vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v15i1.1497vsp-1579Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ ОБРАЗОВАНИЕPROFESSIONAL DEVELOPMENTОстрый постстрептококковый гломерулонефрит у детейAcute Post-Streptococcal Glomerulonephritis in ChildrenКаганМ. Ю.KaganM. Yu.

врач-нефролог высшей категории, педиатр высшей категории отделения гастроэнтерологии и нефрологии,

460000, Оренбург, ул. Рыбаковская, д. 3

mkaganorenburg@yahoo.comОбластная детская клиническая больницаРоссияRegional Children’s Clinical HospitalRussian Federation2016240220161512532Copyright © Каган М.Ю., 20162016Каган М.Ю.Kagan M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/1579

Острый постстрептококковый гломерулонефрит, являясь одним из самых частых гломерулонефритов в детском возрасте, продолжает оставаться серьезной проблемой для педиатров и детских нефрологов в различных странах мира. Заболевание обусловлено предшествующей стрептококковой инфекцией, вызванной β-гемолитическим стрептококком группы А. Нефритассоциированный рецептор плазминового комплекса и стрептококковый пирогенный экзотоксин В считаются основными нефротропными антигенами. Клинические признаки заболевания могут варьировать от бессимптомной микрогематурии до развернутой картины острого нефритического синдрома (отеки, макрогематурия, артериальная гипертензия, почечная недостаточность). Основными лабораторными признаками острого постстрептококкового гломерулонефрита являются изменения в общем анализе мочи (дисморфные эритроциты, протеинурия различной степени выраженности, эритроцитарные цилиндры, сегментоядерные нейтрофилы), увеличение титра антистрептококковых антител и гипокомплементемия. Лечение больных в основном симптоматическое и направлено, прежде всего, на ликвидацию гиперволемии и ее осложнений (отеки, артериальная гипертензия). В этой ситуации наиболее эффективными препаратами являются петлевые диуретики и антигипертензивные средства. Прогноз у детей в основном благоприятный. В обзоре проанализированы современные представления о патогенезе, клинической картине, диагностике, лечении и прогнозе острого постстрептококкового гломерулонефрита.

Acute post-streptococcal glomerulonephritis is the most common form of glomerulonephritis in children, continues to be a major concern for pediatricians and nephrologists worldwide. The disease is caused by prior streptococcal infection caused by -hemolytic streptococcus of A group. Nephritis-associated plasmin receptor and streptococcal pyrogenic exotoxin B are considered to be major renotrophic antigens. Clinical findings of the disease can vary from asymptomatic gross hematuria to the full-blown acute nephritic syndrome (edema, gross hematuria, hypertension, renal failure). The main laboratory findings of acute post-streptococcal glomerulonephritis include an abnormal common urine analysis (dysmorphic erythrocytes, varying degrees of proteinuria, red blood cell casts, and segmentonuclear neutrophils), an elevated titer of antibodies to antistreptococcic antigens, and hypocomplementemia. Treatment of patients is mainly supportive and is focused upon the elimination of hypervolemia and its complications (edema, hypertension). In this situation, the most effective agents are loop diuretics and antihypertensive agents. The prognosis in children is generally favourable. The review analyses the current understanding of the pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of acute post-streptococcal glomerulonephritis.

