Limm-Chan Blair, Musgrave James, Lau Rhiana, Ahn Hyeong Jun, Nguyen Lynn, Kurahara David
Department of Pediatrics, John A Burns School of Medicine, University of Hawai'i, Honolulu, HI (BL-C, JM, RL, LN, DK).
Department of Complementary and Integrative Medicine, John A Burns School of Medicine, University of Hawai'i, Honolulu, HI (HJA).
Hawaii J Health Soc Welf. 2020 May 1;79(5):149-152.
Acute post-streptococcal glomerulonephritis (APSGN) is a disorder of inflammation in the glomeruli and vasculature of the kidneys that is caused by immune-complex formation after Streptococcus pyogenes infection. Most patients with APSGN present with macroscopic hematuria, edema, and hypertension, however presentation can vary from no symptoms to severe proteinuria, or even acute renal failure. This study sought to estimate the incidence of APSGN among children in Hawai'i, to identify populations at increased risk for APSGN, and to recognize risk factors correlated with the length of hospitalization by subtype of APSGN (eg, pyoderma-associated, pharyngitis-associated). This retrospective review of 106 patients found that the incidence of APSGN in Hawai'i is greater than 4 per 100,000 children, which is significantly higher than the incidence of APSGN in high-income countries at 0.3 per 100,000 children. This increased incidence may be due to Hawai'i's unique racial group composition and therefore the unique immunologic response of the children of Hawai'i (particularly Pacific Islanders, who represent 62% of patients with APSGN in this study, but only represent 10% of Hawai'i's general population). In addition, there may be increased prevalence of nephritogenic strains of Streptococcus pyogenes in Hawai'i. The length of hospitalization was significantly increased in children with elevated serum creatinine levels (P <.0001) and lower bicarbonate levels (P =.0003).
急性链球菌感染后肾小球肾炎（APSGN）是一种肾脏肾小球和血管的炎症性疾病，由化脓性链球菌感染后形成免疫复合物所致。大多数APSGN患者表现为肉眼血尿、水肿和高血压，然而其表现可能从无症状到严重蛋白尿，甚至急性肾衰竭不等。本研究旨在估计夏威夷儿童中APSGN的发病率，确定APSGN风险增加的人群，并识别与APSGN亚型（如脓疱病相关型、咽炎相关型）住院时间相关的危险因素。这项对106例患者的回顾性研究发现，夏威夷APSGN的发病率高于每10万名儿童4例，这显著高于高收入国家每10万名儿童0.3例的APSGN发病率。发病率的增加可能归因于夏威夷独特的种族构成，以及因此夏威夷儿童独特的免疫反应（特别是太平洋岛民，在本研究中占APSGN患者的62%，但仅占夏威夷总人口的10%）。此外，夏威夷化脓性链球菌致肾炎菌株的患病率可能更高。血清肌酐水平升高（P <.0001）和碳酸氢盐水平降低（P =.0003）的儿童住院时间显著延长。
