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This video is a brief rundown of the overview of PSGN. This gives us illustrations of what may happen in the glomerulus. They also mention some clinical manifestations such as angioedema and dark urine. They also mention the use of steroids to counteract inflammation and also that dialysis might be useful due to kidney damage.

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Video: Poststreptococcal glomerulonephritis - Video Explanation! | Osmosis | Osmosis

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Video: Poststreptococcal glomerulonephritis: Symptoms, Causes, Videos & Quizzes | Learn Fast for Better Retention! | Osmosis

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A detailed breakdown of what the condition is

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A detailed breakdown of what the condition is

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Rawla P, Padala SA, Ludhwani D. Poststreptococcal Glomerulonephritis. [Updated 2022 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538255/

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Continuing Education Activity

Poststreptococcal glomerulonephritis (PSGN) results from a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response following streptococcal infection. PSGN most commonly presents in children 1 to 2 weeks after a streptococcal throat infection, or within 6 weeks following a streptococcal skin infection. When symptomatic, PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria. This activity reviews the etiology, pathogenesis, evaluation, and management of PSGN and explains the role of the interprofessional team in evaluating and treating patients with this condition.

Objectives:

Identify the epidemiology, etiology, pathophysiology of poststreptococcal glomerulonephritis.

Review how to evaluate a patient for poststreptococcal glomerulonephritis.

Summarize the treatment and management options available for poststreptococcal glomerulonephritis.

Explain interprofessional team strategies for improving care coordination and communication to improve outcomes for patients affected by poststreptococcal glomerulonephritis.

Access free multiple choice questions on this topic.
Introduction

Poststreptococcal glomerulonephritis (PSGN) is characterized by rapid deterioration of kidney functions due to an inflammatory response (type III hypersensitivity reaction) following streptococcal infection. This condition results from specific strains of group A beta-hemolytic streptococci called nephrogenic streptococci. The disease affects the glomeruli and the small blood vessels of the kidneys. PSGN most frequently presents in children 1 to 2 weeks after a sore throat, or 6 weeks after a skin infection (impetigo).[1]

Though the incidence of PSGN has declined in developed countries, the incidence of non-streptococcal organisms is emerging. Nephritis-associated plasmin receptor (NAPlr) and streptococcal pyrogenic exotoxin B (SPeB) are the two common antigens associated with the pathogenesis of PSGN. They not only activate the alternate complement pathway, resulting in hypocomplementemia, but they also have an affinity towards the plasmin and glomerular proteins. The clinical presentation of PIGN can vary from no symptoms to renal failure requiring renal replacement therapy (RRT). [2]

When symptomatic, PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema. Less commonly presentation can mimic nephrotic syndrome with significant proteinuria.

Etiology

Nephrogenic streptococci infection precedes PSGN, which initially affects skin or the oropharynx. More recently, PSGN is associated with skin infections (impetigo) more frequently than throat infections (pharyngitis).[3][4]

Group A Streptococcus (GAS) has been subtyped depending on the surface M protein and opacity factor, which are known to be nephrogenic and can cause PSGN. Other causes of post-infectious glomerulonephritis include bacterial infections including endocarditis, enterocolitis, pneumonia, and intraventricular shunt infections, viral (hepatitis B and C infections, human immunodeficiency virus, cytomegalovirus, Epstein Barr virus, parvovirus B19), fungal (coccidioidomycosis, histoplasmosis), and parasitic infections (malaria, leishmania, toxoplasmosis, and schistosomiasis).[5]

Poor hygiene, overcrowding, and low socioeconomic status are important risk factors for streptococci outbreaks, and this explains the higher incidence of PSGN in impoverished countries. Genetic factors are expected to predispose to the condition since almost 40% of patients with PSGN gave a positive family history. There is no specific gene found to cause PSGN.[5]

Epidemiology

Over the past three decades, PSGN incidence has significantly dropped in developed countries; such as the United States, UK, Central Europe, and Japan. The reason for this progress is the use of antibiotic prophylaxis and the improvement of hygienic states. In these developed countries, PSGN has become more frequently seen in adult patients who suffer from chronic debilitating diseases.[6]

Higher incidence of PSGN in developing countries- due to increased skin infections (pyoderma). Though the incidence in developed countries has gone down, it is still the most common cause of glomerulonephritis (GN) in children in the united states. [5]

PSGN is also the most common cause of kidney injury in children in the Middle East, Africa, Australia, and worldwide. The annual incidence of new cases of PSGN in developing countries ranges from 8.5 to 28.5 per 100000 individuals.[7] Around 97% of cases reported with PSGN live in underprivileged countries.

Clinically manifestations of PSGN are more common in males than in females with a ratio of 2:1. However; the incidence of subclinical PSGN is almost equal in both sexes. Racial factors were not found to play a role. The disease most frequently affects children between the age of 3 and 12 (with the peak incidence between 5 to 6 years), and seniors greater than 60 years old.

Pathophysiology

The disease is immunological; representing a type III hypersensitivity reaction. The exact mechanism by which PSGN occurs is not fully determined. The body responds to nephrogenic streptococcal infection by forming immune complexes containing the streptococcal antigen with a human antibody.[2] Some theories suggest that these immune complexes become deposited in kidney glomeruli reaching through the circulation. Others claim that the condition results from an "in situ" formation of the antigen-antibody complex within the kidney glomeruli. This "In situ immune complex formation" is either due to a reaction against streptococci antigens deposited in the glomerular basement membrane or, according to other theories, due to an antibody reaction against glomerular components that cross-react with streptococcal antigen due to molecular mimicry.[5]

The presence of immune complexes leads to the activation of the alternate complement pathway causing infiltration of the leukocytes, and proliferation of the mesangial cells in the glomerulus thus impairing the capillary perfusion and glomerular filtration rate (GFR). Reduction in GFR can lead to renal failure (oliguria or anuria), acid-base imbalance, electrolyte abnormalities, volume overload, edema, and hypertension.

Histopathology

Light microscopy- The glomeruli show hypercellularity (endothelial, mesangial, and inflammatory cells) which are non-specific.

Electron microscopy- The most characteristic finding is the presence of sub-epithelial humps; which are electron-dense deposits in the subepithelial space near the glomerular basement membrane.[8]

Immunofluorescence microscopy- Evidence of IgG and C3 deposits in the first 2 to 3 weeks of the disease.

History and Physical

Approximately 50% of children with PSGN are asymptomatic and are discovered accidentally during routine urine analysis. The classic triad of glomerulonephritis includes hematuria, edema, and hypertension. Typically, patients give a history of a recent streptococcal infection such as pharyngitis, tonsillitis, or impetigo. However; some patients develop PSGN without experiencing symptoms of respiratory tract infection or pyoderma, which can be a diagnostic challenge.[9]

The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty. The hematuria can be described as postpharyngitic (hematuria seen after weeks of infection).