детиострый постстрептококковый гломерулонефритпатогенезлечениепрогнозchildrenacute post-streptococcal glomerulonephritispathogenesistreatmentprognosisReferencesWells CD. Observations on the dropsy which succeeds scarlet fever. Trans Soc Imp Med Chir Knowledge. 1812;3:167–186.Wells CD. Observations on the dropsy which succeeds scarlet fever. Trans Soc Imp Med Chir Knowledge. 1812;3:167–186.Lange K, Seligson G and Cronin W. Evidence for the in situ origin of post streptococcal glomerulonephritis: glomerular localization of endostreptosin and clinical significance of the subsequent antibody response. Clinical Nephrology. 1983;19:3–10.Lange K, Seligson G and Cronin W. Evidence for the in situ origin of post streptococcal glomerulonephritis: glomerular localization of endostreptosin and clinical significance of the subsequent antibody response. Clinical Nephrology. 1983;19:3–10.Dixon FJ, Feldman JD, Vazquez JJ. Experimental glomerulonephritis. The pathogenesis of a laboratory model resembling the spectrum of human glomerulonephritis. J Exp Med. 1961;113:899–920.Dixon FJ, Feldman JD, Vazquez JJ. Experimental glomerulonephritis. The pathogenesis of a laboratory model resembling the spectrum of human glomerulonephritis. J Exp Med. 1961;113:899–920.Berrios X, Lagomarsino E, Solar E, Sandoval G, Guzman B, Riedel I. Poststreptococcal acute glomerulonephritis in Chile 20 years of experience. Pediatr Nephrol. 2004;19(3):306–312. DOI: 10.1007/s00467-003-1340-9.Berrios X, Lagomarsino E, Solar E, Sandoval G, Guzman B, Riedel I. Poststreptococcal acute glomerulonephritis in Chile 20 years of experience. Pediatr Nephrol. 2004;19(3):306–312. DOI: 10.1007/s00467-003-1340-9.Rammelkamp CH, Weaver RS, Dingle JH. Significance of the epidemiologic differences between acute nephritis and acute rheumatic fever. Trans Assoc Am Phys. 1952;65:168–175.Rammelkamp CH, Weaver RS, Dingle JH. Significance of the epidemiologic differences between acute nephritis and acute rheumatic fever. Trans Assoc Am Phys. 1952;65:168–175.Dale JB, Fischetti VA, Carapetis JR, Steer AC, Sow S, Kumar R, Mayosi BM, Rubin FA, Mulholland K, Hombach JM, Schodel F, Henao-Restrepo AM. Group A streptococcal vaccines: paving a path for accelerated development. Vaccine. 2013;31(Suppl.2):216–222. DOI: 10.1016/j.vaccine.2012.09.045.Dale JB, Fischetti VA, Carapetis JR, Steer AC, Sow S, Kumar R, Mayosi BM, Rubin FA, Mulholland K, Hombach JM, Schodel F, Henao-Restrepo AM. Group A streptococcal vaccines: paving a path for accelerated development. Vaccine. 2013;31(Suppl.2):216–222. DOI: 10.1016/j.vaccine.2012.09.045.Ralph AP, Carapetis JR. Group a streptococcal diseases and their global burden. Curr Top Microbiol Immunol. 2013;368:1–27. DOI: 10.1007/82_2012_280.Ralph AP, Carapetis JR. Group a streptococcal diseases and their global burden. Curr Top Microbiol Immunol. 2013;368:1–27. DOI: 10.1007/82_2012_280.Thongboonkerd V, Luengpailin J, Cao J, Pierce WM, Cai J, Klein JB, Doyle RJ. Fluoride exposure attenuates expression of Streptococcus pyogenes virulence factors. J Biol Chem. 2002;277:16599–16605.Thongboonkerd V, Luengpailin J, Cao J, Pierce WM, Cai J, Klein JB, Doyle RJ. Fluoride exposure attenuates expression of Streptococcus pyogenes virulence factors. J Biol Chem. 2002;277:16599–16605.Becquet O, Pasche J, Gatti H, Chenel C, Abely M, Morville P, Pietrement C. Acute post streptococcal glomerulonephritis in children of French Polynesia: a 3 year retrospective study. Pediatr Nephrol. 