WordNet

of critical importance and consequence; "an acute (or critical) lack of research funds"
having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
of an angle; less than 90 degrees
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

PrepTutorEJDIC

(先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/17 14:50:49」(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]

Causes

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

Pathophysiology

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

Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation. There will be elevated levels of ASOT Ab and low complement levels (C3 and C4) in the blood.

Presentation

1) 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.

2) 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.

3) 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.

4) 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).

5) General

Fever, headache, malaise, anorexia, nausea, and vomiting.

Pallor due to edema and/or anemia.

6) Acute renal necrosis due to injury of capillary or capillary thrombosis.

Acute tubular obstruction by cast.

Mechanism of edema

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

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

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

References

^ 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. http://www.mja.com.au/public/issues/174_10_210501/white/white.html.
^ 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. http://jkms.org/contents/jkms.php?pubyear=2007&vol=22&fpage=1074.

External links

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

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 糸球体疾患の鑑別診断および評価 differential diagnosis and evaluation of glomerular disease
2. 小児における糸球体腎炎の病因と原因の概要 overview of the pathogenesis and causes of glomerulonephritis in children
3. 溶連菌感染後糸球体腎炎 poststreptococcal glomerulonephritis
4. 急速進行性（半月形）糸球体腎炎の分類および治療の概要 overview of the classification and treatment of rapidly progressive crescentic glomerulonephritis
5. 膜性増殖性糸球体腎炎の評価および治療 evaluation and treatment of membranoproliferative glomerulonephritis

English Journal

Serial renal biopsy findings in a case of POEMS syndrome with recurrent acute renal failure.

Higashi AY, Nogaki F, Kato I, Ono T, Fukatsu A.SourceDepartment of Nephrology, Kyoto University Hospital, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
Clinical and experimental nephrology.Clin Exp Nephrol.2011 Oct 8. [Epub ahead of print]
This report describes a patient presenting with recurrent acute renal failure occurring in the course of POEMS syndrome, a multisystem disease associated with plasma cell dyscrasia. Several combined immunosuppression therapies failed to resolve recurrent acute renal failure; autologous peripheral bl
PMID 21979795

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature.

Marshall CS, Cheng AC, Markey PG, Towers RJ, Richardson LJ, Fagan PK, Scott L, Krause VL, Currie BJ.SourceTropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Infectious Diseases Department, Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Disease Control, Northern Territory Department of Health and Families, Darwin, Australia; Serology Division, Pathology Department, Royal Darwin Hospital, Darwin, Australia.
The American journal of tropical medicine and hygiene.Am J Trop Med Hyg.2011 Oct;85(4):703-710.
Abstract. Data relating to acute post-streptococcal glomerulonephritis (APSGN) from the notifiable diseases surveillance system in the Northern Territory of Australia was extracted and analyzed. Isolates of Streptococcus pyogenes from confirmed cases were emm sequence typed. From 1991 to July 2008,
PMID 21976576

Japanese Journal

急性腎不全・急性糸球体腎炎 (特集小児の輸液ベーシックガイド)

吉村仁志
小児科診療 74(2), 260-266,309, 2011-02
NAID 40018277213

Acute glomerulonephritis in a donor as a side effect of allogeneic peripheral blood stem cell mobilization with granulocyte colony-stimulating factor

NASILOWSKA-ADAMSKA B.,PERKOWSKA-PTASINSKA A.,TOMASZEWSKA A.,SERWACKA A.,MARIANSKA B.
International journal of hematology 92(5), 765-768, 2010-12-15
NAID 10027674592

Related Pictures

★リンクテーブル★

リンク元	「急性糸球体腎炎」「急性感染後糸球体腎炎」
拡張検索	「poststreptococcal acute glomerulonephritis」
関連記事	「acute」「glomerulonephritis」

「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: acute glomerulonephritis、AGN
同: 急性腎炎 acute nephritis
関: 管内増殖性糸球体腎炎、急性腎炎症候群 acute nephritic syndrome

概念

急性腎炎症候群を示す代表的疾患
先行感染後、いくらかの潜伏期を経たあとに発症し、急性腎炎症候群の症状を呈する(血尿、蛋白尿、GFR低下、浮腫、高血圧など)

A群β溶血性連鎖球菌が先行感染の場合、潜伏期は10日(1-2)

免疫複合体を形成するタイムラグである。

疫学

3-10歳に好発。男児に多い(男女=2:1)。高齢者でもありうる

病因

Streptococcus pyogenes(A群β溶血性連鎖球菌)による咽頭炎(上気道炎)・膿痂疹に続発
連鎖球菌の菌体成分が腎臓と交差反応するため(交通抗原を有するため)、糸球体基底膜と抗体抗原反応を起こし炎症反応を起こす

A群β溶連菌(12型)が一番多い。

病理

管内性増殖性糸球体腎炎

びまん性増殖性腎炎：C3, IgGの沈着、Hump形成

[show details]

症状

3主徴(血尿・浮腫・高血圧)

検査

溶連菌の場合、ASO, ASKの上昇。
補体価：一過性低下　→　持続するときは膜性増殖性糸球体腎炎 or ループス腎炎

症例

096D036

「急性感染後糸球体腎炎」

　　[★]

英: acute postinfectious glomerulonephritis
関: 急性糸球体腎炎

急性感染後糸球体腎炎

急性連鎖球菌感染後糸球体腎炎・・・A群β溶血性連鎖球菌感染の続発症 =急性糸球体腎炎
非溶連菌性感染後急性糸球体腎炎

なお急性感染後糸球体腎炎=急性連鎖球菌感染後糸球体腎炎として記載している教科書もある。
急性糸球体腎炎 acute glomerulonephritis=急性連鎖球菌感染後糸球体腎炎か。

「poststreptococcal acute glomerulonephritis」

　　[★] 溶連菌感染後急性糸球体腎炎

「acute」

　　[★]

adj.

(疾患)急性の、急性型の、急性的な。(形状が)鋭い、鋭角の。(感覚、才知などが)鋭い。明敏な、鋭い眼識のある。

関: acutely、quick、sharp

「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. http://www.mja.com.au/public/issues/174_10_210501/white/white.html.

[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. http://jkms.org/contents/jkms.php?pubyear=2007&vol=22&fpage=1074.

匿名

検索

案内

案内

acute glomerulonephritis