摘要:

A number of clinical, laboratory and pathologic parameters were assessed for their prognostic significance in 200 children aged less than 15 years with IgA nephropathy, who had shown normal renal function at the time of initial biopsy and were followed for more than 2 years thereafter. After a mean follow-up period of 5.0 years from the initial biopsy, 93 patients had no demonstrable abnormality, 76 had minor urinary abnormalities, 21 had persistent heavy proteinuria and 10 had developed chronic renal impairment. A poor outcome was found to be correlated with heavy proteinuria at biopsy, diffuse mesangial proliferation, a high proportion of glomeruli showing sclerosis, crescents or capsular adhesions, the presence of moderate or severe tubulointerstitial changes, and the presence of subepithelial electron-dense deposits and lysis of the glomerular basement membrane by electron microscopy. The percentage of glomeruli displaying crescents, sclerosis and adhesions appeared to be the most reliable prognostic indicator. Nine of the 27 patients (33%) in whom > 30% of glomeruli showed crescents, sclerosis and adhesions developed chronic renal impairment, and only 14% of these patients had normal urine at follow-up. In contrast, only 1 of the 173 patients in whom < 30% of glomeruli showed such lesions developed chronic renal impairment (p < 0.001) and 51% of these patients showed complete remission at follow-up (p < 0.001). These results demonstrate that an accurate prediction of the outcome based on the initial renal biopsy findings is possible early in the course of children with IgA nephropathy.

ISSN:1660-8151    

DOI:10.1159/000186706

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Carbon tetrachloride (CC14) was intraperitoneally injected into Balb/c mice 4 times at biweekly intervals, and the morphological changes of the liver and kidney were examined during 12 weeks after the last injection. The renal injuries progressed in spite of cessation of CC14 treatment; microcysts with tubular-cell degeneration were manifest on day 42 after the last injection of CC14. At the end of the experiment, however, interstitial fíbrosis with inflammatory cell infiltration was much more prominent. Glomerular changes with IgG deposits also developed following the tubulointerstitial changes. The CC14 treatment induced liver damage as well, but it promptly subsided without formation of cirrhosis. The CC14 nephrotoxicity was completely inhibited by whole body irradiation (200 rad) exposed at each injection of CC14. In contrast, the hepatic damage was not changed by irradiation. These results seem to indicate etiologic independence of renal and hepatic events induced by CC14 treatment. It is also suggested that chronic CC14 nephrotoxicity is mediated, at least in part, by radiosensitive responses of the mice themselves

ISSN:1660-8151    

DOI:10.1159/000186707

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Regular dialysis treatment (RDT) does not obviate hyperoxalemia of chronic renal failure (CRF). However, there is emerging evidence suggesting that current dialysis prescription is not always associated to progressive oxalate accumulation. In view of the controversy still concerning this issue, we have investigated on plasma profiles and dialysis kinetics of oxalate in patients on RDT. Oxalate was determined by ion chromatography on serum ultrafiltrates and on the whole dialyzate in 23 stable patients on RDT for end-stage renal failure unrelated to primary hyperoxaluria. Nine patients were on traditional hemodialysis (HD) and 14 on soft hemodiafiltration (HDF). Dialysis prescription was set so as to obtain similar KT/V of urea. Mean dialyzer clearance of oxalate (KdOx) was calculated by standard procedures and was compared to urea (KdUrea) and creatinine (KdCr) clearances. Oxalate removal was measured on the whole spent dialyzate. Distribution volume of oxalate (VOx) was estimated by assuming a single-pool model and was used to estimate the oxalate appearance rate (OxAR). Plasma profiles showed that dialysis patients were virtually always hyperoxalemia However, the threshold of supersaturation for calcium oxalate was exceeded in only 13 of 138 (9.4%) assayed ultrafiltrates, 13% on HD and 7.1% on HDF. Dialysis reduced plasma oxalate by more than 60%. There was a postdialysis oxalate rebound averaging 9.6% at 30 min from the end of dialysis. Plasma oxalate predialysis was independent of sex, age and time on dialysis. KdOx was mildly higher on HDF than on HD, and was lower than both KdUrea and KdCr, irrespective of the dialysis technique. Estimated VOx was 21.5 litres, that is 37.3% of dry body weight, and was quite similar to estimates obtained in normal subjects and in patients with CRF by alternative isotope dilution methods. OxAR averaged 337 ± 69 μmol/24 h and was not different from the daily oxalate excretion assessed in 40 healthy subjects by the same oxalate assay. OxAR was independent of sex, age and body weight and was significantly related to urea generation and protein catabolic rates. From our results we conclude that, unless the metabolic generation of oxalate is increased, current dialysis programs should prevent progressive oxalate accumulation in the majority of the patient

