While it is generally accepted that acute infection caused by streptococci precedes acute glomerular nephritis in the majority of cases, the exact course of events linking the infection with the renal disturbance is far from clear. Nor is it known whether once the nephritis has manifested itself, chronic infection remains an important agent in prolonging the disease. Authorities differ in the relative emphasis they place on the role of infection in this respect. Among protagonists of the etiologic importance of foci of infection is Kollert,1 who distinguished two types of infection. One is the "primary focus," a chronic, often long-standing obscure process, situated perhaps in a paranasal sinus, which renders the subject peculiarly reactive to the machinations of subsequent acute invasion by the same organism. In the latter, "precipitating infection," the second of the two types, Kollert saw a trigger mechanism which sets off the initial attack of nephritis,
FUTCHER PH. GLOMERULAR NEPHRITIS FOLLOWING INFECTIONS OF THE SKIN. Arch Intern Med (Chic). 1940;65(6):1192–1210. doi:10.1001/archinte.1940.00190120109009
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