Group A streptococcal antigen in the glomeruli of children with Henoch-Schönlein nephritis

Am J Kidney Dis. 2003 Feb;41(2):366-70. doi: 10.1053/ajkd.2003.50045.

Abstract

Background: Although the pathogenesis of Henoch-Schönlein nephritis (HSN) remains unclear, there is substantial evidence that it is an immune complex-mediated disease. HSN is preceded by upper-respiratory tract infection in 30% to 50% of patients, but there is no evidence that group A streptococcal (GAS) infection has a pathogenetic role in this disease. Recently, nephritis-associated plasmin receptor (NAPlr), a GAS antigen, was found primarily in the glomerular mesangium of patients with early-stage acute poststreptococcal glomerulonephritis.

Methods: To determine the possible role of NAPlr in HSN, expression of the receptor was determined in glomeruli using fluorescein isothiocyanate-labeled rabbit polyclonal anti-NAPIr antibody, and serum antistreptolysin O (ASO) titers were measured in children with HSN.

Results: Ten of 33 patients (30%) with HSN showed segmental or global mesangial staining with NAPlr antibody, whereas only 4 of 120 patients (3%) with other renal diseases were positive (P < 0.001, Fisher's exact test). Patients with HSN also showed significantly greater ASO titers than patients with other renal diseases (P = 0.03, Mann-Whitney U test). Serum ASO titers were significantly greater in patients with HSN with than without glomerular NAPlr antigen (P = 0.03, Mann-Whitney U test).

Conclusion: These findings suggest that the deposition of NAPlr in the mesangium, induced by GAS infection, may have a role in the pathogenesis of HSN in some patients. Am J Kidney Dis 41:366-370.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Bacterial / metabolism
  • Antigens, Bacterial / analysis*
  • Antigens, Bacterial / immunology
  • Antigens, Bacterial / physiology
  • Antistreptolysin / blood
  • Child
  • Child, Preschool
  • Female
  • Fluorescein-5-isothiocyanate / metabolism
  • Glomerular Mesangium / immunology
  • Glomerular Mesangium / microbiology
  • Glomerular Mesangium / pathology
  • Glomerulonephritis / microbiology*
  • Humans
  • Kidney Glomerulus / immunology
  • Kidney Glomerulus / microbiology*
  • Kidney Glomerulus / pathology
  • Male
  • Purpura, Schoenlein-Henoch / microbiology*
  • Streptococcal Infections / immunology
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / isolation & purification*
  • Streptococcus pyogenes / pathogenicity

Substances

  • Antibodies, Bacterial
  • Antigens, Bacterial
  • Antistreptolysin
  • Fluorescein-5-isothiocyanate