{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:00:10Z","timestamp":1790312410816,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objective<\/jats:title>\n To systematically evaluate the proportions of major clinical manifestations and severe outcomes in children with acute post-streptococcal glomerulonephritis (APSGN).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eighteen 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%\u201379.2%). 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%\u201366.4%), 40.1% (18 studies, 2,173 children; 95% CI, 28.4%\u201356.7%), and 35.9% (11 studies, 887 children; 95% CI, 26.2%\u201349.0%), 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%\u201320.3%), 12.9% (10 studies, 699 evaluable children; 95% CI, 4.1%\u201340.8%), and 4.0% (15 studies, 1,465 children; 95% CI, 1.4%\u201311.2%), 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 (I\n 2<\/jats:sup>\n , 82.2%\u201397.7%). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Hypertension, 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.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261464457<\/jats:ext-link>\n . PROSPERO CRD420261464457.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1953518","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:28:02Z","timestamp":1790310482000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical manifestations and proportions of severe outcomes in pediatric acute post-streptococcal glomerulonephritis: a systematic review and meta-analysis of predominantly hospital-based cohorts"],"prefix":"10.3389","volume":"13","author":[{"given":"Ronglang","family":"Wu","sequence":"first","affiliation":[{"name":"The Affiliated People\u2019s Hospital of Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Ren","sequence":"additional","affiliation":[{"name":"The Affiliated People\u2019s Hospital of Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]},{"name":"Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenglin","family":"Chen","sequence":"additional","affiliation":[{"name":"Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefen","family":"Kang","sequence":"additional","affiliation":[{"name":"The Affiliated People\u2019s Hospital of Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Affiliated People\u2019s Hospital of Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1681\/ASN.2008010092","article-title":"The current state of post streptococcal glomerulonephritis","volume":"19","author":"Rodriguez-Iturbe","year":"2008","journal-title":"J Am Soc Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/MOP.0b013e3282f45bcf","article-title":"Acute post streptococcal glomerulonephritis: an update","volume":"20","author":"Ahn","year":"2008","journal-title":"Curr Opin Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"5543","DOI":"10.2174\/0929867329666220613103316","article-title":"Acute post-streptococcal glomerulonephritis in children: a comprehensive review","volume":"29","author":"Brant Pinheiro","year":"2022","journal-title":"Curr Med Chem"},{"key":"B4","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"703","DOI":"10.4269\/ajtmh.2011.11-0185","article-title":"Acute post-streptococcal glomerulonephritis in the northern territory of Australia: a review of 16 years data and comparison with the literature","volume":"85","author":"Marshall","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.4269\/ajtmh.18-0827","article-title":"Systematic review of group A streptococcal emm types associated with acute post-streptococcal glomerulonephritis","volume":"100","author":"Worthing","year":"2019","journal-title":"Am J Trop Med Hyg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00467-010-1554-6","article-title":"Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis","volume":"26","author":"Eison","year":"2011","journal-title":"Pediatr Nephrol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1542\/pir.36.1.3","article-title":"Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis","volume":"36","author":"VanDeVoorde","year":"2015","journal-title":"Pediatr Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"139","DOI":"10.5527\/wjn.v11.i5.139","article-title":"Management and outcomes of acute post-streptococcal glomerulonephritis in children","volume":"11","author":"Ong","year":"2022","journal-title":"World J Nephrol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1093\/ndt\/gfaf130","article-title":"Acute post-streptococcal glomerulonephritis in children-treatment standard","volume":"40","author":"Dhakal","year":"2025","journal-title":"Nephrol Dial Transplant"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1007\/s00467-026-07146-4","article-title":"AsPNA clinical practice guidelines for the management of infection-related glomerulonephritis","volume":"41","author":"Meena","year":"2026","journal-title":"Pediatr Nephrol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1111\/jpc.12295","article-title":"Prospective population-based study on the burden of disease from post-streptococcal glomerulonephritis of hospitalised children in New Zealand: epidemiology, clinical features and complications","volume":"49","author":"Wong","year":"2013","journal-title":"J Paediatr Child Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1007\/s12098-015-1752-0","article-title":"Clinical characteristics and outcome of post-infectious glomerulonephritis in children in southern India: a prospective study","volume":"82","author":"Gunasekaran","year":"2015","journal-title":"Indian J Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst Rev"},{"key":"B15","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"100885","DOI":"10.5409\/wjcp.v14.i1.100885","article-title":"Post-streptococcal acute glomerulonephritis in children: association between proteinuria levels and renal outcomes","volume":"14","author":"Ranawaka","year":"2025","journal-title":"World J Clin Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.1007\/s00467-023-05935-9","article-title":"Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis","volume":"38","author":"Karakaya","year":"2023","journal-title":"Pediatr Nephrol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.nephro.2015.04.005","article-title":"Outcome of rapidly progressive glomerulonephritis post-streptococcal disease in children","volume":"11","author":"Jellouli","year":"2015","journal-title":"Nephrol