Renal involvement is common and is transient with recovery in 1-2 weeks. Less than half of the patients experience oliguria. Depending on the severity of renal involvement, signs, and symptoms suggestive of anuric renal failure or life-threatening acid-base imbalance, electrolyte abnormalities (especially hyperkalemia), and fluid overload would require RRT. About 60-80% of the patients experience high blood pressure which typically resolves in 10 days. [5]

The incidence of edema is seen in about 65-90% of the cases. Puffiness of the eyelids (periorbital edema) is typical for the nephritic syndrome. It is most prominent in the morning and tends to resolve at the end of the day. Generalized edema is also a common feature. Moreover, in severe cases, patients might experience respiratory distress as a result of pulmonary edema. They may experience other non-specific symptoms like anorexia, malaise, nausea, vomiting, etc.

Evaluation

PSGN should be suspected in all children with hypertension and heart failure, even in the absence of hematuria or a history of a preceding sore throat or pyoderma.

Laboratory investigations are the most useful in PSGN assessment.

Evidence of a preceding streptococcal infection is determined by measuring anti-streptolysin titer (ASO), and anti-nicotinamide-adenine dinucleotidase (anti-NAD) which tend to rise following pharyngitis. Other antibodies such as anti-DNAse B and anti-hyaluronidase (AHase) are usually elevated after both pharyngitis and skin infections. ASO titer is the most frequently used test, while the most sensitive is the streptozyme test; which includes measuring the titers of all the antibodies mentioned above. ASO titers can be falsely low in patients treated with antibiotics for streptococcal infections.

Serum complement level (C3) is usually low due to its consumption in the inflammatory reaction. Mostly, the decrease in C3 concentration occurs before serum ASO has risen.[5] Complement levels usually return to normal levels in 6-8 weeks.

Progressive decline in the Renal function

When there is no latent period between the acute glomerulonephritis and streptococcal infection

If the complement levels are normal

When there is no rise in antistreptococcal antibodies

Urine analysis: shows macroscopic or microscopic hematuria, RBC casts, mild proteinuria. Only 5% of patients with PSGN have massive proteinuria that indicates nephrotic syndrome. White blood cell casts, hyaline, and cellular casts are usually present in the urine analysis.

Ultrasonography: Kidneys are enlarged only in a few patients.

The chest x-ray may show pulmonary congestion in patients with symptoms consistent with volume overload or heart failure.

Renal Function Tests: Blood urea nitrogen (BUN) and serum creatinine typically elevate during the acute phase. These values usually return to normal later.

In patients with heart failure and PSGN, NT-proBNP levels are elevated along with the findings of pulmonary congestion on the chest x-ray.

Renal biopsy is not recommended for diagnosing patients with PSGN and is performed only when other glomerular pathologies are suspected. Renal biopsy is indicated when:

Imaging Studies

Treatment / Management

PSGN is a self-limiting condition in most cases, and thus only symptomatic treatment is needed. Supportive treatment aims at controlling the complications of volume overload such as hypertension and edema, which are prominent during the acute phase of the disease.[5]

Pharmacological Therapy

Antimicrobials: Patients with evidence of a streptococcal infection should receive a course of antibiotic therapy, and they may not prevent the development of PSGN.

Diuretics: Loop diuretics (furosemide) are preferred over thiazides (hydrochlorothiazide or chlorthalidone). The efficacy of thiazide diuretics is very minimal when GFR < 30 ml/min.

Antihypertensive medications: Blood pressure can be managed by restricting salt and fluid intake along with diuretics are needed. In cases with uncontrolled blood pressure, the use of calcium channel blockers is recommended. The use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) is recommended in patients with stable GFR and with near-normal potassium levels.

Salt and water restriction to treat the edema.

Bed rest and immobilization are recommendations in the first few days of the disease.

Throat cultures on the patient and family members are important.

All affected members need to be treated with penicillin or erythromycin.

Immunosuppressive therapy: There's no evidence that immune suppression is useful in patients with PSGN.[10]However, patients with progressive renal failure or the presence of crescents on the renal biopsy may warrant the use of corticosteroids.[11][11][11]

IgA Nephropathy: usually occurs after an upper respiratory tract or gastrointestinal infection, but it differs from PSGN in the shorter latency period it takes to appear after the episode of infection. It can also be described as synpharyngitic hematuria- hematuria and infection coincide.

Membranoproliferative glomerulonephritis: also presents with a nephritic picture and hypocomplementemia following respiratory tract infection. Complement levels take a longer time to return to normal than in PSGN or persistently low C3 levels.

Lupus nephritis: sometimes PSGN presents with a picture similar to lupus nephritis. Laboratory testing for antibodies specific to each of the diseases can help in the diagnosis. Positive ANA, ds-DNA, cytopenia, and multi-organ involvement.

Nephrotic syndrome: 2 4-hour urine protein excretion is more than 3.5 gram/day along with hypoalbuminemia, edema, hypogammaglobulinemia, and increased risk of thrombosis (due to loss of pro-coagulants).

Henoch Schonlein purpura (HSP): The typical presentation is palpable purpura, renal failure, gastrointestinal and musculoskeletal manifestations. Have normal complement levels.

Hemolytic uremic syndrome (HUS): Labs consistent with Hemolysis (schistocytes, LDH, reticulocyte count, indirect bilirubin), bloody diarrhea, thrombocytopenia, stool culture for Escherichia coil O157: H7

ANCA: Have normal complement levels.

Goodpasture disease: Involves lung and kidneys. Have anti-glomerular basement antibody and normal complement levels.

Dialysis

Dialysis is only performed to manage the acid-base balance, electrolyte abnormalities (especially hyperkalemia), and fluid management

General measures

Differential Diagnosis

Prognosis

PSGN has an excellent prognosis especially in children with complete recovery usually occurring within 6 to 8 weeks. In adults, around 50% of the patients continue to have reduced renal function, hypertension, or persistent proteinuria.[12][13]

Death in adults is often secondary to heart failure and renal dysfunction. Studies show that in the long term some patients may continue to have abnormalities in urine, proteinuria, and hypertension.

Mortality during the acute phase of glomerulonephritis has been estimated at around 2 and 12 percent. It has been assumed that the renal changes found in the majority of patients who survived the initial acute attack would be qualitatively similar to those noted in the fatal cases, although little direct evidence existed to support this view.[14]

Complications

During the acute phase, congestive heart failure and azotemia are likely complications that could be life-threatening. The delayed complications include chronic kidney disease and nephrotic syndrome.

