post-streptococcal glomerulonephritis

溶連菌感染後急性糸球体腎炎

WordNet

1. ride Western style and bob up and down in the saddle in rhythm with a horses trotting gait
2. an upright consisting of a piece of timber or metal fixed firmly in an upright position; "he set a row of posts in the ground and strung barbwire between them"
3. the delivery and collection of letters and packages; "it came by the first post"; "if you hurry youll catch the post"
4. a pole or stake set up to mark something (as the start or end of a race track); "a pair of posts marked the goal"; "the corner of the lot was indicated by a stake" (同)stake
5. the position where someone (as a guard or sentry) stands or is assigned to stand; "a soldier manned the entrance post"; "a sentry station" (同)station
6. mark or expose as infamous; "She was branded a loose woman" (同)brand
7. transfer (entries) from one account book to another (同)carry
8. place so as to be noticed; "post a sign"; "post a warning at the dump" (同)put_up
9. affix in a public place or for public notice; "post a warning"
10. assign to a post; put into a post; "The newspaper posted him in Timbuktu"
11. display, as of records in sports games
12. enter on a public list
13. publicize with, or as if with, a poster; "Ill post the news on the bulletin board"
14. United States manufacturer of breakfast cereals and Postum (1854-1914) (同)C. W. Post, Charles William Post
15. United States female author who wrote a book and a syndicated newspaper column on etiquette (1872-1960) (同)Emily Post, Emily Price Post
16. United States aviator who in 1933 made the first solo flight around the world (1899-1935) (同)Wiley Post
17. (bookkeeping) a listing on the companys records; "the posting was made in the cash account"
18. 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
19. of or relating to or caused by streptococci (同)streptococcic, strep

PrepTutorEJDIC

1. 〈C〉(木・金属・石などの)『柱』,『支柱』,くい / 《the ~》(競馬の)出発標,決勝標 / 〈C〉《話》(ラグビーなどの)ゴールポスト(goalpost) / (柱・壁などに)〈掲示物〉‘を'『張る』,張り出す《+『名』〈掲示物〉+『on』+『名』》;(掲示物を)〈柱・壁など〉‘に'張る《+『名』+『with』+『名』〈掲示物〉》 / (掲示して)…‘を'公表する,公示する / 《通例受動態で》(…として)…‘を'掲示(発表)する《+『名』+『as』+『現分』(過分)》
2. (兵士・警官・看護婦などの)『部署』,『持ち場』 / (軍隊の)駐屯(ちゅうとん)地,駐留地,兵営地 / (指名・任命された)『地位』,職 / (またtrading post)(未開地などの)交易所 / 〈兵士・警官・看護婦など〉‘を'配置する / 《通例受動態で》《おもに英》(…に)〈人〉‘を'任命する《+『名』+『to』+『名』》
3. 〈U〉《おもに英》『郵便』[制度] / 《おもに英》《単数形で》(郵便物の1回の)『集配』,『配達』,便;(1回で集配・配達される)郵便物(《米》mail) / 《the ~》《おもに英》郵便局(post office);ポスト,郵便箱(《米》mailbox) / 〈C〉(昔,郵便物の中断所にした)駅,宿,宿場 / 《おもに英》〈郵便物〉‘を'郵便局に出す,ポストに入れる(《米》mail)《+『off』+『名』+『,』『名』+『off』》 / 《『post』+『名』〈間〉〈人〉+『名』〈直〉=『post』+『名』+『to』+『名』〈人〉》〈人〉‘に'〈手紙など〉‘を'郵便で送る(《米》mail)
4. 《おもに英》(特に軍職に)任命すること
5. 連鎖球菌の(による)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/07 08:39:25」(JST)

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[Wiki en表示]

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

Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12,4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis. It can be a risk factor for future albuminuria. In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, and the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are also used.

Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990.

Signs and symptoms

Hematuria:

• 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 cases.

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/h.
• 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

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 mesangium and 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 an elevated Anti-streptolysin O titre and low complement levels (C3) in the blood.

Mechanism of edema

Diffuse proliferative nephritis (DPN) 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 3.5 g/day). Examples include: minimal change disease (MCD), membranous glomerulonephritis (MGN), focal segmental glomerulosclerosis (FSGS), lupus, amyloidosis, and diabetes.

Differential diagnosis

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

Complications

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

Epidemiology

Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990.

