Acute Appendicitis in Pregnancy

BMrru MEDCL JOURAThe extreme degrees of oedema seen in some of the patients (especially the children with glomerulonephritis) were thought to be associated with gross hypoalbuminaemia.The cause of this was partly albuminuria, which was usually heavy (in one child, loss of urinary protein reached a level of 22 g./litre at a time when the serum albumin level was 0.49%).In some patipnts the serum albumin level continued to fall after admission to hospital, presumably because the patients were admitted early in the course of their illness before the drain of albumin in their urine had fully depleted the serum protein level.Another factor in the development of gross oedema may have been that the serum protein levels of even apparently healthy Africans in Uganda are different from European normals (Holmes, Stanier, Semambo, and Jones, 1951), the albumin levels being lower and the globulin levels higher than in Europeans.The serum albumin levels in these patients, especially in the children, were therefore probably low before the urinary loss began. SummaryThirty-three African patients suffering from glomerulonephritis were studied.In all but the youngest cases the diagnosis was confirmed by renal biopsy.The 12 children in the series presented with massive oedema and ascites associated with heavy albuminuria.Haematuria was only microscopical.A rise in blood-pressure was common.The serum albumin level was constantly low and the serum cholesterol usually raised.Electrophoresis of serum protein characteristically revealed a "nephrotic" pattern.Some rise in the blood-urea level was common in the early stages of the illness.Changes of acute nephritis were generally seen on renal biopsy, though in three out of eight cases in which this was done chronic nephritis was present.The illness ran a protracted course, abruptly curtailed in one case by steroid therapy.The overall prognosis appeared to be poor.Renal biopsy revealed acute nephritis in 6 of the 21 adult patients.One presented with the nephrotic syndrome and made an apparently good recovery.In two others with a raised blood-pressure, macroscopic haematuria, and a raised blood urea, some improvement took place in hospital.In the remaining three the disease was rapidly progressive, two dying in hospital.Severe hypertension, retinopathy, renal insufficiency, and heart failure were characteristic of these cases in which severe changes of recent origin were present on renal biopsy.Chronic nephritis was present in 10 cases, and in these hypertensive heart failure was the commonest mode of presentation.Advanced retinopathy was usual in the presence of severe hypertension.The blood urea was raised in all cases, and in four patients who died while under observation death was due to heart failure associated with insufficiency.