ISSN:1660-8151    

DOI:10.1159/000183106

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Serum IgE was measured by RIST test in 181 adult subjects, with log transformation. In 24 controls the geometric mean was 109 IU/ml, with an upper limit (geometric mean ± 2 SD) of 460 IU/ml. 157 cases of glomerulonephritis (GN) classified according to light and immunofluorescence microscopy were studied. Serum IgE was significantly elevated in 39 lipoid nephrosis patients (p 460 IU/ml), 21 focal and segmental glomerulosclerosis (p 460 IU/ml) and 42 membranous GN (p 460 IU/ml. In addition, the lipoid nephrosis IgE geometric mean is 493 IU/ml, which is keeping with the high incidence of atopic troubles. The significance of raised serum IgE was discussed

ISSN:1660-8151    

DOI:10.1159/000183107

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Circulating levels of eosinophil cationic protein (ECP), an eosinophil-specific granule protein, and peripheral eosinophils were determined in 56 patients with uremia. The patients were on a chronic hemodialysis or CAPD program or treated with diet only. They had normal counts of peripheral eosinophils but on average a threefold increase of the serum ECP concentrations compared with healthy subjects. The intracellular content of ECP in eosinophils isolated from 6 patients on maintenance hemodialysis was normal. The management or duration of the uremic condition did not influence the circulating ECP levels or eosinophil counts. Neither was any relation found between total IgE levels and peripheral eosinophils or serum ECP. The present results are compatible with an accelerated turnover of peripheral eosinophils in uremia. Such a proposed abnormal eosinophil homeostasis should demand an accelerated marrow eosinophil production, thereby explaining the previously reported marrow eosinophilia in azotemic patients.

ISSN:1660-8151    

DOI:10.1159/000183108

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

An experimental model in rats was developed to define the nature of humoral and cellular factors that contribute to impaired immune responsiveness in chronic renal failure. Addition of uremic rat serum to both normal and uremic lymphocytes significantly suppressed cellular responses, the suppression being more pronounced with uremic lymphocytes. Lymphocytes from uremic rats were only marginally less responsive than normal lymphocytes to concanavalin A stimulation when normal rat serum was added to the cultures, indicating that the cellular factors in impairment were less important than humoral ones. Antibody formation in rat splenocyte cultures to bovine serum albumin was suppressed by addition of uremic serum, but the response to sheep erythrocytes was unaffected. Thus the effect on antibody response in uremic animals is dependent upon the antigen tested.

ISSN:1660-8151    

DOI:10.1159/000183109

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

A 2-year prospective study was done in 45 patients to see whether the FENa test, done at first nephrology consultation visit for acute renal failure, was useful in prognosticating whether patients would recover renal function spontaneously or need dialysis. Of 26 patients who recovered renal function spontaneously, 8 had an FENa of less than 1; of the 19 who needed dialysis 8 also had an FeNa of less than 1. The mean FENa was 4.95% in those who recovered, and 6.28% in those who needed dialysis. There was thus no difference in false-positive or negative tests or numerical results of the FENa. Dividing the patients up into those who received and did not receive furosemide before made no difference. There were no differences in plasma or urine, creatinine or sodium, nor in blood pressure nor rate of rehydration measured as change in body weight between the groups. The FENa in our study was of no clinical importance, and of less prognostic use than simple hourly urine volume at time of consultation. We feel that the clinical usefulness of the FENa has been overemphasized in the literature.

ISSN:1660-8151    

DOI:10.1159/000183110

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Plasma catecholamines, hand-grip exercise and orthostatic stress were used to assess sympathetic nerve function in 14 hypertensive patients with mild to moderate renal failure and, for comparison, in 14 age-matched normal subjects. Furthermore, acute and chronic administrations of clonidine were used to determine a participation of the sympathetic nervous system in the maintenance of hypertension in these patients. Baseline mean blood pressure (MBP), plasma norepinephrine (NE), plasma renin activity (PRA) and aldosterone were elevated in patients with renal failure. During hand-grip exercise, the rise in MBP and in heart rate was blunted in these patients. During orthostasis, MBP decreased more while the increments in NE were greater in hypertensive patients that in normal subjects. Acute administration of clonidine (200 µg orally) resulted in a significant decrease in MBP, heart rate, NE, PRA, and aldosterone. There was a significant (p < 0.01) correlation between the decrease in NE and the fall in MBP. After 6 weeks of treatment, clonidine produced a significant decrease in MBP, heart rate, NE and aldosterone, but not in PRA. Chronic treatment with clonidine produced a slight but significant (p < 0.05) rise in serum potassium and in serum creatinine. Exchangeable sodium and plasma volume did not change significantly. The data indicate that abnormalities in the function of the sympathetic nervous system are already evident in patients with mild to moderate renal failure. The data also suggest that the sympathetic nervous system may participate in the maintenance of the hypertension in these patients

