Acute post-streptococcal glomerulonephritis in northwestern Ontario: A six-year retrospective study

Abstract

BACKGROUND: Recent reports have described a high incidence of acute rheumatic fever in northwestern Ontario. However, the full burden of Group A streptococcal infection and its complications, including acute post-streptococcal glomerulonephritis (APSGN), in the region is not well understood. OBJECTIVE: To document the pediatric and adult incidence of APSGN in a predominantly First Nations population in northwestern Ontario. METHODS: The present study was a retrospective case series conducted over a six-year period in a population of 29,000 in northwestern Ontario. Adults and children meeting selection criteria for possible, probable, or confirmed APSGN within the study period were included. Outcome measures included patient demographics, comorbidities, investigations, clinical course, and status of renal function at last follow-up. RESULTS: The authors identified 10 pediatric and five adult cases of APSGN. The incidence rate of APSGN for children <15 years of age was 20.8 cases per 100,000 person-years and, for adults, was 4.0 cases per 100,000 person-years. These rates are comparable with those observed in developing countries and more than triple the expected rate in the rest of Canada. CONCLUSION: The incidence rate of APSGN in northwestern Ontario exceeds the norm for a developed country. Inadequate, overcrowded housing and limited access to clean water experienced by many remote First Nations communities may drive the high burden of Group A streptococcal infection and its sequelae in this region.