Deterrence and Patient Education

Avoidance of overcrowding and personal hygiene are important measures that patients should undertake to decrease the risk of catching streptococcal infections.

Patients with throat or skin infections should seek medical advice and get the proper antibiotic therapy if they receive confirmation of a bacterial infection.

Enhancing Healthcare Team Outcomes

Managing a case of PSGN requires cooperation between internists, nephrologists, infectious disease consultants, pharmacists, and nursing staff, functioning as an interprofessional team, to provide excellent care for their patients. PSGN patient's fluid and salt intake, as well as urine output, should be carefully monitored by the team. The pharmacist should coordinate with the clinician to ensure that the patient is on no nephrotoxic medications and emphasize medication compliance if the patient has hypertension. The visiting nurse should encourage all close contacts and family members to undergo throat swabs to rule out an acute infection. The nurse should also weigh the patient to ensure that the edema is not worsening. Besides, renal function and potassium levels need to be closely monitored.

Consulting a nephrologist (or a pediatric nephrologist) must be sought in complicated cases. These patients need monitoring for fluid and electrolyte status at each visit. Close communication between interprofessional team members is vital to ensure good outcomes. [Level 5]

The prognosis in children is excellent but adults tend to have a protracted course with at least 30 to 50% developing renal dysfunction and hypertension.[15][16][Level 5]

References

1.

2.

3.

4.

5.

6.

Rodriguez-Iturbe B, Haas M. Post-Streptococcal Glomerulonephritis. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. University of Oklahoma Health Sciences Center; Oklahoma City (OK): Feb 10, 2016. [ PubMed: 26866231 ]

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11.

Yang TJ, Shah H, Olagunju A, Novak M, Difilippo W. Role of Steroids in Post-streptococcal Glomerulonephritis Without Crescents on Renal Biopsy. Cureus. 2018 Aug 15;10(8):e3150. [ PMC free article: PMC6191008 ] [ PubMed: 30345206 ]

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13.

14.

JENNINGS RB, EARLE DP. Post-streptococcal glomerulo-nephritis: histopathologic and clinical studies of the acute, subsiding acute and early chronic latent phases. J Clin Invest. 1961 Aug;40:1525-95. [ PMC free article: PMC292535 ] [ PubMed: 13789862 ]

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Poststreptococcal glomerulonephritis (PSGN) is characterized by rapid deterioration of kidney functions due to an inflammatory response (type III hypersensitivity reaction) following streptococcal infection. This condition results from specific strains of group A beta-hemolytic streptococci called nephrogenic streptococci. The disease affects the glomeruli and the small blood vessels of the kidneys.

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This article does a great job of summarizing all of the information presented in the other links/videos/images. It discusses the causes, risk factors, symptoms, what diagnostic tests can be performed, treatment, outlook, and more. It also includes a great image that "zooms in" on where this condition occurs (the glomerulus).

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Glomerulonephritis - poststreptococcal; Postinfectious glomerulonephritis

Poststreptococcal glomerulonephritis (GN) is a kidney disorder that occurs after infection with certain strains of streptococcus bacteria.

The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.

The kidneys remove excess fluid and waste from your body. Blood is filtered in the kidneys through nephrons. Each nephron contains a network of small blood vessels, called glomerulus, which are enclosed in a sac called Bowman's capsule. The filtered waste product (urine) flows through tiny tubes and is then passed from the kidneys to the bladder through bigger tubes called ureters.

Causes

Poststreptococcal GN is a form of glomerulonephritis. It is caused by an infection with a type of streptococcus bacteria. The infection does not occur in the kidneys, but in a different part of the body, such as the skin or throat. The disorder may develop 1 to 2 weeks after an untreated throat infection, or 3 to 4 weeks after a skin infection.

It may occur in people of any age, but it most often occurs in children ages 6 through 10. Although skin and throat infections are common in children, poststreptococcal GN is rarely a complication of these infections. Poststreptococcal GN causes the tiny blood vessels in the filtering units of the kidneys (glomeruli) to become inflamed. This makes the kidneys less able to filter the blood to create urine.

The condition is not common today because infections that can lead to the disorder are treated with antibiotics.

Risk factors include:

Symptoms

Symptoms may include any of the following:

Decreased urine output

Rust-colored urine

Swelling (edema), general swelling, swelling of the abdomen, swelling of the face or eyes, swelling of the feet, ankles, hands

Visible blood in the urine

Joint pain

Joint stiffness or swelling

Exams and Tests

A physical examination shows swelling (edema), especially in the face. Abnormal sounds may be heard when listening to the heart and lungs with a stethoscope. Blood pressure is often high.

Other tests that may be done include:

Treatment

There is no specific treatment for this disorder. Treatment is focused on relieving symptoms.

Antibiotics, such as penicillin, will likely be used to destroy any streptococcal bacteria that remain in the body.

Blood pressure medicines and diuretic drugs may be needed to control swelling and high blood pressure.

Corticosteroids and other anti-inflammatory medicines are generally not effective.

You may need to limit salt in your diet to control swelling and high blood pressure.

Outlook (Prognosis)

Poststreptococcal GN usually goes away by itself after several weeks to months.

In small number of adults, it may get worse and lead to long-term (chronic) kidney failure. Sometimes, it can progress to end-stage kidney disease, which requires dialysis and a kidney transplant.

Possible Complications

Health problems that may result from this disorder include:

Acute renal failure (rapid loss of kidneys' ability to remove waste and help balance fluids and electrolytes in the body)

Chronic glomerulonephritis

Chronic kidney disease

Heart failure or pulmonary edema (fluid buildup in the lungs)

End-stage renal disease

Hyperkalemia (abnormally high potassium level in the blood)

High blood pressure (hypertension)

Nephrotic syndrome (group of symptoms that include protein in the urine, low blood protein levels in the blood, high cholesterol levels, high triglyceride levels, and swelling)

When to Contact a Medical Professional

Contact your health care provider if:

You have symptoms of poststreptococcal GN

You have poststreptococcal GN, and you have decreased urine output or other new symptoms

Prevention

Treating known streptococcal infections may help prevent poststreptococcal GN. Also, practicing good hygiene such as washing hands often prevents the spread of the infection.

Flores FX. Isolated glomerular diseases associated with recurrent gross hematuria. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 537.

Radhakrishnan J, Stokes MB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 107.

Saha MK, Pendergraft WF, Jennette JC, Falk RJ. Primary glomerular disease. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 31.

Stevens DL, Bryant AE, Hagman MM. Nonpneumococcal streptococcal infections and rheumatic fever. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 269.

