==================================CMR54================================== 54. Renal disease in amyloidosis. Plasma cell dyscrasias. Multiple myeloma. 1 UI - 87071031 AU - Pasternack A ; Ahonen J ; Kuhlb:ack B TI - Renal transplantation in 45 patients with amyloidosis. AB - The results of renal transplantation in patients with amyloidosis were studied in 45 patients receiving primary cadaver grafts at a single center between March 1973 and October 1981. A control group of 45 patients with glomerulonephritis receiving primary cadaver grafts during the same period was also studied. These were matched according to the number of A and B locus incompatibilities and the date of transplantation. The 3-year survival of the patients with amyloidosis was statistically significantly inferior (51%) to that of the controls (79%). Age over 40 years was the major factor determining low survival in these patients. Mortality was concentrated in the early posttransplantation period. The 3-year graft survival rate was the same in amyloidotics (38%) and controls (45%); with death of patients not included in graft loss, the corresponding figures were 53% and 49%. Appearance of amyloid in the transplant was established by biopsy in four patients at 11-37 months of follow-up. Renal transplants functioning for more than one year were calculated to incur a minimum risk of 20% of acquiring amyloid. MH - Adult ; Aged ; Amyloidosis/COMPLICATIONS/*THERAPY ; Cardiovascular Diseases/COMPLICATIONS ; Female ; Glomerulonephritis/THERAPY ; Graft Survival ; Human ; Kidney/ *TRANSPLANTATION ; Male ; Middle Age ; Prognosis SO - Transplantation 1986 Dec;42(6):598-601 2 UI - 87069525 AU - Ferri C ; Gremignai G ; Bombardieri S ; Moriconi L ; Pontrandolfo A ; Vitali C ; Fosella PV ; Pasero G TI - Plasma-exchange in mixed cryoglobulinemia. Effects on renal, liver and neurologic involvement. AB - Prolonged plasma-exchange without addition of cytotoxic agents was employed in 16 patients with mixed cryoglobulinemia and kidney, liver or neurologic involvement. Patients with rapidly progressive renal failure or active and reversible lesions generally improved after plasma-exchange, as well as those with a recently occurring sensory-motor peripheral neuropathy. In 4 out of 6 patients with mixed cryoglobulinemia and chronic active hepatitis, plasma-exchange was followed by either normalization or significant reduction of liver enzymes and bromosulfophthalein retention. In all cases responding to plasma-exchange the beneficial effects were evident after the first 2-3 weeks of treatment, while symptoms did not generally recur when the procedures were either slowly tapered or discontinued. Although the pathogenetic mechanism(s) of action of plasma-exchange remains largely unknown, preliminary data indicate that these procedures induce quantitative as well as qualitative changes in the immune system. MH - Adrenal Cortex Hormones/THERAPEUTIC USE ; Adult ; Aged ; Case Report ; Combined Modality Therapy ; Cryoglobulinemia/ COMPLICATIONS/IMMUNOLOGY/*THERAPY ; Female ; Hepatitis/ COMPLICATIONS ; Human ; Kidney Diseases/COMPLICATIONS/ PHYSIOPATHOLOGY ; Liver Diseases/COMPLICATIONS/PHYSIOPATHOLOGY ; Male ; Middle Age ; Nephritis/THERAPY ; Peripheral Nerve Diseases/ COMPLICATIONS/PHYSIOPATHOLOGY ; *Plasma Exchange ; Support, Non-U.S. Gov't SO - Ric Clin Lab 1986 Apr-Jun;16(2):403-11 3 UI - 87069523 AU - Saccardo F ; Massaro P ; Monti G ; Angelopulos N ; Galli M TI - Causes of death in essential mixed cryoglobulinemia. AB - Ninety-three patients with essential mixed cryoglobulinemia have been followed for more than 5 years in 75% of cases; 21 patients died during this period and the mean age at death was 54 years. The most common cause of death was renal failure. The percentages of patients who survived after 5 and 10 years from the diagnosis were 87 and 74%, respectively. The cryoglobulin type seems to be an important prognostic factor: in our population the type II/III ratio is 6/7 at diagnosis, while it becomes 2/1 when the patients who died are considered. MH - Cryoglobulinemia/CLASSIFICATION/COMPLICATIONS/*MORTALITY ; Female ; Follow-Up Studies ; Human ; Kidney Failure, Chronic/PATHOLOGY ; Liver Diseases/PATHOLOGY ; Male ; Middle Age ; Vasculitis/ PATHOLOGY SO - Ric Clin Lab 1986 Apr-Jun;16(2):389-91 4 UI - 87069513 AU - Cattaneo R ; Fenini MG ; Facchetti F TI - The cryoglobulinemic vasculitis. AB - Thirty-eight patients with essential mixed cryoglobulinemia (EMC: 16 type II and 22 type III) were evaluated. Almost all patients had clinical manifestations which could be related to a cutaneous and/or visceral vasculitic process. No significant clinical or laboratory differences were found between type II and type III EMC patients. Kidney biopsy performed in 9 patients showed membranoproliferative glomerulonephritis in 6 cases, diffuse proliferative glomerulonephritis in 2 cases and mesangioproliferative glomerulonephritis in one case. Skin biopsy performed in 11 patients showed typical leukocytoclastic vasculitis as the most common finding. A picture consistent with overlapping vasculitis was found in 2 cases (one type II and one type III) and thrombus-like deposits were observed in 3 cases (2 type II and one type III). These thrombotic lesions, not associated with vessel wall necrosis and inflammatory infiltrate, were indistinguishable from those observed in one case of type I cryoglobulinemia. Our data emphasize the complexity of blood vessel involvement in cryoglobulinemia and point out the possible existence of multiple pathogenetic mechanisms. MH - Capillaries/PATHOLOGY ; Cryoglobulinemia/CLASSIFICATION/ *COMPLICATIONS/DIAGNOSIS ; Cryoglobulins/ANALYSIS ; Histocytochemistry ; Human ; Kidney Diseases/ETIOLOGY ; Kidney/ PATHOLOGY ; Skin/BLOOD SUPPLY/PATHOLOGY ; Vasculitis/BLOOD/ *COMPLICATIONS/DIAGNOSIS SO - Ric Clin Lab 1986 Apr-Jun;16(2):327-33 5 UI - 87069505 AU - Invernizzi F ; Saccardo F ; Galli M ; Monti G ; Zanussi C TI - The cryoglobulinemic syndrome. AB - The clinical and immunochemical classification of 376 patients with cryoglobulinemia is presented. In 141 cases (37.5%) the syndrome was considered idiopathic. Among the secondary forms, chronic liver diseases and connective tissue diseases shared most frequently mixed cryoglobulins (18.8 and 15.4% of cases, respectively). Another common association was that with Waldenstr:om's macroglobulinemia: cryoglobulins were found in 20% of these patients. In 5 patients (2 with the essential form and 3 with cryoglobulinemia secondary to Waldenstr:om's disease) a Cl-inhibitor deficiency was discovered; the complement profile was characteristic of the acquired type and episodes of angioedema occurred. Studying the clinical course of 71 cases of essential mixed cryoglobulinemia followed-up for 4-20 years we concluded that the evolution of type II and type III cryoglobulinemias is different because that of type II seems to have a more severe course and may differentiate in a lymphoproliferative disorder; the immunochemical type of cryoglobulins seems therefore to have a prognostic significance. Because of the considerable overlap in the distribution of immunochemical types among the clinical subsets, a mixed classification (both biochemical and clinical) is proposed. MH - Adult ; Aged ; Cryoglobulinemia/CLASSIFICATION/COMPLICATIONS/ IMMUNOLOGY/*PHYSIOPATHOLOGY ; Cryoglobulins/IMMUNOLOGY/METABOLISM ; Female ; Follow-Up Studies ; Human ; Immune Complex Disease/ BLOOD ; Kidney Diseases/ETIOLOGY ; Lymphoproliferative Disorders/ BLOOD ; Macroglobulinemia/PHYSIOPATHOLOGY ; Male ; Middle Age ; Paraproteins/METABOLISM SO - Ric Clin Lab 1986 Apr-Jun;16(2):269-74 6 UI - 87062030 AU - Gejyo F ; Odani S ; Yamada T ; Honma N ; Saito H ; Suzuki Y ; Nakagawa Y ; Kobayashi H ; Maruyama Y ; Hirasawa Y ; et al TI - Beta 2-microglobulin: a new form of amyloid protein associated with chronic hemodialysis. AB - Carpal tunnel syndrome (CTS) has been associated with amyloid deposits and is now regarded as a major complication in chronic hemodialysis patients. While this new syndrome has been receiving increasing attention, its etiology has not been clarified. We have isolated amyloid fibrils from amyloid laden tissues inside