Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet

• Published in: Kidney international Vol. 71; no. 11; pp. 1094 - 1104
• Main Authors: Rodríguez-Iturbe, B., Batsford, S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2007; Nature Publishing; Elsevier Limited
• Subjects: Animals; Bacterial diseases; Bacterial Proteins - immunology; Biological and medical sciences; exotoxin B; Exotoxins - immunology; Fibrinolysin - metabolism; Glomerulonephritis; Glomerulonephritis - etiology; Glomerulonephritis - immunology; Glomerulonephritis - microbiology; Glomerulonephritis - pathology; Glyceraldehyde-3-Phosphate Dehydrogenases - immunology; Human bacterial diseases; Humans; immune complex disease; Infectious diseases; Kidney Glomerulus - metabolism; Medical sciences; Models, Immunological; Molecular Mimicry; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; plasmin receptor; Scarlet Fever - immunology; Staphylococcal infections, streptococcal infections, pneumococcal infections; streptococcal antigens; streptococcal GAPDH; Streptococcal Infections - complications; Streptococcal Infections - immunology; Streptococcal Infections - pathology; Streptococcus pyogenes - chemistry; Streptococcus pyogenes - pathogenicity; zymogen; exotoxin B; zymogen; immune complex disease; streptococcal GAPDH; streptococcal antigens; plasmin receptor; Glomerulonephritis; Nephrology; Disease; Pathogenesis; Plasmin; Urology; Streptococcal infection; Exotoxin; Biological receptor; Kidney disease; Urinary system disease; Serine endopeptidases; Enzyme; Infection; Antigen; Zymogen; Peptidases; Toxin; Bacteriosis; Hydrolases; Immune complex
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5002169

Considerable insight has been gained into the etiopathogenesis of poststreptococcal glomerulonephritis since the landmark theoretical construct of Clemens von Pirquet postulated that disease-causing immune complexes were responsible for the nephritis that followed scarlet fever. Over the years, molecular mimicry between streptococcal products and renal components, autoimmune reactivity and several streptococcal antigens have been extensively studied. Recent investigations assign a critical role to both in situ formation and deposition of circulating immune complexes that would trigger a variety of effector mechanisms. Glomerular plasmin-binding activity of streptococcal glyceraldehyde-3-phosphate-dehydrogenase may play a role in nephritogenicity and streptococcal pyrogenic exotoxin B and its zymogen precursor may be the long-sought nephritogenic antigen.