Acute Glomerular Nephritis Research Articles

STAGES, PROGNOSIS AND DURATION OF GLOMERULAR NEPHRITIS IN CHILDHOOD

Recent studies of glomerular nephritis in childhood, among which may be mentioned those of Guild,¹Boyd,²Aldrich,³Blackfan,⁴Levy⁵and Lyttle and Rosenberg,⁶disclose two tendencies of opinion with which our⁷own observations do not permit us to concur. One of these is to regard the prognosis of acute glomerular nephritis in childhood, whether postscarlatinal or not, as almost uniformly good for complete recovery. The other is to regard such other manifestations of renal disease as nephrosis with glomerular episodes (Tappan⁸), chronic nonspecific nephritis (Aldrich⁹), subacute parenchymatous nephritis (Holt and McIntosh¹⁰) and chronic nephritis as entities etiologically unconnected with acute glomerular nephritis. The idea that acute nephritis may in some instances lead by direct continuity to chronic forms of nephritis and eventually to death from renal failure, which was upheld in pediatric literature as early as 1897 by the elder

PROGNOSIS IN ACUTE GLOMERULAR NEPHRITIS

Article1 February 1936PROGNOSIS IN ACUTE GLOMERULAR NEPHRITISARTHUR B. RICHTER, M.D.ARTHUR B. RICHTER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-9-8-1057 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe outlook for adults who have acute glomerular nephritis has seldom been the subject of comment in the literature. Excepting war nephritis, the few studies on prognosis are mostly in children. The mortality during the acute stage of the disease is regarded as low in both groups; but both the immediate and the late prognosis are apparently more favorable in the earlier ages. However, the death rate during the acute stage in the cases of acute nephritis, chiefly adults, recently reported by Murphy, Grill and Moxon,1 was so high as to challenge the truth of these beliefs.The present study...

PATHOLOGY OF PNEUMOCOCCUS INFECTION IN MICE FOLLOWING INTRANASAL INSTILLATION

Pneumonia can be produced in mice, which have not been previously prepared, by intranasal inoculation of broth cultures of certain strains of pneumococci. Lesions which are quantitatively different can be produced in different breeds of mice by inoculation of the same type of pneumococcus. Similar inoculation of different types of pneumococci into one breed of mice results in lesions which are qualitatively different. In general, these lesions are as follows: a diffuse pneumonia and an acute glomerular nephritis in unselected mice receiving Type I strains; a confluent pneumonia and a tubular nephritis in the case of Type II strains; and as result of Type III strains, an interstitial pneumonia with extensive gelatinous pleurisy, together with necrosis and abscess formation in the spleen and cervical lymph nodes. Resistant strains of mice with Type III pneumococci show slight changes in the lungs, but marked lesions in the spleen and cervical nodes, while susceptible mice with the same type of pneumococcus show marked changes in the lung and moderate lesions in the spleen and cervical nodes. The method of development of Type III pneumonia, studied by means of serial sections of nasally infected mice, appears to proceed in the stages of vascular engorgement, interalveolar interstitial exudate, albuminous fluid exudate into the alveoli and the perivascular lymphatics draining the affected site, and finally, a frank pneumonia with a cellular exudate in the alveoli but without much fibrin.

Streptococcal Pseudomembranous Conjunctivitis: Report of a Case

The etiologic agent in a case of streptococcal pseudomembranous conjunctivitis which occurred in a girl 6 years old was investigated over a period of 30 months. In the left eye, an extensive involvement of the cornea did not respond to ordinary treatment and after a few months the eye was enucleated. Later the right eye was attacked and there also developed a pseudomembranous vaginitis and acute glomerular nephritis. Various organisms were isolated from the bacterial flora of vagina and conjunctiva, but Streptococcus haemolyticus alone reproduced the symptoms in laboratory animals. At each exacerbation of the disease this organism appeared in cultures, then disappeared after a short time, although the pseudomembranes continued to form, leading to the conviction that the organism persisted dormant subconjunctivally. Lesions of the right eye and vagina responded favorably to treatment with scarlet-fever streptococcal antitoxin and apparently healed after immunization with scarlet-fever toxin and autogenous vaccine, although a granuloma persisted in the left socket over the entire period of 30 months. Extensive studies into the nature of the organism were made as well as pathologic investigations of sections of the pseudomembranes and the enucleated eye. From the Department of Ophthalmology, College of Medicine, State University of Iowa. Read before the Association for Research in Ophthalmology, Atlantic City, June 11, 1935.

INFECTION AND HEMORRHAGIC NEPHRITIS

Infection as a cause of diffuse hemorrhagic or glomerular nephritis is well known. Since Loehlein's1(1907) and Fahr's2(1912) fundamental observations emphasizing the frequency with which glomerular nephritis is associated with streptococcic infections, usually of the upper respiratory tract, subsequent extensive studies,3both clinical and experimental, have tended to confirm these observations. Longcope and his associates4(1927) published the results of detailed clinical and bacteriologic studies of forty cases of acute and subacute glomerular nephritis. The onset of an overwhelming majority of the cases in their series (85 per cent) was accompanied or preceded by acute infections of the upper respiratory tract, of which 68.7 per cent showed the beta type, and 12.2 per cent the alpha type, of the hemolytic streptococcus. After years of observation they concluded that disappearance of infection and of the hemolytic streptococcus was related to recovery in nephritis and, contrariwise, that

