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链球菌感染后肾小球肾炎

Infection-Related Glomerulonephritis

作者信息

Hassanein Mohamed, Gudsoorkar Prakash, Padala Sandeep A., Amarapurkar Pooja

机构信息

Kidney and Urology Center

University of Cincinnati Medical Centre

Abstract

Glomerulonephritis results from immune dysregulation-mediated glomerular injury. Many infections can trigger glomerulonephritis, including endocarditis; enterocolitis; pneumonia; intraventricular shunt infections; viral infections, such as hepatitis B and C, HIV, and SARS-CoV-2; and parasitic infections, such as malaria, filariasis, and schistosomiasis. Previously, poststreptococcal glomerulonephritis was the leading cause of bacterial infection-related glomerulonephritis. During the past few decades, other triggers for bacterial-associated infection-related glomerulonephritis have evolved, including staphylococcalinfection-associated glomerulonephritis, subacute bacterial endocarditis, shunt nephritis, indwelling central venous catheters, and visceral abscesses. For simplification, bacterial infection-related glomerulonephritis can be divided into: Poststreptococcal glomerulonephritis. Staphylococcal infection-associated glomerulonephritis. Other bacterial infection-associated glomerulonephritis, including shunt nephritis, subacute bacterial endocarditis, central venous catheter infections, and visceral abscesses. Nonbacterial causes, including viruses, fungi, and parasites.

摘要

链球菌感染后肾小球肾炎(PSGN)的特征是在链球菌感染后因炎症反应(III型超敏反应)导致肾功能迅速恶化(见链球菌感染后肾小球肾炎)。这种情况由称为致肾炎链球菌的特定A组β溶血性链球菌菌株引起。该疾病影响肾小球和肾脏的小血管。PSGN最常见于儿童,在喉咙痛后1至2周,或皮肤感染(脓疱病)后6周出现。尽管在发达国家PSGN的发病率有所下降,但非链球菌病原体的发病率正在上升。肾炎相关纤溶酶受体(NAPlr)和链球菌致热外毒素B(SPeB)是与PSGN发病机制相关的两种常见抗原。它们不仅激活替代补体途径,导致补体血症,而且它们还对纤溶酶和肾小球蛋白具有亲和力。PIGN的临床表现可以从无症状到需要肾脏替代治疗(RRT)的肾衰竭不等。有症状时,PSGN通常表现为肾炎综合征的特征,如血尿、少尿、高血压和水肿。较少见的表现可模拟肾病综合征,伴有大量蛋白尿。

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