6494                ACUTE DIFFUSE PROLIFERATIVE GLOMERULONEPHRITIS

The patient was a seaman aged 32 who consulted his doctor because of painful swollen ankles. He was febrile (38oC). Next day the knees were pale and swollen and he was treated as acute rheumatic arthritis. One week later he passed smoky urine and after a further week he passed bright red urine. At that time there was oedema of the sacrum and tenderness over the renal angles. The B.P. was 130/80. Blood and albumen but no casts were found in the urine. Three days later he became anuric and died after a further two days. At postmortem there was extensive oedema particularly of the lungs, and the kidneys were uniformly enlarged and intensely congested.

The specimen consists of half a swollen kidney measuring 14 cms in length. It has now darkened and become contaminated by precipitate but at the postmortem it was most intensely congested and appeared reddish-black. The cortex is widened to 8 mms and small dark spots of focal haemorrhage can be seen in places. The mucosa of the calyces is also congested. Histology showed swollen hypercellular and often lobulated glomeruli with occasional focal thickening of the basement membrane and some entrapped polymorphs.  A few epithelial crescents are visible. There is fresh blood in most Bowman's spaces and tubules. Tubule cells show marked cloudy swelling. This is probably severe acute post-streptococcal nephritis.