The aetiological processes involved in the majority of patients with chronic glomerular nephritis are unknown.The case reported here is that of a young man where it is possible that the glomerular injury was secondary to circulating atypical cold antibodies with or without the agency of complement.Case History R.R., a 24-year-old Ceylonese engineering student, was known to have had proteinuria and intermittent ankle oedema for nine years. He had been treated with short courses of corticosteroids and more recently with hypotensive therapy for mild hypertension. For the past four years he had noted polyuria and nocturia with increased thirst. At the time of admission to this hospital his major complaint was of a painful flitting arthralgia of most of the small joints, particularly of the hands, wrists, and elbows. He was also suffering severe muscle cramps.On examination he was an intelligent, healthy looking man with moderate pallor. He was mildly hypertensive. A trace of ankle oedema but no sacral oedema was noted. The liver was not palpable but the spleen was firm, tender and palpable 3 fingerbreadths below the costal margin.
INVESTIGATIONSAt presentation the haemoglobin was 9-1 g/100 ml, PCV 27-5 %, WBC 4 800/cmm, reticulocytes 2%,