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链球菌感染后肾小球肾炎

Author
Patrick Niaudet, MD
Section Editor
F Bruder Stapleton, MD
Deputy Editor
Melanie S Kim, MD
Translators
黄文彦, 主任医师，教授

引言

链球菌感染后肾小球肾炎(poststreptococcal glomerulonephritis, PSGN)是由前驱感染A组β型溶血性链球菌的特异性致肾炎菌株所致。PSGN的临床表现各异，从无症状的镜下血尿到典型的急性肾炎综合征不等，而后者的特征为红色至棕色尿、蛋白尿(可达肾病范围)、水肿、高血压和急性肾损伤。该病通常预后良好，尤其是儿童，但是部分病例远期预后不良。

PSGN的临床表现、诊断、治疗、病程和预后将总结在此。

流行病学

尽管PSGN在全球范围内仍是儿童急性肾炎的最主要原因，但它主要发生在发展中国家。全球每年估计有470,000例新发PSGN病例，其中97%发生在社会经济情况较差的地区，这些地区的年发病率为9.5-28.5例/10万人[1,2]。

在较发达的工业化国家，该病发病率在过去三十年已有所下降[2-4]。根据意大利活检注册数据，1992-1994年间估计的年发病率为0.3例/10万人[5]。较年长患者(60岁以上)和5-12岁的儿童发生PSGN的风险增加[5,6]。而PSGN在3岁以下的儿童中鲜有发生。

PSGN可表现为散发病例，也可出现在A组链球菌(group A streptococcal, GAS)感染(即，皮肤和咽部感染)流行期间[2]。在GAS流行期间感染的儿童中，5%-10%的咽炎患儿和25%的皮肤感染患儿中发生临床可检出的PSGN[7,8]。

                     

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-31.
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