the carpal tunnel in four different hemodialysis patients with CTS. After solubilization in guanidine HCl, a significant amount of the protein was located in a homogeneous, low molecular weight fraction. Each protein was found to be identical to beta 2-microglobulin with regard to its molecular weight of 11,000 on SDS-PAGE, amino acid composition and N-terminal amino acids: Ile-Gln-Arg-Thr-Pro-Lys-Ile-Gln-Val-Tyr-Ser-Arg-His-Pro-Ala-Glu. In direct immunofluorescent study, anti-beta 2-microglobulin did react positively with amyloid deposits. These results demonstrate that the amyloid associated with chronic hemodialysis contains as major component a new form of amyloid fibril protein that is homologous to beta 2-microglobulin. It is postulated that beta 2-microglobulin cannot be removed from the blood by conventional hemodialysis, and accumulates in tissues causing the formation of amyloid fibrils, which, having a relatively high affinity to the carpal tunnel area, thus causes CTS. MH - Amino Acids/ANALYSIS ; Amyloid Protein AA/ANALYSIS/*METABOLISM ; Amyloidosis/COMPLICATIONS/ETIOLOGY/METABOLISM ; Beta 2 Microglobulin/ANALYSIS/*METABOLISM ; Carpal Tunnel Syndrome/ ETIOLOGY/METABOLISM ; Comparative Study ; Hemodialysis/*ADVERSE EFFECTS ; Human ; Kidney Failure, Chronic/COMPLICATIONS/ METABOLISM/THERAPY ; Molecular Weight ; Support, Non-U.S. Gov't SO - Kidney Int 1986 Sep;30(3):385-90 7 UI - 87053764 AU - Klein-Szanto AJ ; Conti CJ ; Aldaz CM ; Clapp N ; Nesnow S ; Slaga TJ TI - Effects of chronic topical application of 12-O-tetradecanoylphorbol-13-acetate on the skin and internal organs of SENCAR mice. AB - Repetitive topical applications of 2 micrograms 12-O-tetradecanoylphorbol-13-acetate (TPA) twice weekly for 37 to 52 weeks induced a sustained epidermal hyperplasia, hyperplasia of hair follicles, and increased dermal cellularity in SENCAR mice. In addition, after 52 weeks of protracted promoter treatment most animals developed generalized amyloidosis involving liver and spleen, as well as interstitial nephritis. Severe pyelonephritis and papillary necrosis were also frequently seen. Reactive lymphoid hyperplasia was also a frequent finding. Chronic administration of TPA is not an innocuous treatment affecting only the interfollicular epidermis. The general effect of the promoter on the animals was a marked decrease in their longevity, probably through impairment of the immune system. MH - Administration, Topical ; Amyloidosis/CHEMICALLY INDUCED ; Animal ; Female ; Hyperplasia ; Immune System/DRUG EFFECTS ; Male ; Mice ; *Mice, Inbred Strains ; Nephritis, Interstitial/CHEMICALLY INDUCED ; Skin/*DRUG EFFECTS/PATHOLOGY ; Support, U.S. Gov't, Non-P.H.S. ; Tetradecanoylphorbol Acetate/ADMINISTRATION & DOSAGE/ *TOXICITY SO - Environ Health Perspect 1986 Sep;68:75-80 8 UI - 87048539 AU - Thomas MA ; Ibels LS ; Wells JV ; Isbister JP ; Cooper DA ; McMahon C TI - IgA kappa multiple myeloma and lymphadenopathy syndrome associated with AIDS virus infection. AB - A 29 year old homosexual male presented with acute renal failure caused by acute myeloma. Subsequent investigation demonstrated antibody to the AIDS-associated virus human T-cell lymphotropic virus III, (HTLV-III/LAV/ARV). The association between lymphadenopathy syndrome and multiple myeloma is discussed. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; AIDS-Related Complex/*COMPLICATIONS ; Case Report ; Human ; IgA/ *IMMUNOLOGY ; Immunoglobulins, Kappa Chain/*IMMUNOLOGY ; Kidney Failure, Acute/ETIOLOGY ; Male ; Multiple Myeloma/*ETIOLOGY ; Support, Non-U.S. Gov't SO - Aust NZ J Med 1986 Jun;16(3):402-4 9 UI - 87039375 AU - Wong GH ; Goeddel DV TI - Tumour necrosis factors alpha and beta inhibit virus replication and synergize with interferons. AB - Tumour necrosis factor (TNF) and lymphotoxin were initially described as tumoricidal proteins that are produced by activated macrophages and lymphocytes, respectively. Since TNF and lymphotoxin are structurally related, bind to the same cell surface receptor and have indistinguishable biological activities, they have been designated as TNF-alpha and TNF-beta, respectively. The multiple activities of these molecules indicate their importance in immunoregulative responses. Here we report that both TNF-alpha and TNF-beta have antiviral activity and synergize with interferons (IFNs) in the induction of resistance to both RNA and DNA virus infection in diverse cell types. These effects of TNFs are not due to the induction of IFN synthesis. Virus-infected cells are selectively killed by TNFs and this activity is accelerated by IFN-gamma. The production of TNFs is induced by viruses, further suggesting the importance of TNFs in the physiological antiviral response. MH - Animal ; Cell Line ; Drug Synergism ; DNA Viruses/DRUG EFFECTS/ PHYSIOLOGY ; Glioma/MICROBIOLOGY ; Glycoproteins/ *PHARMACODYNAMICS ; Human ; Interferons/*PHARMACODYNAMICS ; Kidney Neoplasms/MICROBIOLOGY ; Lung Neoplasms/MICROBIOLOGY ; Mice ; Multiple Myeloma/MICROBIOLOGY ; Poly I-C/PHARMACODYNAMICS ; Rats ; RNA Viruses/DRUG EFFECTS/PHYSIOLOGY ; Virus Replication/ *DRUG EFFECTS SO - Nature 1986 Oct 30-Nov 5;323(6091):819-22 10 UI - 87029013 AU - Lee VW ; Skinner M ; Cohen AS ; Ngai S ; Peng TT TI - Renal amyloidosis. Evaluation by gallium imaging. AB - A study has been performed to evaluate the efficacy of gallium imaging in the detection of renal amyloidosis. Ten of the 11 patients who had biopsy-proven renal amyloidosis demonstrated marked uptake in both kidneys. One patient revealed moderate gallium uptake in his kidneys. None of the patients had underlying renal or extrarenal pathology other than amyloidosis, which could account for renal gallium uptake (renal infection, neoplasm, hepatic failure or frequent blood transfusions). Four patients also had extrarenal foci of abnormal gallium uptake, suggesting other sites of amyloid deposits. Our data strongly suggest that gallium imaging has a high sensitivity for detection of renal amyloidosis. Its specificity is enhanced significantly by careful review of the clinical history to exclude other known causes of renal gallium uptake. Potentially, gallium imaging may be used to monitor the progress of patients under experimental therapy. MH - Adult ; Aged ; Amyloidosis/PATHOLOGY/*RADIONUCLIDE IMAGING ; Female ; Gallium Radioisotopes/DIAGNOSTIC USE ; Human ; Kidney Diseases/PATHOLOGY/*RADIONUCLIDE IMAGING ; Male ; Middle Age ; Prospective Studies SO - Clin Nucl Med 1986 Sep;11(9):642-6 11 UI - 87025037 AU - Jones BA ; Shapiro HS ; Rosenberg BF ; Bernstein J TI - Minimal renal amyloidosis with nephrotic syndrome. AB - Two patients older than age 50 years had minimal amyloidosis in association with the nephrotic syndrome. The amyloid deposits in each case were so inconspicuous as to have been initially overlooked, and both biopsy specimens were thought to show minimal glomerular changes. A few, widely scattered, silver-positive, epimembranous spicules were found on reexamination by light microscopy, and Congo red and thioflavin T stains and electron microscopy confirmed the presence of small glomerular amyloid deposits. Both patients have since died of renal failure. In our series of biopsy specimens, amyloidosis was found in 14.2% of patients older than age 50 years presenting with nephrotic syndrome or severe proteinuria, over 1 1/2 times the frequency of minimal-change nephrotic syndrome. We therefore urge careful examination for amyloid deposits of all kidney biopsy specimens with the appearance of minimal-change nephrotic syndrome in older patients. Fluorescence microscopy of Congo red- and thioflavin T-stained sections is very helpful in the detection of small deposits. MH - Amyloidosis/*COMPLICATIONS/METABOLISM ; Case Report ; Congo Red ; Diagnosis, Differential ; Female ; Fluorescent Antibody Technic ; Histocytochemistry ; Human ; Kidney Glomerulus/*METABOLISM ; Male ; Microscopy, Electron ; Middle Age ; Nephrosis, Lipoid/ *COMPLICATIONS ; Nephrotic Syndrome/*COMPLICATIONS SO - Arch Pathol Lab Med 1986 Oct;110(10):889-92 12 UI - 87023109 AU - Neugarten J ; Gallo GR ; Buxbaum J ; Katz LA ; Rubenstein J ; Baldwin DS TI - Amyloidosis in subcutaneous heroin abusers ("skin