2010;25:275–280. DOI: 10.1007/s00467-009-1325-4.Becquet O, Pasche J, Gatti H, Chenel C, Abely M, Morville P, Pietrement C. Acute post streptococcal glomerulonephritis in children of French Polynesia: a 3 year retrospective study. Pediatr Nephrol. 2010;25:275–280. DOI: 10.1007/s00467-009-1325-4.Anthony BF, Kaplan EL, Wannamaker LW, Briese FW, Chapman SS. Attack rates of acute nephritis after type 49 streptococcal infections of the skin and of the respiratory tract. J Clin Invest. 1969;48: 1697–704. DOI: 10.1172/JCI106135.Anthony BF, Kaplan EL, Wannamaker LW, Briese FW, Chapman SS. Attack rates of acute nephritis after type 49 streptococcal infections of the skin and of the respiratory tract. J Clin Invest. 1969;48: 1697–704. DOI: 10.1172/JCI106135.Poon-King T, Mohammed I, Cox R, Potter EV, Simon NM, Siegel AC, Earle DP. Recurrent epidemic nephritis in South Trinidad. N Engl J Med. 1967;277:728–733. DOI: 10.1056/NEJM196710052771403.Poon-King T, Mohammed I, Cox R, Potter EV, Simon NM, Siegel AC, Earle DP. Recurrent epidemic nephritis in South Trinidad. N Engl J Med. 1967;277:728–733. DOI: 10.1056/NEJM196710052771403.Rodriguez-Iturbe B. Epidemic post streptococcal glomerulonephritis. Kidney Int. 1984;25:129–136. DOI: 10.1038/ki.1984.19.Rodriguez-Iturbe B. Epidemic post streptococcal glomerulonephritis. Kidney Int. 1984;25:129–136. DOI: 10.1038/ki.1984.19.Sesso R, Wyton S, Pinto L. Epidemic glomerulonephritis due to Streptococcus zooepidemicus in Nova Serrana, Brazil. Kidney Int Suppl. 2005;97:132–136. DOI: 10.1111/j.1523-1755.2005.09722.x.Sesso R, Wyton S, Pinto L. Epidemic glomerulonephritis due to Streptococcus zooepidemicus in Nova Serrana, Brazil. Kidney Int Suppl. 2005;97:132–136. DOI: 10.1111/j.1523-1755.2005.09722.x.Tan LK, Eccersley LR, Sriskandan S. Current views of haemolytic streptococcal pathogenesis. Curr Opin Infect Dis. 2014;27(2): 155–164. DOI: 10.1097/QCO.0000000000000047.Tan LK, Eccersley LR, Sriskandan S. Current views of haemolytic streptococcal pathogenesis. Curr Opin Infect Dis. 2014;27(2): 155–164. DOI: 10.1097/QCO.0000000000000047.Nordstrand A, Norgren M, Holm SE. Pathogenic mechanism of acute post-streptococcal glomerulonephritis. Scand J Infect Dis. 1999;31:523–537.Nordstrand A, Norgren M, Holm SE. Pathogenic mechanism of acute post-streptococcal glomerulonephritis. Scand J Infect Dis. 1999;31:523–537.Christensen P, Schalen C, Holm SE. Reevaluation of experiments intended to demonstrate immunological crossreactions between mammalian tissues and streptococci. Prog Allergy. 1979;26:1–41.Christensen P, Schalen C, Holm SE. Reevaluation of experiments intended to demonstrate immunological crossreactions between mammalian tissues and streptococci. Prog Allergy. 1979;26:1–41.Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, Sugisaki T, Boyle MD. Nephritis-associated plasmin receptor and acute post streptococcal glomerulonephritis:Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, Sugisaki T, Boyle MD. Nephritis-associated plasmin receptor and acute post streptococcal glomerulonephritis:characterization of the antigen and associated immune response. J Am Soc Nephrol. 