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An update on acute postinfectious glomerulonephritis worldwide

Abstract

Postinfectious glomerulonephritis is an immunologic response of the kidney to infection, commonly triggered by streptococci, although many other organisms can cause the condition. In recent decades, the prevalence of postinfectious glomerulonephritis has tended to decline in most industrialized countries, but high rates persist in some developing communities. Nowadays, patients in developed countries are usually adult and male, and those with comorbidities such as diabetes and alcoholism are at increased risk of developing the disease. The acute presentation ranges from nephritic syndrome to asymptomatic glomerulonephritis. The exact pathophysiology of postinfectious glomerulonephritis is still unknown; however, several possible pathologic antigens are under investigation. The majority of children and patients with the epidemic form of postinfectious glomerulonephritis have an excellent prognosis, which contrasts with the poor long-term outcome of sporadic cases. Therapy is largely supportive unless renal function fails to recover after eradication of the causative organism. This Review focuses on acute postinfectious glomerulonephritis, and covers its epidemiology, presentation, pathology, pathogenesis, treatment and outcomes.

Key Points

  • Rates of postinfectious glomerulonephritis are declining in most industrialized countries but remain high in some developing communities

  • The clinical manifestations, histopathology, and organisms reported to be associated with postinfectious glomerulonephritis have become increasingly diverse over recent years

  • The fundamental pathogenic mechanism of postinfectious glomerulonephritis is believed to be the deposition of immune complexes within glomerular tufts; however, the pathologic antigen remains obscure

  • Most epidemic cases of postinfectious glomerulonephritis have an excellent prognosis, but outcomes are poor in elderly patients and those with underlying disease

  • Postinfectious glomerulonephritis generally requires only supportive treatment, but corticosteroids or cytotoxic agents might have a role if disease progresses despite eradication of the causative organism

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Figure 1: Estimates of the incidence and prevalence of postinfectious glomerulonephritis in selected countries, based on data from biopsy studies published after 1985.
Figure 2: Global trends in the prevalence of postinfectious glomerulonephritis.
Figure 3: Histologic patterns of postinfectious glomerulonephritis as seen on light microscopy of renal biopsy samples.
Figure 4: Patterns of complement C3 immunofluorescence observed in renal biopsy samples from patients with postinfectious glomerulonephritis.
Figure 5: Possible pathogenic mechanism of poststreptococcal glomerulonephritis.

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Acknowledgements

The authors thank Pornpen Panomwan, MSc for her assistance in epidemiologic analyses. This work was supported by a grant from the Thailand Research Fund (MRG500016). T. Kanjanabuch is supported in part by the Grants for Development of New Faculty Staff Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, and the National research Council of Thailand.

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Correspondence to Somchai Eiam-Ong.

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Kanjanabuch, T., Kittikowit, W. & Eiam-Ong, S. An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol 5, 259–269 (2009). https://doi.org/10.1038/nrneph.2009.44

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