# Acute Post-streptococcal Glomerulonephritis in Children: A Moroccan Experience

## TL;DR

This study examines the characteristics and outcomes of children hospitalized with acute post-streptococcal glomerulonephritis in Morocco, highlighting common symptoms and treatment approaches.

## Contribution

The study provides a detailed analysis of APSGN in Moroccan children, emphasizing local clinical patterns and outcomes.

## Key findings

- Hematuria and hypertension were the most common presenting features in children with APSGN.
- Most patients had reduced C3 levels and elevated antistreptolysin O titers.
- The overall outcome was favorable, but one child developed chronic kidney disease.

## Abstract

Background: Acute post‐streptococcal glomerulonephritis (APSGN) is the most prevalent form of glomerulonephritis in children. It is caused by an immune‐mediated glomerular injury, most commonly secondary to Group A β-hemolytic streptococcus. This study aims to describe the characteristics and outcomes of hospitalized children with APSGN.

Methods: This was a retrospective descriptive study of 83 pediatric patients (<15 years) admitted to the pediatric nephrology department in the Mohamed VI Hospital in Marrakech with APSGN between January 2019 and December 2023, with a follow-up of one year. Children with acute glomerulonephritis not related to APSGN were excluded.

Results: The mean age was 8.34 ± 3.58, and 69.9% (n = 58) were male. Among the 83 APSGN patients, 17 (20.4%) progressed to rapidly progressive glomerulonephritis (RPGN). The most often given presentations were hematuria (90.3%, n=75), edema (77.1%, n=64), hypertension (66.3%, n=55), and oliguria (12%, n=10). 15.6% (n=13) of the patients had an acute kidney injury (AKI). Nephrotic syndrome was found in 33.7% (n=28) of children, reduced C3 level in 84.3% (n=70), and elevated antistreptolysin O titer (ASOT) in 69.9% (n=58). Kidney biopsy was performed in 50.6% of children (n=42). 38.6% (n=32) of our patients required two anti‑hypertensives such as furosemide and nicardipine. Kidney replacement therapy was required for 6% (n=5) of patients, antibiotics for 36.1% (n=30), methylprednisolone pulses for 56.6% (n=47), and cyclophosphamide pulses for 20.4% (n=16). The outcome was favorable for all children, except for one girl with RPGN who developed a chronic kidney disease.

Conclusions: APSGN is still one of the most frequent causes of glomerulonephritis in Morocco. The main presenting features were hematuria and hypertension. Although the outcome of APSGN is good, sequential follow-up is necessary to detect long-term complications and prevent morbidity and mortality.