The Serum Antistreptolysin Titer in Chronic Glomerulonephritis

Abstract

Previous reports (1, 2, 3) have dealt with the serum antistreptolysin titer response in acute glomerulonephritis. Seegal, Lyttle and their associates (2) found that 94 per cent of 116 consecutive cases of acute glomerulonephritis were associated with significant rises in antistreptolysin titer. Longcope (3) found an increased antistreptolysin titer in the acute stage of 72 per cent of 36 cases of acute hemorrhagic nephritis (type A). These studies show that the acute infections, which so typically precede the onset of acute glomerulonephritis, are generally due to the group A hemolytic streptococcus. Winkenwerder, McLeod and Baker (4), however, described another type of glomerulonephritis (type B), characterized by an insidious onset of edema and a progressive downhill course, and usually associated with chronic upper respiratory infection. Although group A hemolytic streptococci were often recovered from the upper respiratory passages of these patients (type B), Longcope (3) showed that rises in antistreptolysin titer were a rarity. Indeed, the titers were frequently found to be abnormally low.The present study is based on the examination of the serum antistreptolysin titer response in patients with chronic glomerulonephritis. This study was undertaken with full knowledge of the difficulty of establishing the diagnosis of chronic glomerulonephritis. In this series of 81 patients presenting the picture of chronic glomerulonephritis, 24 are known to have died. Autopsies performed on 13 of these revealed chronic glomerulonephritis. A biopsy of the kidney established the diagnosis in one additional case. In 23 other cases, attacks typical either of acute glomerulonephritis, i.e., the onset of the disease, or of an exacerbation of chronic glomerulonephritis, have been observed. Thus, the diagnosis of glomerulonephritis seems to have been established beyond doubt in 37 of the 81 cases. The remaining 44 patients were thoroughly studied and, in the opinion of several experienced observers, there was no evidence of renal disease other than chronic glomerulonephritis.The patients comprising this study have been observed over periods of from 4 months to 8 years. Twelve patients were followed for less than one year, the short follow-up being due to early death in 10 instances. Fifty-two, or 64 per cent, were followed for 2 or more years. Sera for the determination of the antistreptolysin titer were obtained at varying intervals in each patient. In hospitalized cases, determinations were made once or twice a week. It was not possible to obtain tests with this frequency in the ambulatory patients seen at the clinic. However, in the majority of these instances, determinations were made at intervals of from 1 to 4 months. In addition, the patients were instructed to report to the clinic whenever an infection developed and were then studied weekly.Todd (5) developed the technique for the determination of serum antistreptolysin and with minor modifications (2) this technique has been employed throughout the present studies. The...

Fractionation of the Serum and Plasma Proteins by Salt Precipitation in Infants and Children. 1. The Changes With Maturity and Age. 2. The Changes in Glomerulonephritis. 3. The Changes in Nephrosis1

“…Longcope (21) has noted that the antistreptolysin titer of nephrotic patients was usually low; Earle and his co-workers (22) (Table VIII). A similar change of lesser degree is to be noted in the patient with acute nephritis.…”

“…The increase in amount of this fraction in the acute stage of glomerulonephritis may be correlated with an increase in the antistreptolysin titer found during the acute phase of this disease (21), and the return of this frac-tion to a normal level with healing of the disease coincides with the fall in antistreptolysin titer occurring during recovery. It is also pertinent that the chronic nephritic, in the absence of active infection, exhibits a decrease in this fraction and does not have a very high antistreptolysin titer (22).…”

The Relation of the Serum Antistreptolysin Titer to the Exacerbation in Chronic Glomerulonephritis

“…Indeed, the two highest rises in antistreptolysin titer (1250 and 1666 units) were associated with exacerbations followed infections of this type. And second, as pointed out in the preceding paper (2), there was no apparent correlation between the magnitude of the antistreptolysin titer response in chronic glomerulonephritis and the "deepness" or "superficiality" of the preceding infection. The superficial infections include pharyngitis, tonsillitis and "common cold."…”

“…Group A hemolytic streptococci were recovered by throat culture from 17 of these instances. Adequately studied rises in antistreptolysin titer, as previously defined (2), were associated with 20 of these exacerbations. Definite rises in titer were associated with 4 additional exacerbations, but the data were not sufficient to determine the maximum titer of the rise and therefore not considered in this study.…”

“…The present study does not include 9 of the 85 adequately studied rises in antistreptolysin titer 1 reported in the preceding paper (2).…”