Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo 193-0998, Japan.
Hemodialysis Unit, Showanomori Hospital, Akishima, Tokyo 196-0024, Japan.
Int J Mol Sci. 2021 Jan 18;22(2):905. doi: 10.3390/ijms22020905.
Acute glomerulonephritis (AGN) triggered by infection is still one of the major causes of acute kidney injury. During the previous two decades, there has been a major paradigm shift in the epidemiology of AGN. The incidence of poststreptococcal acute glomerulonephritis (PSAGN), which develops after the cure of group A infection in children has decreased, whereas adult AGN cases have been increasing, and those associated with nonstreptococcal infections, particularly infections by , are now as common as PSAGN. In adult AGN patients, particularly older patients with comorbidities, infections are usually ongoing at the time when glomerulonephritis is diagnosed; thus, the term "infection-related glomerulonephritis (IRGN)" has recently been popularly used instead of "post-infectious AGN". The prognosis of children with PSAGN is generally considered excellent compared with that of adult IRGN cases. However, long-term epidemiological analysis demonstrated that an episode of PSAGN in childhood is a strong risk factor for chronic kidney disease (CKD), even after the complete remission of PSAGN. Although the precise mechanism of the transition from IRGN to CKD remains unknown, its clarification is important as it will lead to the prevention of CKD. In this review, we therefore focus on the possible factors that may contribute to the progression of IRGN into CKD. Four factors, namely, persistent infection, genetic background of the host's complement system, tubulointerstitial changes, and pre-existing histological damage, are discussed.
急性肾小球肾炎（AGN）由感染引发，仍是急性肾损伤的主要病因之一。在过去的二十年中，AGN 的流行病学发生了重大转变。儿童 A 组链球菌感染治愈后发生的链球菌后急性肾小球肾炎（PSAGN）的发病率有所下降，而成人 AGN 病例却在增加，与非链球菌感染相关的 AGN，尤其是感染 ，现在与 PSAGN 一样常见。在成人 AGN 患者中，特别是合并有并发症的老年患者，在诊断肾小球肾炎时，感染通常仍在持续；因此，“感染相关性肾小球肾炎（IRGN）”这一术语最近已被广泛使用，而非“感染后 AGN”。与成人 IRGN 病例相比，PSAGN 患儿的预后通常被认为较好。然而，长期的流行病学分析表明，儿童 PSAGN 是慢性肾脏病（CKD）的一个强烈危险因素，即使 PSAGN 完全缓解后也是如此。尽管从 IRGN 到 CKD 进展的确切机制尚不清楚，但明确这一点很重要，因为这将有助于预防 CKD。因此，在本篇综述中，我们重点关注可能导致 IRGN 进展为 CKD 的因素。讨论了四个因素，即持续感染、宿主补体系统的遗传背景、肾小管间质变化和预先存在的组织学损伤。
