Recurrent Hemorrhagic Nephritis with Exacerbation Related to Influenza A

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Abstract
Recurrent hemorrhagic nephritis is a distinct clinical entity consisting of repeated attacks of gross hematuria and persistent microscopic hematuria without the development of hypertenr sion or azotemia. Persistent proteinuria is an inconstant finding. A case of recurrent hemorrhagic nephritis in an eighteen year old boy is reported. The first attack of gross hematuria followed an upper respiratory infection by twenty four hours. Throat cultures and anti-streptolysin 0 titers were normal. Proteinuria cleared, but microscopic hematuria persisted. A second attack similar to the first was not observed by a physician. The third attack of gross hematuria was carefully followed, and streptococcal infection was excluded bacterio-logically and serologically. A rising titer to influenza A implicated this virus in the second exacerbation. A renal biopsy showed two of five glomeruli to have focal areas of hypercellularity. Most cases of recurrent hemorrhagic nephritis have been thought clinically to be related to viral and not Streptococcal infection, but in this case there was bacteriologic and serologic evidence to support this concept. In view of the varying renal histologic picture of patients with a similar clinical disease, it is suggested that recurrent hemorrhagic nephritis may be a more appropriate name than focal nephritis.

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