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溶連菌感染後急性糸球体腎炎の診断基準

血尿・乏尿・浮腫・高血圧が三徴である。血尿はほぼ必発である。高血圧は6~7割程度の患者で認められる。
出典
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1: Group A streptococcal infections in children.
著者: Steer AC, Danchin MH, Carapetis JR.
雑誌名: J Paediatr Child Health. 2007 Apr;43(4):203-13. doi: 10.1111/j.1440-1754.2007.01051.x.
Abstract/Text: The group A streptococcus causes the widest range of disease in humans of all bacterial pathogens. Group A streptococcal diseases are more common in children than adults with diseases ranging from pharyngitis and impetigo to invasive infections and the post-streptococcal sequelae--acute rheumatic fever and acute post-streptococcal glomerulonephritis. The global burden of severe group A streptococcal disease is concentrated largely in developing countries and Indigenous populations such as Aboriginal Australians. Control of group A streptococcal disease is poor in these settings and the need for a vaccine has been argued. With an ever-increasing understanding of the group A streptococcus at a molecular level, new and sophisticated vaccines are currently in human trials and the next decade holds exciting prospects for curbing group A streptococcal diseases.
J Paediatr Child Health. 2007 Apr;43(4):203-13. doi: 10.1111/j.1440-17...

典型的な溶連菌感染後急性糸球体腎炎の臨床経過

典型的溶連菌感染後急性糸球体腎炎の経過。
出典
imgimg
1: Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis.
著者: Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ.
雑誌名: Pediatr Nephrol. 2011 Feb;26(2):165-80. doi: 10.1007/s00467-010-1554-6. Epub 2010 Jul 23.
Abstract/Text: Post-streptococcal acute glomerulonephritis (PSAGN) is one of the most important and intriguing conditions in the discipline of pediatric nephrology. Although the eventual outcome is excellent in most cases, PSAGN remains an important cause of acute renal failure and hospitalization for children in both developed and underdeveloped areas. The purpose of this review is to describe both the typical and less common clinical features of PSAGN, to outline the changes in the epidemiology of PSAGN over the past 50 years, and to explore studies on the pathogenesis of the condition with an emphasis on the search for the elusive nephritogenic antigen.
Pediatr Nephrol. 2011 Feb;26(2):165-80. doi: 10.1007/s00467-010-1554-6...

溶連菌感染後急性糸球体腎炎腎組織像

a:正常糸球体 
b:溶連菌感染後急性糸球体腎炎における光学顕微鏡像。著しい管内増殖所見を認める。
c:電子顕微鏡では上皮下にHump形成および毛細血管腔への好中球の浸潤を認める。 
d:糸球体へC3の沈着。
出典
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1: Kumar: Robbins and Cotran Pathologic Basis of Disease, 9th ed. 20.The Kidney, Figure 20-9, Saunders, 2015

急性腎炎の鑑別

小児の急性腎炎の大半は急性溶連菌感染後急性糸球体腎炎であるが、その頻度は減少している。原発性糸球体疾患、続発性糸球体疾患や、黄色ブドウ球菌、肺炎球菌、B型肝炎ウイルス、水痘ウイルス、パルボウイルスB19、マイコプラズマなどの非溶連菌性の急性糸球体腎炎が鑑別として挙げられる。
出典
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1: Kliegman: Nelson Textbook of Pediatrics, 21th ed. 537.4.Acute Poststreptococcal Glomerulonephritis, Figure.537-6, Elsevier, 2020(改変あり)

溶連菌感染後急性糸球体腎炎の診断基準

血尿・乏尿・浮腫・高血圧が三徴である。血尿はほぼ必発である。高血圧は6~7割程度の患者で認められる。
出典
imgimg
1: Group A streptococcal infections in children.
著者: Steer AC, Danchin MH, Carapetis JR.
雑誌名: J Paediatr Child Health. 2007 Apr;43(4):203-13. doi: 10.1111/j.1440-1754.2007.01051.x.
Abstract/Text: The group A streptococcus causes the widest range of disease in humans of all bacterial pathogens. Group A streptococcal diseases are more common in children than adults with diseases ranging from pharyngitis and impetigo to invasive infections and the post-streptococcal sequelae--acute rheumatic fever and acute post-streptococcal glomerulonephritis. The global burden of severe group A streptococcal disease is concentrated largely in developing countries and Indigenous populations such as Aboriginal Australians. Control of group A streptococcal disease is poor in these settings and the need for a vaccine has been argued. With an ever-increasing understanding of the group A streptococcus at a molecular level, new and sophisticated vaccines are currently in human trials and the next decade holds exciting prospects for curbing group A streptococcal diseases.
J Paediatr Child Health. 2007 Apr;43(4):203-13. doi: 10.1111/j.1440-17...

典型的な溶連菌感染後急性糸球体腎炎の臨床経過

典型的溶連菌感染後急性糸球体腎炎の経過。
出典
imgimg
1: Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis.
著者: Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ.
雑誌名: Pediatr Nephrol. 2011 Feb;26(2):165-80. doi: 10.1007/s00467-010-1554-6. Epub 2010 Jul 23.
Abstract/Text: Post-streptococcal acute glomerulonephritis (PSAGN) is one of the most important and intriguing conditions in the discipline of pediatric nephrology. Although the eventual outcome is excellent in most cases, PSAGN remains an important cause of acute renal failure and hospitalization for children in both developed and underdeveloped areas. The purpose of this review is to describe both the typical and less common clinical features of PSAGN, to outline the changes in the epidemiology of PSAGN over the past 50 years, and to explore studies on the pathogenesis of the condition with an emphasis on the search for the elusive nephritogenic antigen.
Pediatr Nephrol. 2011 Feb;26(2):165-80. doi: 10.1007/s00467-010-1554-6...