WordNet

nephritis marked by inflammation of the glomeruli of the kidney; characterized by decreased production of urine and by the presence of blood and protein in the urine and by edema

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/03 13:23:26」(JST)

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Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of infections, typically streptococcal skin infection (impetigo) rather than streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis.^[1]

It can be a risk factor for future albuminuria.^[2]

Signs and symptoms[edit]

Hematuria:^[3]

May be microscopic and not identified by the patient.
May be macroscopic and lead to dark brown or smoky urine.
Frank hematuria may occur in severe case.

Oliguria

Urine output is less than 400 ml/day (normally 600 to 2500 ml/day). In children it is less than 0.5 mL/ kg/ hr.
May not be observed by the patient.

Edema

Acute onset.
Mild to modest severity.
Pitting edema.
Starts in the eyelids and face then the lower and upper limbs then generalized (e.g. hydrocele, ascites.pericardial and pleural effusion.)
It may be migratory: appearing in eyelid in the morning, disappearing in the afternoon, and reappearing around the ankle in ambulatory patients by the end of the day.

Hypertension

It is usually mild to moderate.
Hypertensive encephalopathy, heart failure, and acute pulmonary edema may occur in severe cases.
Pulmonary congestion and congested neck veins may be present, but is usually due to salt and water retention (and, less commonly, heart failure).

General

Fever, headache, malaise, anorexia, nausea, and vomiting.
Pallor due to edema and/or anemia.

Acute renal necrosis due to injury of capillary or capillary thrombosis. Acute tubular obstruction by cast.

Causes[edit]

Acute proliferative glomerulonephritis can be a complication of streptococcal pharyngitis (strep throat) and impetigo.

Pathophysiology[edit]

Schematic representation.

The exact pathology remains unclear, but it is believed to be type III hypersensitivity reaction. Immune complexes (antigen-antibody complexes formed during an infection) become lodged in the glomerular basement membrane below the podocyte foot processes. This creates a lumpy bumpy appearance on light microscopy and subepithelial humps on electron microscopy. Complement activation leads to destruction of the basement membrane. It has also been proposed that specific antigens from certain nephrotoxic streptococcal infections have a high affinity for basement membrane proteins, giving rise to particularly severe, long lasting antibody response.

Diagnosis[edit]

Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation. There will be an elevated Anti-streptolysin O titre and low complement levels (C3 and C4) in the blood.

Mechanism of edema[edit]

Diffuse Proliferative Glomerulonephritis (DPGN) is a nephritic syndrome; therefore, it causes edema through an increase in hydrostatic pressure and fluid overload secondary to inflammatory damage. Examples of nephritic syndrome include: DPGN, IgA nephropathy, lupus nephritis, and MPGN.

Hypoalbuminemia is the cause of edema in nephrotic syndrome (characterized by heavy proteinuria—greater than 3.5g/day). Examples include: minimal change disease (MCD), membranous glomerulonephritis (MGN), focal segmental glomerulosclerosis (FSGS), lupus, amyloidosis, and diabetes.

Differential diagnosis[edit]

Other causes of acute glomerulonephritis:
- IgA Nephropathy
- Lupus nephritis
- Type 1 membranoproliferative glomerulonephritis
- Bacterial endocarditis
- Shunt nephritis
- Cryoglobulinemia
Nephrotic syndrome
Other causes of generalized edema:
- Malnutrition
- Malabsorption
- Renal affection
- Liver cell failure
- Right side heart failure
- Angioedema
Other causes of hematuria

Complications[edit]

Possible complications of acute proliferative glomerulonephritis include renal failure and hypertensive encephalopathy.

Epidemiology[edit]

Acute glomerulonephritis resulted in about 84,000 deaths in 2010 down from 135,000 in 1990.^[4]

References[edit]

^ Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970.
^ White AV, Hoy WE, McCredie DA (May 2001). "Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life". Med. J. Aust. 174 (10): 492–6. PMID 11419767.
^ Sung HY, Lim CH, Shin MJ, et al. (December 2007). "A case of post-streptococcal glomerulonephritis with diffuse alveolar hemorrhage". J. Korean Med. Sci. 22 (6): 1074–8. doi:10.3346/jkms.2007.22.6.1074. PMID 18162726.
^ Lozano, R (2012 Dec 15). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. PMID 23245604.