UREA CLEARANCE TEST AS AN INDEX OF RENAL FUNCTION

The material for this study is a series of ninety-four observations of the urea clearance in twenty-one cases of Bright's disease. Ten ward patients and eleven dispensary and office patients are included; the data for the latter group are of importance in the determination of the value of the urea clearance test in the ambulatory subject. The other ten patients were investigated while at complete rest in bed in the wards of the New York Post-Graduate Hospital. Our observations covered a period of ten months. One case of acute diffuse glomerular nephritis, fifteen cases of chronic diffuse glomerular nephritis and five cases of vascular or arteriosclerotic nephritis were investigated. In two cases of chronic diffuse glomerular nephritis, while the patients were under observation, a definite so-called nephrotic component developed, as shown by increasing edema, a high amount of blood cholesterol, marked proteinuria and a low protein content and an inverted

ACUTE GLOMERULAR NEPHRITIS IN CHILDREN

Acute glomerular nephritis, the form of nephritis encountered most frequently in childhood, is preceded usually by an acute illness commonly associated with the hemolytic streptococcus. 1 Following recovery from the acute infection, a period of from several days to two or three weeks often elapses before the onset of the renal disturbance. The child may be up and about and even return to school, when puffiness of the eyes, especially in the morning, directs attention to the condition, or hematuria may be the first abnormality noted. In many cases a certain amount of pallor and the continued presence of blood in the urine are the presenting signs, which may persist for a period varying from four to six weeks, or even longer. The prognosis in this form of nephritis is good as regards life and freedom from permanent sequelae, in the majority of instances. However, there may develop, in children

Prognosis of Acute Glomerular Nephritis in Children

Prognosis of Acute Glomerular Nephritis in Children

THE RELATION OF SINUSITIS TO NEPHROSIS IN CHILDREN: A STUDY BASED ON INVESTIGATIONS AT THE CHILDREN'S HOSPITAL, LOS ANGELES, 1929

The pathologic process in true nephrosis is confined to the tubular portion of the kidney. All grades of tubular changes may be noted. The cells become granular in an early stage, and finally shed off and regenerate in a lower type as the disease progresses. A pure tubular nephrosis is rare, however, as secondary glomerular changes and interstitial changes are frequent. The glomerular capsule becomes thickened; later the glomerular tuft becomes adherent to the capsule, and finally there is entire obliteration of the tuft. Interstitial changes with round cell infiltration also take place. The condition is then one of chronic parenchymatous nephritis or a mixed nephritis and nephrosis. A somewhat similar picture is sometimes obtained when, following acute glomerular nephritis, as sometimes results from scarlet fever, a secondary degeneration of the tubules occurs. The etiologic agent in this case may be bacterial, in which case the changes in the kidney

THE PROGNOSIS OF ACUTE NEPHRITIS IN CHILDHOOD

In a series of cases of acute nephritis in children studied on the Children's Medical Division at Bellevue Hospital in the past seven years, we have had the opportunity to observe the manifestations of this disease and to note its progress. Though we speak of it as a disease entity involving one organ, the kidney, it must be remembered that at least two distinct types of acute renal involvement may be present, depending on whether glomeruli or tubules are predominantly involved. The classification of acute nephritis on a purely clinical basis affords no great difficulty if one remains aware that no system of classification is absolute. A pure acute glomerular nephritis without tubular damage may be postulated, but it probably exists rarely, if at all. Capon 1 said: It is a truism to state that when a child's kidneys become inflamed it is rare to find on histological examination that

Afebrile Post-Scarlatinal Nephritis.

In many cases of scarlet fever the symptoms of the infection have passed and recovery has apparently been established, when acute nephritic symptoms without fever appear about the third week. Of these, the signs of glomerular nephritis are the most prominent. It is generally thought that the new symptoms are not those of a secondary infection or late manifestations of scarlatina. In this connection Longcope and his co-workers indicate that the late nephritis following scarlet fever is the result of existing foci of streptococci in the throat and other parts of the upper respiratory tract. They could not obtain evidence that the streptococci caused the glomerular nephritis by actual invasion of the kidney, as cultures of the blood and urine were negative. These authors suggest that toxin from streptococcal foci in the throat, sinuses, etc., is eliminated by the kidney, thus causing the acute glomerular nephritis. Our experiments with 17 healthy young dogs support Longcope's contention and furthermore prove that the late acute glomerular nephritis (at least in the dog) is not the result of retained viable streptococci in the body but is due solely to the in vivo prepared streptococcal lysate (endotoxin) of Duval and Hibbard. In the recovered experimental dogs which had been infected with living cultures of scarlatinal streptococci, a second or a third dose of “lysate” (toxin in vivo prepared) produce a severe and often fatal acute hemorrhagic glomerulo nephritis which in every way corresponds to the afebrile post-scarlatinal nephritis of man. These animals tested before administrating the “lysate” showed more or less lytic immunity; that is, a specific streptococcal lysin was demonstrable in the blood serum and the animals could not be infected with the same dosage of living culture that infected them originally.

BLOOD VOLUME IN EDEMA OF GLOMERULAR NEPHRITIS AND NEPHROSIS

The pathogenesis of edema of renal origin is concerned with changes in the blood, vessels and tissues. A review of the literature on the subject is confusing and unsatisfactory. Bright asserted that the depletion of albumin in the blood changed the physicochemical balance and edema resulted. Later Senator suggested the vascular element, and in recent years Fischer has implicated the tissue cells in the genesis of edema. The part played by the blood has interested many observers, but the exact significance of its volume in this connection has not been clear. The following brief excerpts from Loeb's1review of the subject of edema depict the prevailing confusion: Volhard2stated that in acute glomerular nephritis with edema there is no dilution of the blood, while without edema there may be dilution. In the latter, because of the renal block, water is retained in the blood; in the former, water and salts,