The occurrence of azotemia in pneumococcal pneumonia.

Abstract

The advent of antimicrobial therapy, although greatly simplifying the management of patients with pneumococcal pneumonia, has not decreased the frequency of the disease (1, 2). Recently, the writers have been impressed by the frequency with which azotemia seemed to occur in patients with uncomplicated pneumococcal pneumonia. Since this finding has been responsible for prolonging hospitalization in many patients, it seemed important to review this association. In the texts dealing with lobar pneumonia, azotemia is mentioned only by Bullowa (3-8) as a feature of the disease. However, the occurrence of azotemia in the course of uncomplicated pneumococcal (lobar) pneumonia received considerable attention prior to 1930 (9-26) (table 1). In several of the early studies, it was concluded that renal function was increased despite the occurrence of azotemia (20, 24, 25). Such conclusions were based upon estimations of urea clearance which has definite limitations under the circumstances of study. These reports have subsequently served to obscure the frequency and importance of azotemia in pneumococcal pneumonia. Azotemia has been observed occasionally in association with a variety of acute, infectious processes; however, the frequency of occurrence in patients with pneumococcal pneumonia seemed greater than in those with other serious infections (9, 12, 13, 15, 16). The present study is being reported both to re-emphasize the frequent occurrence of significant azotemia during the course of otherwise uncomplicated treated pneumococcal pneumonia and to characterize the clinical features of such patients.