Neugarten J, Baldwin D S
Am J Med. 1984 Aug;77(2):297-304. doi: 10.1016/0002-9343(84)90706-x.
The introduction of antibiotic therapy and changing epidemiologic patterns have altered the nature of glomerulonephritis as it occurs during the course of bacterial endocarditis. Observations made predominantly in the pre-antibiotic era suggested that infections with less virulent organisms, by virtue of their indolent subacute course, favored an antibody response predisposing to immune complex glomerulonephritis. Although antibiotic prophylaxis and therapy have reduced the incidence of both Streptococcus viridans bacterial endocarditis and concomitant glomerulonephritis, Staphylococcus aureus has become a major cause of acute bacterial endocarditis with a high incidence of glomerulonephritis. Parenteral drug abuse itself, which has emerged as a major factor predisposing to endocarditis, may also favor the development of glomerulonephritis. The course of glomerulonephritis has been altered in association with these changes in etiology and epidemiology. This review summarizes the clinical and morphologic features of glomerulonephritis as it currently occurs during the course of bacterial endocarditis.
抗生素治疗的引入以及流行病学模式的改变，已经改变了细菌性心内膜炎病程中所发生的肾小球肾炎的性质。主要在抗生素时代之前所做的观察表明，感染毒力较低的病原体，由于其病程呈隐匿性亚急性，有利于引发抗体反应，从而易患免疫复合物性肾小球肾炎。尽管抗生素预防和治疗已降低了草绿色链球菌性心内膜炎及并发肾小球肾炎的发生率，但金黄色葡萄球菌已成为急性细菌性心内膜炎的主要病因，且肾小球肾炎的发生率很高。静脉药物滥用本身已成为易患心内膜炎的一个主要因素，它也可能有利于肾小球肾炎的发生。随着病因学和流行病学的这些变化，肾小球肾炎的病程也已改变。本综述总结了目前在细菌性心内膜炎病程中所发生的肾小球肾炎的临床和形态学特征。
