Acute glomerulonephritis after streptococcal infection

Introduction to acute glomerulonephritis after streptococcal infection Acute glomerulonephritis (poststreptococcalacuteglomerulonephritis) after streptococcal infection is more common in children and adolescents, and occasionally in the elderly, the incidence rate of males is higher than that of females, about 2 to 3:1. basic knowledge The proportion of illness: 0.001% Susceptible people: good for children and adolescents Mode of infection: non-infectious Complications: hypertensive encephalopathy, heart failure, acute renal failure

Causes of acute glomerulonephritis after streptococcal infection

Causes:

The disease is caused by infection with a type A hemolytic streptococcus, for the following reasons:

1 The disease often occurs after streptococcal infection such as tonsillitis, angina, scarlet fever, erysipelas, pyoderma, etc., and its seizure season is consistent with the epidemic season of streptococcal infection, such as those caused by upper respiratory tract infection, often in winter and spring. The skin caused by purulent diseases is often in summer and autumn.

2 The patient's blood anti-streptolysin "O" antibody (anti-O antibody) titer increased.

3 antibiotics to control streptococcal infection in the onset season, can reduce the incidence of acute glomerulonephritis.

Streptococcal cell wall M protein antigen was found in 4 glomeruli.

The strain of hemolytic streptococcus and the incidence of glomerulonephritis often vary with the epidemic situation. There are so-called "renal inflammatory streptococcus", which is most commonly seen in group A 12, others such as 1, 4, 18, 25, Types 41, 49, etc., and 2, 49, 55, 57, 60 are often associated with pyoderma and glomerulonephritis. The incidence of acute glomerulonephritis and the severity of the disease are associated with streptococcal infection. It has nothing to do with it. People who have suffered from glomerulonephritis after streptococcal infection have type-specific, permanent and protective immunity against M protein, so they rarely re-occur.

Pathogenesis:

It is currently believed that this disease is caused by an immune response after infection, for the following reasons.

1. Acute glomerulonephritis after streptococcal infection generally does not occur at the peak of streptococcal infection, but occurs at 1 week or 2 to 3 weeks after onset, which is consistent with the appearance of general immune response.

2. In the early stage of acute glomerulonephritis, the total serum complement concentration (CH50) can be significantly reduced. The complement values were measured and the concentration was decreased. However, the C3 and C5 decreased more significantly, indicating that there was immunity. In the presence of the reaction, complement may be activated by both classical and bypass pathways, and the circulating immune complex is often positive.

3. Lange et al. used a fluorescent antibody method to detect streptococcal antigens in mesangial cells and glomerular basement membrane. Micron microscopy between glomerular basement membrane and epithelial cell foot was observed under electron microscope. The presence of massive hump-like specimens contains immune complexes and complement. The IgG and C3 on the glomeruli of the patient are granular, and there is complementation in the glomerulus of the patient. Polymorphonuclear leukocytes and monocytes infiltrate, indicating that Three types of inflammatory mediators further promote the development of lesions, and macrophage proliferation also plays an important role in the development of lesions.

Prevention of acute glomerulonephritis after streptococcal infection

Enhance physical fitness, improve body defense function, maintain environmental sanitation, reduce upper respiratory tract infection, angina, tonsillitis and other diseases, pay attention to clean, reduce the occurrence of pyoderma, active treatment in the occurrence of the above diseases, and use to clear chronic Infected foci such as repeated tonsillitis, sinusitis, etc., children living in groups can use antibiotics to prevent the onset of Streptococcus infection. In recent years, the incidence of acute glomerulonephritis has decreased.

Complications of acute glomerulonephritis after streptococcal infection Complications hypertensive encephalopathy heart failure acute renal failure

Often complicated by heart failure, hypertensive encephalopathy, acute renal failure.

Acute glomerular nephritis symptoms after streptococcal infection Common symptoms Hematuria edema proteinuria hypertension oliguria

Typical cases in the pharyngeal isthmus, skin and other streptococcal infections after edema, hematuria, proteinuria and other symptoms, the diagnosis is more difficult, the diagnosis of acute glomerulonephritis after streptococcal infection is at least two of the following three characteristics Based on:

1 The M protein type -hemolytic streptococcus group A which can cause nephritis is detected in the pharyngeal or skin lesions.

2 Immune response to Streptococcal extracellular enzymes - anti-streptolysin "O" (ASO), anti-streptokinase (ASK), anti-DNase B (ADNAaseB), anti-CoA enzyme (ANADase), anti- Hyaluronidase (AH) is positive for one or more of them. ASO is increased after pharyngeal infection, and AH, ADNAase and ANADase are positive after skin infection.

The serum concentration of 3C3 decreased temporarily, and the symptoms of renal inflammation returned to normal within 8 weeks after the onset of symptoms. The symptoms were not obvious and should be examined in detail. In particular, the urine routine should be checked repeatedly to confirm the diagnosis.

Examination of acute glomerulonephritis after streptococcal infection

1. Hematuria, proteinuria, oliguria, edema, hypertension and even azotemia occur in the upper respiratory tract or skin infection 2-3 weeks later.

2. The acute phase of blood complement c3 decreased, and recovered at 6-8 weeks. The anti-streptococcal "O" antibody (ASO) titer increased, the erythrocyte sedimentation rate increased, and the urine specific gravity increased.

3. B ultrasound showed bilateral renal uniformity.

4. Renal puncture shows diffuse intracapillary proliferative glomerulonephritis.

Diagnosis and diagnosis of acute glomerulonephritis after streptococcal infection

diagnosis

According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.

Differential diagnosis

(1) Acute glomerulonephritis manifested by other glomerulonephritis, whether it is primary or secondary glomerulonephritis, can induce activity after upper respiratory tract infection, symptoms of acute nephritic syndrome, should be linked with the chain Identification of glomerulonephritis after cocci infection, glomerulonephritis after non-streptococcal infection including post-infective endocarditis, shunt nephritis, sepsis, pneumococcal pneumonia, typhoid fever, secondary syphilis, meningococcalemia , viral and parasitic infection after glomerulonephritis, secondary including multi-system diseases: systemic lupus erythematosus, vasculitis, allergic purpura, etc., non-glomerular diseases characterized by acute nephritic syndrome mainly including thrombosis Spontaneous thrombocytopenic purpura, hemolytic uremic syndrome, arteriosclerotic embolic nephropathy and acute allergic interstitial nephritis, secondary system often has other systemic symptoms, kidney biopsy can be done when there is a problem, may have a diagnosis help.

(B) a small number of streptococcal infection after glomerulonephritis manifested as nephrotic syndrome, should be differentiated from other nephrotic syndrome.

(3) Rapid glomerulonephritis The onset of acute glomerulonephritis is often similar to acute glomerulonephritis, but the treatment and prognosis are different. Therefore, patients with severe symptoms and rapid deterioration of the disease should be highly vigilant. Biopsy to confirm the diagnosis.

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