Chronic Diffuse Glomerulonephritis Research Articles

Tubular and interstitial lesions and mononuclear cell infiltration in primary forms of glomerulonephritis.

In the present study of 246 patients with primary forms of glomerulonephritis (GN) we investigated their tubular and interstitial changes, especially mononuclear cell infiltration and optical microscopy, and compared this finding with the outcome of the disease (5-year survival rate). Only first biopsies were analyzed in order to detect early tubulointerstitial changes which occur together with the glomerular changes. Different degrees of the lesions of tubules and interstitium were present in different forms of GN. Mononuclear cell infiltration was present in 100% of the patients with crescentic, in 90.9% in focal sclerosing, in 89% in membranoproliferative, and in 76.4% of patients with chronic diffuse GN. Less than 50% of the other patients showed infiltration. Using monoclonal antibodies it was demonstrated that mononuclear cell infiltrates mainly consisted of T and T4 cells. Interstitial edema was expressed in the same forms of GN and in similar proportions. Interstitial fibrosis was found only in patients with: focal sclerosing GN (13.7%), IgA GN (4.1%), membranoproliferative GN (31.4%), chronic diffuse GN (23%), and crescentic GN (27.7%). Tubular atrophic changes were again dominantly present in: crescentic GN (94.2%), focal sclerosing GN (77.8%), chronic diffuse GN (76.4%), and membranoproliferative GN (68.4%). Patients with severe tubulointerstitial changes together with the glomerular changes had a low 5-year survival rate of renal function.

Extracorporeal methods in the management of severe and malignant arterial hypertension.

Novel approaches to managing refractory arterial hypertension (AH) have been tested in 130 patients aged 28 to 59 years with severe or malignant hypertension. Hemosorption was performed in 70 patients in whom AH was caused by chronic diffuse glomerulonephritis (49 cases) or chronic pyelonephritis (21 cases) accompanied by the appearance of chronic renal failure. In all patients, blood pressure after hemosorption decreased by 15% to 16% on the average, resulting in progressively improved renal function and a nearly 2.0-fold reduction in plasma aldosterone concentration (PAC), and allowing the doses of antihypertensive drugs to be reduced. Plasmapheresis was performed in 31 patients with refractory severe or malignant AH due to essential hypertension or parenchymatous diseases of the kidneys. After two to four plasmapheresis sessions with up to 2 L of plasma exchanged, blood pressure dropped by 24% compared to baseline while the doses of antihypertensive drugs were diminished and some were discontinued completely in several cases. Analysis of the sensitivity to antihypertensive drugs after plasmapheresis using the rosette technique revealed a significant decrease in the number of rosette-forming cells. The level of angiotensin II and urinary excretion of aldosterone-18-glucuronide declined progressively by nearly 50% after plasmapheresis, correlating with the antihypertensive effect of plasmapheresis. In 32 patients with severe AH complicated by refractory cardiac failure, isolated ultrafiltration was used. After one to eight sessions and the removal of 1.0 L to 35.8 L of fluid, the signs of cardiac failure diminished, the blood pressure level responded to drug therapy, and the PAC level decreased significantly. Although the mechanisms of the antihypertensive actions of hemosorption, plasmapheresis, and isolated ultracentrifugation are still not completely elucidated, these data suggest that hemosorption may act by removing nitrogenous residues from the body and reducing PAC, plasmapheresis by deblocking receptors for antihypertensive drugs and reducing the concentration of angiotensin II and the synthesis of aldosterone in the body, and isolated ultrafiltration by eliminating hyperhydration and edema of the parenchymatous organs.

The pathology of the hepatosplenic form of schistosomiasis mansoni in its advanced form (study of 232 complete necropsies)

