ISSN:1660-8151    

DOI:10.1159/000188216

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

IgM mesangial nephropathy (IgMN) is a common pathologic finding in Taiwanese children with nephrotic syndrome. The hallmarks of IgMN are mesangial hypercellularity and IgM immune complex deposition in the mesangial area. In order to investigate whether the interleukin-6 (IL-6) and interleukin-1 (IL-1) protein production and gene mRNA expression are augmented in the local renal tissue of IgMN, we performed histobiochemical and mRNA studies using an immunopathologic technique and in situ hybridization. We also studied the correlation between urinary IL-6 levels and intensity of IL-6 expression in renal tissue. The results show that 15 cases of IgMN had overexpression with the highest score of both IL-6 and IL-1 proteins and mRNA expression in glomerular mesangial cells and diffuse distribution throughout the glomerular mesangium and capillary, Bowman’s capsule, interstitium and renal tubule. In contrast, the patients with minimal change nephrotic syndrome and normal controls failed to show IL-6 and IL-1 mRNA overexpression. The urinary IL-6 levels of the patients with IgMN were highly correlated with the intensity of IL-6 protein expression in renal tissue. The higher the IL-6 overexpression, the higher was the rate of steroid resistance with focal sclerosis. These findings suggest that IL-6 and IL-1 mRNA amplification may play important roles in the pathogenesis of IgMN. The urinary level and degree of overexpression of IL-6 may serve as a prognostic paramete

ISSN:1660-8151    

DOI:10.1159/000188217

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In this study, the relationship between serum levels of IgA (s-IgA) and CD4 subsets in peripheral blood was investigated in patients with IgA nephropathy (IgA N). We have also recently reported that the percentage of CD4 + CD45RA+ cells was significantly decreased in this disease. Serum levels of immunoglobulins (IgG, IgA, IgM) and the percentage of CD4 + CD45RA+ cells or CD4 + CD45RO + cells were measured by two-color analysis in blood samples obtained from 45 patients with IgA N, 30 patients with various glomerulonephritides and 30 healthy volunteers. A significant decrease of CD4 + CD45RA+ cells and a significant increase of CD4 + CD45RO+ cells were observed in the IgA N group. Moreover, in the IgA N group, s-IgA correlated negatively with the percentage of CD4 + CD45RA+ cells and correlated positively with that of CD4 + CD45RO + cells. After 1 and 2 years, the same analyses were serially performed in 15 nonmedicated patients with IgA N. Similar results concerning the relationship between s-IgA and CD4 subsets were obtained both after 1 and 2 years. The percent changes of s-IgA (Δs-IgA) correlated with ΔCD4 + CD45RO + cells: r = -0.66483 (p < 0.01) after 1 year, r = -0.69688 (p < 0.01) after 2 years. On the other hand, Δs-IgA correlated with ΔCD4 + CD45RA+ cells (p < 0.05) after 1 year, but no after 2 years. It was concluded that s-IgA levels strongly correlate with the percentage of CD4 + CD45RO+ cells in peripheral blood, in patients with Ig

ISSN:1660-8151    

DOI:10.1159/000188218

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The levels of histone-reactive IgA antibodies in the sera of adult patients with IgA mesangial glomerulonephritis, membranous glomerulonephritis, membranoproliferative glomerulonephritis and idiopathic nephrotic syndrome (minimal change disease + segmental glomerulosclerosis + IgM nephropathy) were evaluated by an enzyme-linked immunosorbent assay. Increased levels of IgA antibodies to all five major histones (H1, H2A, H2B, H3, H4) were found in all four disease groups when compared to normal controls. These histone-reactive IgA antibodies were restricted to the IgA1 subclass and their levels did not correlate with the levels of total serum IgA, nor with serum creatinine, creatinine clearance, and 24-hour proteinuria. Increasing ionic strength resulted in only partial inhibition of the binding to histones and, in individual patients, levels of reactivity with individual histones were usually correlated. This study shows that elevated levels of IgA antibodies reactive with self antigens are present in primary glomerulonephritis and extends previous observations indicating that anomalies of the IgA system occur in various forms of primary glomerulonephritis and are not limited to IgA nephropathy.

ISSN:1660-8151    

DOI:10.1159/000188219

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The rate of progression of renal failure was analyzed in 19 patients with biopsy-proven chronic primary glomerular diseases, by the slope (regression coefficient) of the linear regression of reciprocal serum creatinine on time. The relative importance of proteinuria, sex, underlying disease and components of arterial pressure (systolic, diastolic and mean) was tested using stepwise multiple linear regression, the dependent variable being the slope of progression. We found that the only variable significantly related with slopes of progression was arterial pressure. Hypertension was found in 14 of the 19 patients. There was a significant linear relationship (p < 0.05) between mean arterial pressure and slopes of progression. Notwithstanding, the best fit to the data follows a quadratic function (p < 0.001 for mean arterial pressure), which corresponds to a negative parabolic curve. Therefore, either low or high values of mean arterial pressure were associated with faster mean progression rates. Thus, an accurate approach of this relationship fits a nonlinear regression model.

