Renal disease associated with HIV infection: a multicentric study of 60 patients from Paris hospitals

Sixty HIV-infected patients presenting renal symptoms who underwent percutaneous renal biopsies were analysed. According to the CDC classification, 44 patients were staged in group IV, five in group III, and 11 in group II. Patients were divided in two groups according to their ethnic origin (29 black patients and 31 white patients). Risk factors such as homosexuality, multiple transfusions or intravenous drug abuse (IVDA) were identified in all white patients except two, but in only nine (31%) of the black patients. Three main patterns of renal disease were observed: focal and segmental glomerulosclerosis (FSGS) was found predominantly in black patients (23 black patients versus 3 Caucasians, P < 0.001) and was associated with the nephrotic syndrome; immune-complex-type glomerulonephritis (ICGN) was frequent in black and white patients (21% and 52% respectively) including four cases of IgA nephritis all seen in white patients; and 10 cases of lupus-like nephritis (4 black and 6 white patients). The frequent hypergammaglobulinaemia in those patients suggests a pathogenic role of polyclonal B cell activation in ICGN. Interstitial nephritis was present in 48 and 52% of the black and white patients respectively and did not seem related to drug toxicity or superimposed infectious disease. In addition to interstitial nephritis, the coexistence of multivisceral lymphocytic infiltration involving accessory salivary glands, liver and/or lung, found in six patients possibly suggests a virus-induced immune disorder.

[Beneficial effects of perfusion of atrial natriuretic factor in acute post-ischemic renal insufficiency in the rat]

Owing to its capacity of increasing glomerular filtration, potential beneficial effects of atrial natriuretic factor (ANF) were assessed during a post ischemic acute renal insufficiency in rats. Renal insufficiency was obtained by clamping the renal artery during 30 min., and by performing a reperfusion during 2 hours in uninephrectomized rats. Three groups were defined: a control group where animals were submitted to an operation procedure without renal artery clamping, a control group were animals received a physiological serum perfusion (1.5 ml/h) during the renal reperfusion time and an experimental group where animals were administrated a rat 1-28 ANF perfusion (5 microns/ml in NaCl 0.9%, 1.5 ml/hour) during the reperfusion time. Insulin clearance (1.0 + 0.05 ml/h vs 0.7 + 0.05 ml/h, p < 0.01), and diuresis (32.9 +/- 3.6 microliters/min. vs 7.5 +/- 0.23 microliters/min., p < 0.01) were significantly higher in rats which were administrated a NaCl 0.9% perfusion. Histologically, a significant decrease in kidney weight and in he percentage of diseases nephrons was observed after reperfusion in ANF treated rats. The results obtained demonstrate that ANF perfusion in case of post ischemic acute renal insufficiency in rats improves the recovery of renal function and reduces the renal histologic lesions.

Allograft-induced arterial wall injury and response in normotensive and spontaneously hypertensive rats

The role of genetically determined immune attack and blood pressure in graft rejection-induced arterial wall injury and response was assessed by studying the compliance and changes in wall structure of aortic isografts and allografts in normotensive (Wistar-Kyoto [WKY]) and hypertensive (spontaneously hypertensive [SHR]) rats. Six groups of 8-week-old rats were compared: sham-operated in both strains, isografts, and allografts between the two strains (SHR aortas grafted in WKYs, designated SWs; WKY aortas grafted in SHRs, designated WSs; isografts in SHRs, designated SSs; and isografts in WKYs, designated WWs). Each arterial graft was studied 8 weeks after transplantation for volume and compliance (pressures of 75-175 mm Hg) under basal conditions. The amounts of collagen, elastin, and nuclei in the media and intima of the walls of control and grafted aortas were quantified morphometrically. Isografts and controls had the same mechanical characteristics under basal conditions: the arterial volume and arterial compliance of hypertensive rats were lower than those of normotensive rats (p less than 0.001). Allografts had a greater initial volume (p less than 0.001) and a lower compliance (p less than 0.001) than did isografts. Allografts in SHRs (SSs) were initially dilated, whereas allografted WKYs (WWs) were not. There was intimal proliferation in hypertensive isografts (14 +/- 0.77 microns) and in both types of allografts (WS, 69 +/- 1.55 microns; SW, 44 +/- 1.81 microns); nucleus density was higher in hypertensive allografts (WS) than in normotensive allografts (SW); and collagen density was also higher in SW than in WS allografts. Allografts had decreased medial thickness and decreased smooth muscle cell density.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent acute glomerulonephritis

Biopsy-proven recurrent acute glomerulonephritis (AGN) is extremely rare and is usually seen in children with acute, well-defined streptococcal infections. We present here a patient with recurrent AGN in the absence of chronic bacterial infection. The subject, an 80-year-old man, had eight episodes of acute nephritic syndrome following upper respiratory tract infection. No abnormalities were detected during remissions. Renal biopsies during two of those episodes showed typical postinfectious acute exsudative endocapillary glomerulonephritis, while results of another biopsy performed during remission were normal.

