Argument for the Classical Concept: 

The Postinfectious Occurrence

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As mentioned above, glomerulonephritis often starts 1-3 weeks after an infectious disease  at a time where the body´s immune system is working hardest to combat the infection. The best studied variant is acute poststreptococcal glomerulonephritis, a particular type of glomerulonephritis that appears after an infection of the throat or the skin with certain strains of streptococci (a type of bacteria), the so-called nephritogenic strains. The start of a kidney disease shortly after the start of an infection strongly suggests that the infection, or the immune response that it has elicited, is an important causal factor.  

Counter-Argument

The close association between an infection and the onset of the disease is a good argument for the idea that the immune system is involved in some way, but it does not prove that the infection or the immunological reactions by themselves is the very cause. The large majority of infectious diseases are not associated with glomerulonephritis, and many cases of glomerulonephritis are not initiated by an infectious disease indicating that an infectious process alone is insufficient and not even necessary to produce the disease. Evidently, there must be contributing factors, either hereditary, or environmental, or both.

A strong case for a participating role of hydrocarbon exposure in poststreptococcal glomerulonephritis is the following observation.  Fifteen patients with poststreptococcal glomerulonephritis and fifteen patients who had had an infection with a nephritogenic streptococcal strain without developing glomerulonephritis were asked about possible exposure to organic solvents, fuels, glues or other hydrocarbons timely associated with the onset of the disease (Ravnskov 1978). Ten of the patients with glomerulonephritis had been exposed during the period between the streptococcal infection and the acute onset of the nephritis, whereas none of the control individuals reported exposure timely associated with their infection. In some patients the exposure was heavy, but short and confined to the mentioned period only; others had been exposed less heavily, but during long periods before the streptococcal infection. All exposed patients were ten years or older, five of them were adults, whereas four of the five unexposed patients were preschool children attending a daytime nursery and the interview of these children was performed six months to three years after recovery from the acute glomerulonephritis. Exposure may thus have occurred without the parents knowing or it may have been forgotten by them.

Another interesting observation from this study was the result of a follow-up study. Four of the patients had been exposured also after the acute onset of the disease, three of them had renal failure. The other eleven had not been exposed, nine of them had normal renal function, two had an insignificant lowering.

The logical explanation from this study is that a streptococcal infection, even with strains that are especially known to produce glomerulonephritis, does not harm the kidneys unless the patient is exposed at the same time for nephrotoxic chemicals. Either the chemicals make the kidneys susceptible to immunological harassment, or the chemicals enhance the renal damage by attacking another part of the kidneys, the tubules, and the combined effects of the immunological reactions and the toxic damage may produce the serious kidney disease. The study also points to the influence of continued exposure on renal function.   

In this connection it is worth mentioning that epidemics of acute poststreptococcal glomerulonephritis have been described from oil-producing areas such as Trinidad and Macaraibo in Venezuela (Poon-King et al 1967, Rodriques-Iturbe et al 1976) and here the disease often progressed to renal failure, whereas acute poststreptococcal glomerulonephritis usually is a benign disease, at least in children. Also, in most countries glomerulonephritis has become a rare disease, but not in Kuwait, a small country where a large proportion of the population is engaged in the oil industry (Seligson et al 1985).

Next section: Immunofluorescence Microscopy