Primary persistent glomerulonephritis in Filipino children (a prospecitve study of 17 cases over a period of seven years)

ABSTRACT

Seventeen children, with current age; of 7-5/12 to 15-10/12 years, have been diagnosed to have primary persistent glomerulonephritis of 6 months to 7-3/12 years duration. There were 11 females and 6 males majority of which were in the age bracket of 5 to 8 years at onset of the diseaseThree distinct initial clinical patterns of presentation were noted (1) a picture of nephrotic syndrome, (2) a picture resembling acute glomerulonephritis, and (3) a picture of gross hematuria aloneIn patients with far advanced disease, hypertension, anemia, and sustained azotemia were present. None of non-uremics showed this triad of symptomsIn the 10 non-uremic survivors, a considerable amount of clinical improvement ensued but the urinary abnormalities, in particular that of persistent or recurrent proteinuria with or without microhematuria, failed to clear with timeThe striking features of this study are (1) the lack of parallelism between the initial presenting clinical patterns and the morphologic lesions on renal biopsy, and (2) the lack of correlation between the follow-up histologic changes on subsequent biopsies and ensuing clinical courseFrom the results of the present study, we would like to make the following conclusions: 1. Primary persistent glomerulonephritis of whatever pathologic type may become clinically manifest in a variety of ways2. It may be clinically indistinguisable from acute glomerulophritis and certain cases of lipoid nephrosis3. The clinical manifestations are as variable as the different pathologic changes. The clinical spectrum may range from a patient with hematuria only to a patient in a state of chronic renal insufficiency4. The long-term clinical course which is the major determinant in diagnosis may be as variable as the initial clinical pattern. The spectrum may vary from a patient with proteinuria only to a patient who is dying of uremia5. The course of the disease is measured in several months or years and not in a few weeks. The prolonged clinical course renders prognosis a complete uncertainty. The ultimate outcome of the disease cannot be anticipated. (Summary and Conclusions)