Acute poststreptococcal glomerulonephritis. A review of recent developments.
This revision is concerned with controversial aspects of the etiopathogenesis of acute poststreptococcal glomerulonephritis (APSGN) and with recently published clinical, serologic, immunohistologic and prognostic data. The putative nephritogenic antigens in group A streptococcus are discussed and the pathogenetic alternatives of exogenous (streptococcal) versus autologous (streptococcal-induced) immune complex (IC) disease are analyzed. The possible role of antiglobulins is reviewed in the light of the work that shows high titers of rheumatoid factor activity in the serum, as early as the first day of clinical APSGN, and glomerular-fixed anti-IgG in the biopsies of these patients. Circulating IC have been documented to be more frequent in the first week of the disease (2/3 of patients) that at a later date. Cryoglobulins are present in most cases tested in the first week, and elevation of serum IgG and IgM levels is found in over 90% of the patients. From the immunohistologic viewpoint, emphasis is made in recent work indicating IgG localization in the dermal papillae of uninvolved skin, which may be of potential diagnostic significance. Review of the published data on the prognosis of APSGN suggest that this issue is far from settled. Attention is called to the fact that the conflicting opinions may reflect different interpretations of possibly not too different data.
D000936:Antigen-Antibody Complex; D000942:Antigens, Bacterial; D001327:Autoimmune Diseases / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003450:Cryoglobulins / Q000032:analysis; D005921:Glomerulonephritis / Q000209:etiology* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D011379:Prognosis; D013290:Streptococcal Infections / Q000150:complications* / Q000276:immunology; D013297:Streptococcus pyogenes / Q000276:immunology
D000936:Antigen-Antibody Complex; D000942:Antigens, Bacterial; D003450:Cryoglobulins; D007074:Immunoglobulin G; D007075:Immunoglobulin M