NATURAL HISTORY OF "APPARENTLY HEALED" ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS IN CHILDREN

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Abstract
Twenty-three children with apparent cure of an acute poststreptococcal glomerulonephritis were followed at monthly intervals for periods up to 10 years. They were considered clinically healed if asymptomatic and if the following were normal: blood pressure, urea clearance, and three consecutive Addis counts. Sequential kidney biopsies were performed and studied by light and electromicroscopy and immunohistology. Renal biopsies performed between 1 and 3 years after the onset of the acute disease revealed normal glomerular morphology and no evidence of immune reaction only in four patients. The remaining 19 patients had segmental mesangial lesions and varying degrees of immunofluorescence with antihuman gamma-globulin and antihuman complement. Subsequent biopsies on these patients showed further resolution of the glomerular lesions in 16 cases. The remaining three patients had evidence of continuing immune reaction and morphologic progression of glomerular lesions. No correlation could be found between the duration of symptoms and abnormal laboratory findings at the onset of the disease and the extent or reversibility of the glomerular lesions. In seven patients minimal transient urinary abnormalities reappared after initial clearing. This occurrence need not necessarily carry an ominous prognosis, but it must be interpreted in the light of morphologic and immunologic changes. Continued presence or diminution of immune activity was the most reliable indicator of the evolution of glomerular damage as evidenced by subsequent biopsies.

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