Kapadia A S, Panda M, Fogo A B
Department of Medicine, University of Tennessee College of Medicine, Chattanooga, USA.
Indian J Nephrol. 2011 Apr;21(2):116-9. doi: 10.4103/0971-4065.82141.
The role of steroids in treatment of postinfectious glomerulonephritis (PIGN) has been controversial. The reason for such controversy is the risk of infection relapse associated with steroid therapy. Steroids may have a place in the treatment of resistant cases where renal function does not improve despite aggressive antibiotic therapy as well as in patients with crescentic form of PIGN. We report a case of a 39 year-old Caucasian man who was diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia resulting in acute IgA dominant PIGN that failed to respond to antibiotic treatment alone, but responded significantly to steroids in addition to antibiotics. This anecdotal experience suggests that steroids could be considered in conjunction with antibiotic therapy for the treatment of refractory cases of PIGN or crescentic form of PIGN. More studies with long-term follow-up of patients treated with steroids in addition to antimicrobial agents are required to quantify the risk of infection relapse with steroid therapy.
类固醇在感染后肾小球肾炎（PIGN）治疗中的作用一直存在争议。产生这种争议的原因是类固醇治疗会带来感染复发的风险。对于尽管积极使用抗生素治疗但肾功能仍未改善的耐药病例以及新月体型PIGN患者，类固醇可能在治疗中占有一席之地。我们报告一例39岁的白种男性病例，该患者被诊断为耐甲氧西林金黄色葡萄球菌（MRSA）菌血症，导致急性IgA为主型PIGN，单独使用抗生素治疗无效，但在使用抗生素的基础上加用类固醇后有显著反应。这一轶事性经验表明，对于PIGN难治性病例或新月体型PIGN，可考虑联合使用类固醇与抗生素进行治疗。需要对使用抗菌药物外加类固醇治疗的患者进行更多长期随访研究，以量化类固醇治疗导致感染复发的风险。