ISSN:1660-8151    

DOI:10.1159/000188220

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In order to evaluate the persistence of antibodies against hepatitis C virus (HCV) in a chronic hemodialysis population, we studied 151 HBsAg-negative patients. Anti-HCV titers were evaluated every 3 months over 1 year, and the serum alanine aminotransferase/serum aspartate aminotransferase ratio monthly from the start of hemodialysis. The anti-HCV titers (ELIS A C100-3) remained stable in 127 patients and fluctuated in 24, without an evident correlation with hepatic function. Using our criteria, we found 85 patients with non-A, non-B hepatitis, 57 of them with biochemical criteria of chronic hepatic disease. There was a strong correlation between antibodies to HCV and non-A, non-B hepatitis (χ2; p < 0.05) which was more marked in those patients with biochemical criteria of chronic hepatic disease ( χ2; p < 0.001). We concluded that the anti-HCV titer is reliable as a long-term marker of hepatitis C virus infectio

ISSN:1660-8151    

DOI:10.1159/000188084

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

To evaluate the role and mechanism of action of calcitriol on glucose-induced insulin secretion in uremia, 17 patients with severe chronic renal failure were studied. Glucose metabolism was investigated by the intravenous glucose tolerance test (IVGTT) before and after treatment for 21 days with 0.5 µg/day of calcitriol and 500 mg/day of calcium (C + Ca) (6 cases) or 0.5 µg/day of calcitriol alone (C) (11 cases). After these evaluations the patients on C + Ca were shifted to C and 6 patients on C were shifted to C + Ca, and IVGTT was repeated 21 days after the shift. For each test plasma glucose (G), immunoreactive insulin (IRI) and C-peptide (C-p) were measured at -30,0,2,5,15,30,45,60 min, and baseline plasma values of 1α,25(HO)2-vitamin D3, C-terminal parathyroid hormone (PTH-C), intact parathyroid hormone (PTH-I), calcitonin, and serum values of total and ionized calcium were dosed. Also, glucose constant decay (K-G), insulin response (IRI area), C-p production (C-p area), insulinogenic index (IGI) and insulin resistance index (RI) were calculated. A historical group of 21 healthy volunteers formed the normal controls. 1α,25(HO)2-vitamin D3 plasma levels in uremic patients before treatment were significantly lower than normal range. As compared to controls, uremic patients showed significantly lower K-G, IRI area and IGI values and significantly higher RI values. After treatment with C or C + Ca, the insulin response improved significantly at 2 and 5 min and G decrement was more marked at 30,45 and 60 min. K-G and 0-15 min IRI area, 0-15 min IGI and 0-15 min C-p area values increased significantly but did not reach the normal values. Serum calcium and plasma 1α,25(HO)2-vitamin D3 levels significantly increased after treatment but no correlations were found between changes in glucose metabolism parameters and changes in total or ionized serum calcium or changes in 1α,25(HO)2-vitamin D3 plasma levels. Serum calcium values significantly decreased after shift from C + Ca to C and significantly increased after shift from C to C + Ca, but glucose metabolism parameters showed no further changes. From these data we inferred that 1α,25(HO)2-vitamin D3 deficiency may contribute to the inhibition of glucose-induced insulin secretion in uremia. Calcitriol mainly influences the first phase of insulin release and its effect may be due to a direct action on the pancreatic

ISSN:1660-8151    

DOI:10.1159/000188085

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Although serologic studies have identified hantaviral infection in the United States, acute disease has not been recognized. This study describes 3 cases of domestically acquired hemorrhagic fever with renal syndrome (HFRS) in the United States. Infection was due to a local strain of Seoul virus (Baltimore rat virus). A review of the clinical features indicated a mild illness characterized by nausea, vomiting, renal and liver failure similar to HFRS described elsewhere for rat-borne viruses. Follow-up of 2 patients identified persitent hypertension and renal disease providing further evidence of an association between past hantaviral infection and hypertensive renal disease.

ISSN:1660-8151    

DOI:10.1159/000188086

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Juxtapapillary subretinal neovascular membranes developed in both eyes of a patient who had been treated for Goodpasture’s syndrome for 4 years. These lesions caused visual impairment but were successfully treated by laser photocoagulation. Subretinal neovascularisation has not been reported before in association with Goodpasture’s syndrome, but diverse ocular abnormalities have been described. It is not certain whether these lesions were caused by anti-basement-membrane auto-antibodies. The eyes of 13 other patients with Goodpasture’s syndrome were examined, in order to detect other unsuspected ocular pathology. In 1 further patient, both retinae contained a few unexplained superficial retinal haemorrhages. During follow-up, the original patient developed bilateral peripheral retinoschisis. From this short series and from cases previously described, we conclude that sight-threatening ocular abnormalities are rare in Goodpasture’s syndrome. It is, however, particularly important to be aware of the possibility of treatable eye disease in Goodpasture’s syndrome, since the introduction of effective treatment with immunosuppression and plasmapheresis has made long-term surviv

ISSN:1660-8151    

DOI:10.1159/000188087

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The high prevalence of hypercholesterolemia in kidney transplant recipients probably contributes to the high cardiovascular mortality in these patients. Except for diet, there is no generally recommended cholesterol-lowering treatment. We conducted a double-blind, randomized, placebo-controlled study with low-dose simvastatin in 40 ciclosporin (CS)-treated kidney transplant recipients during 16 weeks, focusing on side effects and dose finding. In the simvastatin group, the mean serum total and LDL cholesterol concentrations decreased by 23 and 33%, respectively, and the mean serum HDL cholesterol concentration increased by 12%, after 4 weeks of treatment with simvastatin 10 mg daily. Increasing the dose to 20 mg daily in a few patients only resulted in marginal further reductions of the serum cholesterol concentrations at the expense of doubling the plasma simvastatin 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitory activity concentrations. The differences between the changes in the serum cholesterol concentrations in the simvastatin group and the negligible changes in the placebo group were statistically significant. There was no case of proximal myopathy and the serum creatine kinase concentrations did not differ between treatment groups. In conclusion, low-dose simvastatin appears to be a well tolerated and efficacious cholesterol-lowering treatment in CS-treated kidney transplant recipients. Simvastatin 10 mg daily seems to be the most suitable dose for the majority of these patients.

ISSN:1660-8151    

DOI:10.1159/000188088

出版商:S. Karger AG    

年代:1994

数据来源: Karger