Facultad de Medicina, Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Universidad del Zulia, Maracaibo, Venezuela.
Facultad de Medicina, Cátedra de Inmunología, Escuela de Bioanálisis, Universidad del Zulia, Maracaibo, Venezuela.
Int Rev Immunol. 2021;40(6):381-400. doi: 10.1080/08830185.2020.1830083. Epub 2020 Oct 8.
Increasing evidence supports a central role of the immune system in acute post streptococcal glomerulonephritis (APSGN), but the current view of how streptococcal biology affects immunity, and vice versa, remains to be clarified. Renal glomerular immune complex deposition is critical in the initiation of APSGN; however, mechanisms previous to immune complex formation could modulate the initiation and the progression of the disease. Initial and late renal events involved in the nephritis can also be related to host factors and streptococcal factors. In this review we describe the mechanisms reported for the APSGN pathogenesis, the interactions of streptococcal products with renal cells and leukocytes, the possible effects of different nephritogenic antigens in the renal environment and the possibility that APSGN is not just due to a single streptococcal antigen and its antibody; instead, kidney damage may be the result of different factors acting at the same time related to both streptococcus and host factors. Addressing these points should help us to better understand APSGN physiopathology.
越来越多的证据支持免疫系统在急性链球菌后肾小球肾炎 (APSGN) 中的核心作用，但目前对于链球菌生物学如何影响免疫以及反之亦然的观点仍有待阐明。肾脏肾小球免疫复合物沉积在 APSGN 的起始中至关重要；然而，在免疫复合物形成之前的机制可以调节疾病的起始和进展。肾炎中涉及的初始和晚期肾脏事件也可能与宿主因素和链球菌因素有关。在这篇综述中，我们描述了 APSGN 发病机制的报告机制、链球菌产物与肾细胞和白细胞的相互作用、不同肾炎性抗原在肾脏环境中的可能作用以及 APSGN 可能不仅仅是由于单个链球菌抗原及其抗体引起的；相反，肾脏损伤可能是同时作用于与链球菌和宿主因素相关的不同因素的结果。解决这些问题应该有助于我们更好地理解 APSGN 的病理生理学。
