C CHONG 1, T HUNG 1, A HOHLS 1, J FRANCIS 1,2, S CHATURVEDI S1,2
1Royal Darwin Hospital, Darwin, Australia, 2Menzies School of Health Research, Darwin, Australia
Aim: To describe clinical characteristics and outcome of hospitalized children with Acute post-streptococcal glomerulonephritis (APSGN) at a tertiary hospital in the Northern Territory.
Background:APSGN is an inflammatory disease of the kidneys which occurs 2-3 weeks after skin or throat infection with nephrogenic strains of Group A streptococcus. Despite the declining incidence of APSGN in Australia, there is still a significant burden of disease amongst Indigenous population in the Northern Territory. Childhood APSGN has been highlighted as a predictor of chronic kidney disease amongst Indigenous Australians.
Methods:We performed a retrospective descriptive analysis of paediatric patients (<18 years) with APSGN admitted to the Royal Darwin Hospital between 2012 and 2017. Cases were confirmed using the Centre of Disease Control case definition guidelines. Data were extracted from the case notes and electronic medical records.
Results: There were 96 cases of APSGN with median age 7.8 years (range 1.4-17.4 years) and males constituting 51%. Majority were Indigenous children (90.6%). Preceding skin infections were identified in 65.5% and sore throat in 27.1% cases. Complications included hypertension (78.1%), acute kidney injury (43.8%), hyperkalemia (18.8%) and hypertensive encephalopathy (16.7%). Most children required at least two anti-hypertensives (61.5%). The median hospital stay was 7 days (inter-quartile range 4-11). At discharge, three quarters (76%) were normotensive but had ongoing proteinuria (31.3%) and haematuria (96.9%). Only 58 (60.4%) of the children had documentation follow-up within a year of their admission.
Conclusions: Our study confirms that APSGN disproportionately affects Indigenous children and highlights the need for continued and improved public health response. Furthermore, there is room for significant improvement in medium and long term follow up of affected children.
Connie Chong is an Advanced trainee in General Paediatrics and Adolescent Medicine. She is passionate about rural and remote medicine, and working with vulnerable populations with difficult access to care. Her interest in post-infectious glomerulonephritis arose from experiences working in Darwin and South Sudan between 2018-2020. She is currently working as an Adolescent Fellow at the Royal Children’s Hospital, Melbourne.