Wegener's granulomatosis presenting as diffuse pulmonary hemorrhage

A 35-year-old woman experienced diffuse intraalveolar haemorrhage with respiratory distress and acute renal failure. Renal histology and evolution confirmed Wegener's granulomatosis. Early use of immunosuppressive drugs allowed weaning from mechanical ventilation and temporary improvement of the renal failure. A review of the literature emphasizes the rarity of alveolar hemorrhage as an initial symptom of Wegener's granulomatosis and the necessity of aggressive management.

Experimental gold-induced autoimmunity

The pathogenesis of gold-induced autoimmunity and membranous glomerulopathy is not well understood. HgCl2 and D-penicillamine, other chemicals known to trigger membranous glomerulopathy in humans, induce autoimmune manifestations in Brown-Norway (BN) rats but not in Lewis (LEW) rats. These chemicals trigger T-cell clones which are specific for self class II molecules from the major histocompatibility complex and are probably responsible for the polyclonal B-cell activation observed. The aim of this work was to test the effects of aurothiopropanolsulphonate (ATPS) in BN and LEW rats. In BN rats, ATPS induced a polyclonal B-cell activation marked by lymphoproliferation, hyperimmunoglobulinaemia affecting mainly IgE, and by the production of numerous autoantibodies. A glomerulonephritis occurred, initially due to anti-glomerular basement membrane antibody deposition, and later to the formation of granular deposits, occasionally resulting in a typical membranous glomerulopathy. Self class-II-specific T-cells were found that might be responsible for the polyclonal B-cell activation. Lewis rats were free of glomerulopathy but, like BN rats, exhibited an interstitial nephritis and some degree of polyclonal B-cell activation. These findings demonstrate that, depending on the strain, ATPS triggers different B-cell clones inducing different degrees of autoimmunity.

Mesangial IgA deposits in two patients with AIDS-related complex

Two patients with AIDS-related complex who presented with renal failure and microscopic hematuria were found to have mesangial deposits of IgA at renal biopsy. Though such glomerular deposits have not yet been reported in patients with HIV infection, their occurrence is most likely not coincidental. Indeed, there are striking similar abnormalities in patients with primary IgA nephropathy and in those infected with HIV. A careful screening for microscopic hematuria may lead to disclose further cases of mesangial IgA deposits in patients with HIV infection.

Distinct phenotypic composition of diffuse interstitial and perivascular focal infiltrates in renal allografts: a morphometric analysis of cellular infiltration under conventional immunosuppressive therapy and under cyclosporine A

Phenotypic analysis of interstitial mononuclear cell infiltrates was undertaken in 40 transplant renal specimens obtained from 38 patients in order to assess the influence of immunosuppressive therapy. Thirteen patients were given conventional immunosuppressive treatment (azathioprine and prednisone) and the other 25 received cyclosporine. The immunostaining was performed using seven antileucocyte antibodies by alkaline phosphatase-anti-alkaline phosphatase method. Interstitial infiltrates were distributed in two patterns: diffuse infiltrates and periglomerular/perivascular aggregates. The phenotypic composition was distinct in these two patterns: in diffuse infiltrates, monocytes/macrophages (EBM 11) represented the predominant inflammatory cell and were associated with a minor component of T cells (T 11). In contrast, aggregates had a major T lymphocyte phenotype in addition with few foci of B cells. T4 subset of T lymphocytes always predominated over T8 subset. The repartition and the proportion of each cell type were not significantly different in rejecting and not rejecting grafts and were not affected by the immunosuppressive regimen.

