The Study of Clinical Characteristic Changes in Acute Poststreptococcal Glomerulonephtritis - Comparision of Clinical Manifestations between Recent 5 Years and Past 5 Years -

연구균 감염 후 급성 사구체신염의 임상 양상 변화에 대한 연구 - 최근 5년과 이전 5년 동안의 임상 증상 비교 -

  • Yoon, Hye Won (Department of Pediatrics, College of Medicine, Chungnam National University) ;
  • Park, Kyung Soo (Department of Pediatrics, College of Medicine, Chungnam National University) ;
  • Lee, Jae Ho (Department of Pediatrics, College of Medicine, Chungnam National University)
  • 윤혜원 (충남대학교 의과대학 소아과학교실) ;
  • 박경수 (충남대학교 의과대학 소아과학교실) ;
  • 이재호 (충남대학교 의과대학 소아과학교실)
  • Received : 2005.06.13
  • Accepted : 2005.08.09
  • Published : 2005.11.15

Abstract

Purpose : The purpose of this study is to evaluate the clinical characteristic changes of acute poststeptococcal glomerulonephritis(APSGN) in recent. The cases of APSGN occurred for the last ten years were divided into group I and II by the unit of 5 years and clinical manifestations and laboratory findings of each groups were analyzed. Methods : Total of 74 cases of APSGN, diagnosed at the department of Pediatrics, Chungnam National University Hospital from January 1995 to August 2004 were divided into group I(31 cases from January 1995 to December 1999) & II(43 cases from January 2000 to August 2004). In addition, the clinical records of each group were reviewed retrospectively and compared. Results : In both groups, the prevalence rate was much higher in males than females, the seasonal prevalence rate was higher in winter, the upper respiratory infection was most frequent predisposing illness, and one to two weeks of latent period was the highest. However, the average age for group II were younger than group I. The prevalence rate of gross hematuria was higher in group II, but there was no significant difference between two groups. In the course of clinical symptoms, edema and hypertension were relieved within two weeks in both groups. In group II, the prevalence rate of proteinuria was higher, and the duration of proteinuria and gross hematuria were longer than group I. Conclusion : In this comparative study, the average age became younger. Clinically the duration of gross hematuria and proteinuria became longer, and the prevalence rate of proteinuria increased in recent 5 years. However, there was no difference between two groups in clinical courses and prognosis.

목 적 : 최근 10년 동안 발생하였던 연구균 감염 후 급성 사구체신염을 5년 단위로 I군과 II군로 나누어 기간에 따른 임상 양상과 검사 소견들의 변화를 비교 분석하고자 하였다. 방 법 : 충남대학교병원 소아과에서 1995년 1월부터 2004년 8월까지 10년 동안 연구균 감염 후 급성 사구체신염으로 진단되어 입원 치료를 받았던 환아들 중에서 추적 관찰이 가능하였던 74례를 대상으로 1995년 1월부터 1999년 12월까지 I군(31명), 2000년 1월부터 2004년 8월까지 II군(43명)으로 나누어 임상 및 검사 소견들을 후향적으로 비교 분석하였다. 결 과 : I군과 II군에 대한 비교연구 결과 두 군 모두에서 남아에서 많이 발생하였고, 겨울에 빈발하였으며 1-2주의 잠복기를 나타낸 상기도 감염이 선행 질환으로 가장 많았다. 발생 연령은 II군(7.4세)에서 I군(9.2세)보다 낮았다. 육안적 혈뇨 증상의 발생 빈도는 I군과 II군 모두에서 높게 나타났으나, 두 그룹간에 의미 있는 차이는 없었다. 임상 증상의 경과에서 부종과 고혈압은 2주내에 I군과 II군 모두에서 완해되었다. 단백뇨 증상의 발생 빈도는 II군에서 I군보다 높았으며, 육안적 혈뇨와 단백뇨 증상의 발현 기간도 II군에서 I군 보다 오래 지속되었다. 결 론 : 최근 2000년대에는 연구균 감염 후 급성 사구체신염의 발생 연령이 이전보다 낮아지고, 높은 발생 빈도를 나타낸 육안적 혈뇨 증상의 발현 기간이 연장되면서, 단백뇨 증상의 발현 빈도가 증가하면서 단백뇨가 완해되는 기간도 연장되었다. 그러나 임상 경과와 예후는 차이가 없었다.

Keywords

References

  1. Avner ED, Harmon WE, Niaudet P. Pediatric Nephrology. 5th ed. Philadelphia : Lippincott Williams & Wilkins Co. 2004:601-13
  2. Webb NJA. Postlethwaite RJ. Clinical Padiatrics Nephrology. 3rd ed. Oxford : Oxford University Press. 2003:367-79
  3. Friedman J, van de Rijn I, Ohkuni H, Fischetti VA, Zabriskie JB. Immunological studies of poststreptococcal sequelae : evidence for presence of streptococcal antigens in circulating immune complexes. J Clin Invest 1984;74:1027- 34 https://doi.org/10.1172/JCI111470
  4. Coroncy-Bermes P, Dale JB, Beachey EH, Opferkuch W. Monoclonal antibody to human renal glomeruli cross reacts with streptococcal M protein. Infect Immun 1987;55:2416-9
  5. Lange K, Seligson G, Gronin W. Evidence for the in situ origin of streptococcal GN : glomerular localization of endostreptosin and the clinical significance of the subsequent antibody response. Clin Nephrol 1983;19:3-10
  6. Brady HR, Brenner BM. Pathogenetic mechanism of glomerular injury. In : Fauci AS, ed. Harrison's principles of internal medicine. New York : McGraw-Hill, 1998:1529-36
  7. West CD, McAdams AJ, Witte DP. Acute non-proliferative glomerulitis : a cause of renal failure unique to children. Pediatr Nephrol 2000;14:786-9
  8. Grunfeld JP, Noel LH, Hafz S, Droz D. Renal prognosis in women with hereditary nephritis. Clin Nephrol 1985;23:267- 71
  9. Van Iseghem P, Hauglustain D, Bollens W, Michielsen P. Urinary erythrocyte morphology in acute glomrulonephritis. BMJ 1983;287:1183
  10. Levy M, Sich M, Pirotzky E, Habib F. Complement activation in acute glomerulonephritis in children. Int J pediatr nephrol 1985;6:17-24
  11. Schwartz B, Facklan RR, Breiman RF. Changing epidemiology of group A streptococcal infection in the USA. Lancet 1990;336:1167-71 https://doi.org/10.1016/0140-6736(90)92777-F
  12. Anthony BF, Kaplan EL, Wannamaker LW, Briese FW, Chapman SS. Attack rates of acute nephritis after type 49 streptococcal infection of the skin and of the respiratory tract. J Clin Invest 1969;48:1697-1704 https://doi.org/10.1172/JCI106135
  13. Dedeoglu IO, Springate JE, Waz WR, Stapleton FB, Feld LG. Prolonged hypocomplementemia in poststreptococcal acute glomerulonephritis. Clin Nephrol 1996;46:302-5
  14. Lee YS, Ou KS, Kim SH, Kee BK. Serum C3 & C4 levels and its clinical significance in acute poststreptococcal glomerulonephritis. J Korean Pediatr Soc 1986;29:368-71
  15. Long SS, Pickering LK, Prober CG. Principle and practice of pediatric infectious diseases. 2nd ed. 2003:723-5