AsPNA Clinical Practice Guidelines for the management of infection-related glomerulonephritis

Abstract

Infection-related glomerulonephritis (IRGN) is the leading cause of acute glomerulonephritis (GN) in children worldwide, particularly in low- and middle-income countries. To provide evidence-based care, the Glomerular Disease Workgroup of the Asian Pediatric Nephrology Association (AsPNA) convened a panel of experts to develop recommendations on diagnosis, evaluation and management of pediatric IRGN. Following a comprehensive literature search, available evidence was graded using the AAP-GRADE approach, and recommendations finalized through Delphi consensus. The panel recommends diagnosing acute GN in children presenting with hematuria and proteinuria, if accompanied with edema, oliguria, or hypertension. Postinfectious GN is suspected in patients with acute GN with recent streptococcal or staphylococcal infection and transient hypocomplementemia. The evaluation includes urinalysis, kidney function tests, serum albumin, complement C3, blood counts and kidney ultrasonography. Kidney biopsy is required for patients with atypical features, nephrotic syndrome, persistently low C3 beyond 12 weeks, and/or rapidly progressive GN. Therapy is chiefly supportive, including fluid and salt restriction in patients with edema or hypertension, diuretics for volume overload, and calcium channel blockers for stage 2 hypertension. Patients with significant edema, severe hypertension, or acute kidney injury require inpatient monitoring. Patients with staphylococcus-associated GN infective endocarditis associated GN and shunt nephritis require therapy with antibiotics. Immunosuppressive therapy is suggested in patients with crescentic IRGN or rapidly progressive course. All patients with IRGN, particularly those with crescentic GN or rapidly progressive GN, require long-term monitoring of serum creatinine, urinalysis and blood pressure. These guidelines intend to provide a structured, evidence-informed approach for the management of patients with IRGN.