Clinical and renal biopsy observations in oliguric glomerulonephritis

• Published in: Journal of chronic diseases Vol. 19; no. 2; pp. 163,IN3,167 - 166,IN6,177
• Main Authors: Forland, Marvin, Jones, Robert E., Easterling, Ronald E., Forrester, Ralph H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.02.1966
• Subjects: Adult; Anuria - pathology; Biopsy; Glomerulonephritis - pathology; Humans; Male
• ISSN: 0021-9681
• DOI: 10.1016/0021-9681(66)90047-6

The development of oliguric glomerulonephritis has been seen in five relatively young men (mean age: 29.8 years). Four had bacteriological and/or serological evidence of recent streptococcal infection; the fifth had received early antibiotic therapy for a sore throat. The primacy of these attacks of glomerulonephritis is suggested on the basis of the patients' previous military screening, clinical features, latent period post-infection and initial evaluations of renal size. Three patients who expired were maintained for periods of 4, 7 and 28 weeks (of oliguria or anuria) by dialysis techniques. One totally anuric patient has been on a chronic dialysis program for one year and the second oliguric survivor has been referred for renal homotransplantation. Biopsy and autopsy studies revealed the rapidity with which crescent formation may occur and glomerular obsolescence produce the histopathological picture of chronic glomerulonephritis. Capsular epithelial proliferation appeared to be the most significant morphological and destructive factor, although an early exudative response was prominent in two patients. Two had the autopsy features of Goodpasture's syndrome without evidence of vasculitis. One of these had minimal respiratory symptoms and the second responded rapidly to corticosteroids during three exacerbations of pulmonary involvement, but ultimately succumbed to this aspect of his illness. Such rapid progression of Ellis Type-1 nephritis into a histological picture of chronic glomerulonephritis supports both their pathogenetic relationship and the need for a critical re-assessment of the significance of histopathological classification for the clinician. While the widespread obliterative capsular lesion seems to exclude functional return, chronic dialysis and renal homotransplantation have become realistic alternatives to the previous situation of therapeutic ineffectuality.