Enhancing Patient Care: Insights on Acute Post-Streptococcal Glomerulonephritis

Background and Epidemiology of Acute Post-Streptococcal Glomerulonephritis

Acute post-streptococcal glomerulonephritis (APSGN) is a significant public health concern, particularly in developing countries like Nepal. It is primarily caused by infections with Group A beta-hemolytic Streptococcus (GABHS), which can originate from skin infections (pyoderma) or throat infections (pharyngitis). The incidence rates of APSGN vary widely, with studies indicating that it accounts for a substantial proportion of hospitalizations due to acute glomerulonephritis (AGN) in children, particularly in socioeconomically disadvantaged regions where access to healthcare is limited.

In Nepal, the prevalence of APSGN is exacerbated by environmental factors, including poor sanitation and overcrowding, which contribute to the continued transmission of streptococcal infections. Literature indicates that the disease is more prevalent among male children aged 5 to 12 years, with seasonal variations showing increased incidence during the monsoon and winter months. Additionally, studies have shown that the anti-streptolysin O (ASO) titer is positive in a significant percentage of cases, indicating a recent streptococcal infection, which serves as a crucial diagnostic marker (Dhakal et al., 2025).

Clinical Manifestations and Diagnostic Challenges in Nepali Children

The clinical manifestations of APSGN in children typically include edema, hypertension, hematuria, and oliguria. Complications can range from acute kidney injury to hypertensive emergencies and, in severe cases, the need for kidney replacement therapy. Diagnosing APSGN in Nepali children poses several challenges, primarily due to the inaccessibility of serological tests and complement testing in many healthcare facilities.

Most children are diagnosed based on clinical signs and symptoms, often without laboratory confirmation. For instance, urinalysis typically reveals hematuria in a high percentage of patients, while a significant number show elevated ASO titers. However, the lack of resources often leads to misdiagnosis or underdiagnosis of the condition, since milder cases may not present at tertiary care facilities, leading to a gap in epidemiological data.

Table 1: Common Clinical Features of APSGN in Nepali Children

Current Management Strategies for APSGN in Pediatric Patients

Management of APSGN in children typically involves conservative treatment focused on symptomatic relief and monitoring. Most patients receive diuretics to manage edema and antihypertensive medications to control blood pressure. In more severe cases, particularly those with rapidly progressive glomerulonephritis, corticosteroids or immunosuppressive therapy may be required.

The treatment strategies reflect a conservative approach, with an emphasis on supportive care rather than aggressive intervention. Most patients exhibit favorable short-term outcomes, with a significant percentage recovering completely. However, the inconsistency in treatment practices and access to healthcare resources leads to varying outcomes across different regions.

Table 2: Treatment Modalities for APSGN in Nepali Children

Epidemiological Trends and Socioeconomic Impact on APSGN

The socioeconomic factors significantly impact the epidemiological trends of APSGN in Nepal. Children from low-income families are disproportionately affected due to limited access to healthcare services and poor living conditions. The disease is primarily prevalent in rural areas, where healthcare infrastructure is often lacking.

Epidemiological data have shown that the incidence of APSGN has fluctuated over the years, with recent reports indicating a gradual decline in hospitalizations due to improved healthcare access and public health interventions. Nevertheless, the burden of disease remains high, necessitating ongoing public health initiatives to reduce the incidence of streptococcal infections.

Table 3: Socioeconomic Distribution of APSGN Cases in Nepal

Recommendations for Future Research and Public Health Initiatives

To enhance the management and understanding of APSGN, it is crucial to implement standardized diagnostic and treatment protocols across healthcare facilities in Nepal. This includes improving access to diagnostic tests such as ASO titers and complement levels, as well as ensuring that healthcare providers are trained in recognizing the clinical manifestations of APSGN.

Further research is needed to document the incidence of subclinical cases and to investigate the long-term outcomes of children diagnosed with APSGN. Establishing a national registry for kidney diseases could facilitate better data collection and epidemiological research, ultimately leading to improved patient care and outcomes.

FAQ

What is Acute Post-Streptococcal Glomerulonephritis (APSGN)? APSGN is a type of kidney inflammation that occurs after an infection with Group A streptococcus bacteria, commonly following skin or throat infections.

How is APSGN diagnosed? Diagnosis is primarily based on clinical symptoms such as edema and hematuria, along with supportive laboratory tests like ASO titers and urinalysis.

What are the common treatments for APSGN? Treatment usually involves diuretics for edema, antihypertensive medications for high blood pressure, and in some cases, corticosteroids.

Why is APSGN more prevalent in certain populations? The incidence of APSGN is higher in regions with poor sanitation and overcrowding, particularly among socioeconomically disadvantaged children.

What are the long-term outcomes for children with APSGN? Most children experience favorable outcomes with proper management, although some may develop complications such as chronic kidney disease.

References

1. Dhakal, A. K., Shrestha, D., K.C., D., Yadav, S. P. (2025). A narrative review of acute post-streptococcal glomerulonephritis in Nepali children. BMC Nephrology, 26(1), 40. doi:10.1186/s12882-025-04073-8
2. Bhatta, N. K., Shrestha, P., Budhathoki, S., Kalakheti, B. K., Poudel, P., & Sinha, A. (2008). Profile of renal diseases in Nepalese children. Kathmandu University Medical Journal, 6(2), 191–194. doi:10.5542/kuhm.6.2.191
3. Yadav, S. P., Shah, G. S. (2016). Pattern of renal diseases in children: A developing country experience. Saudi Journal of Kidney Diseases and Transplantation, 27(2), 371-376. doi:10.4103/1319-2442.178565
4. Malla, K., Sarma, M. S., Malla, T., Thaplial, A. (2008). Varied presentations of acute glomerulonephritis in children: single centre experience from a developing country. Sultan Qaboos University Medical Journal, 8(2), 193-199. doi:10.18295/squmj.2008.8.2.004
5. Adhikari, S., Sitaula, D., Regmi, S., Parajuli, B., Poudel, S. (2022). Acute glomerulonephritis in children: A hospital-based study in a tertiary care centre in Nepal. J Chitwan Med College, 12(1), 9-12. doi:10.54530/jcmc.548