Version Info

Last reviewed on: 8/28/2023

Reviewed by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Learn about Post-streptococcal glomerulonephritis (GN), find a doctor, complications, outcomes, recovery and follow-up care for Post-streptococcal glomerulonephritis (GN).

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Group A strep will release antigens (Nephritis-associated plasmin receptor and Streptococcal pyrogenic exotoxin B) that IgG & IgM antibodies will then bind to and form immune complexes. These will then insert themselves into the wall of the glomerular capillary. Immune complexes activate the complement system which brings in neutrophils with bind to receptors on the immune complex to release proteases, reactive oxygen species and neutrophil extracellular traps which damage the capillary wall. Macrophages enter and cytokines exacerbate the capillary damage. Mesangial cells with proliferate and cause expansion. This will all cumulate in hematuria, proteinuria, edema and hypertension.

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Leventoglu E, Soran M. Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and Re-Evaluation of Patients with Artificial Intelligence. Medeni Med J. 2024 Sep 30;39(3):221-229. doi: 10.4274/MMJ.galenos.2024.09382. PMID: 39350577; PMCID: PMC11572215.

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Abstract

Objective

Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute glomerulonephritis in children. The condition may present as acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. ChatGPT (OpenAI, San Francisco, California, United States of America) has been developed as a chat robot supported by artificial intelligence (AI). In this study, we evaluated whether AI can be used in the follow-up of patients with APSGN.

Methods

The clinical characteristics of patients with APSGN were noted from patient records. Twelve questions about APSGN were directed to ChatGPT 3.5. The accuracy of the answers was evaluated by the researchers. Then, the clinical features of the patients were transferred to ChatGPT 3.5 and the follow-up management of the patients was examined.

Results

The study included 11 patients with an average age of 9.08±3.96 years. Eight (72.7%) patients had elevated creatinine and 10 (90.9%) had hematuria and/or proteinuria. Anti-streptolysin O was high in all patients (955±353 IU/mL) and C3 was low in 9 (81.8%) patients (0.56±0.34 g/L). Hypertensive encephalopathy, nephrotic syndrome, and rapidly progressive glomerulonephritis were observed in three patients. Normal creatinine levels were achieved in all patients. Questions assessing the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN were answered correctly by ChatGPT 3.5. All patients were diagnosed with APSGN, and the treatment steps applied by clinicians were similarly recommended by ChatGPT 3.5.

Conclusions

The insights and recommendations offered by ChatGPT for patients with APSGN can be an asset in the care and management of patients. With AI applications, clinicians can review treatment decisions and create more effective treatment plans.

Keywords: Acute postinfection glomerulonephritis, artificial intelligence, ChatGPT

Abstract

Amaç

Akut post-streptokokal glomerülonefrit (APSGN) çocuklar arasında akut glomerülonefritin önde gelen nedenidir. Akut nefritik sendrom, nefrotik sendrom ve hızlı ilerleyen glomerülonefrit şeklinde ortaya çıkabilir. ChatGPT (OpenAI, San Francisco, California, Amerika Birleşik Devletleri) yapay zeka destekli bir sohbet robotu olarak geliştirilmiştir. Bu çalışmada, yapay zekanın APSGN'nin tanı, tedavi ve takibinde kullanılıp kullanılamayacağı ilk kez değerlendirilmiştir.

Yöntemler

APSGN tanısı alan hastaların klinik özellikleri hasta dosyalarından not edildi. APSGN hakkında genel bilgileri sorgulayan on iki soru ChatGPT 3.5'e yöneltildi. Cevapların doğruluğu iki araştırmacı tarafından değerlendirildi. Daha sonra hastaların klinik ve laboratuvar özellikleri ChatGPT 3.5'e aktarılarak hastaların takibinin yapay zeka tarafından nasıl yönetileceği incelendi.

Bulgular

Çalışmaya toplam 11 hasta dahil edildi. Hastaların yaş ortalaması 9,08±3,96 yıldı. Sekiz (%72,7) hastada kreatinin yüksekliği ve 10 (%90,9) hastada hematüri ve/veya proteinüri vardı. Anti-streptolisin O tüm hastalarda yüksek (955±353 IU/mL) ve C3 9 (%81,8) hastada düşüktü (0,56±0,34 g/L). Üç farklı hastada hipertansif ensefalopati, nefrotik sendrom ve hızlı ilerleyen glomerülonefrit gözlendi. Tüm hastalarda normal kreatinin değerlerine ulaşıldı. APSGN'nin tanımı, epidemiyolojik özellikleri ve patofizyolojik mekanizmaları, tanı ve tedavisini değerlendiren sorular chatGPT 3.5 tarafından doğru yanıtlandı. Ayrıca, tüm hastalara APSGN tanısı konmuş ve klinisyenler tarafından uygulanan tedavi adımları ChatGPT 3.5 tarafından benzer şekilde önerilmiştir.

Sonuçlar

ChatGPT tarafından APSGN için sağlanan bilgi ve rehberlik, hastaların bakım ve yönetiminde değerli bir kaynak olabilir. Yapay zeka uygulamaları ile klinisyenler kararlarını gözden geçirebilir ve daha etkili tedavi planları oluşturabilirler.

Keywords: Akut postenfeksiyon glomerülonefrit, yapay zeka, ChatGPT

INTRODUCTION

Acute post-streptococcal glomerulonephritis (APSGN) is the leading cause of acute glomerulonephritis in children resulting from group A beta-hemolytic streptococcal infection. It is frequently observed in children aged 4-12 years. Enhancements in socioeconomic conditions, sanitation practices, healthcare systems, and the rational use of antibiotics for group A streptococcal infections have reduced the prevalence of APSGN in high-income nations. Nevertheless, it remains a significant public health issue in developing countries.

APSGN typically occurs 1-2 weeks after a throat infection and 3-6 weeks after skin infections. It shows seasonal variation, with pharyngeal infections being more prevalent in winter and skin infections in summer. APSGN may be subclinical or may be observed in severe clinical spectra, including acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. Edema, tea/cola-colored urine, decreased urine output, and hypertension may be present at presentation. In addition to general measures such as rest, fluid, and salt restriction, immunosuppressive therapies, and renal replacement therapies may be necessary in some cases.

ChatGPT (Chat Generative Pre-trained Transformer, OpenAI, San Francisco, California, United States of America), which has gained momentum in the medical field and started to be used daily in many branches, was developed as a chat robot supported by artificial intelligence (AI). Trained on vast Internet text, it can generate human-like language and cover various topics. In medicine, ChatGPT can help identify research topics, assist with clinical and lab assessments, and keep healthcare professionals updated on new developments.