References

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. 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. 小児における顕微鏡的血尿の評価 evaluation of microscopic hematuria in children
• 5. A群レンサ球菌：病原性因子および発症機序 group a streptococcus virulence factors and pathogenic mechanisms

English Journal

• [Epidemiology of Streptococcus pyogenes infections in developing countries].

• Minodier P1, Laporte R2, Miramont S2.
• Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie.Arch Pediatr.2014 Nov;21 Suppl 2:S69-72. doi: 10.1016/S0929-693X(14)72263-8. Epub 2014 Nov 13.
• Group A streptococcal (GAS) infections are frequent in developing countries but the epidemiology is incompletely known. In 2005, 90 % of symptomatic pharyngitis, 96 % of invasive diseases and 97 % of deaths due to GAS were observed in these countries. Clinical features of GAS invasive infections are
• PMID 25456683

• [Epidemiology of Streptococcus pyogenes infections in developing countries].

• Minodier P1, Laporte R2, Miramont S2.
• Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie.Arch Pediatr.2014 Nov;21 Suppl 2:S69-72. doi: 10.1016/S0929-693X(14)72263-8.
• Group A streptococcal (GAS) infections are frequent in developing countries but the epidemiology is incompletely known. In 2005, 90 % of symptomatic pharyngitis, 96 % of invasive diseases and 97 % of deaths due to GAS were observed in these countries. Clinical features of GAS invasive infections are
• PMID 25399497

• Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report.

• Adikari M1, Priyangika D, Marasingha I, Thamotheram S, Premawansa G.
• BMC research notes.BMC Res Notes.2014 Sep 13;7:644. doi: 10.1186/1756-0500-7-644.
• BACKGROUND: Posterior reversible encephalopathy syndrome is a clinical radiographic syndrome of heterogeneous etiologies. Developing hypertensive encephalopathy following post-streptococcal glomerulonephritis is a known but uncommon manifestation and developing posterior reversible encephalopathy sy
• PMID 25218027

Japanese Journal

• Acute Post-streptococcal Glomerulonephritis with Acute Kidney Injury in Nephrotic Syndrome with the Glomerular Deposition of Nephritis-associated Plasmin Receptor Antigen

• Kokuzawa Ayako,Morishita Yoshiyuki,Yoshizawa Hiromichi,Iwazu Kana,Komada Takanori,Akimoto Tetsu,Saito Osamu,Oda Takashi,Takemoto Fumi,Ando Yasuhiro,Muto Shigeaki,Yumura Wako,Kusano Eiji
• Internal Medicine 52(18), 2087-2091, 2013
• … The histology of the renal biopsy specimens showed diffuse endocapillary proliferative glomerulonephritis with the deposition of nephritis-associated plasmin receptor in the glomerulus. … A case of acute kidney injury due to nephrotic syndrome caused by acute post-streptococcal glomerulonephritis was diagnosed. …
• NAID 130003365808

• 近年の小児の溶連菌感染後急性糸球体腎炎の実態調査

• 坂田 宏
• 日本小児科学会雑誌 113(12), 1809-1813, 2009-12-01
• NAID 10026276862

• Rapidly progressive acute post-streptococcal glomerulonephritis in a child with IgA nephropathy

• FUJINAGA Shuichiro,OHTOMO Yoshiyuki,MOCHIZUKI Hiroshi,MURAKAMI Hitohiko,SHIMIZU Toshiaki,YAMASHIRO Yuichiro,KANEKO Kazunari
• Pediatrics international : official journal of the Japan Pediatric Society 51(3), 425-428, 2009-06-01
• NAID 10025347162

Related Links

• Post-streptococcal glomerulonephritis (GN): MedlinePlus Medical ...

Causes. Post-streptococcal GN is a form of glomerulonephritis. It is caused by an infection with a type of streptococcus bacteria. The infection does not occur in the kidneys, but in a different part of the body, such as the skin or throat. The strep ...

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★リンクテーブル★

リンク元	「溶連菌感染後急性糸球体腎炎」
関連記事	「post」「glomerulonephritis」

「溶連菌感染後急性糸球体腎炎」

　　[★]

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

「post」

　　[★]

• comb form.

• ポスト、後

• v.

• ポストする

関

after、afterward、afterwards、behind、following、late、posterior、subsequent

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「glomerulonephritis」

　　[★] 糸球体腎炎 GN