Nodular renal blastema, nephroblastomatosis, and Wilms' tumor. Different points on the same disease spectrum?

A case of nodular renal blastema developing into nephroblastomatosis is presented. Definitions and histopathology of these entities is given, and it is suggested that they represent a developmental spectrum with natural progression to Wilms' tumor.

Acute and chronic effects of chemically induced unilateral renal disease in rats

Chemically induced unilateral renal disease was associated with a high incidence of proteinuria, diuresis, a morphological spectrum ranging from perinephritis to acute tubular or cortical necrosis, and unilateral or bilateral glomerular fibrinogen deposition during the first 2 wk after induction. Later, a decrease in proteinuria and return to normal urine output was not infrequently followed by recurrent proteinuria, hypergammaglobulinemia, morphological alterations, and deposition of IgG and beta1C on the glomerular basement membranes and mesangium of the contralateral kidney and the treated kidney. Intercapillary deposition of fibrinogen in association with IgG and beta1C was occasionally observed in one or both kidneys. The morphologic, immunohistologic, serologic, and chemical findings suggest that this model may be useful for further defining the course and prognosis of unilateral renal disease produced by vascular insufficiency.

Cryoglobulins. III. Further studies on the nature, incidence, clinical, diagnostic, prognostic, and immunopathologic significance of cryoproteins in renal disease

Serial serum samples from a large number of patients with immunologic renal disease, normal healthy controls, acute infections as well as non-immunological renal disease were studied for the presence, nature and properties of cryoproteins, and these correlated with serial renal functional, morphologic, immunohistologic and clinical fingings as well as serologic observations. A high incidence of cryoproteins were found in renal disease thought to be mediated by immune complexes. Cryoprecipitates were not detected in the other patients. The presence of fibrinogen in a serum cryoprecipitate was always associated with rapidly progressive disease and poor prognosis. An association between the detection of cryoproteins and the clinical and morphological activity of disease was observed. Persistence of cryoproteinemia was associated with progression and apparent disappearance with resolution or progression to end stage renal disease. In patients with hematuria or proteinuria of questionable significance cryoprotein detection was always associated with immune complex nephritis. Renal transplantation in the presence of cryoproteinemia was associated with recurrent nephritis in the graft. Cryoproteins were found to have biologic properties attributable to antigen-antibody complexes, to contain immune complexes of antigen and antibody and to have serologic factors concentrated. The detection of serum cryoglobulins was found to be a better index of clinical and morphologic activity of immune complex renal disease than was serum complement. As in our previous studies, these proteins appear to be of diagnostic and prognostic value in renal disease and provide a method of antigen identification in these disorders.

Chemical and immunological characterization of a basement membrane-like glycoprotein in the rat

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Cryoglobulins. II. The biological and chemical properties of cryoproteins in acute post-streptococcal glomerulonephritis

Cryoglobulins isolated from patients with acute post-streptococcal glomerulonephritis, fixed complement <i>in vitro </i>and were associated with inflammatory changes following intradermal administration to unsensitized guinea pigs. Intravenous administration to laboratory animals was followed by clinical and morphologic changes resembling anaphylactic shock or by glomerulitis with the deposition of human IgG but no host IgC on the glomerular basement membrane and in the mesangium. Gel filtration using Sephadex G200 of cryoglobulin solution dissolved in, and eluted with, barbital buffer yielded a single component in the macroglobulin fraction. Gel filtration chromatography using dilute acid yielded 2 components; a large molecular weight component which was not identified by chemical or immunologic methods and another fraction which had the same chemical composition as normal human IgG except for a lower sialic acid content. Streptococcal antibody was not detected in either fraction and streptococcal antigens were not localized in the glomeruli of animals that developed glomerulitis. These studies show that mixed cryoglobulins isolated from patients with acute post-streptococcal glomerulonephritis exhibit properties similar to those of antigen-antibody complexes and suggest that they may have a primary or secondary role in the production of glomerular injury.

Secretory IgA in urinary tract infections

Secretory IgA, measured by radial immunodiffusion, was compared in the urine of children with chronic and recurrent non-obstructive urinary tract infections with that in normal children. IgA, IgG, and IgM were also measured. Absent and low levels of IgA(s) were found in both groups; however, the mean levels of IgA(s) were significantly higher in the infected group compared with normals-3.3 to 0.78 mg./24 hours, respectively. Secretory IgA was found to be locally produced in the bladder. It is suggested that IgA(s) levels reflect an antibody response to infection.