Wenderfer Scott E
Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Pediatr Nephrol. 2015 Nov;30(11):1929-38. doi: 10.1007/s00467-015-3057-y. Epub 2015 Mar 10.
Viral infections associate temporally with the onset of many glomerular diseases, particularly in children. In other cases of glomerulonephritis, when infection is clinically silent, viral syndromes can still be implicated as a trigger. However, strong evidence for viral causality in most glomerular disease is still lacking. While numerous case reports in children document the occurrence of specific forms of glomerular disease after seroconversion to a wide range of viruses, relatively few reports provide pathologic evidence of viral infection associated with glomerular lesions on kidney biopsy. Strong associations between hepatitis viruses and glomerular injury have been acknowledged in adults, but hepatitis C virus appears not to be an etiology in children. In the context of treating glomerular diseases, when diagnosed, the treatment of hepatitis B virus, cytomegalovirus and human immunodeficiency virus in children with membranoproliferative, membranous and collapsing glomerulopathy plays an important role. Otherwise, there is no evidence suggesting that the identification of a viral infection in a child with glomerulopathy should change the management of the infection or the glomerulonephritis. Therefore, additional research into this topic is very much needed.
病毒感染在时间上与许多肾小球疾病的发病相关,尤其是在儿童中。在其他肾小球肾炎病例中,当感染在临床上不明显时,病毒综合征仍可能被认为是触发因素。然而,大多数肾小球疾病中病毒因果关系的有力证据仍然缺乏。虽然儿童中的大量病例报告记录了血清转化为多种病毒后特定形式肾小球疾病的发生,但相对较少的报告提供了肾活检中与肾小球病变相关的病毒感染的病理证据。成人中已确认肝炎病毒与肾小球损伤之间存在密切关联,但丙型肝炎病毒似乎不是儿童的病因。在治疗肾小球疾病时,一旦确诊,对患有膜增生性、膜性和塌陷性肾小球病的儿童进行乙型肝炎病毒、巨细胞病毒和人类免疫缺陷病毒的治疗具有重要作用。否则,没有证据表明在患有肾小球病的儿童中识别出病毒感染应改变感染或肾小球肾炎的治疗方法。因此,非常需要对该主题进行更多研究。