Ther"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3309","DOI":"10.1007\/s00467-023-06000-1","article-title":"Risk factors associated with short- and long-term kidney injury in children with post infectious glomerulonephritis","volume":"38","author":"Matsell","year":"2023","journal-title":"Pediatr Nephrol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/BF00853424","article-title":"Poststreptococcal glomerulonephritis in children: clinicopathological correlations and long-term prognosis","volume":"2","author":"Clark","year":"1988","journal-title":"Pediatr Nephrol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"492","DOI":"10.5694\/j.1326-5377.2001.tb143394.x","article-title":"Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life","volume":"174","author":"White","year":"2001","journal-title":"Med J Aust"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1038\/ki.2011.478","article-title":"Post-streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life","volume":"81","author":"Hoy","year":"2012","journal-title":"Kidney Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1093\/ndt\/gfu241","article-title":"The influence of birthweight, past poststreptococcal glomerulonephritis and current body mass index on levels of albuminuria in young adults: the multideterminant model of renal disease in a remote Australian Aboriginal population with high rates of renal disease and renal failure","volume":"31","author":"Hoy","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"B24","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"Br Med J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1007\/s00467-008-1086-5","article-title":"Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children","volume":"24","author":"Wong","year":"2009","journal-title":"Pediatr Nephrol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s00467-009-1325-4","article-title":"Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study","volume":"25","author":"Becquet","year":"2010","journal-title":"Pediatr Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1111\/j.1440-1797.2010.01352.x","article-title":"Clinicopathological features and prognosis of Chinese patients with acute post-streptococcal glomerulonephritis","volume":"15","author":"Luo","year":"2010","journal-title":"Nephrology (Carlton)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"5163065","DOI":"10.1155\/2016\/5163065","article-title":"Acute kidney injury and atypical features during pediatric poststreptococcal glomerulonephritis","volume":"2016","author":"Ayoob","year":"2016","journal-title":"Int J Nephrol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1111\/ped.13587","article-title":"Pediatric post-streptococcal glomerulonephritis: clinical and laboratory data","volume":"60","author":"Demircioglu K\u0131l\u0131c","year":"2018","journal-title":"Pediatr Int"},{"key":"B30","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1186\/s13104-018-3794-7","article-title":"Factors associated with treatment outcome of acute post streptococcal glomerulonephritis among patients less than 18 years in mekelle city, public hospitals, north Ethiopia","volume":"11","author":"Gebreyesus","year":"2018","journal-title":"BMC Res Notes"},{"key":"B31","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/j.nephro.2018.04.001","article-title":"Post-streptococcal glomerulonephritis in the south of Tunisia: a 12-year retrospective review","volume":"14","author":"Maalej","year":"2018","journal-title":"Nephrol Ther"},{"key":"B32","first-page":"375","article-title":"Acute glomerulonephritis: a 7 years follow up of children in center of Iran","volume":"49","author":"Sepahi","year":"2011","journal-title":"Acta Med Iran"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e56082","DOI":"10.7759\/cureus.56082","article-title":"Acute post-streptococcal glomerulonephritis in a pediatric population: a five-year retrospective study","volume":"16","author":"Bajracharya","year":"2024","journal-title":"Cureus"},{"key":"B34","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1111\/jpc.16386","article-title":"Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the top end of Australia","volume":"59","author":"Chong","year":"2023","journal-title":"J Paediatr Child Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"54","DOI":"10.4103\/singaporemedj.SMJ-2021-092","article-title":"Clinical predictors of acute kidney injury in children with acute post-streptococcal glomerulonephritis: a tertiary centre experience","volume":"66","author":"Wan Yusof","year":"2025","journal-title":"Singapore Med J"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e72751","DOI":"10.1002\/hsr2.72751","article-title":"Outcomes and predictors of acute post-streptococcal glomerulonephritis in hospitalized children in northwest Ethiopia: a multicenter retrospective cohort study","volume":"9","author":"Moges","year":"2026","journal-title":"Health Sci Rep"},{"key":"B37","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.pedhc.2025.09.002","article-title":"Fever in acute post-streptococcal glomerulonephritis: prevalence and clinical significance","volume":"40","author":"Curelaru","year":"2026","journal-title":"J Pediatr Health Care"},{"key":"B38","doi-asserted-by":"publisher","first-page":"287","DOI":"10.35755\/jmedassocthai.2023.03.13805","article-title":"Clinical manifestations, pathological correlations, prognostic factors, and outcomes of severe acute postinfectious glomerulonephritis with rapidly progressive glomerulonephritis in children","volume":"106","author":"Hongsawong","year":"2023","journal-title":"J Med Assoc Thail"},{"key":"B39","first-page":"336","article-title":"Post-infectious glomerulonephritis in pediatric patients over two decades: severity-associated features","volume":"18","author":"Dagan","year":"2016","journal-title":"Isr Med Assoc J"},{"key":"B40","first-page":"103","article-title":"Prognosis of acute post-streptococcal glomerulonephritis in Sudanese children","volume":"7","author":"Ali el","year":"2014","journal-title":"Arab J Nephrol Transplant"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1953518\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:28:03Z","timestamp":1790310483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1953518\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":40,"alternative-id":["10.3389\/fmed.2026.1953518"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1953518","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1953518"}}