Pediatrics focuses on the health of infants, children, and adolescents. Early diagnosis and appropriate management are vital, and effective clinical decision-making is crucial for patient outcomes. Evaluating ChatGPT's ability to support clinical decision-making in pediatrics is essential because of the unique challenges in this field.

In this study, the clinical characteristics, laboratory parameters, complications, and prognosis of pediatric patients diagnosed with APSGN were evaluated. We also examined whether ChatGPT can be used for APSGN management.

MATERIALS and METHODS

Research Framework and Participant Group

This was a retrospective observational study with a cross-sectional design in which the demographic, clinical, and laboratory characteristics of patients aged 0-18 years who were followed up with a diagnosis of APSGN in the department of pediatric nephrology between September 2023 and March 2024 were analyzed from patient records.

Demographic characteristics such as age and sex, history of streptococcal infection, presence of macroscopic hematuria, and physical examination findings such as edema and blood pressure at presentation were analyzed. Complete urinalysis, spot urine protein-to-creatinine ratio, serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, and electrolyte levels (Na, K, Ca and P) were noted to evaluate renal function. Throat culture results, anti-streptolysin O (ASO) titer, and complement levels of C3 and C4 were analyzed. Urinary system ultrasonography was performed for increased renal parenchymal echogenicity and corticomedullary differentiation. If available, a renal biopsy report was obtained. Treatments and medications administered to the patients were noted. Posttreatment hematuria, proteinuria, blood pressure, serum creatinine, and complement C3 levels were analyzed.

Definitions

Blood pressure was measured using a manual auscultation device after a 10-min rest, with two measurements taken in the same arm using the appropriate cuff. The average of these readings was recorded. All measurements were performed by the same pediatric nephrologist during each outpatient visit. Hypertension was diagnosed based on the 2017 guidelines. The presence of more than 5 erythrocytes per high-power field (HPF) in centrifuged urine indicates microscopic hematuria, whereas dark brown urine, resembling cola or tea, indicates macroscopic hematuria. Macroscopic hematuria lasting longer than 4 weeks is defined as persistent macroscopic hematuria. A spot urine protein-to-creatinine ratio >0.2 mg/mg indicates proteinuria, whereas a ratio exceeding 2 mg/mg is considered nephrotic-level proteinuria. Nephrotic-level proteinuria accompanied by edema, hypoalbuminemia (less than 2.5 g/dL), and hypercholesterolemia (greater than 200 mg/dL) is defined as nephrotic syndrome. eGFR was determined using a modified Schwartz formula. Nephritic syndrome has been defined as the sudden onset of glomerular damage features manifested as hematuria, proteinuria, oliguria, edema, hypertension, and elevated creatinine. Moreover, nephritic syndrome, which is characterized by a rapid decline in kidney function over a matter of days, has been defined as rapidly progressive glomerulonephritis.

AI

Using the local internet network of Konya City 12 open-ended questions about APSGN were directed to ChatGPT 3.5 in English ( Table 1). No additional training was provided to the AI before the questions and clinical information of the cases were routed to it. No query was made to APSGN or any other subject, and the application was used immediately after the computer was turned on. The accuracy of the AI answers to the questions was evaluated by two researchers according to internationally accepted publications and guidelines. Each answer was categorized as "incorrect", "missing information", "correct" according to the evaluation result. Then, the characteristics of the patients included in the study were transferred to ChatGPT 3.5, and diagnosis and follow-up of the patients were managed using AI was examined. We evaluated whether there was a difference between the clinicians and AI follow-up.

Table 1. Questions directed to ChatGPT 3.5.

The study received approval from the KTO-Karatay University Rectorate Dean of the Faculty of Medicine non-Drug and non-Medical Device Research Ethics Committee Presidency (decision no: 2024/57, date: 16.01.2024).

Statistical Analysis

In presenting descriptive statistics, continuous data were reported as mean±standard deviation, whereas categorical data were presented as counts (percentages). The Shapiro-Wilk test was used to assess the normality of the numerical data in the groups. Statistical analyses were performed using International Business Machines Statistical Package for Social Sciences statistics version 22.

RESULTS

Clinical and Laboratory Characteristics of Patients

The study included 11 patients, with a male-to-female ratio of 1.2. The mean age was 9.08±3.96 years (range, 5-16.3 years). The present complaints included bloody urine (n=7, 63.6%), edema (n=3, 27.3%), and headache/seizure (n=1, 9.1%). All patients had upper respiratory tract infection (URTI) before the onset of symptoms. The mean duration after URTI until the onset of symptoms was 10.1±2.8 (7-15) days.

At the time of presentation, the mean systolic and diastolic blood pressure z-score was 1.21±0.43 (0.56-2.33) and the mean diastolic blood pressure Z-score was 1.39±0.37 (0.67-2.33), and approximately half of the patients (n=5, 45.5%) had hypertension. Malignant hypertension was detected in one patient. Mean creatinine was 1.12±1.1 mg/dL (0.48-2.42) and mean eGFR was 78.7±31.8 mL/min/1.73m (50.6-117.2). The mean serum albumin was 3.46±0.60 g/dL (2.3-4.1) and hypoalbuminemia was found in 3 (27.2%) patients. Throat culture samples were obtained from all patients, and group A b hemolytic streptococcus was grown in 4 (36.3%) patients. ASO was high in all patients [mean 955±353 IU/mL (488-1614)]. The mean complement C3 level was 0.56±0.34 g/L (0.19-1.17) and 9 (81.8%) patients had low complement levels. All patients had varying degrees of hematuria. The mean erythrocyte count was 525±915.4/HPF (10-3171) and spot urine protein/creatinine value was 2.85±2.16 mg/mg (0.19-6.94). Proteinuria was present in 10 patients (90.9%). In addition to rest, fluid, and salt restriction, angiotensin-converting enzyme inhibitors were started in 5 (45.5%) patients with hypertension associated with proteinuria ( Table 2).

A patient with malignant hypertension presented to the emergency department because of headache and seizures. Cranial imaging showing posterior reversible encephalopathy syndrome. In the intensive care unit, intravenous esmolol and diuretics were initiated, and no hypertensive need remained during follow-up. Renal biopsy was performed in a patient whose serum creatinine was 2.42 mg/dL at admission and increased to 5.35 mg/dL within 4 days was thought to have rapidly progressive glomerulonephritis. The biopsy showed intense mesangial proliferation, matrix increase, and increased interstitial inflammation. Immunofluorescence staining revealed C3 and immunoglobulin G deposition in glomeruli. Crescent formation was observed in 55.5% and fibrinoid necrosis in 12.5% of the evaluated glomeruli. The patient received intravenous pulse methylprednisolone for 3 days, followed by oral prednisolone at a dose of 2 mg/kg/day, with a maximum dose of 60 mg/day. Intermittent hemodialysis was performed for a total of 14 days because of uremia. Pulse cyclophosphamide was started in a patient who did not have the expected creatinine decrease with hemodialysis, 3 doses have been administered so far, and it is planned to complete a total of 6 doses. Daily treatment with 10 mg of prednisolone is continued. Another patient who had hypoalbuminemia (2.3 g/dL) on admission and developed nephrotic syndrome during follow-up underwent renal biopsy. Unlike the first patient, no evidence of crescent or necrosis was observed. Treatment was continued with oral 2 mg/kg/day of pulse methylprednisolone. A patient with decreased proteinuria and improved hypoalbuminemia is being treated with a steroid taper. The clinical characteristics of the AI ​​for these three patients and their responses are shown in Table 3.

