Icahn School of Medicine at Mount Sinai, New York, NY.
Pediatr Rev. 2023 Sep 1;44(9):498-512. doi: 10.1542/pir.2021-005259.
Glomerulonephritis (GN) encompasses several disorders that cause glomerular inflammation and injury through an interplay of immune-mediated mechanisms, host characteristics, and environmental triggers, such as infections. GN can manifest solely in the kidney or in the setting of a systemic illness, and presentation can range from chronic and relatively asymptomatic hematuria to fulminant renal failure. Classic acute GN is characterized by hematuria, edema, and hypertension, the latter 2 of which are the consequence of sodium and water retention in the setting of renal impairment. Although presenting signs and symptoms and a compatible clinical history can suggest GN, serologic and urinary testing can further refine the differential diagnosis, and renal biopsy can be used for definitive diagnosis. Treatment of GN can include supportive care, renin-angiotensin-aldosterone system blockade, immunomodulatory therapy, and renal transplant. Prognosis is largely dependent on the underlying cause of GN and can vary from a self-limited course to chronic kidney disease. This review focuses on lupus nephritis, IgA nephropathy, IgA vasculitis, and postinfectious GN.
肾小球肾炎 (GN) 包括几种通过免疫介导机制、宿主特征和环境触发因素（如感染）相互作用引起肾小球炎症和损伤的疾病。GN 可以仅在肾脏中表现出来，也可以在全身性疾病的背景下表现出来，其表现范围从慢性且相对无症状性血尿到暴发性肾衰竭不等。典型的急性 GN 表现为血尿、水肿和高血压，后两者是由于肾功能受损时钠和水潴留引起的。尽管出现的体征、症状和相符的临床病史可以提示 GN，但血清学和尿液检查可以进一步细化鉴别诊断，肾活检可用于明确诊断。GN 的治疗可包括支持性治疗、肾素-血管紧张素-醛固酮系统阻断、免疫调节治疗和肾移植。预后在很大程度上取决于 GN 的潜在原因，从自限性病程到慢性肾脏病不等。本篇综述重点介绍狼疮性肾炎、IgA 肾病、IgA 血管炎和感染后肾小球肾炎。