External links[edit]

Post-infectious glomerulonephritis - Mayo Clinic
Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases

UpToDate Contents

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1. 溶連菌感染後糸球体腎炎 poststreptococcal glomerulonephritis
2. 成人におけるブドウ球菌随伴糸球体腎炎 staphylococcus associated glomerulonephritis in adults
3. 糸球体疾患の鑑別診断および評価 differential diagnosis and evaluation of glomerular disease
4. 好酸球の生物学および好酸球増多症の原因 eosinophil biology and causes of eosinophilia
5. 糸球体の免疫障害の機序 mechanisms of immune injury of the glomerulus

English Journal

Impact of scabies in resource-poor communities.

Heukelbach J, Mazigo HD, Ugbomoiko US.SourceDepartment of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil. heukelbach@web.de
Current opinion in infectious diseases.Curr Opin Infect Dis.2013 Apr;26(2):127-32. doi: 10.1097/QCO.0b013e32835e847b.
PURPOSE OF REVIEW: Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed.RECENT FINDINGS: Scabies is endemic in many resource-poor communities, with
PMID 23343887

Poststreptococcal glomerulonephritis and rheumatic fever: two faces of the same coin.

Fioretti M, Napodano S, Patti M, Rigante D.SourceInstitute of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy. drigante@gmail.com.
European review for medical and pharmacological sciences.Eur Rev Med Pharmacol Sci.2013 Apr;17(8):1139-40.
PMID 23661531

Japanese Journal

Diffuse Alveolar Hemorrhage in a Patient with Acute Poststreptococcal Glomerulonephritis Caused by Impetigo

, , , , , , , ,
Internal Medicine 54(8), 961-964, 2015
… We herein report a case of pulmonary renal syndrome with nephritis in a 17-year-old boy with diffuse alveolar hemorrhage (DAH) associated with acute poststreptococcal glomerulonephritis (APSGN). …
NAID 130005065257

Poststreptococcal Glomerulonephritis in a Patient with Essential Thrombocytosis

, , , , , ,
Journal of Nippon Medical School 82(1), 59-63, 2015
… In addition to being the main cause of glomerulonephritis in children, poststreptococcal glomerulonephritis (PSGN) has recently been shown in older patients, especially those with malignancy or diabetes mellitus. …
NAID 130004926736

ネフローゼ症候群を呈し，非典型的な経過をたどった溶連菌感染後急性糸球体腎炎の1 例

橋本淳也,浅野貴子,加藤環,釜江智佳子,若松太,尾田高志,大橋隆治,長田道夫,野々山恵章
日本小児腎臓病学会雑誌 26(2), 278-284, 2014
ネフローゼ症候群，遷延する蛋白尿，反復する肉眼的血尿発作など，溶連菌感染後急性糸球体腎炎（PSAGN）としては非典型的な経過をたどった症例を経験した。症例は11 歳男児。一過性の肉眼的血尿発作の3 か月後に溶連菌感染に伴う肉眼的血尿・蛋白尿を認めた。低補体血症はなく，慢性腎炎の急性増悪と考えたが，感染から約3週間後に，肉眼的血尿・ネフローゼ症候群・低補体血症を伴う急性糸球体腎炎を発症した。初回腎生 …
NAID 130004495422

Related Pictures

★リンクテーブル★

リンク元	「溶連菌感染後急性糸球体腎炎」「PSGN」
拡張検索	「acute poststreptococcal glomerulonephritis」
関連記事	「poststreptococcal」「glomerulonephritis」

「溶連菌感染後急性糸球体腎炎」

Acute proliferative glomerulonephritis
	Classification and external resources
	; Micrograph of a post-infectious glomerulonephritis. Kidney biopsy. PAS stain.
ICD-9	580.0
DiseasesDB	29306
MedlinePlus	000503
eMedicine	med/889

　　[★]

