Acute Glomerulonephritis in Southern Iran

Acute post streptococcal glomerulonephritis (APSGN) is the most common type of in-patient glomerulonephritis (GN) in childhood. It has not been studied well in this region yet. Here, we report our experience with APSGN in a tertiary referral center during a five-year period. Hospital records of all 137 children who had been admitted to Nemazee hospital, between 2001 and 2006, with diagnosis of acute glomerulonephritis (AGN) were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 137 children diagnosed as AGN, 122 (89%) had APSGN. Other 15 (11%) children had membranoproliferative glomerulonephritis (n=4), mesangioproliferative glomerulonephritis (n=4), IgA nephropathy (n=2), lupus nephritis (n=2), rapidly progressive glomerulonephritis (n=2), and focal segmental glomerulosclerosis (n=1). Mean (SD) age in children with APSGN was 8.5 (3.5) (range, 3.5-13) years, 117 (96%) children developed APSGN following a sore throat and 5 (4%) following an impetigo, with 95 (78%) during the cold seasons of the year. Periorbital edema was found in 97.5%, hypertension 75%, gross hematuria 72%, oliguria 37%, generalized edema 19%, azotemia (BUN>20) 80%, and nephrotic-range proteinuria 24.5%. A high anti streptolysin-O (ASO) titer and a low C3 level was detected in 84% and 86%, respectively. There was dilutional anemia in 51.5%, hyponatremia in 27%, and hyperkalemia 14%. With regard to medications, 19 patients received only furosemide, 73 cases furosemide and nifidipine, and 10 patients furosemide, nifidipine, and another antihypertensive medication. Hypertensive encephalopathy occurred in 3 cases, but no mortality was reported during the study period. APSGN is the most common type of glomerulonephritis in this region. It follows sore throat in the majority of cases. It usually has an uneventful course.