Acute post-streptococcal glomerulonephritis in children—treatment standard

Acute post-streptococcal glomerulonephritis (APSGN) is the leading cause of acute glomerulonephritis in children worldwide, owing to the high incidence of nephritogenic strains of group A beta-haemolytic streptococcal throat and skin infections. The incidence of APSGN is declining in developed countries because of better access to clean drinking water, enhanced sanitation and improved hygiene. However, it remains a public health problem and a significant cause of hospitalization in low- and middle-income countries. The pathogenesis of APSGN involves the activation of the alternate complement pathway mediated by immune complexes, resulting in glomerular inflammation and subsequent kidney injury. The disease characteristically presents with features of acute nephritic syndrome and occasionally with complications such as hypertensive emergencies, congestive cardiac failure, nephrotic syndrome, severe acute kidney injury and rapidly progressive glomerulonephritis. Preventing streptococcal throat and skin infections, early diagnosis and identification of complications and prompt initiation of treatment are the cornerstones of APSGN management and recovery. Treatment primarily consists of supportive care along with diuretics and antihypertensive therapy, while only a small number of patients require immunosuppressants or kidney replacement therapy. Kidney biopsies are seldom required to guide subsequent treatment, particularly in cases of diagnostic uncertainty, rapidly progressive glomerulonephritis or atypical disease progression. Most patients make a full recovery from the disease. However, persistent proteinuria, hypertension and progression to chronic kidney disease may require long-term monitoring. Here, we review current treatment standards and discuss novel developments in the pathophysiology, diagnosis, outcome prediction and management of APSGN in children.