2004;15:1785–1793. DOI: 10.1097/01.ASN.0000130624.94920.6B.characterization of the antigen and associated immune response. J Am Soc Nephrol. 2004;15:1785–1793. DOI: 10.1097/01.ASN.0000130624.94920.6B.Rodriguez-Iturbe B, Batsford S. Pathogenesis of post streptococcal glomerulonephritis a century after Clemens von Pirquet. Kidney Int. 2007;71:1094–1104. DOI: 10.1038/sj.ki.5002169.Rodriguez-Iturbe B, Batsford S. Pathogenesis of post streptococcal glomerulonephritis a century after Clemens von Pirquet. Kidney Int. 2007;71:1094–1104. DOI: 10.1038/sj.ki.5002169.Lange K, Azadegan AA, Seligson G, Bovie RC, Majeed H. Asymp tomatic post streptococcal glomerulonephritis in relatives of patients with symptomatic glomerulonephritis. Diagnostic value of endostreptosin antibodies. Child Nephrol Urol. 1988;9:11–15.Lange K, Azadegan AA, Seligson G, Bovie RC, Majeed H. Asymp tomatic post streptococcal glomerulonephritis in relatives of patients with symptomatic glomerulonephritis. Diagnostic value of endostreptosin antibodies. Child Nephrol Urol. 1988;9:11–15.Sanjad S, Tolaymat A, Whitworth J, Levin S. Acute glomerulonephritis in children: a review of 153 cases. South Med J. 1977;70:1202.Sanjad S, Tolaymat A, Whitworth J, Levin S. Acute glomerulonephritis in children: a review of 153 cases. South Med J. 1977;70:1202.Rodriguez-Iturbe B, Baggio B, Colina-Chouria J. Studies on the renin-aldosterone system in the acute nephritic syndrome. Kidney Int. 1981;19:445–453. DOI: 10.1038/ki.1981.38.Rodriguez-Iturbe B, Baggio B, Colina-Chouria J. Studies on the renin-aldosterone system in the acute nephritic syndrome. Kidney Int. 1981;19:445–453. DOI: 10.1038/ki.1981.38.Watanable T, Nitta K. Transient hyporeninemic hypoaldosteronism in acute glomerulonephritis. Pediatr Nephrol. 2002;17(6): 959–963. DOI: 10.1007/s00467-002-0984-1.Watanable T, Nitta K. Transient hyporeninemic hypoaldosteronism in acute glomerulonephritis. Pediatr Nephrol. 2002;17(6): 959–963. DOI: 10.1007/s00467-002-0984-1.Rodriguez-Iturbe B, Colic D, Parra G. Atrial natriuretic factor in the acute nephritic and nephrotic syndromes. Kidney Int. 1990;38: 512–517. DOI: 10.1038/ki.1990.233.Rodriguez-Iturbe B, Colic D, Parra G. Atrial natriuretic factor in the acute nephritic and nephrotic syndromes. Kidney Int. 1990;38: 512–517. DOI: 10.1038/ki.1990.233.Juncos LI. Intrarenal mechanisms of salt and water retention in the nephritic syndrome. Kidney Int. 2002;61:1182–1195. DOI: 10.1046/j.1523–1755.2002.00203.x.Juncos LI. Intrarenal mechanisms of salt and water retention in the nephritic syndrome. Kidney Int. 2002;61:1182–1195. DOI: 10.1046/j.1523–1755.2002.00203.x.Fogo AB, Cohen AH, Colvin RB, Jennette JC, Alpers CE. Post infectious Glomerulonephritis. In: Fundamentals of Renal Pathology. Verlag, Berlin. 2014. P. 61–67. DOI: 10.1007/978-3-642-39080-7_5.Fogo AB, Cohen AH, Colvin RB, Jennette JC, Alpers CE. Post infectious Glomerulonephritis. In: Fundamentals of Renal Pathology. Verlag, Berlin. 2014. P. 61–67. DOI: 10.1007/978-3-642-39080-7_5.Pan CG, Avner ED. Acute post streptococcal glomerulonephritis. In: Nelson’s textbook of pediatrics. Ed. Kliegman RM, Stanton BM, St. Geme J, Schor N, Behrman RE. Philadelphia: Elsevier Saunders. 2015. P. 2498–2501.Pan CG, Avner ED. Acute post streptococcal glomerulonephritis. In: Nelson’s textbook of pediatrics. Ed. Kliegman RM, Stanton BM, St. Geme J, Schor N, Behrman RE. Philadelphia: Elsevier Saunders. 