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金黄色葡萄球菌相关性肾小球肾炎:皮质类固醇的潜在作用。

Staphylococcus-induced glomerulonephritis: potential role for corticosteroids.

机构信息

Department of Nephrology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal

Department of Nephrology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.

出版信息

BMJ Case Rep. 2021 Jan 27;14(1):e237011. doi: 10.1136/bcr-2020-237011.

Abstract

is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection's course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease's pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control.

摘要

金黄色葡萄球菌是一种棘手的病原体,可引起多种临床表现,从良性皮肤感染到危及生命的感染,如心内膜炎和骨髓炎。金黄色葡萄球菌感染过程中,超抗原沉积在肾小球,可通过炎症反应引起快速进行性肾小球肾炎,导致肾脏受累。这种肾小球病预后不良,常导致慢性肾功能受损,最终进展为终末期肾病。治疗依赖于抗生素治疗。尽管在这种疾病的病理生理学中存在炎症作用,但由于同时存在感染,大多数作者不赞成同时进行免疫抑制治疗。然而,有一些报告称,在这些患者中使用全身皮质类固醇治疗后取得了成功。我们报告了一例 66 岁男性,因血管移植物感染导致金黄色葡萄球菌肾小球肾炎,尽管取出了感染的移植物并进行了 3 周的抗生素治疗以控制感染,但肾功能仍迅速恶化。在引入皮质类固醇后,肾功能得到改善。该病例强调了皮质类固醇在某些金黄色葡萄球菌肾小球肾炎病例中的潜在作用,特别是在感染得到控制的情况下。

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