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. 2022 Jun 30;7(9):2029-2038.
doi: 10.1016/j.ekir.2022.06.011. eCollection 2022 Sep.

Twenty-year Follow-up of Patients With Epidemic Glomerulonephritis due to Streptococcus zooepidemicus in Brazil

Sergio Wyton Pinto  1 , Helbert do Nascimento Lima  2 , Thalles Trindade de Abreu  1 , Alba Otoni  3 , Paulo Cesar Koch Nogueira  4 , Ricardo Sesso  5
Affiliations

Twenty-year Follow-up of Patients With Epidemic Glomerulonephritis due to Streptococcus zooepidemicus in Brazil

Sergio Wyton Pinto et al. Kidney Int Rep. .

Abstract

Introduction: Post-streptococcal glomerulonephritis (PSGN) has a good prognosis in children, but few studies have evaluated the long-term renal outcomes in adults with PSGN.

Methods: In a follow-up study, 47 predominantly adult patients with PSGN due to group C Streptococcus zooepidemicus were reassessed 20 years after an outbreak in Nova Serrana, Brazil. We evaluated clinical characteristics, renal outcomes, and the trajectory of the estimated glomerular filtration rate (eGFR) by the creatinine-based chronic kidney disease-epidemiology collaboration equation from 5 follow-up assessments. Logistic regression and mixed-effects regression were used in the analysis.

Results: After 20 years, the participants' mean age was 56.6±15.1 years. Thirty-four (72%) patients had hypertension, 21 (44.7%) had eGFR <60 ml/min per 1.73 m2, 8 of 43 (18.6%) had urine protein-to-creatinine ratio >150 mg/g, and 25 (53%) had CKD (low eGFR and/or increased proteinuria). Increasing age was associated with CKD (odds ratio: 1.07; 95% confidence interval [CI]: 1.02-1.13; P = 0.011) in multivariate analysis. The mean eGFR decline in the last 11 years of follow-up was -3.2 ml/min per 1.73 m2 per year (95% CI: -3.7 to -2.7). Older age at baseline (coefficient -1.05 ml/min per 1.73 m2 per year; 95% CI -1.28 to -0.81; P < 0.001), and hypertension 5 years after the outbreak (coefficient -7.78 ml/min/1.73 m2; 95% CI -14.67 to -0.78; P = 0.027) were associated with lower eGFR during the whole study period.

Conclusion: There was a marked worsening of renal function and a high prevalence of CKD and hypertension after 20 years of PSGN outbreak. Long-term follow-up is warranted after PSGN, especially among older patients.

Keywords: Streptococcus zooepidemicus; acute nephritis; epidemic nephritis; follow-up; post-streptococcal glomerulonephritis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flow chart of the study population during the follow-up.
Figure 2
Figure 2
Estimated glomerular filtration rate at follow-up visits in post-streptococcal glomerulonephritis patients during 20-year follow-up using mixed-effects regression analysis. eGFR, estimated glomerular filteration rate. Values are mean and 95% CI. Predicted mean eGFR and number of patients (in parenthesis) at each visit: 59 ml/min per 1.73 m2 (n = 47), 89 ml/min per 1.73 m2 (n = 36), 85 ml/min per 1.73 m2 (n = 30), 101 ml/min per 1.73 m2 (n = 46), and 65 ml/min per 1.73m2 (n = 47) in 1998, 2000, 2003, 2008, and 2019, respectively.
Figure 3
Figure 3
Estimated glomerular filtration rate at follow-up visits by baseline age tertile in post-streptococcal glomerulonephritis patients during 20-year follow-up using mixed-effects regression analysis. Values are mean and 95% CI. Age tertile 1: 11 to 27.9 years; age tertile 2: 28 to 39.9 years; age tertile 3: 40 to 70.9 years.
Figure 4
Figure 4
Estimated glomerular filtration rate at follow-up visits by hypertension classification in post-streptococcal glomerulonephritis patients during 20-year follow-up using mixed-effects regression analysis. Values are mean and 95% CI. The presence of hypertension was ascertained at the 2003 visit.
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References

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