poppers' amyloidosis:). AB - Systemic amyloidosis has recently emerged as a major cause of nephropathy among heroin abusers in New York City. Although focal glomerulosclerosis is typically seen in intravenous drug abusers who present with the nephrotic syndrome, those who escape this complication are at risk for the later development of amyloidosis related to their use of the subcutaneous route. Twenty such addicts identified between 1981 and 1984 are described. Patients typically present with chronic suppurative skin infections, edema, the nephrotic syndrome, benign urinary sediment, and normal-sized or enlarged kidneys. Tubular dysfunction, particularly renal tubular acidosis and diabetes insipidus, is frequent. Progression of renal insufficiency is characteristically rapid. Prolonged survival of heroin abusers and exhaustion of intravenous access requiring recourse to the subcutaneous route underlie the occurrence of amyloidosis in the addict population. Chronic suppurative skin infection consequent to repeated subcutaneous injection appears to be the underlying cause. MH - Adult ; Amyloidosis/COMPLICATIONS/*ETIOLOGY/PHYSIOPATHOLOGY ; *Diacetylmorphine ; Female ; Human ; Injections, Subcutaneous ; Kidney Diseases/COMPLICATIONS/*ETIOLOGY/PATHOLOGY ; Male ; Middle Age ; Substance Abuse/*COMPLICATIONS SO - Am J Med 1986 Oct;81(4):635-40 13 UI - 87011186 AU - Kirschner BS ; Samowitz WS TI - Secondary amyloidosis in Crohn's disease of childhood. AB - Secondary amyloidosis is a rare complication of Crohn's disease, especially in pediatric patients. This report describes an 11-year-old child with Crohn's disease who developed intermittent proteinuria and thyroid enlargement at 14 years of age as the initial manifestations of secondary amyloidosis. Deterioration in renal function resulted in her death at 20 years of age. Published reports that discuss the occurrence of systemic amyloidosis in Crohn's disease and the pediatric age group are reviewed. MH - Adolescence ; Adult ; Amyloidosis/*ETIOLOGY/PATHOLOGY ; Case Report ; Child ; Crohn Disease/*COMPLICATIONS ; Female ; Human ; Kidney Diseases/ETIOLOGY/PATHOLOGY ; Thyroid Diseases/ETIOLOGY/ PATHOLOGY SO - J Pediatr Gastroenterol Nutr 1986 Sep-Oct;5(5):816-21 14 UI - 86100538 AU - Dabbs DJ ; Striker LM ; Mignon F ; Striker G TI - Glomerular lesions in lymphomas and leukemias. AB - Renal lesions in lymphoid malignancies are rare, with most lesions observed in association with Hodgkin's disease. In two large series of patients with Hodgkin's disease, only 0.4 percent had minimal-change lesion whereas 0.1 percent had amyloidosis. The non-Hodgkin's lymphomas and leukemias comprise large and heterogeneous groups with equally diverse renal lesions. As in Hodgkin's disease, the most frequent lesion is minimal-change nephrotic syndrome. Also recognized are rare reports of renal disease associated with the atypical lymphoid proliferations of angioimmunoblastic lymphadenopathy, giant lymph node hyperplasia syndrome, and acquired immune deficiency syndrome. Broad generalizations regarding the pathogenesis of renal disease in these syndromes are difficult, partly due to the paucity and sporadic reporting of such cases. Mechanisms proposed to explain the renal pathologic findings include autologous nontumor antigens, tumor antigens, fetal antigen expression, immune complex deposition, viral antigens, and disordered T cell function. MH - Amyloidosis/ETIOLOGY ; Burkitt's Lymphoma/COMPLICATIONS ; Glomerulonephritis/ETIOLOGY ; Glomerulosclerosis, Focal/ETIOLOGY ; Hodgkin's Disease/COMPLICATIONS ; Human ; Hyperplasia ; Immunoblastic Lymphadenopathy/COMPLICATIONS ; Kidney Diseases/ *ETIOLOGY/PATHOLOGY ; Kidney Glomerulus/PATHOLOGY ; Leukemia/ *COMPLICATIONS ; Leukemia, Lymphocytic/COMPLICATIONS ; Leukemia, Myeloblastic/COMPLICATIONS ; Leukemia, Myelocytic/COMPLICATIONS ; Lymph Nodes/PATHOLOGY ; Lymphoma/*COMPLICATIONS ; Lymphoma, Non-Hodgkin's/COMPLICATIONS ; Nephrosis, Lipoid/ETIOLOGY ; Review SO - Am J Med 1986 Jan;80(1):63-70 15 UI - 86322255 AU - Conte G ; Dal Canton A ; Marcuccio F ; Stanziale P ; Andreucci VE TI - Polyuric prerenal failure after reduction from high to normal dietary intake of sodium. AB - In a patient with renal amyloidosis secondary to chronic urinary tract infection with nephrotic syndrome, polyuric acute renal failure developed after reduction from a high to a normal dietary intake of sodium and was reversed by salt replacement therapy. As documented by functional and morphological studies, the patient had a marked defect of tubular sodium reabsorption at the proximal site and along the ascending limb of Henle's loop, a distal tubular unresponsiveness to aldosterone, and severe tubulointerstitial damage in the medulla. We propose that the sodium dietary reduction in conjunction with severe tubular dysfunction and hypovolemia due to nephrotic syndrome is responsible for this unused form of polyuric acute prerenal failure. MH - Adult ; Amyloidosis/COMPLICATIONS ; Case Report ; *Diet ; Human ; Kidney Diseases/COMPLICATIONS ; Kidney Failure, Acute/*ETIOLOGY/ METABOLISM ; Kidney Tubules/METABOLISM ; Male ; Nephrotic Syndrome/COMPLICATIONS ; Sodium/METABOLISM ; Sodium Chloride/ *ADMINISTRATION & DOSAGE ; Support, Non-U.S. Gov't ; Urinary Tract Infections/COMPLICATIONS SO - Arch Intern Med 1986 Sep;146(9):1814-6 16 UI - 86312866 AU - Cavo M ; Baccarani M ; Galieni P ; Gobbi M ; Tura S TI - Renal failure in multiple myeloma. A study of the presenting findings, response to treatment and prognosis in 26 patients. AB - The presenting clinical features, response to treatment and survival duration of 26 consecutive multiple myeloma patients with renal failure at diagnosis were investigated. All but 1 of the patients had high tumour cell mass stage, as identified by one (3 cases) or more (22 cases) of the criteria defined by Durie and Salmon. Survival length of azotaemic patients was significantly shorter than that of stage III patients with normal renal function (median: 4 months vs 41 months, respectively, P less than 0.0005), and was positively affected by reversal of renal failure following treatment (P less than 0.0005). Of the 26 patients, 56% achieved reversal of renal failure. Recovery of normal renal function was prompt in most of the cases and appeared to be independent from both M component type and pretreatment serum creatinine levels. Finally, it was shown that patients with reversible renal impairment but with myeloma unresponsive to alkylating agents had early recurrence of impaired renal function and a shorter life expectancy than patients with a significant decrease in tumour cell mass. MH - Adrenal Cortex Hormones/*THERAPEUTIC USE ; Adult ; Aged ; Calcium/ BLOOD ; Female ; Follow-Up Studies ; Hemoglobins/ANALYSIS ; Human ; Kidney Failure, Chronic/*COMPLICATIONS/PHYSIOPATHOLOGY ; Male ; Melphalan/*THERAPEUTIC USE ; Middle Age ; Multiple Myeloma/ *COMPLICATIONS/DRUG THERAPY/PHYSIOPATHOLOGY ; Prognosis ; Support, Non-U.S. Gov't SO - Nouv Rev Fr Hematol 1986;28(3):147-52 17 UI - 86308886 AU - Macdougall DF ; Cook T ; Steward AP ; Cattell V TI - Canine chronic renal disease: prevalence and types of glomerulonephritis in the dog. AB - In a prospective survey, one hundred and eleven dogs with canine chronic renal disease, presenting to 24 veterinary practices in East Anglia and the West Midlands (geographical area 8,600 square miles) were identified. More than 20 different breeds were represented. In 76 cases, clinical details, blood and urine biochemistry, serology and kidney tissue for light and electron microscopy, and immunohistochemistry were obtained. Forty (52%) had glomerular (GN) and 36 (48%) non-glomerular (NGN) disease. Types of GN identified were (W.H.O. classification, number of cases in brackets): focal glomerulonephritis (gn) (5), diffuse mesangial proliferative gn (8), diffuse endocapillary proliferative gn (2), mesangiocapillary gn type I (8), diffuse crescentic gn (1), diffuse sclerosing gn (7), amyloid (6), unclassifiable gn (3). Eight dogs with GN and 13 with NGN had extra-renal lesions. In only one GN case (bacterial endocarditis) was the etiology clear. Proteinuria, but not age, breed, sex, serum creatinine or hematuria, discriminated