A narrative review of acute post-streptococcal glomerulonephritis in Nepali children

BACKGROUND

Acute post-streptococcal glomerulonephritis (APSGN) is the primary cause of acute glomerulonephritis in children in Nepal and contributes significantly to paediatric hospitalisations in the country. This review discusses the current status of streptococcal infections, epidemiological trends, and the challenges in diagnosing and managing APSGN in Nepalese children. This study aimed to develop local data on acute post-streptococcal glomerulonephritis to help compare epidemiological trends and patterns with regions where this disease is less prevalent.

METHODS

A targeted literature review was conducted in PubMed, Google Scholar, and Nepal Journals Online (a local database) to identify relevant literature published between 1 January 2000 and 31 December 2024. Additional searches of conference abstracts and reviews were performed using Google. The collected literature was analysed to determine the kidney disease patterns, current status of Group A Streptococcal infection, epidemiological trends, clinical manifestations, management, and outcomes of APSGN in Nepali children aged < 16 years.

RESULTS

Thirty-four articles were selected for in-depth review. A synthesis of local hospital studies revealed significant differences in the application of diagnostic criteria for APSGN owing to the inaccessibility of serological tests and complement testing. Children over five years of age, particularly those aged 8 to 11 years and predominantly male, were more severely affected. The disease was present year-round, with pyoderma identified as the main route of preceding streptococcal infection rather than throat infection, particularly affecting economically disadvantaged children. The classical manifestations were oedema, hypertension, gross haematuria, and oliguria, whereas complications included acute kidney injury, rapidly progressive glomerulonephritis, hypertensive emergency, congestive cardiac failure, and the need for kidney replacement therapy. The anti-streptolysin O titre was positive in 34-72.7% of patients, while complement C3 levels were depressed in 61.9-100% of cases. Urinalysis showed haematuria in 67-100% of patients and pyuria in 7.9-37%. Kidney ultrasonography indicated increased echogenicity in 37-78% of the cases. Most patients were managed conservatively with diuretics and anti-hypertensives. Atypical cases and those with a progressive disease course were further managed with steroids, kidney biopsies, or kidney replacement therapy. Most patients exhibited favourable short-term kidney outcomes. There was low mortality among patients with rapidly progressive glomerulonephritis and those who required kidney replacement therapy.

CONCLUSIONS

This review highlights that acute post-streptococcal glomerulonephritis remains a common cause of hospitalisation in Nepal. It remains a diagnostic difficulty owing to the inaccessibility of serological and complement tests. The disease has distinct clinical manifestations, demographic patterns, histological findings and outcomes in Nepali children.