Prognosis of post-streptococcal glomerulonephritis: Chandigarh study.
144 patients (107 adults and 37 children) belonging to a homogenous North Indian population who were hospitalised for acute post-streptococcal glomerulonephritis have been followed up for a period of ten years. The majority of these belonged to the lower socio-economic group. Varying degrees of proteinuria was present in 88.2%, hypertension in 62.5%, renal insufficiency in 61% and hematuria in 51.4% of the patients at the onset of the disease. By the end of the two years, 25 patients were dead because of rapid progression to end stage renal failure and 6 patients had mild to moderate renal insufficiency. Of the 119 patients who were alive at the end of the two years, 32 patients (who had shown a clinical recovery) were not available for further regular follow up and were excluded from the long term study, 87 patients were followed up beyond 2 years. In addition to 6 patients who were already in renal insufficiency at two years, 6 more developed renal failure on further follow up. 3 out of these 12 patients progressed to end stage renal failure 5 to 10.5 years after the onset of the disease. Persistence of nephrotic state, hypertension and renal insufficiency following an acute attack, and the presence of glomerular crescents on renal histology were associated with a poor outcome. Whereas only 2 out of 37 children died of end-stage renal failure, the majority of the deaths were in the adults (26 out of 107). Thus, 17% of the patients of acute post-streptococcal glomerulonephritis progressed to end stage renal failure within 2 weeks to 2 years, another 2% within 10 years and more than 6% will ultimately progress failure beyond 10 years.