between GN and NGN groups. This prospective survey identifies GN, with morphological types as found in humans, as a common cause of canine chronic renal disease. MH - Amyloidosis/PATHOLOGY/VETERINARY ; Animal ; Autoantibodies/ ANALYSIS ; Capillaries/ULTRASTRUCTURE ; Comparative Study ; Complement 3/ANALYSIS ; Dog Diseases/*PATHOLOGY ; Dogs ; Glomerulonephritis/PATHOLOGY/*VETERINARY ; Kidney Failure, Chronic/PATHOLOGY/VETERINARY ; Kidney Tubular Necrosis, Acute/ PATHOLOGY/VETERINARY ; Microscopy, Electron ; Pyelonephritis/ PATHOLOGY/VETERINARY ; Support, Non-U.S. Gov't SO - Kidney Int 1986 Jun;29(6):1144-51 18 UI - 86305020 AU - Johns EA ; Turner R ; Cooper EH ; Maclennan IC TI - Isoelectric points of urinary light chains in myelomatosis: analysis in relation to nephrotoxicity. AB - Measurements of the isoelectric point (pI), sialic acid content, and polymerisation were made of 43 light chains isolated from the urine of patients with myelomatosis excreting large amounts of light chains. The pIs ranged from 3.5-9.5, and 23 were greater than 7.0. Sialylation was detected in 62% of light chains, and 69% showed microheterogeneity of charge. There was no clear association between the pI, sialylation, or polymerisation and the presence of renal failure, as assessed by serum creatinine concentrations. Light chains with pI spectrotype in the basic range, however, were found to produce more proximal tubular dysfunction than acidic light chains. MH - Alpha Macroglobulins/URINE ; Creatinine/BLOOD ; Human ; Immunoglobulins, Light Chain/*URINE ; Isoelectric Point ; Kidney Failure, Acute/COMPLICATIONS ; Kidney Tubules, Proximal/ METABOLISM ; Multiple Myeloma/COMPLICATIONS/*URINE ; Polymers ; Sialic Acids/ANALYSIS ; Support, Non-U.S. Gov't SO - J Clin Pathol 1986 Aug;39(8):833-7 19 UI - 86294783 AU - Laakso M ; Mutru O ; Isom:aki H ; Koota K TI - Mortality from amyloidosis and renal diseases in patients with rheumatoid arthritis. AB - Patients with rheumatoid arthritis (RA), 500 men and 500 women, aged 40 years and over, together with a control population matched by age and sex, were observed over a 10 year period. The overall mortality was significantly higher in both men and women with rheumatoid arthritis than in the controls due to an excess mortality from infections and cardiovascular and renal diseases. During the follow up 31 patients with RA (12 male, 19 female) and one male control subject died from amyloidosis and 42 RA patients (19 male, 23 female) and one male control from renal diseases. The most important causes of renal deaths were chronic nephritis and renal infections. MH - Adult ; Aged ; Amyloidosis/COMPLICATIONS/*MORTALITY ; Arthritis, Rheumatoid/COMPLICATIONS/*MORTALITY ; Female ; Finland ; Human ; Kidney Diseases/COMPLICATIONS/*MORTALITY ; Male ; Middle Age ; Prospective Studies SO - Ann Rheum Dis 1986 Aug;45(8):663-7 20 UI - 86292220 AU - Ogura M ; Toki J ; Maeda R TI - An electron microscopical and histochemical study on ferric nitrilotriacetate-induced "F1 amyloidosis:. AB - Of a total of 80 offspring obtained by reciprocal crossing of ICR/JCL strain of mice of both sexes receiving 84-140 injections of Fe-NTA over 98-163 days before crossing, 52 (65%) showed severe generalized amyloidosis after 93-502 injections of Fe-NTA over 115-522 days, but not "hemochromatosis:, which was a striking contrast to the findings of "hemochromatosis: without amyloidosis observed in the parent mice. Electron microscopic examinations revealed numerous bundles of non-branching, well-oriented amyloid fibrils radiated outward from the surface of cytoplasmic invaginations of the Kupffer cells or splenic reticuloendothelial cells of the F1 mice with amyloidosis, and close contact frequently observed between "amyloid-forming cells: and adjacent lymphocytes in the amyloid-laden liver and spleen of the F1 mice. Since the above findings in the F1 mice were not found in the parent mice treated with multiple Fe-NTA injections, the present authors assumed that the immunological memory for the Fe-NTA conjugate transmitted via the placenta to the fetus from the mother that received multiple Fe-NTA injections might be involved in the development of generalized amyloidosis in the F1 mice, although the possible mechanism by which Fe-NTA-induced "F1 amyloidosis: has been developed remains yet undetermined. MH - Amyloidosis/CHEMICALLY INDUCED/FAMILIAL & GENETIC/*PATHOLOGY ; Animal ; Crosses, Genetic ; Disease Models, Animal ; Female ; *Ferric Compounds/ADMINISTRATION & DOSAGE ; Histocytochemistry ; Injections, Intraperitoneal ; *Iron/ADMINISTRATION & DOSAGE ; Kidney Diseases/PATHOLOGY ; Liver Diseases/METABOLISM/PATHOLOGY ; Male ; Mice ; Mice, Inbred ICR ; Microscopy, Electron ; Pedigree ; Splenic Diseases/METABOLISM/PATHOLOGY ; Support, Non-U.S. Gov't SO - Acta Pathol Jpn 1986 May;36(5):715-32 21 UI - 86290724 AU - Mazzucco G ; Monga G ; Casanova S ; Cagnoli L TI - Cell interposition in glomerular capillary walls in cryoglobulinemic glomerulonephritis (CRYGN). Ultrastructural investigation of 23 cases. AB - The present report describes ultrastructural findings on twenty-three cases of CRYGN showing membranoproliferative pattern under light microscopy. Attention was paid to the presence of double contoured peripheral basement membranes and to the characteristics of the interposed cells. The latter, according to the well known characteristics of membranoproliferative GN, are thought to be mesangial in nature. In fact, mesangial cells were found in 8 cases only, always associated with monocytes. Only monocytes were recorded in 12 cases, whereas in other 3 cases double contours were not connected to cell interposition. Despite similarities under light microscopy, CRYGN is therefore rather different from idiopathic membranoproliferative GN because of the prevalence of exudative changes, mainly due to monocyte infiltration, over proliferative lesions. MH - Cryoglobulinemia/*PATHOLOGY ; Glomerulonephritis/*PATHOLOGY ; Human ; Kidney Glomerulus/*ULTRASTRUCTURE ; Microscopy, Electron ; Support, Non-U.S. Gov't SO - Ultrastruct Pathol 1986;10(4):355-61 22 UI - 86285216 AU - Ferri C ; Moriconi L ; Gremignai G ; Migliorini P ; Paleologo G ; Fosella PV ; Bombardieri S TI - Treatment of the renal involvement in mixed cryoglobulinemia with prolonged plasma exchange. AB - Nine patients with mixed cryoglobulinemia and severe membranoproliferative glomerulonephritis were treated with plasma exchange alone or in combination with medium to low amounts of corticosteroids, but never with cytotoxic drugs. In 5 patients renal function and/or proteinuria improved after plasma exchange, and no clinical relapse usually occurred when the procedures were reduced or discontinued. These procedures seemed of particular effect in the presence of histologically active and not irreversible lesions and rapid deterioration of renal function. While cryocrit almost invariably decreased, circulating immune complex or complement levels were unpredictably affected by plasma exchange. Cryocrit, but not immune complex or complement levels, was the serological parameter which most often closely correlated with signs of renal involvement (i.e., proteinuria and/or serum creatinine). Thus, plasma exchange might be a safe and useful tool in the treatment of an often drug-resistant and rapidly progressive renal involvement occurring in patients with mixed cryoglobulinemia. MH - Adult ; Antigen-Antibody Complex ; Blood Proteins/METABOLISM ; Complement/METABOLISM ; Creatinine/BLOOD ; Cryoglobulinemia/BLOOD/ COMPLICATIONS/*THERAPY ; Female ; Glomerulonephritis/BLOOD/ ETIOLOGY/*THERAPY ; Human ; IgG/METABOLISM ; IgM/METABOLISM ; Male ; Middle Age ; *Plasma Exchange ; Proteinuria/THERAPY ; Support, Non-U.S. Gov't SO - Nephron 1986;43(4):246-53 23 UI - 86245779 AU - Malaise MG ; Davin JC ; Mahieu PR ; Franchimont P TI - Elevated antigalactosyl antibody titers reflect renal injury after gold or D-penicillamine in rheumatoid arthritis [published erratum appears in Clin Immunol Immunopathol 1986 Nov;41(2):303] AB - Titers of circulating antigalactosyl antibodies (a-Gal Ab) were assessed by passive hemagglutination using rabbit red blood cells in 40 normal subjects, in 