14516              ACUTE DISEASE GLOMERULONEPHRITIS

The patient was a woman aged 31 whose illness began with an upper respiratory infection associated with headache and sinus pain.  Three days before admission there was swelling of the ankles and knees and she was breathless.  On the day of admission the urine was dark brown and albumin and red cells were found in it.  She was hypertensive and cyanosed with pulmonary oedema, papilloedema and moderate peripheral oedema.  Acute nephritis with cardiac failure was diagnosed.  Haemolytic streptococci of Lancefield Group C were cultured from the nose and throat.  She failed to respond to penicillin and digoxin and died within 12 hours of admission.

The specimen consists of half a kidney which measures 11 cms in length.  The capsule is thin and the cortex is smooth.  The cut surface shows widening of the cortex to 8 mms, and marked generalised congestion of both cortex and medulla.  The pelvis is normal.  Histology shows swollen lobulated glomeruli with capsular adhesions in places.  The glomeruli are hypercellular and some show focal hyaline thickening of loops and focal intracapillary thrombi.  Polymorphs are present in moderate numbers.  Tubules show severe cloudy swelling, and many contain hyaline or granular casts and some contain fresh blood.  The picture is that of severe progressive acute proliferative poststreptococcal glomerulonephritis.