41 Investigation of 26 Childhood Cases of Acute Epidemic Poststreptococcal Glomerulonephritis

Abstract

Controversy concerns immunological and ultrastructural features of acute poststreptococcal glomerulonephritis. Opportunity to study, by renal biopsy, immunohistochemistry and electron microscopy, an entire single population of patients with poststreptococcal glomerulonephritis permitted us to resolve several conflicts and to learn more of pathogenesis and natural history. An epidemic of 26 cases of acute poststreptococcal glomerulonephritis occurred among Red Lake Reservation Indian children 2 to 15 years of age. Type 49 beta hemolytic streptococci reappeared at Red Lake for the first time since the 1953 epidemic of acute glomerulonephritis. Clinical manifestations were minimal but most children had pustular streptococcal skin lesions. Endothelial proliferation and leukocytic infiltration was observed in percutaneous renal biopsies. As regularly observed in our previous studies of sporadic acute glomerulonephritis, approximately ¼ of these patients had nodular deposits of IgG and beta 1C globulin along the glomerular basement membranes by immunohistochemical analysis. 90 % of remaining patients showed interrupted linear deposition of beta 1C along glomerular membranes without IgG. Electron microscopic study revealed minimal development of the characteristic discrete electron dense deposits' on the epithelial side of the glomerular basement membrane. Focal membrane thickening and basement membrane-like material among mesangial cells was observed. This study, sampling an entire spectrum of acute poststreptococcal glomerulonephritis, suggests that nephritogenic strains of streptococci may exert a toxic action rendering the glomerulus susceptible to injury by antigen-antibody complexes. (Supported by American Heart Association, USPHS, and Minn. Heart) (SPR)