14 patients with immunodeficient states, in 47 patients with active rheumatoid arthritis (RA), and in 15 patients with an Henoch-Sch:onlein disease (HS). Titers of controls ranged from 1:16 to 1:64. All immunodeficient patients exhibited very low titers (1:1). On the contrary, the existence of an enhanced humoral immune response status, as observed in RA, was not reflected by a parallel increase of a-Gal Ab titers. However, in this disease, a strong relationship existed between titers exceeding control values (greater than 1:64) and the prior occurrence of renal injury under gold or D-penicillamine therapy. Lastly, the discovery of elevated titers (greater than 1:64) in HS only when renal involvement occurred further suggests that such antibodies reflect a renal injury. MH - Acquired Immunodeficiency Syndrome/*IMMUNOLOGY ; Adolescence ; Adult ; Aged ; Antibody Formation ; Antibody Specificity ; Arthritis, Rheumatoid/DRUG THERAPY/*IMMUNOLOGY ; Child ; Child, Preschool ; Dimercaprol/*ANALOGS & DERIVATIVES/ADVERSE EFFECTS/ THERAPEUTIC USE ; Female ; Gold/*ADVERSE EFFECTS/THERAPEUTIC USE ; Hemagglutination Tests ; Human ; IgG/*ANALYSIS ; Immune Complex Disease/*CHEMICALLY INDUCED/IMMUNOLOGY ; Infant ; Kidney/ IMMUNOLOGY ; Kidney Diseases/*CHEMICALLY INDUCED/IMMUNOLOGY ; Male ; Middle Age ; Multiple Myeloma/*IMMUNOLOGY ; Penicillamine/ *ADVERSE EFFECTS/THERAPEUTIC USE ; Purpura, Schoenlein-Henoch/ DRUG THERAPY/*IMMUNOLOGY SO - Clin Immunol Immunopathol 1986 Aug;40(2):356-64 24 UI - 86243663 AU - Kyle RA ; Greipp PR ; O'Fallon WM TI - Primary systemic amyloidosis: multivariate analysis for prognostic factors in 168 cases. AB - One hundred sixty-eight patients with primary systemic amyloidosis (AL) were identified. Median survival after diagnosis was 12 months and ranged from 4 months for patients presenting with congestive heart failure to 50 months for those presenting with peripheral neuropathy only. Utilizing the proportional-hazards model in a stepwise multivariate fashion to evaluate the simultaneous influence of putative risk factors as of diagnosis revealed that congestive heart failure, urine light chain, hepatomegaly, and multiple myeloma were the major factors adversely affecting survival during the first year after diagnosis. Serum creatinine, multiple myeloma, orthostatic hypotension, and monoclonal serum protein were the most important variables adversely affecting survival for patients surviving 1 year. These models were used to categorize patients according to the variables in the models into low-, moderate-, and high-risk groups for the first year after diagnosis and separately for subsequent years. The influence of these variables on survival is important in stratification of patients randomized to prospective clinical trials. MH - Adult ; Aged ; Amyloidosis/COMPLICATIONS/*MORTALITY ; Blood Proteins/ANALYSIS ; Female ; Heart Failure, Congestive/ETIOLOGY ; Human ; Male ; Middle Age ; Nephrotic Syndrome/ETIOLOGY ; Prognosis ; Proteinuria/ETIOLOGY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Syndrome SO - Blood 1986 Jul;68(1):220-4 25 UI - 86235123 AU - Hill GS TI - Drug-associated glomerulopathies. AB - The renal glomeruli are vulnerable to injury by a number of drugs and other toxic agents. These agents may lead to damage by one of two basic mechanisms: direct, dose-related toxic injury; indirect, immunologically mediated injury, largely dose-independent. Proteinuria is the simplest and most important functional indicator of glomerular injury. It occurs almost immediately in direct toxic injury, but there is a latent period of weeks to months with immunologically mediated processes. Of the two mechanisms, the second is by far the more common in clinical settings. The best studied experimental agent causing direct toxic injury is the aminonucleoside of puromycin. Clinically, perhaps the most important agent is Cyclosporine A. Although this agent is usually thought of primarily as a tubular toxin, it is capable of giving rise to a microangiopathic glomerular lesion similar to that in the hemolytic uremic syndrome. The classic model for immunologic glomerular lesion is Heymann nephritis, which produces a membranous glomerulopathy. Clinically, most drug mediated glomerulopathies also take the form of a membranous nephropathy, usually with a frank nephrotic syndrome. Among the more common offenders are penicillamine, gold salts used in rheumatoid arthritis, and captopril used in hypertension. The other common type of drug-related glomerulopathy occurs as part of a lupus-like syndrome induced by a variety of drugs, including hydralazine, procainamide, and penicillamine. All of these give rise to a variety of antibodies, most prominently antinuclear antibodies, and in the more severe cases there may be lupus-like glomerular lesions as well. MH - Amyloidosis/CHEMICALLY INDUCED/PATHOLOGY ; Animal ; Captopril/ ADVERSE EFFECTS ; Cyclosporins/ADVERSE EFFECTS ; Disease Models, Animal ; Gold/ADVERSE EFFECTS ; Heroin Dependence/COMPLICATIONS ; Human ; Hydrocarbons/ADVERSE EFFECTS ; Immune Complex Disease ; Kidney Diseases/*CHEMICALLY INDUCED/IMMUNOLOGY ; Kidney Glomerulus/DRUG EFFECTS ; Lupus Erythematosus, Systemic/ CHEMICALLY INDUCED ; Mercury/ADVERSE EFFECTS ; Nephrotic Syndrome/ CHEMICALLY INDUCED ; Penicillamine/ADVERSE EFFECTS ; Puromycin Aminonucleoside ; Serum Sickness/COMPLICATIONS ; Solvents/ADVERSE EFFECTS ; Tetradecanoylphorbol Acetate SO - Toxicol Pathol 1986;14(1):37-44 26 UI - 86235115 AU - Robertson JL TI - Spontaneous renal disease in dogs. AB - Renal disease is common in dogs. The incidence of significant renal disease increases with age. Many disease processes are subtle and subacute, and so many are not detected until they result in chronic renal failure. The causes of many renal diseases are not known but one must suspect immune-mediated damage in some. MH - Aging ; Amyloidosis/VETERINARY ; Animal ; Dog Diseases/ *OCCURRENCE/PATHOLOGY ; Dogs ; Glomerulonephritis/VETERINARY ; Glomerulosclerosis, Focal/VETERINARY ; Kidney Calculi/VETERINARY ; Kidney Diseases/OCCURRENCE/PATHOLOGY/*VETERINARY ; Kidney Glomerulus/PATHOLOGY ; Kidney Neoplasms/VETERINARY ; Kidney Tubules/PATHOLOGY ; Kidney, Cystic/VETERINARY ; Nephritis, Interstitial/VETERINARY ; Pyelonephritis/VETERINARY SO - Toxicol Pathol 1986;14(1):101-8 27 UI - 86233959 AU - Jones JM ; Davison AM TI - Persistent infection as a cause of renal disease in patients submitted to renal biopsy: a report from the Glomerulonephritis Registry of the United Kingdom MRC. AB - We report the results of a survey within the United Kingdom of the importance of persistent systemic infection in patients with unexplained renal disease who undergo renal biopsy. Twenty-two units participated. Overall 1.7 per cent of patients undergoing biopsy had an infection but there was large variation between units. Interstitial nephritis and amyloid deposits were more common in patients with infection, and minimal change nephropathy was less common than in patients undergoing biopsy but without infection. The respiratory tract was the most common site of infection but was rarely associated with glomerulonephritis of which the most common cause was infective endocarditis. Drug treatment may have caused the renal lesion in 16 per cent of patients. Amyloid deposits, present in 13.6 per cent of patients, was the most common cause of progressive renal failure. Most other patients had some improvement in renal function once the putative cause, whether infection or antibiotic, was removed. MH - Adolescence ; Adult ; Aged ; Amyloidosis/ETIOLOGY ; Biopsy ; Child ; Child, Preschool ; Endocarditis, Bacterial/COMPLICATIONS ; Female ; Glomerulonephritis/ETIOLOGY ; Human ; Infection/ *COMPLICATIONS ; Kidney/PATHOLOGY ; Kidney Diseases/*ETIOLOGY ; Male ; Middle Age ; Nephritis, Interstitial/CHEMICALLY INDUCED/ ETIOLOGY ; Nephrosis, Lipoid/ETIOLOGY ; Support, Non-U.S. Gov't SO - Q J Med 1986 Feb;58(226):123-32 28 UI - 86224769 AU - Kantor GR ; Bergfeld WF ; Katzin WE ; Reynolds OD ; Biscardi AP ; Lobur DM ; Box TA ; Schreiber MJ Jr ; Ratliff NB TI - Scleromyxedema associated with scleroderma renal disease and acute psychosis. AB - Scleromyxedema is a rare cutaneous