Table 3. Clinical and laboratory characteristics of three patients and responses given by artificial intelligence.

5.4-year-old girl presents to the emergency department due to seizures following a headache for a few days. Eyelid edema is noted in the postictal period. It is learned that she had an upper respiratory tract infection about 14 days ago. On examination, her blood pressure is 145/89 mmHg (above 99 th percentile for both). Laboratory findings show serum creatinine 1.32 mg/dL, serum albumin 3.3 g/L, Na 133 mmol/L, K 5.9 mmol/L, Ca 8.7 mg/dL, and P 5.3 mg/dL. Urinalysis reveals a red blood cell-count of 211 /HPF and a spot urine protein/creatinine ratio of 2.07 mg/mg. Complement C3 level is 0.19 g/L, and anti-streptolysin O (ASO) level is 1322 IU/mL. The throat culture shows no growth.

Based on the provided clinical information, the diagnosis of this patient is likely posterior reversible encephalopathy syndrome (PRES) with hypertension and seizure. The causes of PRES appears to be acute poststreptococcal glomerulonephritis (APSGN). This diagnosis is supported by the history of upper respiratory tract infection, significantly elevated ASO titer, low serum C3 level, and hematuria.

Hospitalization: Given the severity of the presentation, the patient should be hospitalized in intensive care unit for close monitoring and management. Management of hypertension: Aggressive control of hypertension is essential to prevent complications. Intravenous antihypertensive medications are commonly used in PRES to help lower blood pressure. Management of hyperkalemia: Given the high serum potassium level (6.9 mEq/L), measures to lower potassium levels should be initiated promptly, such as dietary restriction of potassium and possibly administration of potassium-lowering medications like loop diuretics or potassium binders. Inhaled salbutamol and insulin treatments can also be used if hyperkalemia persists.

14.4-year-old boy presents with complaints of bloody urine. It is learned that he had an upper respiratory tract infection about 10 days ago. On examination, his blood pressure is 145/91 mmHg (above 99 th percentile for both). Laboratory findings show serum creatinine 2.42 mg/dL, serum albumin (2.3 g/L, Na 135 mmol/L, K 6.2 mmol/L, Ca 7.9 mg/dL, and P 6.6 mg/dL. Urinalysis reveals a red blood cell-count of 237 /HPF and a spot urine protein/creatinine ratio of 6.94 mg/mg. Complement C3 level is 0.52 g/L, and ASO level is 1614 IU/mL. The throat culture shows no growth. The patient's serum creatinine rises to 5.35 mg/dL within 4 days.

Based on the provided clinical information, the diagnosis of this patient is likely rapidly progressive glomerulonephritis (RPGN) with severe kidney impairment and hypertension. The causes of RPGN appears to be APSGN. This diagnosis is supported by the history of upper respiratory tract infection, significantly elevated ASO (anti-streptolysin O) titer, low serum C3 level, and hematuria.

Hospitalization: Given the severity of the presentation, the patient should be hospitalized for close monitoring and management. Management of hypertension: Aggressive control of hypertension is essential to prevent further kidney damage. Antihypertensive medications such as angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) are commonly used in RPGN to help reduce proteinuria and lower blood pressure. Management of hyperkalemia: Given the high serum potassium level (6.2 mEq/L), measures to lower potassium levels should be initiated promptly, such as dietary restriction of potassium and possibly administration of potassium-lowering medications like loop diuretics or potassium binders. Inhaled salbutamol and insulin treatments can also be used if hyperkalemia persists. Renal replacement therapy: With severe kidney impairment (serum creatinine 5.35 mg/dL), renal replacement therapy such as hemodialysis or peritoneal dialysis may be required to manage uremia and electrolyte abnormalities. Corticosteroids or immunosuppressive therapy: In cases of RPGN, particularly if there is evidence of crescentic glomerulonephritis on renal biopsy, corticosteroids and immunosuppressive agents such as cyclophosphamide may be initiated to suppress inflammation and prevent further kidney damage.

7.9-year-old girl presents with complaints of bloody urine. It is learned that she had an upper respiratory tract infection 12 days ago. On examination, her blood pressure is 132/92 mmHg (above 99 th percentile for both). Laboratory findings show serum creatinine 0.48 mg/dL, serum albumin 2.6 g/L, Na 131 mmol/L, K 5.5 mmol/L, Ca 8.5 mg/dL, and P 5.7 mg/dL. Urinalysis reveals a red blood cell-count of 588 /HPF and a spot urine protein/creatinine ratio of 6.02 mg/mg. Complement C3 level is 1.07 g/L, and ASO level is 988 IU/mL. The throat culture shows no growth. ACE inhibitors were started for the patient, and blood pressure returned to normal, but hematuria and proteinuria persisted. During follow-up, significant edema develops in the face and legs, and serum albumin levels drop to 1.5 g/L. A kidney biopsy was performed, which showed mesangial IgG and C3 deposits, no IgA deposits, a starry sky appearance, and endocapillary proliferation.

Based on the provided clinical information, the diagnosis of this patient is likely nephrotic syndrome with hypoalbuminemia, proteinuria and edema. The causes of nephrotic syndrome appears to be APSGN. This diagnosis is supported by the history of upper respiratory tract infection, significantly elevated ASO titer, hematuria and a starry sky appearance in biopsy.

Hospitalization: Given the severity of the presentation, the patient should be hospitalized for close monitoring and management. Management of hypertension: Aggressive control of hypertension is essential to prevent further kidney damage. Antihypertensive medications such as angiotensin-converting enzyme inhibitors (ACE inhibitors) or ARBs are commonly used in APSGN to help reduce proteinuria and lower blood pressure. Management of hyperkalemia: Given the high serum potassium level (6.2 mEq/L), measures to lower potassium levels should be initiated promptly, such as dietary restriction of potassium and possibly administration of potassium-lowering medications like loop diuretics or potassium binders. Inhaled salbutamol and insulin treatments can also be used if hyperkalemia persists. Corticosteroids or immunosuppressive therapy: In cases of nephrotic syndrome, corticosteroids such as prednisolone for 6-8 weeks may be initiated to suppress inflammation and prevent further kidney damage.

