Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-09T16:20:43.421Z Has data issue: false hasContentIssue false

Acute poststreptococcal glomerulo-nephritis in general practice: the contribution of infection to its onset and course

Published online by Cambridge University Press:  15 May 2009

P. M. Higgins
Affiliation:
Wallings, Heathfield Lane, Chislehurst, Kent BR7 6AH
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Twenty-one patients considered to have acute poststreptococcal glomerulo-nephritis were encountered during 35 years of general practice. In ten of them good evidence of active streptococcal infection at the time of discovery of nephritis was recorded. The more complete the data the more convincing was the evidence of active infection.

In over half of those whose urines were routinely cultured pathogens were isolated and over a third were treated for infection of the urinary tract. Such infections were associated with adverse effects and prolonged illness.

As compared with children, adults in general had a longer history of ill-health, were less likely to present with acute infections and more likely to have urinary tract infections and prolonged illness.

Vigorous antistreptococcal treatment was followed by rapid recovery in those patients so treated whose illnesses were not complicated by urinary tract infections.

Concurrent streptococcal infection and secondary infection of the urinary tract may contribute more to the onset of acute poststreptococcal glomerulo-nephritis and to its course than is currently believed.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1996

References

1.Yoshizawa, N, Oshima, S, Sagel, I, Shimizu, J, Treser, G. Role of a streptococcal antigen in the pathogenesis of acute poststreptococcal glomerulonephritis: Characterisation of the antigen and a proposed mechanism for the disease. J Immunol 1992; 148: 3110–6.CrossRefGoogle Scholar
2.Tejani, A, Inguli, E. Poststreptococcal glomerulo-nephritis. Current clinical and pathological concepts. Nephron 1990; 55: 15.CrossRefGoogle Scholar
3.Holm, SE. The pathogenesis of acute post-streptococcal glomerulo-nephritis in new lights. APMIS 1988; 96: 189–93.CrossRefGoogle Scholar
4.Earle, DP, Seegal, D. Natural history of glomerulonephritis. J Chron Dis 1957; 5: 313.CrossRefGoogle ScholarPubMed
5.Stetson, CA, Rammelkamp, CH, Krause, RM, Kohen, RJ, Perry, WD. Epidemic acute nephritis: studies on etiology, natural history and prevention. Medicine 1955; 34: 431–50.CrossRefGoogle ScholarPubMed
6.Longcope, WT. Some observations on the course and outcome of haemorrhagic nephritis. Tr Am Clin Climat Assoc 1939; 53: 153–9.Google Scholar
7.Goodall, EW. On the etiology and clinical aspects of scarlatinal nephritis. Guys Hospital Reports 1889; 46: 91116.Google Scholar
8.Turner, FM. On scarlatinal nephritis and its variations. Guys Hospital Reports 1894; 21: 173201.Google Scholar
9.Peters, JP. Some factors in the etiology of Bright's disease. N Engl J Med 1935; 213: 653–8.CrossRefGoogle Scholar
10.Seegal, D, Earle, DP. A consideration of certain biological differences between glomerulo-nephritis and rheumatic fever. Am J Med Sci 1941; 201: 528–39.CrossRefGoogle Scholar
11.Lasch, EE, Frankel, VI, Vardy, PA, Bergner-Rabinowitz, S, Ofek, I, Rabinowitz, K. Epidemic glomerulonephritis in Israel. J Infect Dis 1971; 124: 141–7.CrossRefGoogle ScholarPubMed
12.Weinstein, L, Bachrach, L, Boyer, NH. Observations on the development of rheumatic fever and glomerulonephritis in cases of scarlet fever treated with penicillin. N Engl J Med 1950; 242: 1002–10.CrossRefGoogle ScholarPubMed
13.Weinstein, L, LeFrock, J. Does antimicrobial therapy of streptococcal pharyngitis or pyoderma alter the risk of glomerulo nephritis? J Infect Dis 1971; 124: 229–31.CrossRefGoogle ScholarPubMed
14.Peter, G, Smith, AL. Group A streptococcal infections of the skin and pharynx. New Engl J Med 1977; 297: 311–7.CrossRefGoogle ScholarPubMed
15.Editorial. Poststreptococcal glomerulo-nephritis. BMJ 1979; 2: 1243–4.CrossRefGoogle Scholar
16.Sen, S. Acute nephritis in children. Am J Med Sci 1946; 211: 289–92.CrossRefGoogle ScholarPubMed
17.Higgins, PM. Streptococcal pharyngitis in general practice. 1. Some unusual features of the epidemiology. Epidemiol Infect 1992; 109: 181–9.CrossRefGoogle ScholarPubMed
18.Hope-Simpson, RE. Streptococcus pyogenes in the throat: a study in a small population 1962–1971. J Hyg 1982; 87: 109–29.CrossRefGoogle Scholar
19.Valkenburg, HA, Haverkorn, MJ, Goslings, WRO, Lorrier, JC, de Moor, CE, Maxted, WR. Streptococcal pharyngitis in general practice. II. The attack rate of rheumatic fever and acute glomerulo-nephritis in patients not treated with penicillin. J Infect Dis 1971; 124: 348–58.CrossRefGoogle Scholar
20.Higgins, PM, Abbott, BA, James, PM, Dillon, S, MacMonagle, PJ. Acute nephritis and streptococcal sore throat: A prospective study in general practice. BMJ 1965; 2: 1156–60.CrossRefGoogle ScholarPubMed
21.Higgins, PM. Acute nephritis presenting with a normal urine: Report of a case. J Roy Coll Gen Practit 1968; 15: 154–9.Google ScholarPubMed
22.Higgins, PM. Obscure streptococcal syndromes. Proc Roy Soc Med 1970; 63: 409–12.CrossRefGoogle ScholarPubMed
23.Lawy, HS. Use and interpretation of the antistreptolysin test. Ann Rheumat Dis 1960; 19: 42–7.CrossRefGoogle ScholarPubMed
24.Meadow, SR. Poststreptococcal nephritis – a rare disease? Arch Dis Child 1975; 50: 37–8.CrossRefGoogle ScholarPubMed
25.Hutt, MSR, White, RHR. A clinico-pathological study of acute glomerulonephritis in E. African children. Arch Dis Child 1964; 39: 313–23.CrossRefGoogle Scholar
26.Freedman, P, Meister, HP, Lee, HJ, Smith, EC, Nidus, BD. The renal response to streptococcal infection. Medicine 1970; 49: 433–63.CrossRefGoogle ScholarPubMed
27.Cameron, JS. Membranous nephropathy in childhood and its treatment. Pediatric Nephrol 1990; 4: 193–8.CrossRefGoogle ScholarPubMed
28.D'Amico, G. The commonest glomerulo-nephritis in the world: IgA nephropathy. Quart J Med 1987; 245: 709–27.Google Scholar
29.Higgins, PM. Streptococcal pharyngitis in general practice. 2. A note on dual infection and urinary abnormalities. Epidemiol Infect 1992; 109: 191–7.CrossRefGoogle ScholarPubMed
30.Kassirer, JP, Schwartz, WB. Acute glomerulo-nephritis. N Engl J Med 1961; 256: 686–92.CrossRefGoogle Scholar