Outlook for Patients With Glomerulonephritis

Abstract

Bright realized early in his studies that renal disease was a complex problem.1 He stressed the relationship of renal dysfunction and abnormality to general edema and cardiovascular abnormalities. In addition, he recognized the development of metabolic disturbances as the disease progressed and, for a better understanding of their significance, invited the cooperation of the chemist. The results of this joint venture, though meager, anticipated by 75 years some of the biochemical findings now thoroughly appreciated by the medical profession.The early students of diffuse nephritis realized the serious outlook for the patient suffering from the progressive form of the disease. They learned slowly, however, that there was an acute reversible type 2 that often healed, and that some of the patients with the chronic form lived and were able to work for a number of years. Bright, after a decade of study,1b partially reversed his earlier gloomy predictions with regard to the latter group and stated, "I believe with care its fatal effects may be kept at bay and a hazardous life may be protracted for many years." This was also the viewpoint in succeeding generations of such authorities as Johnson,3 Bartels " and Roberts 5 and others.6 Bartels and Roberts went a step further and stated that they had observed patients who had chronic parenchymatous nephritis but later recovered.To clarify our present conceptions with regard to the course of diffuse nephritis, a group of us in Rochester made a follow-up study of a special series of 50 patients who had acute or chronic glomerulonephritis or lipoid nephrosis. We endeavored to make the diagnosis as accu¬ rate as possible and thus to avoid cases of a mixed type, which have in the past confused similar studies. Only cases of which we have records for nine and one-half years or more were included; actually some patients were observed over periods of 20 to 40 years (table 1 ).The data of this follow-up study were obtained by ( 1 ) subsequent visit and examination, (2) letter from patient or patient's near relative, (3) letter from patient's home physician, (4) sometimes on change of address, through a credit bureau, or (5) statement from the municipal or state bureau of statistics in case of death in certain instances.Periodic investigation of the individual patient in¬ cluded a clinical evaluation, appropriate chemical esti¬ mations of certain constituents of the blood and urine, and specific renal functional studies. These observations were frequently made during a period of hospital care and therapeutic investigation. Our chief objective has been the accumulation of significant data during the longterm course of the disease and the interpretation of their value as to the initiation of treatment and as to prognosis. RESULTS Acute Glomerulonephritis.-Our results in a smallseries of eight cases of acute glomerulonephritis with regard to age, sex, and duration of the disease confirmed previous investigations.6b All our patients were males, aged 11 to 63 years. Five were young adults,...

Acute and Rapidly Progressive Forms of Glomerulonephritis in the Elderly

“…Acute glomerulonephritis (AGN) is generally regarded as a disease of children, the majority of reports on series of cases indicating a clear predominance in the younger age groups (1–6). The occurrence of AGN in the elderly is considered to be rare, although several cases have now been reported (7–10).…”