In all patients with elevated serum creatinine levels, normal serum creatinine levels were reached after a mean of 12.5±4.9 days. At the last follow-up, the mean serum creatinine level of the study population was 0.54±0.15 mg/dL (0.38-0.89). Complement C3 levels returned to normal in all patients. Microscopic hematuria persisted in 8 patients (72.7%) (median 27±72/HPF erythrocytes on urinalysis). Except for the patient with rapidly progressive glomerulonephritis, proteinuria levels decreased significantly in all patients compared with baseline (median spot urine protein/creatinine 0.71±2.38 mg/mg). In a patient with rapidly progressive glomerulonephritis, the spot urine protein/creatinine ratio was 8.39 mg/mg ( Table 2).

Evaluations Using AI

ChatGPT 3.5 answered questions evaluating the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN as "correct". Questions directed to ChatGPT and responses provided by ChatGPT are presented in Supplemental File 1.

When the clinical and laboratory characteristics of all patients were directed to the program, they were diagnosed with APSGN using ChatGPT 3.5. In terms of treatment and follow-up, the practices performed by ChatGPT 3.5 and clinicians were highly similar. Rest, fluid, and salt restriction were recommended to all patients by ChatGPT 3.5. The initiation of an angiotensin-converting enzyme inhibitor is recommended for hypertension and/or proteinuria. In patients with malignant hypertension, intravenous anti-hypertensives were initiated, and the patient was recommended to be followed up in the intensive care unit. In patients with hyperkalemia, a potassium-poor diet, inhaled salbutamol, and oral potassium binders are recommended. Steroid treatment was recommended for patients with nephrotic syndrome, but no recommendation was made regarding the route of administration or dosage. The patient with a rapid creatinine increase was also diagnosed with rapidly progressive glomerulonephritis by ChatGPT 3.5 and was recommended to start steroid and cyclophosphamide treatments without any opinion on the dose and route of administration. No kidney biopsy was advised for any patient. Except for those presented in Table 2, the clinical characteristics of other patients referred to ChatGPT and the responses provided by ChatGPT are presented in Supplemental File 2.

DISCUSSION

APSGN is the most common glomerulonephritis in childhood caused by some strains of group A b-hemolytic streptococci following urticaria or skin infection, and develops with immune complex deposition in the kidney. Patients may experience sudden onset of bloody urination, edema, hypertension, and clinical findings of acute renal failure. In our study, all patients had URTI before kidney involvement. Group A b-hemolytic streptococcus positivity was demonstrated in throat culture in some patients, but all patients had markedly elevated ASO levels, which is a marker of previous infection. Although macroscopic hematuria was seen in 63.6% of the patients who presented with hematuria, all patients had hematuria. Although nephrotic syndrome was observed in one patient and rapidly progressive glomerulonephritis in another, most patients presented with acute nephritic syndrome.

Precautions should be taken for acute renal failure due to APSGN. Penicillin is recommended for streptococcal infections. However, antibiotic treatment had no impact on the progression of the disease. In our study, only penicillin was used in patients with a history of throat culture. Activity should not be restricted except in the acute period. Salt restriction should be performed during kidney impairment and hypertension. In selected cases, antihypertensive drugs, such as an angiotensin-converting enzyme inhibitor and/or calcium channel blockers, may be used. Although normotension can be achieved with oral antihypertensives, malignant hypertension and related complications that may require the use of intravenous antihypertensives may also develop. In our study, one of our patients presented to the hospital with headache, seizures, mild periorbital edema, and significantly elevated blood pressure according to age, sex, and height. The patient was diagnosed with posterior reversible encephalopathy on magnetic resonance imaging. Although serum creatinine was normal at presentation, the patient had a history of URTI, elevated ASO, and low complement C3. On follow-up, laboratory findings normalized, and normotension was achieved without the need for long-term antihypertensives. It was thought that the patient had acute renal failure with oliguria before presentation to the hospital and presented to the hospital with seizure in the late period when renal function started to improve. Apart from general recommendations and antihypertensive drugs for APSGN, immunosuppressive treatments may be indicated for patients with a noisy picture. In our study, two patients who developed nephrotic syndrome and rapidly progressive glomerulonephritis were initiated on steroids and cyclophosphamide, respectively.

Among patients with APSGN, 95% recover without developing permanent problems. If the acute phase has a very severe course and glomerular hyalinization is caused, kidney failure may be observed in 5% of the cases. In our study, except for the patient diagnosed with rapidly progressive glomerulonephritis, the hematuria level decreased significantly, and improvement was observed in the proteinuria levels in other patients. Even in our patient with severe initial findings due to rapidly progressive glomerulonephritis, serum creatinine levels regressed to normal values, but nephrotic proteinuria persisted.

ChatGPT is a language model developed by OpenAI. It is an AI system that is highly skilled in natural language processing and specializes in understanding, analyzing, and generating text data. It can interact with users in a natural language and generate meaningful responses. The design and development phases of ChatGPT are complex. It is based on an architecture called "Generative Pre-trained Transformer". This architecture was pre-trained on datasets containing large amounts of text. These datasets are obtained from diverse sources, including books, articles, web pages, and forums. ChatGPT can be customized to specific tasks or datasets, typically by tweaking a pre-trained model. This fine-tuning process allows the model to produce more specific and accurate answers on a given topic.

Thanks to rapid technological advancement, ChatGPT versions have been rapidly updated in recent years as ChatGPT-3.0, 3.5, 4.0, and 4.0-Turbo, respectively. While ChatGPT-3.5 offers higher accuracy and consistency than ChatGPT-3.0, ChatGPT-4.0 can be trained with a larger training dataset and more parameters, resulting in more complex and nuanced responses. ChatGPT-4.0 also gained the ability to process text and visual inputs simultaneously. ChatGPT-4.0 Turbo is optimized for speed and cost, offering faster response times, especially in real-time applications. Although ChatGPT 4.0 and 4.0-turbo require a monthly fee, the previous versions can be used free of charge by anyone. For this reason, ChatGTP 3.5, which is publicly and freely available, was used in this study, and the economic burden associated with the use of AI was avoided. However, since ChatGPT-3.5 is trained on data up to September 2021, the accuracy of answers given after this date may be affected, especially in cases that query more recent developments in medical issues. It is indisputable that the answers given by AI would contain much more up-to-date information if ChatGPT 4.0 or the 4.0-Turbo versions had been used in our study.