英: poststreptococcal acute glomerulonephritis PSAGN
同: 急性溶連菌性糸球体腎炎 acute poststreptococcal glomerulonephritis; 連鎖球菌感染後糸球体腎炎 poststreptococcal glomerulonephritis poststrepococcal GN, post-streptococcal glomerulonephritis; 猩紅熱腎炎 scarlatinal nephritis
関: 非溶連菌性感染後急性糸球体腎炎、急性糸球体腎炎、糸球体腎炎。IgA腎症

[show details]

溶連菌感染後急性糸球体腎炎 : 約 4,800 件
急性溶連菌性糸球体腎炎 : 3 件
連鎖球菌感染後糸球体腎炎 : 88 件
猩紅熱腎炎 : 77 件
acute poststreptococcal glomerulonephritis : 約 8,110 件
poststreptococcal acute glomerulonephritis : 約 13,400 件

first aid step1 2006 p.385(Glomerular pathology)

概念

A群β溶血性連鎖球菌感染症後に1-2週間して発症するnephritic syndrome

疫学

学童期(5-8歳)に後発

病因

A群β溶血性連鎖球菌感染後(上気道炎、皮膚膿痂疹)に続発
潜伏期：1-2週間　←　IgA腎症との鑑別点

病態

溶連菌成分を抗原とする抗体が産生されて免疫複合体が形成され、この免疫複合体が糸球体基底膜に沈着し(上皮側)、III型アレルギーの機序により補体活性化、多形白血球浸潤、ケミカルメディエーターの放出が起こる。

病理

光顕：管内性増殖性糸球体腎炎

糸球体の腫大、富核、白血球の浸潤　←　白血球の浸潤と糸球体内の細胞の増殖による

蛍光抗体法：係蹄壁へのC3の顆粒状沈着
電顕：上皮細胞下沈着物(ハンプ)　→　subepithelial humps on EM

typical electron-dense subepithelial(足細胞と基底膜の間) "hump" and intramembranous deposites.

症状

血尿、浮腫、高血圧、蛋白尿、乏尿

検査

抗ストレプトリジンO抗体(ASO)上昇
補体価低下：C3低下, CH50低下
腎機能低下：クレアチニン上昇、カリウム上昇、尿素窒素上昇
腎生検：

糸球体係蹄壁への顆粒状C3の沈着、IgGの沈着は50-60%の例に認められる。

合併症

うっ血性心不全、高血圧性脳症、急性腎不全

治療

対症療法

急性期：安静、食事療法(水分制限、塩分制限、蛋白制限)

薬物療法：必要に応じて

利尿薬：フロセミド
降圧薬：カルシウム拮抗薬

予後

良好。90%以上が1-3ヶ月で治癒。一部急性期に死亡/慢性腎不全への移行(SPE.596)

USMLE

Q book p.244 30

参考

1. [charged] poststreptococcal-glomerulonephritis - uptodate [1]

国試

105A047、101A035

「PSGN」

　　[★] 溶連菌感染後急性糸球体腎炎 = 連鎖球菌感染後糸球体腎炎 poststreptococcal glomerulonephritis

「acute poststreptococcal glomerulonephritis」

　　[★] 溶連菌感染後急性糸球体腎炎

「poststreptococcal」

　　[★]

adj.

連鎖球菌感染後の

「glomerulonephritis」

　　[★] 糸球体腎炎 GN

[Review10-1] Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970.

[pmid11419767-2] White AV, Hoy WE, McCredie DA (May 2001). "Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life". Med. J. Aust. 174 (10): 492–6. PMID 11419767.

[pmid18162726-3] Sung HY, Lim CH, Shin MJ, et al. (December 2007). "A case of post-streptococcal glomerulonephritis with diffuse alveolar hemorrhage". J. Korean Med. Sci. 22 (6): 1074–8. doi:10.3346/jkms.2007.22.6.1074. PMID 18162726.

[Loz2012-4] Lozano, R (2012 Dec 15). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. PMID 23245604.

Acute proliferative glomerulonephritis
Classification and external resources
Micrograph of a post-infectious glomerulonephritis. Kidney biopsy. PAS stain.
ICD-9	580.0
DiseasesDB	29306
MedlinePlus	000503
eMedicine	med/889

匿名

検索

案内

poststreptococcal glomerulonephritis