Twelve to seventeen-year follow-up of patients with poststreptococcal acute glomerulonephritis in Trinidad

Three patients of the 760 with symptomatic poststreptococcal acute glomerulonephritis in Trinidad who were chosen for follow-up in 1968 or 1970 apparently had not healed initially and consistently had hematuria, usually with proteinuria, in our studies. One of these patients died in renal failure between 1972 and 1976 (six to 10 years after her initial illness). The other two are now 19 and 25 years old, 12 and 15 years after their initial illnesses, with normal blood pressures and serum creatinine values. Another 14 of the 534 patients currently examined had persistent abnormalities: three of these 14 appeared to have had lipoid nephrosis in the beginning, with recurrent proteinria since then; two had urinary-tract infections when examined; one had probably had a third attack of poststreptococcal acute glomerulonephritis; and eight had acquired proteinuria, which may or may not have been related to poststreptococcal acute glomerulonephritis. Thus, our data continue to indicate a good long-term prognosis for most of the patients with this disease in Trinindad.(AU)

Continued absence of clinical renal disease seven to 12 years after poststreptococcal acute glomerulonephritis in Trinidad

Continued improvement was noted among 722 patients in Trinidad seven to 12 years after the onset of poststreptococcal glomerulonephritis. In the five years since earlier follow-up, two of 709 patients with previous symptomatic disease apparently had died from renal failure, and 10 patients had died from unrelated causes. Nineteen patients presently had proteinuria, three had hematurias, and three had proteinuria plus hematuria. Of these abnormalities, proteinurias in only three patients and proteinuria plus hematuria in three more patients were persistent. Thus, 0.8 per cent of the study group had persistent abnormalities. When one adds those dead with renal disease, the percentage with renal damage becomes 1.1 per cent. In addition, six patients had protein in the two urine samples obtained after assuming the lordotic position for 10 minutes and in only one of the two urine samples obtained upon rising in the morning, making 1.4 per cent with probable evidence of chronic renal disease including the dead patients. Hypertension was present in 16 (2.3 per cent) of the patients and was much more common in those more than 20 years old (18.4 per cent). However, this prevalence of hypertension did not exceed that found in normal Trinidadians. Only three patients had serum creatitine values greater than 1.2 mg/dl. None of 13 patients with previous asymptomatic glomerulonephritis presently showed any abnormality. Thus, very few cases of chronic poststreptococcal glomerulonephritis appear to have developed in the 722 patients studied (AU)

Streptococcal strains associated with different phases of epidemic acute nephritis in Trinidad

We will present bacteriological evidence for an association of acute glomerulonephritis with several streptococcal strains isolated from skin lesions in Trinidad; Types 52 and 55 during the first wave and type 49 during the second wave of the 1964-65 epidemic; atypical "type 2" in a sub-epidemic rise in cases during an endemic year; type 57 during a subsequent epidemic period; and type 60 most recently. Immunological confirmation of association of these strains with acute glomerulonephritis was obtained only for type 55. Low incidence of serum type specific antibodies to types 49 and "type 2" may be attribued to their poor antigenicity. However, this is not the case with type 57. Emergence of at least five and perhaps six apparently new types of nephritogenic streptococci during a relatively short period suggests that each recurrent epidemic wave of acute nephritis is the result of a newly introduced or newly developed strain of nephritogenic streptococci. Several questions might be asked: From where do these different types come?. Are they brought into Trinidad from outside or do they represent local mutants? Does a skin infection represent a particularly suitable environment for development of new streptococcal antigens? (AU)