Buerger's disease associated with IgA nephropathy: report of two cases

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HgC12 induces T and B cells to proliferate and differentiate in BN rats

Mercuric chloride induces in Brown-Norway (BN) rats an autoimmune disease characterized by the production of various autoantibodies and by a marked increase in the IgE serum concentration. This agent is responsible for a T dependent polyclonal activation of B cells, which is probably due to the emergence of autoreactive T cells. The aim of this study was to evaluate the effect of HgCl2 injections on lymphoid organs and on the serum concentration of the various Ig isotypes. HgCl2 induced (1) a lymphoproliferation in spleen and lymph nodes involving B and T helper cells while the number of T suppressor/cytotoxic cells was not modified, (2) an increase in the number of Ig containing cells resulting in a rise in all serum Ig isotypes, and (3) an early thymic atrophy probably immunologically mediated, which was not involved in the induction phase of the disease since adult thymectomy had no effect. These findings demonstrate that the polyclonal effect of HgCl2 is not isotype-restricted although the IgE response is predominantly affected and they support evidence for a major role for an excess of T help in the HgCl2-induced polyclonal activation of B cells. It was also observed that B cell areas are present in normal BN rat thymuses, the potential role of which in the induction of autoimmunity remains to be investigated.

Consequences of renal morphologic damage induced by inhibition of converting enzyme in rat renovascular hypertension

The consequences of morphologic changes in the kidney distal to a stenosis induced by chronic administration of a converting enzyme inhibitor were determined after induction of experimental renovascular hypertension in rats. The relationship between changes in morphology in the clipped kidney and diuresis, creatinine, and mortality was studied by converting a two-kidney, one-clip model into a one-kidney, one-clip model after 1 month of converting enzyme inhibition. The right renal artery was constricted with a clip of 0.2 mm diameter to increase blood pressure, the left kidney was left untouched. After 1 month, systolic blood pressure had increased to 173 +/- 27 mm Hg in the clipped animals (n = 47) compared with 139 +/- 8 mm Hg in sham-operated animals (n = 15; group 1). An inhibitor of angiotensin-converting enzyme, MK421 (2 mg/kg, po), or an equivalent volume of vehicle was then administered daily for 1 month. After treatment with the converting enzyme inhibitor, blood pressure (148 +/- 28 mm Hg) was virtually identical with that of a sham-operated, vehicle-treated control group (145 +/- 16 mm Hg, n = 15), and was significantly lower than that of untreated hypertensive rats (186 +/- 30 mm Hg, n = 17) (group 2). The weight of the left kidney was increased in the untreated hypertensive animals as compared with sham-operated controls (1260 +/- 168 mg for group 2 versus 1075 +/- 100 mg for group 1). After treatment with MK421, the weight of the contralateral kidney (1472 +/- 190 mg) was further increased. After 1 month of treatment with MK421 or vehicle, the unclipped left kidney was removed from all animals. The treated animals were then randomly divided into two groups: one in which treatment with MK421 was stopped (treated/untreated, n = 24; group 3) and a second in which the treatment was continued (treated/treated, n = 23; group 4). The ability of the rats to excrete a water load of 15 ml was then examined 12 hours after removal of the unclipped left kidney. In the two groups of treated rats, the urinary excretion of the water load was decreased and frequency of oliguria was increased as compared with controls and hypertensive untreated rats. Survival rates were affected by the treatment: 3 deaths occurred in the hypertensive untreated group 2, 10 in the treated/untreated group 3, and 12 in the treated/treated group 4. The majority of these deaths could be attributed to renal insufficiency.(ABSTRACT TRUNCATED AT 400 WORDS)

Enhanced glomerular procoagulant activity and fibrin deposition in rats with mercuric chloride-induced autoimmune nephritis

The mechanism involved in glomerular fibrin deposition was investigated during mercuric chloride (HgCl2)-induced autoimmune glomerulonephritis in the Brown Norway rat. To ascertain whether the local hemostatic system was activated secondarily to the immunological conflict, the ability of glomerular lysates to induce coagulation in vitro was assessed in treated and control rats. Glomerular procoagulant activity (PCA) of HgCl2-injected rats was measured on day 12 (latent phase of the disease), day 20 (acme), and days 32 and 42 (recovery phase) after the first mercury injection. PCA rose 3-fold (p less than 0.02) at day 20 and then almost returned to control values. Proteinuria, PCA, and the incidence of glomerular fibrin deposits peaked concomitantly at day 20. Glomerular PCA was characterized as thromboplastin. The number of Ia positive cells detected by monoclonal OX-6 antibody was not different from the control number at any phase of the disease; the number of macrophages per glomerular section detected by electron microscopy at day 20 in HgCl2-injected rats was 1.80 +/- 0.60, versus 0.30 +/- 0.11 in the controls. No correlation was found between glomerular PCA and either the number of monocytes/macrophages or of Ia-positive cells present in the glomeruli. Since glomerular PCA was maximal at the onset of fibrin formation in the glomeruli and then decreased toward its basal level, and since the fibrin disappeared, it is concluded that increased production of thromboplastin by glomeruli, with activation of the extrinsic coagulation pathway, may contribute to intraglomerular fibrin deposition in HgCl2-induced glomerulonephritis.

