Children with acute poststreptococcal glomerulonephritis. When is ambulatory care adequate?

In most cases, acute poststreptococcal glomerulonephritis (APSGN) is a mild disease with excellent prognosis. Nevertheless some cases can progress to renal failure. The course of the disease is in general unpredictable. The present study was carried out to evaluate the adequacy of an ambulatory follow-up of children with APSGN. Sixty-six consecutive affected patients were retrospectively studied, of whom 35 (53%) were hospitalized and 31 (47%) were followed on an ambulatory basis. Hospitalized children had more severe disease, based on findings of renal function tests, complement levels and ASLO. Nevertheless, the rate of complications was similar in both groups. In only three patients (4.5%) did hypertension develop after the initial presentation; children who did not have pulmonary findings of circulatory congestion at presentation, did not develop such complications later. These findings support the approach that children with APSGN without hypertension and with a normal chest X-ray and electrocardiographic picture, good urine output and only mildly disturbed renal function, may be followed on an ambulatory basis.