급성증식성 사구체신염

Acute proliferative glomerulonephritis
여기서 "PIGN"이 리다이렉트 됩니다.유전자는 PIGN(유전자)을 참조한다.
급성증식성 사구체신염
Post-infectious glomerulonephritis - very high mag.jpg
감염 후 사구체신염의 현미경 사진.신장 생검이요PAS 얼룩
전문신장학 Edit this on Wikidata
증상고혈압[1]
원인들연쇄상구균에 의한 원인
진단 방법신장 생검, 보체[2] 프로파일
치료저나트륨 다이어트, 혈압 관리[2]
빈도수.150만 (2015년)[3]

급성 증식성 사구체신염은 신장의 작은 혈관에 생기는 질환이다.이것은 박테리아 감염의 흔한 합병증이며, 전형적으로 Streptoccus 박테리아 유형 12, 4 및 1(임페티고)에 의한 피부 감염이지만, 연쇄상구균 인두염(PIGN) 또는 연쇄상구균 후 사구체신염([4]PSGN)으로도 알려져 있다.그것은 미래의 단백뇨의 [5]위험 요인이 될 수 있다.성인에서도 신장 질환이 발병할 때 감염 징후와 증상이 나타날 수 있으며, 감염 관련 사구체신염이나 세균 감염 관련 사구체신염이라는 용어도 사용된다.[6]2013년 급성 사구체신염으로 인한 사망자는 19,000명으로 1990년 [7]전 세계적으로 24,000명이었던 것에 비해 감소했다.

징후 및 증상

혈뇨

급성 증식성 사구체신염의 징후와 증상에는 다음이 포함된다.

원인들

급성 증식성 사구체신염(스트렙토코커스 후 사구체신염)은 항체를 키우고 단백질을 [11][12]보완하는 데 걸리는 시간을 감안할 때 보통 감염 후 3주 후에 연쇄상구균 박테리아에 의한 감염에 의해 발생한다.이 감염은 신장의 혈관에 염증이 생기게 하고,[citation needed] 이것은 소변을 걸러내는 신장의 기능을 방해한다.급성 증식성 사구체신염은 [12]아이들에게서 가장 흔하게 발생한다.

병태생리학

이 질환의 병태생리학은 면역 복합 매개 메커니즘인 타입 III 과민반응과 일치한다.이 장애는 다른 항원 결정 인자를 가진 단백질을 생성하며, 이는 다시 사구체의 부위에 친화력을 갖는다.프로퍼딘과의 상호작용을 통해 사구체에 결합하는 즉시 보체가 활성화된다.보체 고정은 추가적인 염증 매개체를 [2]발생시킨다.

보체 활성화는 급성 증식성 사구체신염에서 매우 중요하다.면역글로불린(Ig) 결합단백질이 C4BP에 결합하는 것으로 보인다.보체조절단백질(FH 및 FHL-1)은 SpEB에 의해 제거될 수 있으므로 감염 과정에서 [13]FH 및 FHL-1의 신병을 억제할 수 있다.

진단.

급성 사구체신염입니다

급성 증식성 [2]사구체신염에는 다음과 같은 진단 방법을 사용할 수 있습니다.

임상적으로 급성 증식성 사구체신염은 포도상구균과 연쇄상구균의 이페티고(그리고 궁극적으로 진단)의 차이 진단 후에 진단된다.혈청학적으로 진단마커를 시험할 수 있다.구체적으로는 스트렙토코커스 테스트를 사용하여 항스트렙톨리신, 항히알루로니다아제, 항스트렙토키나아제, 항니코틴아미드아데닌디뉴클레오티다아제 및 항DNAse B 항체를 [2]측정한다.

차동 진단

급성 증식성 사구체신염의 감별 진단은 [citation needed]다음을 기반으로 한다.

  1. 급성 사구체신염의 원인:
  2. 네프로제 증후군
  3. 전신성 부종의 원인:

예방

항생제 종류

일부 당국은 항생제가 급성 증식성 사구체신염의 발병을 예방할 수 있다고 주장하면서 급성 증식성 사구체신염[14](즉, 후스트렙토코커스성 사구체신염)을 초기 예방 항생제 치료로 예방할 수 있을지는 불확실하다.

치료

급성 증식성 사구체신염의 급성 관리는 주로 혈압(BP) 조절로 이루어진다.저나트륨 식단은 고혈압이 있을 때 시행될 수 있다.과두성 급성 신장 손상을 입은 개인은 칼륨 수치를 [2]조절해야 한다.티아지드 또는 루프 이뇨제를 사용하여 부종을 감소시키고 고혈압을 제어할 수 있지만 칼륨과 같은 전해질을 모니터링해야 합니다.혈압이 [2]이뇨만으로 효과적으로 제어되지 않는 경우에는 베타차단제, 칼슘채널차단제 및/또는 ACE억제제를 첨가해도 된다.

역학

급성 사구체신염은 1990년 [7]24,000명에서 2013년 19,000명의 사망자를 낳았다.

레퍼런스

  1. ^ a b c Surgeons, American Academy of Orthopaedic; Physicians, American College of Emergency (2009-11-13). Critical Care Transport. Jones & Bartlett Learning. p. 959. ISBN 9780763712235.
  2. ^ a b c d e f g h eMedicine에서의 급성 연쇄상구균 후 사구체신염 검사
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스콜리아는 급성증식성 사구체신염에 대한 주제 프로파일을 가지고 있다.