Acute poststreptococcal glomerulonephritis: an update.
OBJECTIVE
Acute poststreptococcal glomerulonephritis, the most common form of acute glomerulonephritis in children, continues to be a major concern worldwide. This review summarizes the recent advances in the pathogenesis, host susceptibility factors, diverse clinical presentations, and treatment of the condition.


RESULTS
Several recent advances have been made in identifying streptococcal antigens that may play a pathogenic role in acute poststreptococcal glomerulonephritis. Nephritis-associated streptococcal plasmin receptor and streptococcal pyrogenic exotoxin B are currently considered major putative nephritogens. Host susceptibility factors including HLA-DRB1*03011 have been found at a higher frequency in acute poststreptococcal glomerulonephritis patients than in healthy controls. Reversible posterior leukoencephalopathy and autoimmune hemolytic anemia are newly reported clinical associations with the disease. Studies from developing countries question whether the outcome is always benign. Treatment remains mostly conservative; however, controversy exists over the use of aggressive therapy with poor prognostic factors.


CONCLUSIONS
Severe group A streptococcal disease including acute poststreptococcal glomerulonephritis remains a cause of morbidity and mortality in developing countries and among impoverished populations. Various reports on the diverse clinical manifestations that can be associated with the condition will aid physicians in prompt diagnosis and intervention, while studies focusing on better understanding of immunopathogenesis may facilitate vaccine development and prevention.
Ahn
Sun-Young
SY
Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, La Jolla, California 92093-0815, USA.
Ingulli
Elizabeth
E
D000818:Animals; D002648:Child; D003167:Complement Activation; D004198:Disease Susceptibility; D005921:Glomerulonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D026541:Heymann Nephritis Antigenic Complex / Q000276:immunology; D006801:Humans; D007105:Immune Complex Diseases / Q000150:complications*; D018716:Molecular Mimicry; D011379:Prognosis; D013290:Streptococcal Infections / Q000150:complications*
D026541:Heymann Nephritis Antigenic Complex