ISSN:1660-8151    

DOI:10.1159/000183111

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

8 cirrhotics with hyponatremia were given demeclocycline (DMC) 900 mg/day to investigate its effect on renal function, plasma renin activity, aldosterone and urinary excretion of prostaglandin E2 and kallikrein. In 7 patients DMC induced an increase of free water clearance (from – 0.36 ± 0.06 to 0.13 ± 0.06 ml/min) and serum sodium concentration (from 125.4 ± 0.09 to 131.1 ± 1.0 mEq/l, mmol/l). In 5 of these patients DMC also induced a marked reduction of glomerular filtration rate (from 72.2 ± 6.2 to 31,2 ± 4.7 ml/min) and renal plasma flow (from468 ± 98 to 195 ± 55 ml/min) which could not be explained on the basis of hypovolemia. In each case this renal impairment was not associated with changes in urinary concentration of β2-microglobulin, urinary casts excretion, fresh urine sediment or urine protein content and disappeared after discontinuation of the drug. DMC induced a marked increase in the urinary excretion of prostaglandin E2 (from 0.82 ± 0.27 to 6.16 ± 1.91 ng/min) in 6 out of the 7 patients who responded to DMC and a marked reduction in urinary kallikrein (from 16.1 ± 4.4 to 4.2 ± 1.6 pkat/min) in the 5 patients who developed renal insufficiency. The serum DMC concentration was greater than 5 µg/ml in all patients who responded to DMC, greater than 8 µg/ml in all cases who developed renal insufficiency and of 3 µg/ml in the case not responding to DMC. These findings indicate that: (1) DMC is an effective therapy for water retention and dilutional hyponatremia in cirrhosis but it produces renal insufficiency associated with an impairment of renal perfusion and with a reduced urinary kallikrein activity in a high proportion of patients. (2) The inhibitory effect of DMC on water reabsorption in these patients may be due, at least in part, to an increased renal synthesis of prostaglandin E2 induced by the drug. (3) A closed relationship exists between the renal effects and the serum levels of

ISSN:1660-8151    

DOI:10.1159/000183112

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

It has been reported that agents which block the prostaglandin system inhibit the development of glomerulonephritis. However, the mechanisms of these effects are not clear. We studied the effect of a selective thromboxane A2 (TXA2) synthetase inhibitor, 1-benzylimidazole (BIm), on the immune complex glomerulonephritis produced by bovine serum albumin (BSA) in New Zealand white rabbits. As the BSA nephritis developed, there was no change of creatinine (Cr), serum urea nitrogen (SUN), or creatinine clearance (Ccr), but urinary protein excretion increased almost 3-fold. Coagulation and fibrinolytic studies suggested a hypercoagulable state and increased fibrinolytic activity. Platelet aggregation showed the reduction of maximum aggregation induced by ADP and collagen. Histological examination by light microscopy, immunofiuorescence, and electron microscopy revealed glomerular polymorphonuclear leukocyte (PMN) infiltration, mononuclear cell (MON) proliferation, and fibrin deposition. In 70% of the rabbits, IgG and C3 deposits were seen by immunofluorescene mainly in mesangial areas. The administration of BIm to BSA nephritis had no effects on Cr, SUN or Ccr, but it significantly lessened the proteinuria. The study of coagulation and fibrinolytic activity suggested a less hypercoagulable state, and more efficient fibrinolysis occurred than in the group without BIm. BIm tended to normalize platelet aggregation. It also lessened the histological PMN infiltration (p < 0.05), MON proliferation (p < 0.01), and fibrin deposition (p < 0.05). These data suggest that TxA2 may play an important pathogenetic role in the development and progression of glomerulonephritis.

ISSN:1660-8151    

DOI:10.1159/000183113

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

We describe 26 pregnancies in 19 patients with lupus nephritis. There were 4 spontaneous abortions, 2 therapeutic abortions, 4 stillbirths and 1 neonatal death. 10 deliverieswere preterm and 2 fetuses were small for gestational age. 8 pregnancies were not accompanied by change of renal symptoms. Mild signs of renal involvement appeared during pregnancy in 4 patients. 6 patients showed an increase in proteinuria already present before pregnancy without renal function deterioration. A moderate worsening of renal function was observed in 3 patients. 4 patients, 3 of whom had an apparent onset of systemic lupus erythematosus during pregnancy, developed anuric acute renal failure after delivery or after late spontaneous abortion. 2 of them died from sepsis and disseminated intravascular coagulation while 2 had complete recovery of renal function. A high rate of complications was observed in patients not adequately treated during pregnancy. Renal biopsy before gestation was not predictive of the outcome of nephropathy during pregnancy, and change of histology in repeated biopsies was frequently observed.

ISSN:1660-8151    

DOI:10.1159/000183114

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

The presence of circulating immune complexes in 54 patients with IgA nephropathy has been studied by two different techniques. 64% of the patients had IgG immune complexes and 37% had IgA immune complexes, both determined with the Raji cell assay, and 48% of patients had IgA immune complexes with the anti-IgA inhibition binding assay (anti-IgA Inh BA). In sequential sera from individual patients, immune complexes remained persistently positive or negative in more than 50% of the cases being intermittently in the rest. The immune complexes detected by the Raji cell assay were mostly of 7–13S in size, while those detected by anti-IgA Inh BA were bigger. There was a good correlation between the serum levels of polymeric IgA and the presence of IgA complexes (Raji cell assay). A certain correlation (p < 0.05) was found between these IgA immune complexes and the clinical activity assessed by the hematuria. A similar correlation (p < 0.05) was found with specific polymeric IgA immune complexes studied by a method recently described. No relationship was observed between the presence of any HLA antigens and the existence of circulating immune complexes. These results support the contention that IgA immune complexes, especially those composed of polymeric IgA, may have a role in the pathogenesis of IgA nephropathy. Moreover, the high serum levels of polymeric IgA observed in these patients could contribute to the slow clearance and long persistence in the circulation of IgA immune complexes with their subsequent deposition at the glomerular mesangiu

ISSN:1660-8151    

DOI:10.1159/000183115

出版商:S. Karger AG    

年代:1984

数据来源: Karger