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During an observation period of 14 months, 84/440 (19%) patients had upper respiratory tract infections caused by 3 hemolytic streptococci. A prospective study of renal involvement after the infection was undertaken in 32 patients who had weekly examinations for at least 4 weeks. 8 patients (5-13 Y. 0.) developed either transient CH50 depression (1 patient) or mild urinary abnormalities with CH50 depression (7 patients), although they remained clinically asymptomatic. Renal biopsy specimens of 4 patients with Subclinical AGN (Sub-AGN) were examined by light microscopy and immunohistology. Lesions ranged from mild to moderately prolif erative glomerulonc-phritis. IgG and C3 were consistently deposited in the glomeruli from all patients, but, other immunog-lobulins and complement components were almost negative. Streptococcal antigen was negative in all. CH50 levels were as low as 10% of normal in 1 case, from 50 to 90% of normal in 7 cases at the time of onset. When they were depressed below 70% of normal, C3 and C4 were also decreased at the same time. They returned to normal in all patients within 1 to 18 weeks (average 7 weeks). Mean changes of CH50 levels in 8 patients with Sub-AGN were slightly depressed with C3 and C4 in 7-8 weeks after the infection. 7 patients developed mild proteinuria (+-++) and 3 patients had mild hematuria dissappeared within the first 10 weeks. The latent period of Sub-AGN was between 1 and 9 weeks after the infection with exception of one case. In 5 patients CH50 depression and proteinuria were developed at the same time, and the CH50 decrease preceded the proteinuria in 1 patient. The increase of Clq-BA preceded the proteinuria in 4/89 patients, Mean value of Clq-BA in 8 patients with Sub-AGN (0 to 44 weeks after the infection) was not significantly higher than normal. It was not correlated to any of the parameters by regression analysis, however, in three individual cases, it was reversely correlated to CH50, C3 and C4. These date suggest that the incidence of glomerular injury after streptococcal infection seems much higher than previously thought. With respect to pathogenesis of Sub-AGN, systemic immune com-plex mechanism as seen in AGN may sometimes involve or the renal symtoms after the infection some-times may reflect the direct toxic effect of streptococci.
- 社団法人 日本腎臓学会の論文
社団法人 日本腎臓学会 | 論文
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