On the Permanence of Recovery in Acute Glomerulonephritis.

Although there is common agreement and occasionfal mention of the fact that nephritis once healed does not recur, there has been little evidence presented in the literature to substantiate this impression. Longcope (1) reports 4 cases out of a series of 24 with healed acute nephritis in whom beta hemolytic streptococci were found subsequently. Two of these, in a single throat culture each, revealed beta hemolytic streptococci, and, in a third patient, beta hemolytic streptococci were cultured repeatedly from chronically infected tonsils. Active invasion of tissue by the streptococcus, as measured by the antistreptolysin titer, was not reported. The fourth patient suffered a severe bronchitis caused by the beta hemolytic streptococcus. In none of these patients was there evidence of an exacerbation or recurrence of nephritis. Boyle et al. (2) mention the cases of 2 boys, each of whom they state had two distinct attacks of nephritis, each followed by complete recovery. Detailed data on the courses and urinary findings in these 2 patients were not given. In the present study, a group of patients was observed during an attack of acute glomerulonephritis, after recovery, and during a subsequent infection. The infection at the onset of the acute glomerulonephritis and the subsequent infection were proved bacteriologically and immunologically to be caused by the hemolytic streptococcus. It was hoped that such a study might throw light on the alleged permanence of recovery in this disease. The present paper offers bacteriological, immunological, and clinical data on two groups of patients. The case histories have been divided into 2 groups which are described in the following protocols and are presented in Tables I and II respectively. The 8 cases of Group I include all those observed over an approximately four-year period, from 1933 to 1937. The two individuals in Group II are selected on the basis of their unique manifestations.