ChatGPT is used in many medical departments. In the field of pediatric dentistry, ChatGPT is used to identify caries lesions, improve diagnostic imaging accuracy and efficiency, improve treatment esthetics, simulate outcomes, and predict oral diseases. The ability to provide immediate feedback and clarify doubts has been shown to help improve health status and oral hygiene by providing patients with relevant information. However, it should be noted that ChatGPT is not completely free of errors or limitations, and the plausibility of incorrect answers can be surprising. Therefore, it is emphasized that ChatGPT outputs should be checked manually by clinicians. However, in our study, questions evaluating the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN were answered correctly by ChatGPT 3.5. Answers to these questions can also be obtained using traditional search engines such as Google or medical/scientific databases such as PubMed or UpToDate. However, ChatGPT provides general medical information derived from various sources and responds very quickly. Both PubMed and UpToDate present pages of data when information on a medical topic is sought, which may take users hours to sift through to find the desired information. Thus, ChatGPT saves users significant time. In a study in which ChatGPT asked junior and senior specialist questions about the thyroid, ChatGPT was shown to produce responses quickly. However, unlike these search engines, ChatGPT does not provide references. This lack of citations is a potential weakness of ChatGPT. In a study comparing ChatGPT and UptoDate, ChatGPT could not provide references for some questions. In addition, the accuracy score of the responses provided by ChatGPT in this study was significantly lower than that of UptoDate.

There are some studies stating that the use of ChatGPT in the medical field is beneficial. For example, ChatGPT can play a role in various fields, including pediatric radiology. In this study, various case scenarios related to pediatric radiological imaging methods were directed to ChatGPT, and the responses of AI were evaluated. ChatGPT provided suggestions about imaging modalities that could be applied for each clinical scenario. It was able to provide information on whether imaging techniques that do not use radiation can be used in the current scenario. If radiation is to be used, it provides information on the optimum dose. It has been pointed out that ChatGPT can provide valuable information, but the final interpretation and diagnosis should always be made by a radiologist. In another medical field, the integration of AI into the field of pediatrics has the potential to transform healthcare with new and effective approaches for supporting diagnoses, treatment plans, and specific clinical decisions. This study explored ChatGPT's effectiveness as a decision-making tool in pediatrics by posing 8 clinical symptom-related questions. Two pediatricians independently assessed ChatGPT's open-ended responses. The findings indicated that ChatGPT could enhance clinical workflows and support decision-making in pediatrics. In our study, when the features of the cases were assessed, treatments administered by clinicians to all patients with a diagnosis of APSGN and the ChatGPT recommendations. However, it did not mention the route of administration or dosage of the recommended drugs. In the field of pediatrics, the route of administration and dosage of each drug are of great importance. Although this situation seems to be a limitation of ChatGPT, ChatGPT will be used by medical specialists, as in this study. In any event, it is suggested to use ChatGPT's recommendations with questioning. It should be used together with the clinician and should be considered as an assistant to the clinician. Therefore, we believe that the lack of ChatGPT's information about drug administration routes and dosages is an acceptable deficiency.

CONCLUSION

Further investigations and advancements in ChatGPT's capabilities related to pediatric care could potentially enhance patient management and healthcare delivery. In our study, the information and guidance provided by ChatGPT on APSGN may be a valuable resource for patient care and management. However, under current conditions, the recommendations provided by ChatGPT applications must be manually checked and evaluated by clinicians. New updates and developments are required for AI to be routinely used.

Ethics

Ethics Committee Approval: The study received approval from the KTO-Karatay University Rectorate Dean of the Faculty of Medicine non-Drug and non-Medical Device Research Ethics Committee Presidency (decision no: 77998, date: 16.01.2024).

Informed Consent: This was a retrospective observational study with a cross-sectional design in which the demographic, clinical, and laboratory characteristics of patients aged 0-18 years who were followed up with a diagnosis of APSGN in the Department of Pediatric Nephrology between September 2023 and March 2024 were analyzed from patient records.

Footnotes

Author Contributions

Surgical and Medical Practices: E.L., Concept: E.L., M.S., Design: E.L., M.S., Data Collection and/or Processing: E.L., Analysis and/or Interpretation: E.L., M.S., Literature Search: E.L., M.S., Writing: E.L., M.S.

Conflict of Interest: The authors have no conflict of interest to declare.

Financial Disclosure: The authors declared that this study has received no financial support

References

16. Asinobi AO, Ademola AD, Nwankwo AF. Childhood acute glomerulonephritis in Ibadan Nigeria. Nigerian journal of paediatrics. 2020;47:345-52. [Google Scholar]

20. Zaffanello M, Cataldi L, Franchini M, Fanos V. Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children. Med Sci Monit. 2010;16(4):RA79-84. [PubMed] [Google Scholar]

28. Andykarayalar R, Mohan Surapaneni K. ChatGPT in Pediatrics: Unraveling its Significance as a Clinical Decision Support Tool. Indian Pediatr. 2024;61:357-8. [PubMed] [Google Scholar]

Articles from Medeniyet Medical Journal are provided here courtesy of Istanbul Medeniyet University

# data[].attributes.attachment_link.title
Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and Re-Evaluation of Patients with Artificial Intelligence

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Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute glomerulonephritis in children. The condition may present as acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. ChatGPT ...

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Learn about post-streptococcal glomerulonephritis: Symptoms, treatment, and more.

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This link describes the affects of poststreptococcal glomerulonephritis on the systems of the body. Poststreptococcal glomerulonephritis primarily affects the kidneys, which results in edema, hematuria, proteinuria, and oliguria. The cardiovascular system is also affected however, by the resulting hypertension and potential heart failure.

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Post-Strep Glomerulonephritis: Causes & Symptoms | Ada

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Post-streptococcal glomerulonephritis is a kidney condition after strep infection, causing swelling, blood in urine, and high blood pressure. Learn with Ada.

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This link describes the therapeutic management of this condition. It details how management is typically supportive to manage the symptoms. A diuretic is normally prescribed to manage the associated hypertension and fluid overload. Antibiotics are prescribed to control the Streptococcal infection. This link also does a great job of confirming the information provided by the other sources we have listed.

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POST STREPTOCOCCAL GLOMERULONEPHRITIS, Causes, Signs and Symptoms, Diagnosis and Treatment.

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Type III hypersensitivity (immune complex mediated) - causes, symptoms & pathology

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A true Type III hypersensitivity reaction?

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A true Type III hypersensitivity reaction?

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This image shows that poststeptococcal glomerulonephritis does conform to the traditional definition of a type III hypersensitivity reaction. This condition is the result of inflammatory responses triggered by deposition of immune complexes into the tissue.