disease with occasional systemic involvement and characteristic poor response to treatment. A case of scleromyxedema associated with renal scleroderma and acute psychosis is presented, along with a review of treatment and associated internal disorders. MH - Biopsy ; Case Report ; Human ; Immunoglobulins, Lambda Chain/ ANALYSIS ; Kidney/PATHOLOGY ; Kidney Diseases/*COMPLICATIONS/ PATHOLOGY ; Male ; Microscopy, Electron ; Middle Age ; Paraproteinemias/COMPLICATIONS ; Psychotic Disorders/ *COMPLICATIONS ; Scleroderma, Circumscribed/*COMPLICATIONS/ PATHOLOGY ; Skin/PATHOLOGY ; Skin Diseases/*COMPLICATIONS SO - J Am Acad Dermatol 1986 May;14(5 Pt 2):879-88 29 UI - 86220512 AU - Yamasaki K TI - Pathology of renal secondary hyperparathyroidism in mice. AB - Typical renal secondary hyperparathyroidism was observed in 19 specific pathogen-free ICR mice. The renal lesions were severe amyloidosis and glomerulonephritis. The bone lesion, osteodystrophia fibrosa, consisted of both resorptive and reparative processes. The parathyroid glands were enlarged and there was hyperplasia of the chief cells. MH - Amyloidosis/PATHOLOGY ; Animal ; Bone and Bones/PATHOLOGY ; Female ; Glomerulonephritis/PATHOLOGY ; Kidney/PATHOLOGY ; Male ; Mice ; *Mice, Inbred ICR ; Parathyroid Glands/PATHOLOGY ; Renal Osteodystrophy/PATHOLOGY/*VETERINARY ; Rodent Diseases/*PATHOLOGY SO - Jikken Dobutsu 1986 Jan;35(1):93-6 30 UI - 86209626 AU - Murphy MN ; Alguacil-Garcia A ; MacDonald RG TI - Primary amyloidosis of renal pelvis with duplicate collecting system. AB - A case of primary amyloidosis localized to the inferior renal pelvis of a kidney with a duplex collecting system is described. The onset of gross hematuria and mild flank pain necessitated investigations which yielded a clinical impression of tumor within the lower pelvis of a duplex collecting system. At laparotomy a grossly hemorrhagic-appearing mass in the lower pelvis was noted and a left ureteronephrectomy was undertaken. Histologic examination of the surgical specimen revealed amyloid deposition within the inferior pelvis, the corresponding distal portions of the papillae, and the most proximal ureter. Amyloid was not present elsewhere within either the renal parenchyma or the superior collecting system. MH - Aged ; Amyloidosis/COMPLICATIONS/*PATHOLOGY ; Case Report ; Female ; Human ; Kidney Diseases/COMPLICATIONS/*PATHOLOGY ; *Kidney Pelvis ; Kidney Tubules/*ABNORMALITIES ; Kidney Tubules, Collecting/*ABNORMALITIES/RADIOGRAPHY SO - Urology 1986 May;27(5):470-3 31 UI - 86209132 AU - Kimura I ; Sekino H ; Ayyar DR ; Kimura N ; Saso S ; Makino M TI - Carpal tunnel syndrome in patients on long-term hemodialysis. AB - Sixteen cases with carpal tunnel syndrome (CTS) were reported out of 412 patients on long-term hemodialysis due to chronic renal failure. Clinical symptoms included numbness in the area innervated by the median nerve in 100% of symptomatic hands and pain in the wrist and hand in 81%. This pain usually became severer at night and during hemodialysis. Muscle atrophy was noted in 41% of the hands. Nerve conduction studies revealed prolonged distal sensory latency, slowed sensory nerve conduction velocity across the wrist and normal distal motor latency in 18%, prolonged distal motor latency in 51% and no response in motor or sensory stimulation in 31%. Evidence of denervation on electromyography was seen in 36% of the hands. Patients were conservatively treated avoiding daily activities precipitating the condition with volar wrist splint only at night in 18% and in 90% with steroid hormone injection in the carpal tunnel. Median nerve release was performed in 18% of the hands. Amyloid deposit was demonstrated in 3 of 4 operated hands. Although the relation between long-term hemodialysis and the occurrence of the amyloid deposition in the carpal tunnel has not been established, the present data along with other recent reports strongly indicate that amyloid deposit in the carpal tunnel on hemodialysis patients could be one of the most possible cause of CTS. MH - Action Potentials ; Adult ; Aged ; Amyloidosis/COMPLICATIONS/ PATHOLOGY ; Arteriovenous Shunt, Surgical/ADVERSE EFFECTS ; Carpal Tunnel Syndrome/DIAGNOSIS/*ETIOLOGY/THERAPY ; Female ; Hemodialysis/*ADVERSE EFFECTS ; Human ; Kidney Failure, Chronic/ THERAPY ; Male ; Middle Age ; Neural Conduction ; Steroids/ THERAPEUTIC USE ; Time Factors SO - Tohoku J Exp Med 1986 Mar;148(3):257-66 32 UI - 86208390 AU - Eisner SB ; Mitnick PD TI - Hypercalcemia and reversible renal failure in heavy-chain disease. AB - We have reported a case of gamma heavy-chain disease associated with hypercalcemia and reversible renal failure. After combined chemotherapy the patient remains well after 21 months of follow-up, and serum calcium levels remain in the normal range. This case supports the notion of Kyle et al that heavy-chain disease may present a diverse picture, and documents the first use of aggressive combination chemotherapy in the management of associated moderately severe hypercalcemia and hypercalcemic renal failure. MH - Aged ; Calcium/BLOOD ; Case Report ; Cyclophosphamide/ ADMINISTRATION & DOSAGE ; Diagnosis, Differential ; Drug Therapy, Combination ; Heavy Chain Disease/*COMPLICATIONS/DIAGNOSIS ; Human ; Hypercalcemia/DRUG THERAPY/*ETIOLOGY ; Immunoglobulins, Gamma Chain/ANALYSIS ; Kidney Diseases/DRUG THERAPY ; Kidney Failure, Acute/*ETIOLOGY ; Male ; Melanoma/DIAGNOSIS ; Prednisone/ ADMINISTRATION & DOSAGE ; Time Factors ; Vincristine/ ADMINISTRATION & DOSAGE SO - South Med J 1986 Apr;79(4):507-9 33 UI - 86205559 AU - Yaginuma N ; Takahashi T ; Saito K ; Kyoguku M TI - The microvasculature of the human pancreas and its relation to Langerhans islets and lobules. AB - The 3-D relation between the lobules, terminal blood vessels and Langerhans islets of human pancreas was established by graphic reconstruction from serial histologic sections. The material included three pancreases obtained at autopsy. It was found that the lobule is an assembly of sublobular parenchymal units which have a terminal arteriole at the center. These, being considered to be an elemental structure of microcirculation, were named the "primary lobule: of the pancreas. The concept was also supported by the 3-D analysis of a pancreas "pseudolobulated: due to chronic venous congestion, in which "primary lobules: were clearly demarcated by atrophic zones distributed along the periphery of circulation. Four types of terminal arterioles were discriminated: 1) those terminating at an islet, 2) those having no relation with islet, 3) those with islets dispersed near the ending and 4) those coming directly from an interlobular artery. More than half the endings were found to belong to either Type 2 or 3, which was quite different from the traditional assumption of complete arterio-insular correlation. Consequently, islets could also be classified according to whether or not having an afferent arteriole, namely, into "arterial: and "non-arterial: islets. The "arterial: islets amounted to 75% in the total islet volume, although in islet number, the "non-arterial: ones accounted for as much as 72.5%. Thus, at least in man, functional correlation between islets and exocrine gland is not so tight as claimed by the insulo-acinar axis theory. MH - Adult ; Aortic Valve Stenosis/PATHOLOGY ; Arteries/PATHOLOGY ; Arterioles/PATHOLOGY ; Capillaries/PATHOLOGY ; Case Report ; Glomerulonephritis/PATHOLOGY ; Human ; Islands of Langerhans/ *BLOOD SUPPLY ; Male ; Middle Age ; Multiple Myeloma/PATHOLOGY ; Pancreas/*BLOOD SUPPLY/PATHOLOGY ; Veins/PATHOLOGY SO - Pathol Res Pract 1986 Mar;181(1):77-84 34 UI - 86203766 AU - DiRaimondo CR ; Casey TT ; DiRaimondo CV ; Stone WJ TI - Pathologic fractures associated with idiopathic amyloidosis of bone in chronic hemodialysis patients. AB - Amyloid bone lesions were found in 2 chronic hemodialysis patients presenting with pathologic hip fractures. These amyloid deposits were noted as lytic defects on plain skeletal radiographs. No evidence for disseminated amyloidosis was discovered on physical examination, skin biopsy, or bone marrow biopsy. Myeloma, other plasma cell dyscrasia, and preceding chronic inflammatory states were