STUDIES OF POSTSTREPTOCOCCAL NEPHRITIS AND OTHER GLOMERULAR DISEASES

Abstract

Pathologic findings on renal biopsy in 36 adult patients with proved poststreptococcal acute nephritis were quite characteristic. Almost all glomeruli were diffusely hypercellular. One patient whose glomerular capillaries were completely blocked by leucocytes died. Both acute and chronic changes were observed in biopsies obtained after 4 exacerbations in 3 patients with chronic glomerulonephritis. Of the remaining 32 patients, 16 healed. In general, the clinical course was more severe in the 16 patients whose disease became chronic, and on biopsy there was more evidence of glomerular damage (necrosis, crescents, adhesions, hyalinization), more interstitial fibrosis and more erythrocyte casts. Clinical acute nephritis was observed in 14 patients without evidence of preceding streptococcal infection. Little or no glomerular changes were observed in these patients. Of 37 patients with histologic chronic diffuse proliferative glomerulonephritis, an acute onset followed proven streptococcal infections in 20, an acute onset followed probable streptococcal infections in 9, while in 8 the nature of the onset of renal disease was unknown. Serum antibodies against type 12 hemolytic streptococci were demonstrated in 12 of these 37 patients. In contrast, type 12 antibodies were found in only 5 of 72 other patients with chronic proteinuria. These patients, on renal biopsy, had a variety of renal diseases which differed significantly from the diffuse proliferative glomerulonephritis so common in the poststreptococcal nephritic patients.