What is the incidence of acute poststreptococcal glomerulonephritis (APSGN) in the US?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Over the last 2-3 decades, the incidence of acute poststreptococcal glomerulonephritis (APSGN) has declined in the United States as well as in other countries, such as Japan, Central Europe, and Great Britain. The estimated worldwide burden of APSGN is approximately 472,000 cases per year, with approximately 404,000 cases being reported in children and 456,000 cases occurring in less developed countries. [33]   The overall decline in the incidence of the disease in both the developed and non-developed world is likely due to the increase of earlier overall use of antibiotics for skin infections, leading to decreased transmission of virulent strains. Also, easier access to health care and fluoridation of water that is bacteriocidal for streptococcus has been thought to play a role.  APSGN associated with skin infections is most common in tropical areas where pyoderma is endemic, whilst pharyngitis-associated APSGN predominates in temperate climates. [33]

However, in recent years, a slight increase in the incidence of the disease has been reported, although the actual incidence is still unknown. This is particularly true in elderly persons, especially in association with debilitating conditions such as alcoholism or intravenous drug abuse. [34] The overall decline in APSGN may be due to the improvement in living conditions with less crowding. However, other factors, including decreased prevalence or infectivity of the nephritogenic streptococci, may also have contributed to the decline in incidence. The recently observed increase in incidence is more difficult to explain. In the past 30 years, large epidemics have been reported in middle-income countries, with clusters of cases in more developed countries. [35] However, in poorly developed countries, it is likely that clusters of cases of APSGN may go underreported.

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