Home›Rheumatology› Hypertension and acute kidney dysfunction are common clinical manifestations in pediatric acute post-streptococcal glomerulonephritis
Hypertension and acute kidney dysfunction are common clinical manifestations in pediatric acute post-streptococcal glomerulonephritisCommon kidney complications for children after strep throat infections
Frontiers in MedicinePublished September 25, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Note that hypertension and acute kidney dysfunction are common in pediatric APSGN, but high heterogeneity limits generalizability.
This meta-analysis synthesized data from 18 studies involving 2,191 children to determine the prevalence of clinical manifestations in acute post-streptococcal glomerulonephritis (APSGN). The analysis identified several primary outcomes, including hypertension (65.0%), gross hematuria (47.5%), and study-defined acute kidney dysfunction (40.1%). Other findings included nephrotic-range proteinuria (35.9%) and severe complications (12.9%).
Secondary outcomes included renal replacement therapy (4.0%) and an exploratory RPGN/crescentic-lesion composite (12.9%). The authors noted that the estimates for renal replacement therapy and the exploratory RPGN composite were particularly sensitive to cohort selection. The study also noted that the RPGN/crescentic-lesion composite should not be interpreted as the prevalence of either condition separately.
Significant limitations include high between-study heterogeneity (I2, 82.2% to 97.7%) and potential small-study effects. Due to these factors, the authors state that results are not stable population-level frequencies applicable to all children with APSGN. Clinicians should maintain close monitoring of blood pressure, volume status, and kidney function during the acute phase of the disease.
When a child develops a strep throat infection, it can sometimes lead to a condition called acute post-streptococcal glomerulonephritis. This is a type of inflammation in the kidneys that can cause serious issues, such as high blood pressure and kidney dysfunction.
Researchers looked at data from 2,191 children across 18 different studies to see how often these complications occur. They found that about 65% of these children experienced high blood pressure, and nearly half had visible blood in their urine. About 40% of the children showed signs of acute kidney dysfunction, while roughly 13% faced more severe complications.
While these numbers help doctors understand what to expect, the researchers noted that the data varies quite a bit between different studies. Because of this variation, these percentages might not be exactly the same for every child. However, the findings highlight why doctors must closely monitor a child's blood pressure and kidney function during the active phase of the illness.
What this means for you:
Most children with this kidney condition after strep infections experience high blood pressure or kidney issues.
Common questions
How common is high blood pressure after a strep infection?
In the study of 2,164 children, about 65% experienced high blood pressure. This is a common finding for children with this specific kidney condition following a strep infection.
What are the risks to a child's kidneys after strep?
The study found that about 40.1% of children experienced acute kidney dysfunction. Additionally, about 12.9% of children faced more severe complications during the acute phase of the illness.
Is it common for children to need kidney replacement therapy?
The data shows that about 4% of the 1,465 children studied required renal replacement therapy. However, researchers noted that this specific number can vary depending on the group of patients being looked at.
Study Details
Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
ObjectiveTo systematically evaluate the proportions of major clinical manifestations and severe outcomes in children with acute post-streptococcal glomerulonephritis (APSGN).MethodsPubMed, Embase, Web of Science, the Cochrane Library, Scopus, and ClinicalTrials.gov were systematically searched for observational studies reporting clinical manifestations or outcomes of APSGN in children. Outcomes of interest included hypertension, gross hematuria, study-defined AKI/acute kidney dysfunction, nephrotic-range proteinuria, severe complications, an exploratory RPGN/crescentic-lesion composite (rapidly progressive glomerulonephritis and/or crescentic lesions), and renal replacement therapy (RRT). Random-effects single-proportion meta-analyses were performed to estimate pooled proportions and 95% confidence intervals (CIs). Robustness was assessed using heterogeneity and sensitivity analyses, with funnel plots and Egger's regression used to evaluate possible small-study effects.ResultsEighteen studies involving 2,191 children were included, predominantly from APSGN cohorts, with some studies using broader acute glomerulonephritis (AGN) or postinfectious glomerulonephritis (PIGN) definitions. Across these predominantly hospital-based cohorts, hypertension was the most commonly reported clinical manifestation, with a pooled proportion of 65.0% (17 studies, 2,164 children; 95% CI, 53.3%–79.2%). The pooled proportions of gross hematuria, study-defined AKI/acute kidney dysfunction, and nephrotic-range proteinuria were 47.5% (14 studies, 1,665 children; 95% CI, 34.0%–66.4%), 40.1% (18 studies, 2,173 children; 95% CI, 28.4%–56.7%), and 35.9% (11 studies, 887 children; 95% CI, 26.2%–49.0%), respectively. The pooled proportions of severe complications, the exploratory RPGN/crescentic-lesion composite, and RRT were 12.9% (16 studies, 1,722 children; 95% CI, 8.2%–20.3%), 12.9% (10 studies, 699 evaluable children; 95% CI, 4.1%–40.8%), and 4.0% (15 studies, 1,465 children; 95% CI, 1.4%–11.2%), respectively. The exploratory composite combined three clinically defined RPGN entries with seven crescentic-lesion entries and should not be interpreted as the prevalence of either clinical RPGN or crescentic glomerulonephritis separately. Significant between-study heterogeneity was observed for all outcomes (I2, 82.2%–97.7%). Sensitivity analyses generally supported the pooled estimates for common manifestations, whereas the RRT estimate and the exploratory RPGN/crescentic-lesion composite estimate were more sensitive to cohort selection. Funnel-plot asymmetry was observed across the evaluated outcomes and was interpreted cautiously as possible small-study effects rather than definitive publication bias.ConclusionHypertension, gross hematuria, study-defined AKI/acute kidney dysfunction, and nephrotic-range proteinuria were commonly reported across the predominantly hospital-based cohorts, whereas RRT and severe complications were reported less often. The heterogeneous exploratory RPGN/crescentic-lesion composite should not be interpreted as the prevalence of either clinical RPGN or crescentic glomerulonephritis separately. Given the clinically heterogeneous evidence base and substantial statistical uncertainty, these pooled proportions summarize published clinical cohorts and are not stable population-level frequencies applicable to all children with APSGN. Close monitoring of blood pressure, volume status, and kidney function is warranted during the acute phase.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261464457. PROSPERO CRD420261464457.
