Post-streptococcal glomerulonephritis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
It is thought that post-streptococcal glomerulonephritis (PSGN) is caused by nephritogenic strains of group A beta-hemolytic streptococcus (GAS). The mechanism which leads to immunologic injury to the glomerulus include there is deposition of immune complexes with streptococcal antigenic components, immune complexes are deposited in glomerular basement membrane and antibodies bind to the GBM and there is an accumulation of mononuclear leukocytic infiltrate and edema in the interstitium
Pathophysiology
- It is thought that post-streptococcal glomerulonephritis (PSGN) is caused by nephritogenic strains of group A beta-hemolytic streptococcus (GAS)
- Other strains of Group A streptococci which cause PSGN include:
- Group A streptococci M protein types 47, 49, 55, 2, 60
- Group A streptococci M types 1, 2, 4, 3, 25, 49, and 12
- Two antigens isolated from nephritogenic streptococci are commonly implicated are:[1][2]
- Streptococcal pyrogenic exotoxin B
- Nephritis-associated plasmin receptor
The mechanism which leads to immunologic injury to the glomerulus are:[3]
- There is deposition of immune complexes with streptococcal antigenic components
- Immune complexes are deposited in glomerular basement membrane and antibodies bind to the GBM
- Further antigen reacts with antibodies bind to GBM and cross glomerular membranes
Associated Conditions
Gross Pathology
- On gross pathology, following features are seen:
- Kidney are enlarged and pale in color
Microscopic Pathology
On microscopic histopathological analysis:
- Glomeruli are enlarged and hypercellular due to the deposition of neutrophils and macrophages
- There is a proliferation of mesangial and endothelial cells
- There is a swelling of endothelial cells and presence of inflammatory cells obstructs capillary lumina
- There is an accumulation of mononuclear leukocytic infiltrate and edema in the interstitium
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References
- ↑ Yoshizawa N, Yamakami K, Fujino M, Oda T, Tamura K, Matsumoto K, Sugisaki T, Boyle MD (July 2004). "Nephritis-associated plasmin receptor and acute poststreptococcal glomerulonephritis: characterization of the antigen and associated immune response". J. Am. Soc. Nephrol. 15 (7): 1785–93. PMID 15213266.
- ↑ Oda T, Yoshizawa N, Yamakami K, Tamura K, Kuroki A, Sugisaki T, Sawanobori E, Higashida K, Ohtomo Y, Hotta O, Kumagai H, Miura S (September 2010). "Localization of nephritis-associated plasmin receptor in acute poststreptococcal glomerulonephritis". Hum. Pathol. 41 (9): 1276–85. doi:10.1016/j.humpath.2010.02.006. PMID 20708459.
- ↑ Rodríguez-Iturbe B, Batsford S (June 2007). "Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet". Kidney Int. 71 (11): 1094–104. doi:10.1038/sj.ki.5002169. PMID 17342179.