.442, r: -0.315; p :< 0.05, respectively), and increased urine density and urinary protein excretion, correlated significantly with prolonged hospitalization r: 0.413, r: 0.362; p:< 0.05, respectively). Conclusion: Despite the generally favorable prognosis of pediatric APSGN, this study highlights the potential for severe complications. Elevated inflammatory markers signal severe renal involvement, while decreased GFR, albumin, and complement-3 levels, as well as increased urine density and protein excretion, lead to extended hospital stays. These findings may be used for anticipating patient outcomes and optimizing resource utilization in pediatric APSGN care.

Keywords

• acute post-streptococcal glomerulonephritis
• glomerular filtration rate
• hematuria
• nephritic syndrome
• pediatric nephrology