Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Nat Rev Nephrol. 2020 Jan;16(1):32-50. doi: 10.1038/s41581-019-0178-8. Epub 2019 Aug 9.
For over a century, acute 'post-streptococcal glomerulonephritis' (APSGN) was the prototypical form of bacterial infection-associated glomerulonephritis, typically occurring after resolution of infection and a distinct infection-free latent period. Other less common forms of infection-associated glomerulonephritides resulted from persistent bacteraemia in association with subacute bacterial endocarditis and shunt nephritis. However, a major paradigm shift in the epidemiology and bacteriology of infection-associated glomerulonephritides has occurred over the past few decades. The incidence of APSGN has sharply declined in the Western world, whereas the number of Staphylococcus infection-associated glomerulonephritis (SAGN) cases increased owing to a surge in drug-resistant Staphylococcus aureus infections, both in the hospital and community settings. These Staphylococcus infections range from superficial skin infections to deep-seated invasive infections such as endocarditis, which is on the rise among young adults owing to the ongoing intravenous drug use epidemic. SAGN is markedly different from APSGN in terms of its demographic profile, temporal association with active infection and disease outcomes. The diagnosis and management of SAGN is challenging because of the lack of unique histological features, the frequently occult nature of the underlying infection and the older age and co-morbidities in the affected patients. The emergence of multi-drug-resistant bacterial strains further complicates patient treatment.
一个多世纪以来，急性“链球菌后肾小球肾炎”（APSGN）一直是细菌性感染相关性肾小球肾炎的典型形式，通常发生在感染消退和明确的无感染潜伏期之后。其他不太常见的感染相关性肾小球肾炎形式则源于持续性菌血症，与亚急性细菌性心内膜炎和分流性肾炎有关。然而，过去几十年来，感染相关性肾小球肾炎的流行病学和细菌学发生了重大转变。在西方世界，APSGN 的发病率急剧下降，而由于医院和社区环境中耐多药金黄色葡萄球菌感染的激增，金黄色葡萄球菌感染相关性肾小球肾炎（SAGN）的病例数量有所增加。这些金黄色葡萄球菌感染从皮肤浅表感染到深部侵袭性感染，如心内膜炎，由于静脉药物使用的持续流行，心内膜炎在年轻人中的发病率正在上升。SAGN 在其人口统计学特征、与活动性感染的时间关联和疾病结局方面与 APSGN 明显不同。由于缺乏独特的组织学特征、潜在感染的隐匿性以及受影响患者的年龄较大和合并症较多，SAGN 的诊断和管理具有挑战性。多药耐药细菌株的出现进一步使患者的治疗复杂化。
