On the Exacerbation in Chronic Glomerulonephritis

Abstract

In order to gain a better understanding of the r6le of infection in chronic glomerulonephritis, a study of the exacerbations in this disease was undertaken. Sixty-eight patients with chronic glomerulonephritis were observed closely for periods of from 1 to 8 years. An analysis was made of the incidence of the exacerbations in this group, the presence and nature of the infection preceding each exacerbation, the latent period between the infection and the signs of increased renal inflammation and, finally, the immediate and subsequent effect of each exacerbation on the renal function. It was hoped that these observations might contribute information concerning factors responsible for the progressive nature of chronic Bright's disease.Definition of exacerbation in chronic glomerulonephritis Although there is agreement as to the criteria necessary to establish the diagnosis of acute glomerulonephritis, it is difficult to derive a satisfactory definition for the exacerbation in the chronic phase of this disease. Criteria to describe this state are of necessity arbitrary. For the purpose of this investigation we have been guided by the following objective and relatively simple considerations:It has been assumed that the development of an exacerbation in chronic glomerulonephritis is indicated by an abrupt and marked increase in the degree of hematuria. A concomitant impairment of renal function adds weight to this interpretation, but its absence does not militate against the diagnosis of exacerbation. Since most patients with chronic glomerulonephritis usually pass moderate to large quantities of albumin in the urine, changes in this abnormality are difficult to interpret. Slight variations in the urinary 1 Formerly the Research Division for Chronic Diseases.output of erythrocytes, a common finding in chronic glomerulonephritis, do not necessarily signify the presence of an exacerbation.The pre-exacerbation period includes observations made at any time prior to the onset of the exacerbation. The beginning of the post-exacerbation period is determined with difficulty. It is believed to be present when clinical and laboratory findings have reached the pre-exacerbation level or have become stabilized.Several instances of increased generalized edema in the absence of changes in the urinary findings were proved to be related to dietary deficiency and these cases were consequently not included in this study. In one such individual, for example, a prolonged alcoholic bout with in-

Renal Function and Electrolyte Metabolism in Acute Glomerulonephritis 1

“…Four instances of exacerbation in chronic glomerulonephritis were observed, one of which occurred in patient 8, whose initial attack of acute glomerulonephritis was also studied. The criterion accepted for the diagnosis of exacerbation in chronic glomerulonephritis was "an abrupt and marked increase in the degree of hematuria" (8). Foreshortening of the latent period between infection and onset of symptoms characteristic of the exacerbation (8,9) was noted in two of these patients.…”

“…A greater fraction than normal of filtered potassium and inorganic phosphate appear in the urine in the majority of patients. 8. Ammonia excretion is greater than normal during the early phases of acute glomerulonephritis but subsequently falls below the usual normal range.…”

Post-Streptococcal Glomerulonephritis: Histopathologic and Clinical Studies of the Acute, Subsiding Acute and Early Chronic Latent Phases*†

“…Further, the latent period between precipitating infection and the onset of symptoms or signs of acute nephritis exceeded 5 days in 29 of the 33 patients in whom the latent period could be estimated. Latent periods of 5 to 28 days are characteristic of the initial attack of acute poststreptoccocal glomerulonephritis, in contrast to 1 to 5 days of the exacerbation in chronic glomerulonephritis (26).…”

The Relation of the Serum Antistreptolysin Titer to the Exacerbation in Chronic Glomerulonephritis

“…The present study is based on this material, with the addition of 5 exacerbations that have been observed since the completion of the earlier study. Two of these exacerbations occurred in a patient (Case XI, PA) previously reported (1), while the other 3 were observed in 2 of 13 new cases studied.…”

“…In a previous study (1), an exacerbation in chronic glomerulonephritis was defined arbitrarily as an abrupt and marked increase in the degree of hematuria. It was pointed out that slight variations in the urinary output of erythrocytes perhaps do not signify the presence of an exacerbation.…”