A Clinico-pathological Study of Acute Glomerulonephritis in East African Children

Abstract

The clinical and pathological features of 24 East African children suffering from acute diffuse glomerulonephritis, and studied by means of renal biopsy, are described. The diagnostic histo-logical criteria were (a) diffuse proliferation and swelling of glomerular endothelial cells, and (b) infiltration by polymorphonuclear leucocytes. Serological evidence of [beta]-hemolytic streptococcal infection was obtained in 75% of cases. The age incidence is lower than that found in temperate climates. A case of post-streptococcal neonatal nephritis, simulating nephrosis, is described. The clinical pattern was varied; only 14 children had "haemorrhagic" nephritis; 4 presented as nephrotic syndrome, and 3 with cardiac failure, but malnutrition and hookworm infection were contributory factors in most cases; 3 were detected only on routine urinalysis. Hypertension, macroscopic hematuria, heavy pro-teinuria, and raised ASO [antistreptolysin-O] titres were prevalent where histological changes were more severe. Widespread interstitial and tubular lesions, associated with numberous epithelial crescents and seen within 2 weeks of onset in 2 patients, probably denote a progressive lesion. In contrast to previous reports, it is evident that acute, post-streptococcal nephritis is common in Uganda.