Progression to Uremia after Remission of Acute Poststreptococcal Glomerulonephritis

Abstract

Whether or not poststreptococcal glomerulonephritis advances over the long term to uremia remains an unsettled issue. We documented ultimate progression to renal failure in six patients who were observed at onset with the typical clinical and morphologic features of acute nephritis after proved betahemolytic streptococcal infection. Within one year, renal function returned essentially to normal in all, as the proliferative changes in glomeruli subsided. Subsequently, increasing renal failure developed in these patients over periods ranging from two to 12 years, during which all were hypertensive. As the renal disease progressed, glomeruli showed increasing sclerosis in the absence of proliferation, and fibrohyaline thickening of renal arterioles appeared. (N Engl J Med 295:977–981, 1976)