Hospitals, London

Is there a distinct renal glomerular pathology which is diagnostic of quartan malarial nephropathy? Workers in Nigeria who have studied children with the nephrotic syndrome have long maintained that there is [1]. In this issue of the Journal, Abdurrahman et ai present their analysis of 100 consecutive cases studied from 1977 to 1981, and they also accept this claim. However, they present no new proof: Plasmodium malariae parasitaemia rates were just as high (40 per cent) in their membranoproliferative glomerulonephritis patients in those diagnosed as quartan malarial nephropathy. The role of P. malariae in the aetiology of human glomerulonephritis is based on circumstantial clinical and epidemiological evidence, and on experimental work [3]. P. malariae appears to be the most important single aetiological factor in nephritis in both West Africa [2] and East Africa [4], however, it is not easy to sustain an argument that it is the sole factor in individual cases. Parasitaemia and malarial antibodies are found in association with a wide variety of glomerular appearances and in patients without renal disease. Furthermore, experimental pathology has provided little support for the concept of simple cause and effect due to a single agent. While it is relatively easy to produce mild proteinuri