Cardiac changes in children with post-streptococcal glomerulonephritis: a prospective observational study.

BACKGROUND

Acute poststreptococcal glomerulonephritis (PSGN) is the most common type of glomerulonephritis which may involve multiple organs, including the heart. This study aimed to explore cardiac status of children with PSGN and track progression of any cardiac impairment using a comprehensive multimodal assessment approach.

METHODS

This observational study included 41 patients with PSGN (1-12 years) who underwent clinical, laboratory, electrocardiography, echocardiography and tissue Doppler assessment between January 2024 and April 2025 at Fayoum University Hospitals. Patients were followed up for 12 weeks after the diagnosis was established.

RESULTS

Prolonged QTc was reported in 13 cases (median=431ms), showing a significant negative correlation with ejection fraction (EF) (r=-0.40, P = 0.009) and fractional shortening (FS) (r=-0.38, P = 0.01) and a positive correlation with estimated systolic pulmonary artery pressure (ESPAP) (r = 0.36, P = 0.02). Ten patients (24.4%) had mild mitral regurgitation, and one (2.4%) had moderate regurgitation. At follow-up, cases showed a significant decrease in interventricular septum thickness (IVS), left ventricular end-diastolic diameter (LVEDD), and ESPAP with P = 0.003, 0.01, and 0.001, respectively. Thirty patients had high right ventricular myocardial performance index (MPI), and 17 had high left ventricular MPI at diagnosis. Significant decrease was observed in isovolumetric contraction time (IVCT) (RV: P = 0.03, LV P = 0.01) and MPI (P < 0.001 for both ventricles).

CONCLUSION

Transient subclinical functional cardiac changes were evident in pediatric patients with PSGN. These transient changes may impose significant clinically relevant risks, particularly in the acute phase of the disease. Selected patients in appropriate clinical contexts may benefit from advanced cardiac investigations. QTc prolongation may warrant attention as an initial assessment tool of myocardial status, while myocardial performance index can be considered as an advanced measure. However, both tools should be interpreted with caution and within the relevant clinical context since they are subjected to various confounders.