S CHATURVEDI1, R BOYD 2, P MORRIS1, V KRAUSE2
1Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory; 2Centre for Disease Control, Department of Health, Darwin, Northern Territory
Aim: We discuss a typical case presentation of Acute Post-Streptococcal Glomerulonephritis (APSGN) and highlight the heavy burden of APSGN in the Northern Territory (NT) over 26 years.
Background: APSGN is an inflammatory kidney disease caused by prior infection with nephritogenic strains of Group A Streptococcus (GAS). It is a notifiable disease in the NT with data collection established in 1991. The case definition of a confirmed case is a clinically compatible illness and laboratory evidence. Probable cases require clinical evidence only.
Case Report: A 13 year old Indigenous girl was admitted to hospital with gross haematuria, edema, and hypertension with history of impetigo and sore throat 2 weeks previously. Laboratory results revealed elevated ASOT (467 IU/ml), elevated serum creatinine 103 µmol/L, nephrotic range proteinuria, low C3< 0.2gm/L (0.83-2.02), and negative ANA. Her serum creatinine continued to rise over 2 weeks and she had persistent hypertension. Given the prolonged renal impairment, she underwent a kidney biopsy which revealed diffuse proliferative glomerulonephritis with 37% crescents.
Epidemiological data: Over the 26 years (1991-2016), there were 777 notifications of APSGN, of which Indigenous people comprised 94 %. Males represented 411 (53%) episodes and median age was 7 years (range 0-64).
Conclusions: APSGN notifications in the NT remain high, with an upward trend and affect almost exclusively the Indigenous population. While the upward trend may reflect better surveillance measures, it may also signal a higher burden of GAS or change in organism virulence. The results emphasise the need for continued and improved public health response including education, reduction and early treatment of GAS infections, capacity for secondary prophylaxis of contacts and recognition of potential long term renal impact.