ISSN:1660-8151    

DOI:10.1159/000186708

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Adriamycin (ADR)-induced nephropathy is characterized by focal and segmental glomerulosclerosis and is supposed to be an ideal model of chronic progressive renal disease. The aim of our study was to investigate whether there might be an altered activity of glomerular proteinases in ADR nephropathy, thereby aggravating glomerular protein accumulation as an important initiating hallmark of glomerulosclerosis. In fact, we could demonstrate significantly enhanced levels of intraglomerular protein and DNA content in the experimental animals at week 7, 12 and 22 after administration of ADR. When relating intraglomerular proteinase activity, which was measured in ultrasonically destroyed isolated glomeruli, obtained by differential sieving techniques, to the intraglomerular protein and DNA content, this enzyme activity was significantly reduced throughout the observation period. Based on these data, we suggest that this relatively decreased proteinase activity in glomeruli exposed to ADR might play a pathogenetic role in the development of glomerular hypertrophy, an important harbinger of glomerulosclerosis.

ISSN:1660-8151    

DOI:10.1159/000186709

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We investigated changes in the levels of mRNA transcripts encoding types I and IV collagen in the kidney following the administration of ciclosporin (CS) in mice. Daily doses of CS increased the levels of mRNAs encoding collagen types I and IV in whole kidneys harvested 4 weeks after treatment. At this time point, neither a reduction of renal function detected by serum creatinine, nor histologic evidence of interstitial damage were present. Elevated levels of serum creatinine as well as mild interstitial changes did develop, however, 12 weeks after daily treatment with CS. Collagen type I transcripts were almost normal after 12 weeks, whereas levels of type IV mRNA were still elevated. Our findings indicate that increases in transcripts encoding collagens precede a deterioration in renal function and the development of interstitial changes in this murine model of chronic CS nephrotoxicity.

ISSN:1660-8151    

DOI:10.1159/000186710

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The present experiment demonstrated that an irreversible glomerulosclerosis could be induced in the rat through repeated intravenous administrations of OX-7 (a monoclonal anti-Thy-1.1 antibody). Rats were injected with 0.2 mg of affinity-purified OX-7 at 1-week intervals for a period of 4 weeks. Glomerular damage was periodically examined at light-microscopic level. Thirty-five days after the initial injection (7 days after the final injection), capillary aneurysms and expansion of the mesangial areas with hypercellularity were frequently observed. Similar glomerular damage was also observed in rats 7 days after they received a single injection of either 1.0 or 0.2 mg of OX-7. After repeated injections, 112 days from the initial administration (84 days after the final injection), approximately 60% of the glomeruli had expanded mesangial areas with an apparent increase in the mesangial matrix. The result contrasts sharply with that obtained from a single injection of OX-7 in that more than 85% of the glomeruli showed no abnormalities 84 days after the injection. This chronic model, as a result of repeated injections of the antibody, could serve as a potential for further investigation of the mechanisms involved in the development of chronic glomerulonephritis.

ISSN:1660-8151    

DOI:10.1159/000186711

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We report a chronic hemodialysis patient with severe hyperparathyroidism who developed hypoglycemia with inappropriate hyperinsulinemia following parathyroidectomy. An abrupt fall in parathyroid hormone level and administration of large amounts of calcitriol may have resulted in increased insulin release and enhanced tissue sensitivity to insulin producing sustained hypoglycemia in this patient.

ISSN:1660-8151    

DOI:10.1159/000186712

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Two cases of severe ovarian hyperstimulation syndrome following ovulation induction are described, one of them following in vitro fertilization and embryo transfer, and the other after conventional ovarian stimulation. This condition was associated with an acute reversible decline in renal function. The treatment and the possible pathophysiological mechanisms are discussed.

ISSN:1660-8151    

DOI:10.1159/000186713

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Diffusely enlarged nonhydronephrotic kidneys on ultrasound and computer-tomographic examination in a case of progressive preterminal renal insufficiency were very suggestive of extensive lymphomatous infiltration. Diffuse infiltration of the kidney by centrocytic/centroblastic non-Hodgkin lymphoma was confirmed upon renal biopsy. No other localizations of lymphoma could be found. After four courses of CHOP chemotherapy there was a complete remission of this primary renal non-Hodgkin lymphoma, with complete recovery of renal function.

ISSN:1660-8151    

DOI:10.1159/000186714

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000186715

出版商:S. Karger AG    

年代:1992

数据来源: Karger