Glomerulonephritis, B monoclonal small lymphocytic lymphoma and mixed cryoglobulinemia

A novel association in the same patient with small lymphocytic lymphoma, type II cryoglobulinemia and glomerulonephritis is reported. This case is also characterized by a quite unusual sequence of glomerular alterations. A first renal biopsy showed severe endocapillary proliferative glomerulonephritis due to monocytic infiltration without any evidence of deposition of immune reactants. The immune deposits associated with type II cryoglobulinemia were only observed at a second renal biopsy performed five months later. This case shows that mononuclear cells can be responsible in and of themselves for severe glomerular damage, without deposition of immune material, and suggests that monocytic infiltration might be the first stage of type II cryoglobulinemia associated glomerulonephritis.

In vitro myotrophic effect of serum kappa chain immunoglobulins from a patient with kappa light chain myeloma and muscular hypertrophy

Muscle hypertrophy due to enlarged muscle fibers was accompanied by kappa light chain myeloma in a 62-yr-old man. Immunofluorescence showed kappa light chain deposits around muscle fibers. We hypothesized that a circulating growth factor may be involved in the pathogeny of this muscular hypertrophy. Patient serum cultured with muscle cells showed that (a) the patient's serum exhibited a trophic effect on human muscle cells in culture, (b) this trophic effect increased the differentiation and did not influence the proliferation of human muscle cells, and (c) the fraction of the patient's serum immunoadsorbed on antihuman kappa chain antibodies exhibited the same in vitro effect on the muscle cells, whereas the fraction immunoadsorbed on antihuman lambda chain antibodies did not. These results support the hypothesis that the patient's kappa light chains have a specific enhancing effect on human muscle cell differentiation, perhaps leading to an acquired muscular hypertrophy.

Effects of antihypertensive treatment in one-clip, two kidney hypertension in rats

In order to investigate the consequences of antihypertensive therapy on hormonal and renal parameters in one-clip, two kidney renovascular hypertension, we compared the effects of converting enzyme inhibition (CEI) with those of tripletherapy (clonidine, dihydralazine and furosemide) in this experimental model in rats. The treatment period was initiated four weeks after application of the clip and was continued for five weeks. In plasma, renin was increased and renin substrate was negatively correlated to plasma renin. Hypertension was associated with activation of the renin angiotensin system in both plasma and kidney. The degree of activation of the renin-angiotensin system in the clipped kidney and its suppression in the unclipped kidney was evaluated by two methods, renal renin content and semi-quantification of juxtaglomerular hyperplasia by immunofluorescent renin. These two methods were correlated. During the treatment period, average systolic blood pressure was 144 +/- 13 mmHg in the CEI treated group (HT1) which was not significantly different from the value found in the sham-operated group (139 +/- 4 mmHg; C2). Blood pressure, however, was lowered only to 173 +/- 18 mmHg in the group treated with tripletherapy (HT2). In control hypertensive animals, the wt of the clipped kidney did not decrease whereas significant hypertrophy was present in the unclipped kidney. Tripletherapy did not alter this relationship, whereas converting enzyme inhibition decreased kidney wt in the clipped kidney and increased further the hypertrophy of the contralateral unclipped kidney. A histological examination revealed that hypertensive microangiopathy was a predominant feature in the unclipped kidney of the untreated hypertensive group and of the group treated with tripletherapy, these lesions were completely absent in the CEI treated group. In the CEI treated group, however, ischemic lesions during this treatment were found to be decreased in the contralateral unclipped kidney and increased in the clipped kidney by comparison with untreated hypertensive rats. These renal lesions observed in the clipped kidney were most likely related to the normalization of blood pressure or to a disturbance of intrarenal mechanisms normally mediated by the renin-angiotensin system during stenosis of a renal artery.