2015. P. 2498–2501.Rodriguez-Iturbe B, Burdmann EA, Ophascharoensuk V, Barsoum R. Glomerular disease associated with infection. In: Comprehensive Clinical Nephrology. Ed. Feehally J, Floege J, Johnson RJ. London: Mosby. 2007. P. 305–316.Rodriguez-Iturbe B, Burdmann EA, Ophascharoensuk V, Barsoum R. Glomerular disease associated with infection. In: Comprehensive Clinical Nephrology. Ed. Feehally J, Floege J, Johnson RJ. London: Mosby. 2007. P. 305–316.Parks T, Smeesters PR, Curtis N, Steer AC. ASO titer or not? When to use streptococcal serology: a guide for clinicians. Eur J Clin Microbiol Infect Dis. 2015;34(5):845–849. DOI: 10.1007/s10096-014-2303-8.Parks T, Smeesters PR, Curtis N, Steer AC. ASO titer or not? When to use streptococcal serology: a guide for clinicians. Eur J Clin Microbiol Infect Dis. 2015;34(5):845–849. DOI: 10.1007/s10096-014-2303-8.Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Poststreptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol. 2011;26:165–180. DOI: 10.1007/s00467-010-1554-6.Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Poststreptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol. 2011;26:165–180. DOI: 10.1007/s00467-010-1554-6.Prasto J, Kaplan BS, Russo P, Chan E, Smith RJ, Meyers KE. Streptococcal infection as possible trigger for dense deposit disease (C3 glomerulopathy). Eur J Pediatr. 2014;173(6):767–772. DOI: 10.1007/s00431-013-2245-7.Prasto J, Kaplan BS, Russo P, Chan E, Smith RJ, Meyers KE. Streptococcal infection as possible trigger for dense deposit disease (C3 glomerulopathy). Eur J Pediatr. 2014;173(6):767–772. DOI: 10.1007/s00431-013-2245-7.Van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;30(4): CD004406. DOI: 10.1002/14651858.CD004406.Van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;30(4): CD004406. DOI: 10.1002/14651858.CD004406.Welch TR. An approach to the child with acute glomeruloneph ritis. Int J Pediatr. 2012; Article ID426192. DOI: 10.1155/2012/426192.Welch TR. An approach to the child with acute glomeruloneph ritis. Int J Pediatr. 2012; Article ID426192. DOI: 10.1155/2012/426192.Rodriguez-Iturbe B, Mezzano S. Acute post infectious glomerulo nephritis. In: Pediatric Nephrology. Ed. Avner ED., Harmon WE., Niaudet P., Yoshikawa N. Berlin, Heidelberg: Springer. 2009. P. 744–755.Rodriguez-Iturbe B, Mezzano S. Acute post infectious glomerulo nephritis. In: Pediatric Nephrology. Ed. Avner ED., Harmon WE., Niaudet P., Yoshikawa N. Berlin, Heidelberg: Springer. 2009. P. 744–755.Wong W, Morris M, Zwi J. Outcome of severe acute post streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. 2009;24:1021–1026. DOI: 10.1007/s00467-008-1086-5.Wong W, Morris M, Zwi J. Outcome of severe acute post streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. 2009;24:1021–1026. DOI: 10.1007/s00467-008-1086-5.Rodriguez-Iturbe B., Musser JM. The current state of post streptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19: 1855–1864. DOI: 10.1681/ASN.2008010092.Rodriguez-Iturbe B., Musser JM. The current state of post streptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19: 1855–1864. DOI: 10.1681/ASN.2008010092.

The authors declare that there are no conflicts of interest present.