Clinical Manifestations and Outcomes of Acute Post-Streptococcal Glomerulonephritis in Hospitalized Children Under 12 Years at a Tertiary Care Hospital

Abstract

Background: Acute post-streptococcal glomerulonephritis (APSGN) is a common immune-mediated renal disease in children, often following throat or skin infections with nephritogenic strains of Group A β-haemolytic Streptococcus. While the condition is frequently self-limiting, severe cases can result in acute kidney injury (AKI) and long-term morbidity. Limited data exist on the clinical profile and outcomes of APSGN in children under 12 years in Pakistan. Objectives: To describe the clinical manifestations of APSGN in hospitalized children under 12 years and to evaluate their outcomes during hospital stay and at three-month follow-up. Methods: This cross-sectional study was conducted in the Pediatric Department of Bacha Khan Medical Complex, Swabi, Pakistan, over six months. A total of 110 children under 12 years with APSGN were included using consecutive sampling. Data on demographics, antecedent infections, clinical and laboratory features, management, and outcomes were collected prospectively. Descriptive statistics were used for frequencies and percentages, while Chi-square/Fisher’s exact test assessed associations with outcomes. A p-value ≤0.05 was considered statistically significant. Results: Among 110 patients, 56.4% were male, and 55.5% belonged to low socioeconomic backgrounds. A history of sore throat preceded illness in 72.7% of cases, while skin infection was noted in 17.3%. Common clinical features included edema (83.6%), hematuria (87.2%; gross 62.7%, microscopic 24.5%), hypertension (56.4%), proteinuria (63.6%), oliguria (31.8%), and AKI (14.5%). Treatment comprised supportive care (32.7%), diuretics (25.5%), antihypertensives (35.5%), and dialysis (6.4%). At discharge, 64.5% had recovered and 35.5% had residual renal abnormalities. At three months, 91.8% achieved complete recovery, while 8.2% showed persistent abnormalities. AKI (p=0.00) and dialysis requirement (p=0.034) were significantly associated with poor outcomes. Conclusion: APSGN in children under 12 years was more common in males and those from low socioeconomic backgrounds, predominantly following sore throat infections. Most children achieved full recovery within three months; however, AKI and dialysis were predictors of adverse outcomes. Early recognition and close follow-up of high-risk patients remain essential for improving long-term prognosis.