De novo focal glomerular sclerosis in preeclampsia

Eleven women were selected on the presence, in postpartum renal biopsies, of focal glomerulosclerosis (FGS) superimposed to glomerular lesions of typical pregnancy-induced nephropathy. Ten out of them presented with severe preeclampsia. The renal specimens were examined by light and/or electron and/or immunofluorescence microscopy. The present study gathered clinical and morphological data suggesting that FGS might develop during preeclampsia. In these renal biopsies with FGS and lesions of pregnancy-induced nephropathy a sparse detachment of podocyte was observed at a distance from the segmental lesions by electron microscopy. The latter has also been observed in experimental models of FGS in which FGS is dependent on glomerular hemodynamic alterations. We think that the mechanism of the development of FGS in these pathological pregnancies may be analogous to these experimental models of FGS with hyperfiltration.

Immunohistochemical demonstration of parietal epithelial cells and macrophages in human proliferative extra-capillary lesions

The cellular composition of crescents in diffuse crescentic glomerulonephritis is still controversial. Ten renal biopsies were studied on serial sections by using antikeratin antibodies as specific markers of epithelial cells of Bowman's capsule and both anti-macrophage and anti-lymphocyte antibodies. Semiautomatic morphometry showed that cellular crescents consisted of epithelial cells of Bowman's capsule (24-61%), of macrophages (19-34%) and of unlabelled cells (12-53%). In each biopsy, parietal epithelial cells outnumbered macrophages within crescents.

Association light chain deposition disease (LCDD) and amyloidosis. One case

Up to now, light chain deposition disease (L.C.D.D.) and amyloidosis have been shown to occur in different individuals. A case of association is described in a 76 year old man with terminal renal failure and normal size kidneys. Percutaneous renal biopsy showed glomerular and peritubular fixation of labeled antikappa light chain serum. Stains for amyloidosis were positive in small vessels. Kappa free chains were found in both serum and urine and the bone marrow showed predominantly kappa-containing plasma cells. By electron microscopy both electron-dense granular deposits and amyloid like fibrils were found in the wall of arterioles and small arteries.

Association of systemic light-chain deposition disease and amyloidosis: a report of three patients with renal involvement

Three patients with renal involvement, plasma cell dyscrasia and systemic light chain deposition are reported in whom well characterized amyloid deposits were also found in the vessel walls. This association, not yet reported, is probably more frequent than believed and still brings nearer these two manifestations of monoclonal light chain deposition. Whether or not the finding of amyloid deposits during systemic light chain deposition is a separate entity and modifies the prognosis remains to be answered.

Glomerular matrix proteins in nodular glomerulosclerosis in association with light chain deposition disease and diabetes mellitus

The diagnosis of light chain deposition nephropathy is based on the immunohistochemical demonstration of monoclonal light chain deposits within connective tissue matrix and on the presence at the ultrastructural level of electron-dense granular deposits along glomerular and tubular basement membranes. A nodular glomerulopathy characterized by amorphous periodic acid-Schiff-positive and argyrophilic widened mesangium and nodules is described in three patients with light chain deposition nephropathy. Light microscopic examination did not allow discrimination between the glomerular changes found in these specimens and the nodular glomerulosclerosis described in four patients with well-documented diabetes mellitus. Electron microscopic examination revealed microtubular fibrils 10 to 12 nm thick in mesangial areas in both groups. Such microfibrils could be glycoproteins. Immunofluorescence localization of matrix proteins, by staining with affinity-purified antibodies to types I, III, IV, and V (A, B) collagens, fibronectin, laminin, and heparan sulfate-containing proteoglycans, showed similar distributions in the two conditions. The mechanism of this abnormal accumulation of mesangial and glomerular basement membrane matrix proteins in two different conditions remains unknown.

[Light chain deposit disease: an anatomopathological entity]

The light chain deposition disease was recently identified as a systemic clinicopathological entity characterized by amorphous extracellular deposits which differ from the amyloid substance. Various organs may be involved, notably the kidney, the liver, the myocardium and the skin. The histopathological aspects were investigated in 3 cases. By immunofluorescence using frozen sections the deposits were shown to contain monoclonal light kappa or lambda chains. By electron microscopy they appeared to be granular and usually located close to epithelial and/or vascular basal lamina. There was in every case a monoclonal lymphoplasmacytoid proliferation. In one case amyloid deposits were associated in small vessels. In another one, follow-up study after chemotherapy showed improvement of hepatomegaly, stabilization of renal function, and regression of light chain deposits in skin biopsy specimens.

