ACUTE DIFFUSE PROLIFERATIVE GLOMERULONEPHRITIS
A man of 59, complaining of breathlessness on exertion and a chronic cough, noticed that his urine was dark in colour and reduced in volume. On examination, his temperature was 38.5oC, pulse 116 and blood pressure 150/90 mm Hg. Cardiac enlargement, left loin tenderness and slight ankle oedema were present. No urine was obtained on catheterization and anuria persisted until death occurred a few days after admission. The blood urea rose to 34 mmol/L and the serum potassium reached 9.4 mmol/L.
The kidney has been sliced to display a congested cut surface. The cortico- medullary junction is clearly defined and there are several pinpoint haemorrhages in the cortex and also on the external surface. The renal pelvis is normal. The amount of peri-pelvic fat is consistent with the age of the patient. This is a case of acute diffuse proliferative glomerulonephritis.
Acute diffuse proliferative glomerulonephritis occurs at all ages, but is more common in children. It usually follows a group A haemolytic streptococcal infection, most often pharyngitis. However, other infections have occasionally been implicated. The clinical features are nephritic in type. In childhood, the prognosis is usually good, however, the mortality increases with age.