Group A streptococcal antigen in the glomeruli of children with Henoch-Schönlein nephritis.
BACKGROUND
Although the pathogenesis of Henoch-Schönlein nephritis (HSN) remains unclear, there is substantial evidence that it is an immune complex-mediated disease. HSN is preceded by upper-respiratory tract infection in 30% to 50% of patients, but there is no evidence that group A streptococcal (GAS) infection has a pathogenetic role in this disease. Recently, nephritis-associated plasmin receptor (NAPlr), a GAS antigen, was found primarily in the glomerular mesangium of patients with early-stage acute poststreptococcal glomerulonephritis.


METHODS
To determine the possible role of NAPlr in HSN, expression of the receptor was determined in glomeruli using fluorescein isothiocyanate-labeled rabbit polyclonal anti-NAPIr antibody, and serum antistreptolysin O (ASO) titers were measured in children with HSN.


RESULTS
Ten of 33 patients (30%) with HSN showed segmental or global mesangial staining with NAPlr antibody, whereas only 4 of 120 patients (3%) with other renal diseases were positive (P < 0.001, Fisher's exact test). Patients with HSN also showed significantly greater ASO titers than patients with other renal diseases (P = 0.03, Mann-Whitney U test). Serum ASO titers were significantly greater in patients with HSN with than without glomerular NAPlr antigen (P = 0.03, Mann-Whitney U test).


CONCLUSIONS
These findings suggest that the deposition of NAPlr in the mesangium, induced by GAS infection, may have a role in the pathogenesis of HSN in some patients. Am J Kidney Dis 41:366-370.
Masuda
Miwa
M
Faculty of Health Science, Kobe University School of Medicine, Kobe, Hyogo, Japan.
Nakanishi
Koichi
K
Yoshizawa
Nobuyuki
N
Iijima
Kazumoto
K
Yoshikawa
Norishige
N
D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000378:metabolism; D000942:Antigens, Bacterial / Q000032:analysis* / Q000276:immunology / Q000502:physiology; D000989:Antistreptolysin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D016650:Fluorescein-5-isothiocyanate / Q000378:metabolism; D005920:Glomerular Mesangium / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D005921:Glomerulonephritis / Q000382:microbiology*; D006801:Humans; D011695:IgA Vasculitis / Q000382:microbiology*; D007678:Kidney Glomerulus / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D008297:Male; D013290:Streptococcal Infections / Q000276:immunology / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification* / Q000472:pathogenicity
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D000989:Antistreptolysin; D016650:Fluorescein-5-isothiocyanate