Accumulation of several basement membrane proteins in glomeruli of patients with preeclampsia and other hypertensive syndromes of pregnancy. Possible role of renal prostaglandins and fibronectin

The glomerular lesions of preeclampsia consist of swelling of endothelial cells, interposition of mesangial cells and matrix between the endothelial cells and the glomerular basement membrane, and organization of subendothelial deposits of incompletely characterized material. Fibrin and immunoglobulins have previously been localized to these deposits. Laminin, a large basement membrane glycoprotein, type IV collagen, fibronectin, and a basement membrane proteoglycan were found in moderate amounts in the mesangium and prominently in the thickened glomerular capillary walls of patients with preeclampsia or other hypertensive syndromes of pregnancy. Fibrin showed the same pattern of distribution as that of fibronectin. The material deposited in the subendothelial layer of the capillary loops thus consists not only of plasma-derived proteins but also structural components of the glomerular basement membrane and of the mesangial matrix. Type I collagen deposits were demonstrated only in mesangium of pregnant patients with chronic or recurrent hypertension. Glomerular epithelial and mesangial cells synthesize in vitro the basement membrane proteins that accumulate in glomeruli of pregnant hypertensive patients. We have tested the influence of some of the pathophysiologic changes occurring during preeclampsia on the biosynthesis of collagen by rat glomerular epithelial and mesangial cells. Addition of indomethacin to the cultures transiently inhibited the synthesis of prostaglandins (PGE2) and of collagen. Addition of exogenous fibronectin to the media stimulated the production of collagen by mesangial and epithelial cells. Alterations in the metabolism of prostaglandins and the increased deposition of fibronectin observed during preeclampsia could thus play a pathogenic role in the accumulation of basement membrane proteins in glomeruli of these patients.

Abnormalities of renin-containing cells in human glomerular and vascular renal diseases

The distribution of renin was investigated by immunofluorescence in human kidney biopsy specimens (27 patients with lipoid nephrosis, 39 with Berger disease, 17 with membranous glomerulonephritis, 5 with thrombotic microangiopathy, and 7 with malignant nephroangiosclerosis). A semiquantitative assessment was carried out. Two ratios were found significatively increased in the study groups as compared with the control group: JGA + and JGA ++ which expressed, respectively, the number of fluorescent JGA in relation to the number of glomerular sections and the number of fluorescent JGA with more than six renin-containing cells (RCC) in relation to the number of immunoreactive JGA. Highest values were observed in patients with thrombotic microangiopathy and malignant nephroangiosclerosis (P less than 0.001). The above immunomorphological parameters were correlated with clinical and laboratory data. A positive dependency was found between JGA + and JGA ++ ratios and a low sodium diet, diuretic therapy and serum creatinine. A negative dependency was seen in the albumin and hemoglobin serum levels. No correlation was found with blood pressure values. These observations suggested that decreased plasma volume and impaired renal function could be factors leading to an increased renin production in the kidney.

Immunohistochemistry of renin in human diseased kidney

The distribution of renin in human kidney was investigated by immunofluorescence and the peroxidase-antiperoxidase (PAP) procedure at the light and ultrastructural level. In three cases of juxtaglomerular renin-secreting tumors, renin was localized within the cytoplasm of tumor cells. In kidney biopsies, a semi-quantitative assessment was carried out, taking into account the size and the number of immunostained juxtaglomerular apparatuses. In 12 cases of ischemic kidneys and 8 cases of segmental renal hypoplasia, the increase in immunostaining for renin was striking in altered areas, while spared areas remained negative. In 2 cases of Bartter's syndrome, the pattern was similar to that found in ischemic kidneys. The study was extended to a series of 133 needle kidney biopsies from patients with various glomerular and vascular diseases; the immunomorphological parameters were correlated with serum creatinine levels but not with blood pressure values. Post-embedding immunoelectronmicroscopy using the PAP procedure performed on two of the cases of renin-secreting tumors, showed renin in all types of secretory granules.