not found in either patient. The amyloid deposits had staining characteristics suggestive of secondary amyloid based on the potassium permanganate reaction. Isolated amyloid bone deposits should be included in the differential diagnosis of lytic bone lesions or pathologic fractures in chronic dialysis patients. MH - Aged ; Amyloidosis/COMPLICATIONS/*PATHOLOGY ; Bone Diseases/ *ETIOLOGY ; Case Report ; Femoral Neck Fractures/*COMPLICATIONS ; Fractures, Spontaneous/COMPLICATIONS ; *Hemodialysis ; Human ; Kidney Failure, Chronic/COMPLICATIONS/THERAPY ; Male ; Middle Age ; Potassium Permanganate/DIAGNOSTIC USE SO - Nephron 1986;43(1):22-7 35 UI - 86191742 AU - Lowdell CP ; Shousha S ; Parkins RA TI - The incidence of amyloidosis complicating inflammatory bowel disease. A prospective survey of 177 patients. AB - Three cases of secondary amyloidosis are reported, two in patients who had unequivocal Crohn's disease and one in whom the clinical course was that of Crohn's disease, but with histologic findings that were more suggestive of ulcerative colitis. All had evidence of renal failure. A prospective study of 177 patients with inflammatory bowel disease of greater than five years' duration was carried out in an attempt to establish the incidence of secondary amyloidosis, using rectal biopsy and simple renal function tests. No new cases were found. Neither was there evidence of renal failure due to other conditions. In the absence of renal dysfunction, a search for secondary amyloidosis probably is not justified. MH - Adult ; Aged ; Amyloidosis/*ETIOLOGY/OCCURRENCE ; Case Report ; Colitis, Ulcerative/*COMPLICATIONS ; Comparative Study ; Crohn Disease/*COMPLICATIONS ; Female ; Human ; Kidney Failure, Chronic/ ETIOLOGY ; Male ; Middle Age ; Prospective Studies SO - Dis Colon Rectum 1986 May;29(5):351-4 36 UI - 86179706 AU - Warlow RS TI - Subsets of autoantibodies to extractable nuclear antigens (ENA) as assayed by ELISA correlate with specific clinical abnormalities in SLE. AB - A clinicopathological study of antinuclear antibodies was performed in 43 patients with SLE. Autoantibodies to double-stranded DNA, measured by RIA, were found in 56% of subjects and were associated with the presence of mesangioproliferative glomerulonephritis, Raynaud's phenomenon and cryoglobulinaemia. Antibodies to extractable nuclear antigens (ENA), when assayed by ELISA, were found in 81% of subjects and were associated with photosensitivity and thrombocytopaenia. Antibodies to RNA-ase-resistant ENA were found in 42% and were associated with cryoglobulinaemia and sclerodactyly, while antibodies to RNA-ase sensitive ENA which had a 49% prevalence were associated with haemolysis and neutropaenia. RNP antibodies (detected by immunodiffusion in 40%) were also associated with photosensitivity. RNP antibody positive and negative sera differed from each other by virtue of their relationship with other autoantibodies, and because RNP-positive sera had significantly higher ENA antibody titres and affinities than did RNP-negative sera. We therefore concluded that various combinations of antinuclear antibodies may predispose to the development of specific clinicopathological lesions in SLE. MH - Adolescence ; Adult ; Autoantibodies/*ANALYSIS ; Cryoglobulinemia/ IMMUNOLOGY ; DNA/IMMUNOLOGY ; Enzyme-Linked Immunosorbent Assay/ METHODS ; Female ; Gel Diffusion Tests ; Glomerulonephritis/ IMMUNOLOGY ; Human ; Lupus Erythematosus, Systemic/COMPLICATIONS/ *IMMUNOLOGY ; Male ; Middle Age ; Nucleoproteins/*IMMUNOLOGY ; Photosensitivity Disorders/IMMUNOLOGY ; Raynaud's Disease/ IMMUNOLOGY ; Rheumatoid Factor/ANALYSIS ; RNA/IMMUNOLOGY ; Support, Non-U.S. Gov't ; Thrombocytopenia/IMMUNOLOGY SO - Scand J Rheumatol 1986;15(1):57-67 37 UI - 86174926 AU - Zemer D ; Pras M ; Sohar E ; Modan M ; Cabili S ; Gafni J TI - Colchicine in the prevention and treatment of the amyloidosis of familial Mediterranean fever. AB - To determine whether colchicine prevents or ameliorates amyloidosis in patients with familial Mediterranean fever, we followed 1070 patients with the latter disease for 4 to 11 years after they were advised to take colchicine to prevent febrile attacks. Overall, at the end of the study, the prevalence of nephropathy was one third of that in a study conducted before colchicine was used to treat familial Mediterranean fever. Among 960 patients who initially had no evidence of amyloidosis, proteinuria appeared in 4 who adhered to the prophylactic schedule and in 16 of 54 who admitted non-compliance. Life-table analysis showed that the cumulative rate of proteinuria was 1.7 percent (90 percent confidence limits, 0.0 and 11.3 percent) after 11 years in the compliant patients and 48.9 percent (18.8 and 79.0 percent) after 9 years in the noncompliant patients (P less than 0.0001). A total of 110 patients had overt nephropathy when they started to take colchicine. Among 86 patients who had proteinuria but not the nephrotic syndrome, proteinuria resolved in 5 and stabilized in 68 (for more than eight years in 40). Renal function deteriorated in 13 of the patients with proteinuria and in all of the 24 patients with the nephrotic syndrome or uremia. We conclude that colchicine prevented amyloidosis in our high-risk population and that it can prevent additional deterioration of renal function in patients with amyloidosis who have proteinuria but not the nephrotic syndrome. MH - Actuarial Analysis ; Adult ; Amyloidosis/DRUG THERAPY/*PREVENTION & CONTROL ; Clinical Trials ; Colchicine/*THERAPEUTIC USE ; Follow-Up Studies ; Human ; Kidney Diseases/OCCURRENCE/PREVENTION & CONTROL ; Middle Age ; Nephrotic Syndrome/OCCURRENCE/PREVENTION & CONTROL ; Patient Compliance ; Periodic Disease/*COMPLICATIONS ; Proteinuria/OCCURRENCE/PREVENTION & CONTROL ; Support, Non-U.S. Gov't SO - N Engl J Med 1986 Apr 17;314(16):1001-5 38 UI - 86163371 AU - Colyer RA TI - Surgical stabilization of pathological neoplastic fractures. AB - The most important factor to consider in deciding between treatment options in the management of metastatic bone disease is the level of the patient's dysfunction and pain. Severe dysfunction or pain demands a treatment that predictably leads to a quick resumption of the painless activities of daily living. A treatment that predictably will restore function in months may seem reasonable in patients with a normal remaining life span, but is untenable if those months represent a high percentage of remaining life span, as they do in metastatic disease afflicted patients. The treating physician needs also to understand the basis for the patient's dysfunction. A destroyed joint will not return to painless function even if the metastasis responsible is totally eliminated. A bone that has lost its structural integrity, even though not grossly fractured, will not support weight bearing for months even if the metastasis is eliminated. Control of the metastatic tumor does not always equate with return to function. Treatment options in the management of metastatic bone disease are not mutually exclusive. In many patients treatment options are combined. Surgical stabilization may best return the patient's function while he is being treated postoperatively with radiotherapy or chemotherapy for good neoplasm control. Neoplasm control should not be such an overriding concern that function is not addressed. Function can almost always be returned to the patient, but neoplasm "cure: is rarely achieved in this group of patients. It is a reasonable goal to avoid allowing bone metastasis to progress to pathological fracture. Routine periodic examinations and bone scans should commonly alert the treating physician to the presence of metastatic bone disease well before fracture occurs. Pathological fracture narrows the range of treatment options, mitigates against full functional restoration, demands a rehabilitation hiatus, and acutely frightens the patient who does not have time to participate fully in treatment decisions. An impending pathological fracture can be treated with surgery, radiotherapy, chemotherapy, or hormonal manipulation. The options are basically operative or nonoperative. Lesions that predictably will fracture short term, involve joints, or will cause catastrophic consequences if fracture occurs should be strongly considered for surgical stabilization. Other factors to consider are the location of the metastasis, the primary tumor, and the expected response to nonoperative therapy. The patient becomes a surgical candidate for the above reasons and not because of any estimated life span.