Ong Leong Tung
Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
World J Nephrol. 2022 Sep 25;11(5):139-145. doi: 10.5527/wjn.v11.i5.139.
Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in low- and middle-income countries. APSGN commonly occurs following pharyngitis due to the activation of antibodies and complements proteins against streptococcal antigens through the immune-complex-mediated mechanism. APSGN can be presented as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. The management of APSGN is mainly supportive in nature with fluid restriction, anti-hypertensives, diuretics, and renal replacement therapy with dialysis, when necessary, as the disease is self-limiting. Congestive heart failure, pulmonary edema, and severe hypertension-induced encephalopathy might occur during the acute phase of APSGN due to hypervolemia. APSGN generally has a favorable prognosis with only a small percentage of patients with persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. Decreased complement levels, increased C-reactive protein, and hypoalbuminemia are associated with disease severity. Crescent formations on renal biopsy and renal insufficiency on presentation may be the predictors of disease severity and poor outcomes in APSGN in children.
急性链球菌感染后肾小球肾炎（APSGN）是儿童急性肾小球肾炎的主要病因，在低收入和中等收入国家尤为如此。APSGN通常在咽炎后发生，是由于通过免疫复合物介导的机制激活了针对链球菌抗原的抗体和补体蛋白。APSGN可表现为急性肾炎综合征、肾病综合征和急进性肾小球肾炎，也可能是亚临床的。APSGN的治疗主要是支持性的，包括限制液体摄入、使用抗高血压药、利尿剂，必要时进行透析等肾脏替代治疗，因为该病具有自限性。在APSGN的急性期，由于血容量过多，可能会发生充血性心力衰竭、肺水肿和严重高血压诱发的脑病。APSGN总体预后良好，只有一小部分患者在APSGN急性发作后会出现持续性尿液异常、持续性高血压和慢性肾脏病。补体水平降低、C反应蛋白升高和低白蛋白血症与疾病严重程度相关。肾活检显示新月体形成以及就诊时存在肾功能不全可能是儿童APSGN疾病严重程度和不良预后的预测因素。