Nephrotic syndrome, linear glomerular IgG deposits, and minimal glomerular changes. Report of a case

A young adult patient had an unusual acute idiopathic nephrotic syndrome. This nephrotic syndrome was remarkable for (1) association with acute renal failure and hypertension, (2) finding of minimal glomerular changes with a linear fixation of the anti-human IgG conjugate along the glomerular capillary wall without demonstrable antiglomerular basement membrane antibodies, and (3) complete recovery, including disappearance of the linear staining, after treatment with prednisone, cyclophosphamide, and plasmapheresis.

Renal lesions in the hypertensive syndromes of pregnancy: immunomorphological and ultrastructural studies in 114 cases

One hundred and fourteen women presenting during pregnancy with an abnormally high blood pressure and/or proteinuria had a renal biopsy usually on the 8th day following delivery. The pathological specimens were examined by light and/or electron and/or immunofluorescence microscopy. Forty-one cases were studied with all three techniques. The patients could be allocated to six groups on the basis of clinical criteria. The first two groups (52 patients) showed the typical clinical and pathological features of classical preeclampsia. The remaining 62 women (four groups) had isolated hypertension, and, of these, 42 had a renal pathological pattern similar to that of preeclampsia. These 42 patients also had persistent hyperuricemia. Thus in pregnancy, hypertension and persistently elevated uric acid levels are indicative of glomerular lesions of "pregnancy induced nephropathy".

[Glomerulopathies during hepatic disease (author's transl)]

Glomerular lesions essentially characterized by IgA deposits are very frequent in the course of alcoholic hepatopathies. Such glomerular lesions might be due to the deposition of the circulating immune complexes. Portal hypertension, by altering the epuration function of the liver could be one determining factor. The presence of similar glomerular lesions in other non alcoholic hepatopathies with portal hypertension and in experimental portal hypertension support such an hypothesis. In other circumstances where the liver disease is directly related to a viral or a parasitic agent glomerular lesion of the type seen in circulating immune complexes disease are also encountered. However in such a situation there is no evidence that the hepatic disease bears any influence on the renal disease.

Renal transplantation and viral infections. III. Clinical and virological correlations

Studies of the serological development after 26 renal transplants confirm the high frequency of antibody rises not only against the herpes virus group, but also against other virus groups such as measles, Coxsackie B viruses. These antibody rises correlate with febrile episodes and hepatic dysfunction in which CMV is the most often involved. However, the frequency of antibody rises against various viral antigens without any clinical event to suggest viral etiology; the lack of concomitant virus isolation (except the herpes group), as well as the ocurrence of simultaneous antibody rises against several viruses, all suggest that some of these various antibody rises observed may be related to immunological dysfunction rather than to virus infection.

Association of overt glomerulonephritis and liver disease: a study of 34 patients

Thirty-four patients with overt glomerulonephritis and chronic liver disease were studied. Kidney specimens were examined by light, electron and immunofluorescence microscopy. Plasma C3 levels were measured and a search for cryoglobulinemia was carried out in all patients. Twenty-six out of the thirty-four patients had an immune complex type glomerulonephritis (membrano-proliferative glomerulonephritis or glomerulosclerosis with mesangial deposits) suggestive of hepatic glomerulonephritis. The glomerular deposits almost always contained IgA and very frequently other immunoglobulins as well as C3. The membrano-proliferative glomerulonephritis was characterized by severe renal symptoms, mixed cryoglobulinemia and the frequent finding of low C3 levels. These data suggest that there is a linkage between liver disease and glomerulonephritis. The immunomorphological type of glomerulonephritis and the cryoglobulinemia are both suggestive of an immune complex disease. The lowering of the C3 levels could be due to activation of complement components by immune complexes, to hepatic hyposynthesis, or to a combination of the two.

["Pearl necklace" arteries in vascular nephropathy with acute renal insufficiency (author's transl)]

The authors study "pearl necklace" arteries (PNA) in vascular nephropathies with acute renal insufficiency. Seventeen patients underwent aortography complemented by selective angiography of the renal, superior mesenteric and coeliac arteries to seek renal and extra-renal lesions. PNA were discovered remarkably often (mesenteric branches and renal arteries above all). Three types of PNA are described. PNA do not occur in acute angitis (3 cases, 2 PAN). They almost invariably occur in ATN (7 cases) and may be seen in ASMN (7 cases), which eliminates any diagnostic value in the distinction of these two types of acute anuric vascular nephropathy. The functional nature of PNA is open to discussion, but it appears that in the long term histological changes and functional modifications in the involved areas may occur. The role of hypertension and vaso-active substances in the aetiology of PNA is discussed.