What is a proposed inflammatory mechanism for the pathogenesis of acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

A proposed mechanism for acute poststreptococcal glomerulonephritis is that soluble, released NAPlr binds to glomeruli and provide a mechanism to capture plasmin activated by streptokinase. The activated plasmin bound to NAPlr associates with the GBM and mesangium. Both NAPlr and NSAP are capable of inducing chemotactic (monocyte chemoattractant protein 1) and interleukin (IL)–6 moieties in mesangial cells, promoting enhanced expression of adhesion molecules. Peripheral blood leukocytes also release other cytokines such as tumor necrosis factor-alpha, IL-8, and transforming growth factor-beta, which react with NSAP. These findings highlight the inflammatory potential of these nephritogenic antigens. [19, 20, 21, 22]

Bound plasmin can cause tissue destruction by direct action on the glomerular basement membrane or by indirect activation of procollagenases and other matrix metalloproteinases (MMPs). NAPlr can also activate the alternate complement pathway, leading to accumulation of polymorphonuclear cells and macrophages and local inflammation. In addition, the in situ–formed and circulating immune complexes can readily pass through the altered glomerular basement membrane and accumulate on the subepithelial space as humps.


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