Acute poststreptococcal glomerulonephritis: immune deposit disease.

Abstract

The possible role of immunologic mechanisms in acute poststreptococcal glomerulonephritis was suggested in 1908 by Schick (2), who compared the delay in appearance of serum sickness after injection of heterologous serum to the latent pe- riod between scarlet fever and onset of acute glo- merulonephritis. Evidence in support of this con- cept is the depression of serum complement during the early stages of the disease (3) and glomerular localization of immunoglobulin. Immunofluores- cent studies have revealed either no glomerular deposition of a-globulin (4) or a diffuse involve- ment of the capillary wall (5-9). Seegal, Andres, Hsu, and Zabriskie (10) demonstrated the pres- ence of 7 S y-globulin, /31c-globulin, and strepto- coccal antigen in the glomeruli of most patients with this disease. By studies employing ferritin- labeled antibodies, these proteins could be demon- strated in the mesangium, between the endothelial cells, and within and adjacent to the basement membrane. Electron microscopic observations of