Acute poststreptococcal glomerulonephritis: immune deposit disease.

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 period between scarlet fever and onset of acute glomerulonephritis. Evidence in support of this concept is the depression of serum complement during the early stages of the disease (3) and glomerular localization of immunoglobulin. Immunofluorescent studies have revealed either no glomerular deposition of a-globulin (4) or a diffuse involvement of the capillary wall (5-9). Seegal, Andres, Hsu, and Zabriskie (10) demonstrated the presence of 7 S y-globulin, /31c-globulin, and streptococcal antigen in the glomeruli of most patients with this disease. By studies employing ferritinlabeled antibodies, these proteins could be demonstrated in the mesangium, between the endothelial cells, and within and adjacent to the basement membrane. Electron microscopic observations of