(ABSTRACT TRUNCATED AT 400 WORDS) MH - Adolescence ; Adult ; Aged ; Bone Neoplasms/*COMPLICATIONS/ RADIOGRAPHY/SECONDARY/THERAPY ; Breast Neoplasms ; Carcinoma, Renal Cell ; Case Report ; Female ; Femoral Fractures/ETIOLOGY/ SURGERY ; *Fracture Fixation ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous/ ETIOLOGY/RADIOGRAPHY/*SURGERY ; Hip Fractures/ETIOLOGY/SURGERY ; Human ; Humeral Fractures/ETIOLOGY/SURGERY ; Kidney Neoplasms ; Lung Neoplasms ; Male ; Middle Age ; Multiple Myeloma ; Prostatic Neoplasms ; Review ; Spinal Injuries/ETIOLOGY/SURGERY ; Tibial Fractures/ETIOLOGY/SURGERY SO - Curr Probl Cancer 1986 Mar;10(3):117-68 39 UI - 86158919 AU - Fam AG ; Rubenstein JD ; Cowan DH TI - POEMS syndrome. Study of a patient with proteinuria, microangiopathic glomerulopathy, and renal enlargement. AB - We studied a patient with POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal [M]-protein, skin changes) who was also found to have renal enlargement and microangiopathic glomerulopathy. The latter finding is unusual in POEMS syndrome patients, and the associated symptoms can lead to confusion in diagnosis. We emphasize the importance of considering POEMS syndrome in the differential diagnosis of patients who have unexplained neuropathy, scleroderma-like skin changes, and/or monoclonal gammopathy. MH - Adult ; Case Report ; Connective Tissue Diseases/DIAGNOSIS ; Diagnosis, Differential ; Human ; Kidney Diseases/*COMPLICATIONS ; Kidney Glomerulus/BLOOD SUPPLY/*PATHOLOGY ; Male ; Microcirculation ; Multiple Myeloma/COMPLICATIONS/DIAGNOSIS ; Osteosclerosis/COMPLICATIONS/DIAGNOSIS ; Paraproteinemias/ *COMPLICATIONS/DIAGNOSIS ; Polyneuritis/COMPLICATIONS/DIAGNOSIS ; Proteinuria/*COMPLICATIONS/DIAGNOSIS ; Sacrum ; Scleroderma, Systemic/DIAGNOSIS ; Syndrome SO - Arthritis Rheum 1986 Feb;29(2):233-41 40 UI - 86151409 AU - Gavarotti P ; Fortina F ; Costa D ; Verzetti G ; Redoglia V ; Boccadoro M TI - Benign monoclonal gammopathy presenting with severe renal failure. AB - A patient with monoclonal gammopathy and renal failure due to kappa light chain deposition in the glomerular basement membrane is reported. After 8 months, he developed a progressive and severe renal failure requiring haemodialysis. 30 months later, the monoclonal gammopathy was unchanged. Clinical features, as well as kinetic and immunological studies, were consistent with a diagnosis of benign monoclonal gammopathy (BMG). This case suggests that the renal failure complicating a monoclonal gammopathy is not related to its malignancy. MH - Adult ; Basement Membrane/IMMUNOLOGY ; Case Report ; Fluorescent Antibody Technic ; Human ; Hypergammaglobulinemia/*COMPLICATIONS ; *Immunoglobulins, Kappa Chain/ANALYSIS/URINE ; Kidney Failure, Chronic/*IMMUNOLOGY ; Kidney Glomerulus/IMMUNOLOGY ; Kinetics ; Male ; Monoclonal Gammopathies, Benign/*COMPLICATIONS ; Plasma Cells/IMMUNOLOGY ; Support, Non-U.S. Gov't SO - Scand J Haematol 1986 Jan;36(1):115-7 41 UI - 86118945 AU - Helin H ; Korpela M ; Mustonen J ; Pasternack A TI - Mild mesangial glomerulopathy--a frequent finding in rheumatoid arthritis patients with hematuria or proteinuria. AB - Renal biopsy specimens from 39 patients with rheumatoid arthritis and clinical signs of renal disease disclosed a mild mesangial glomerulopathy in more than 1 in 4 cases. Almost all patients had deposits of immunoglobulin and complement in the mesangial lesions. This type of glomerulopathy was the most common cause of hematuria and was also frequently encountered in proteinuric patients. Clinically it was not possible to distinguish between mesangial and membranous nephropathy. MH - Adult ; Aged ; Amyloidosis/COMPLICATIONS/PATHOLOGY ; Arthritis, Rheumatoid/*COMPLICATIONS ; Female ; Glomerular Mesangium/ PATHOLOGY ; Glomerulonephritis/*COMPLICATIONS/PATHOLOGY ; Glomerulonephritis, IGA/COMPLICATIONS/PATHOLOGY ; Hematuria/ *ETIOLOGY ; Human ; Male ; Microscopy, Fluorescence ; Middle Age ; Proteinuria/*ETIOLOGY ; Support, Non-U.S. Gov't SO - Nephron 1986;42(3):224-30 42 UI - 86100544 AU - Palant CE ; Bonitati J ; Bartholomew WR ; Brentjens JR ; Walshe JJ ; Bentzel CJ TI - Nodular glomerulosclerosis associated with multiple myeloma. Role of light chain isoelectric point. AB - A 68-year-old female patient with multiple myeloma exhibited advanced nodular glomerulosclerosis. Immunofluorescence of the kidney showed kappa light chain deposition in the mesangium and in glomerular and tubular basement membrane. Isoelectric focusing and immunofixation of urinary proteins revealed an isolated kappa light chain with an unusually high isoelectric point of 8.4. Most light chain proteins have isoelectric points in the 4.6 to 6.7 range. Since loss of fixed negative charges may precede experimental glomerulosclerosis, it is proposed that this cationic circulating kappa chain may have interacted with glomerular polyanion, thereby inducing a nodular sclerotic reaction leading to irreversible renal damage. MH - Aged ; Case Report ; Female ; Fluorescent Antibody Technic ; Glomerulonephritis/*ETIOLOGY ; Glomerulosclerosis, Focal/ *ETIOLOGY/IMMUNOLOGY/PATHOLOGY ; Human ; Immunoglobulins, Kappa Chain/*ANALYSIS/IMMUNOLOGY ; Isoelectric Focusing ; Isoelectric Point ; Kidney Glomerulus/*IMMUNOLOGY/PATHOLOGY ; Microscopy, Electron ; Multiple Myeloma/*COMPLICATIONS/IMMUNOLOGY/PATHOLOGY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. SO - Am J Med 1986 Jan;80(1):98-102 43 UI - 86090058 AU - Pour PM ; Birt DF TI - Effect of dietary protein on N-nitrosobis(2-oxopropyl)amine-induced carcinogenesis and on spontaneous diseases in Syrian golden hamsters. AB - For assessment of the effect of dietary protein on spontaneous diseases and on the carcinogenicity of N-nitrosobis(2-oxopropyl)amine [(BOP) CAS: 60599-38-4], Syrian golden hamsters were fed either low protein (LP; 9% casein), medium protein (MP; 18% casein), or high protein (HP; 36% casein) in a diet containing a medium fat (corn oil) level. The experimental design permitted distinguishing between the effects of protein levels on initiation and development of various lesions in hamsters, in comparison with a control group that was given MP diet for life. When fed after BOP treatment, HP diet inhibited, among induced tumors, pulmonary adenomas in males. Among spontaneous diseases, LP diet fed before 8 weeks of age enhanced colitis in both males and females, renal and adrenal gland amyloidosis in males, and gastric vascular calcinosis in males but inhibited liver abscesses and liver cysts in both males and females. When fed after 8 weeks of age, LP diet enhanced gastric and renal vascular calcification and parathyroid gland adenomas in both sexes but inhibited hepatic, renal, and adrenal gland amyloidosis in females and liver abscesses and liver cysts in both males and females. The feeding of HP diet before 8 weeks of age enhanced the development of colitis and adrenal gland lipomatosis in both males and females but inhibited the development of adrenal gland amyloidosis and adrenal cortical cell hyperplasia in males. When fed to hamsters after 8 weeks of age, HP diet increased the incidence of adrenal gland amyloidosis in females and colitis in both males and females but reduced the frequency of liver cysts in both males and females and of adrenal cortical cell hyperplasia in males. The overall data and literature review indicate that the effect of dietary protein on tumorigenesis is tissue, sex, species, and strain related. MH - Amyloidosis/ETIOLOGY ; Animal ; Calcinosis/ETIOLOGY ; *Carcinogens ; Dietary Proteins/ADMINISTRATION & DOSAGE/ *PHARMACODYNAMICS ; Female ; Hamsters ; Kidney Neoplasms/ CHEMICALLY INDUCED ; Lung Neoplasms/CHEMICALLY INDUCED ; Male ; Mesocricetus ; Neoplasms, Experimental/*CHEMICALLY INDUCED ; Nitrosamines/*TOXICITY ; Support, U.S. Gov't, P.H.S. ; Vascular Diseases/ETIOLOGY SO - JNCI 1986 Jan;76(1):67-72