Korean Journal of Nephrology 1987;6(2):295-303.
용연균감염후 급성 사구체신여멩 관한 임상적 관찰
장수경 , 이재승 , 오승환 , 박혜준 , 김병길
Abstract
A clinical study was performed on 452 cases of post- streptococcal acute glomerulonephritis from January 1979 to December 1986. The criteria for diagnosis rest upon acute onset of glomerular injury (proteinuria and hematuria), almost always with edema, hypertension and renal insufficiency; the absence of evidence for pre-existing renal disease; a history of a recent preced- ing infection with serologic and bacteriologic evidence of streptococcal infection; trensient decrement of serum C, level; renal biopsy compatible with the diagnosis of poststreptococcal acute glomerulonephritis. Ther results were as follows; 1) Sex distribution showed male preponderance with male to female ratio of 1.9:1 and age incidence was highest in children from 7-9 years (39.7%), with a sea- sonal peak from October to December (56.6%). Prece- ding infection was acute pharyngitis (73.0%), scarlet fever (2.7%) and skin infection (1.1%). 2) Clinical manifestations were edema (87.8%), gross hematuria (56.2%), hypertension (53.8%) and decreased urine output (22.6%). 3) The group A B-hemolytic streptococci was cultured in 6.2% and antistreptolysin 0 titer of greater than 200 IU/ml was noted in 81.9%. The laboratory findings revealed elevated ESR (70.8%), positive CRP (37.6%), increased BUN over 21 mg/dl (38.1%), increased serurn creatinine over 1.1 mg/dl (Z9.2%), decreased GFR below 60 ml/min/1.73 M (28.5%) and on urinalysis, micro- hematuria (100.0%) and prtoteinuria over 1.0 gm/24 hr (18.5%). 4) 95.0% of cases had decreased C, level at initial findings and C, level returned to normal with 4th week (66.4%) and 8th week (96.1%) although some took as long as 14 weeks. Serum immunoglobulin levels of IgG, IgA and IgM were elevated in 28.2%, 21.0% and 12.8% of cases. 5) Edema, gross hematuria and hypertension nearly subsided within 3rd week and complications in acute phase were hypertensive encephalopathy (11.5%), acute renal failure (3.3%), congestive heart failure (3,1%), hyperkalemia (3.1%), hyponatremia (0.7%) and death (0. 4)
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