The Serum Antistreptolysin Titer in Acute Glomerulonephritis.

This work on the level of an'tistreptolysin titer in the serum of patients with acute glomerulonephritis is part of a study being conducted by the Departments of Medicine and Pediatrics on the role of infection in acute and chronic glomerulonephritis. The literature and texts list the most heterogeneous types of infection (influenza, diphtheria, measles, the common cold, sore throat, exposure, osteomyelitis, "pregnancy," intestinal catarrh, pyodermia, etc.), as the prodromal episode in acute glomerulonephritis. For this reason and because at the time the patients are first observed (at the onset of the nephritis) the clinical and bacteriological evidence of the preceding infection may be inadequate, it seemed desirable to obtain more specific evidence on the character of the infection which precedes the nephritis. A preliminary study (1) in 1933 showed that of 22 patients with acute glomerulonephritis the sera of 20 had a definite increase in antistreptolysin titer. The present report is a more complete study of this antibody in a larger group of patients observed over a period of four years. In 1932, Todd (2) demonstrated that the sera ofanimals immunized with the hemolysin of the Streptococcus hemolyticus developed a significant amount of an antibody inhibiting the activity of this hemolysin. This antibody had been called antistreptohemolysin or antistreptolysin. The sera of animals immunized to a variety of other bacterial antigens did not contain appreciable quantities of this antibody. Later Todd (2), Coburn and Pauli (3), Griffiths (4), Myers and Keefer (5), Lippard and Johnson (6), Wilson, Wheeler, and Leask (7), Blair and Hallman (8), Longcope (9) and others have investigated and reported the antistreptolysin content of the sera in normal individuals and in patients with infections resulting from Streptococcus hemolyticus and other organisms. A description of the technique used in determining the serum antistreptolysin is found in the Appendix of Todd's publication (2). The preparation of the medium now used to produce the streptolysin is that outlined by Todd and Hewitt (10), with the exception that beef heart is used instead of horse meat. In the titration of the streptolysin', however, we follow the method of Hodge and Swift (11) and determine its combining unit. For this method we use Dr. Todd's standard antistreptolysin horse globulin which he kindly furnished us. In the routine test this globulin (diluted so that 1.0 cc.=20,000 units) and normal human sera are run regularly as controls.