Uma análise de 232 necrópsias completas realizadas em portadores de esquistossomose hepática avançada evidenciou em todos a lesão constante e característica de fibrose periportal com alterações destrutivas e obstrutivas de ramos intra-hepáticos da veia porta. Geralmente esta lesão estava associada a sinais de hipertensão porta (esplenomegalia e varizes do esôfago), constitutindo-se na forma hépato-esplênica mas em 12 casos estes sinais não existiam (a forma hepática avançada). Ao passar para a fase descompensada da esquistossomose hépato-esplênica, o fígado geralmente exibia uma acentuação da fibrose ao lado de sinais de inflamação crônica ativa, mas não mostrava uma evolução para a cirrose difusa. A esplenomegalia se acompanhou de lesões congestivas crônicas e de evidências de hiperplasia celular, especialmente no setor fagocítico mononucelar. Excepecionalmente se superajuntou a tais lesões um linfoma tipo nodular, o qual tende a ocorrer em mulheres após os 45 anos de idade. O envolvimento intestinal foi muito menor do que se poderia esperar. As lesões mais salientes foram a fibrose peri-intestinal, qua não parece ter maior repercussão clínica, e, raramente, as lesões pseudoneoplásicas e os polipos. Uma complicação freqüente foi o cor pulmonale secundário às elsões de arterite pulmonar esquistossomótica, que apareceu em 44 casos (18,9%). O aparecimento de doença renal associada se deu em 15% dos casos e foi geralmente representada por glomerulonefrite crônica, o que se presume seja devido a um processo mediado por complexos imunes na esquistossomose. Muitos dos casos exibiam infecções intercorrentes, com algumas delas, como a salmonelose e a hepatite viral, tendendo a ter um curso mais prolongado. Assim a esquistossomose avançada se apresentou um processo que atinge fundamentalmente of fígado, mas que repercute em vários outros órgãos através uma patogenia variada, complexa, ainda não bem entendida em toda a sua extensão.

Changes in lipid metabolism and microcirculation in chronic diffuse glomerulonephritis

Recent studies have shown the frequency of atherosclerosis and its complications in chronic diffuse glomerulonephritis [2, 7]. This disease is often accompanied by a violation of lipid metabolism. It has been shown that all forms of chronic glomerulonephritis (CGN) are characterized by hypercholesterolemia, hyper-b-lipoproteidemia, as well as an increase in total lipids, hypertriglyceridemia [5, 6]. The influence of hyperlipemia on the development of atherosclerosis and its complications, mainly thrombosis, is well known, which also largely depends on microcirculatory disorders.

Thromboelastography indices for certain kidney diseases

Thromboelastogram (TEG) indices were studied in 89 patients. 26 of them had pyelonephritis, 6 had hemorrhagic fever with renal syndrome (HFRS), 26 had acute nephritis and 31 had a mixed form of chronic diffuse glomerulonephritis.

About Shifts in K and Na Metabolism in Diffuse Kidney Diseases

We carried out a complex-synchronous study of the content of K and Na in blood plasma, erythrocytes, urine and gastric contents in 87 people, including 19 healthy people who made up the control group and 68 patients with diffuse kidney diseases without pronounced clinical disorders of water metabolism and without significant violations of the concentration and nitrogen excretion function of the kidneys. The patients were mostly young and middle-aged, 44 of them suffered from chronic pyelonephritis, 24 - from chronic diffuse glomerulonephritis. The content of K and Na was determined using flame photometry. Gastric contents were received on an empty stomach and after the introduction of Erman's breakfast. The gastric juice was diluted 40 times and filtered through two layers of gauze.

Lipodystrophia progressiva and temporary hydronephrosis.

If the association of two diseases in a patient is not fortuitous their relationship to each other may throw light on the aetiology of one or both diseases. Law rence's (1946) study of a woman with lipodystrophia progressiva and insulin-resistant diabetes supports the concept of two types of diabetes mellitus and suggests the simple explanation that the elderly obese person develops diabetes because she is unable to convert any more carbohydrate into fat. In this paper the association of temporary hydro nephrosis with lipodystrophia progressiva is reported and the renal disorders which have been described with this disease are reviewed. It is suggested that in some of the case reports the renal changes may have been similar to those present in the patient described here. Gross can develop in a week and dis appear completely if the obstruction is removed early enough, and the term temporary hydronephrosis has been used to describe these transient changes (Fowler and Frankel, 1947). Ellis (1951), writing about lipodystrophia progressiva, mentions the association of this condition with renal disease. He makes a brief reference to the occurrence of oliguria in Gerhartz's case (1916). The daily urinary output of this patient was 400-1,100 ml., and it is difficult to believe that this is a significant oliguria. Klien (1921) reports on a patient with lipodystrophy and mentions polyuria. Recently a patient with this disease was shown at the Royal Society of Medicine (Tizard, 1954), and the summary of the case included the information that she is said to drink and void excessive quantities of fluid. The glucose-tolerance test in this patient was normal, but full urinary investigations including a pyelo gram had not been done. Following the paper by Law rence (1946) on the association of lipodystrophy and diabetes, any patient with lipodystrophy complaining of thirst and polyuria may be examined for further evidence of diabetes mellitus only, as happened to our patient, when studied for a short period at another hospital. In 1932 two cases were reported in which lipo dystrophia progressiva and uraemia occurred in the same patient. They were both thought to have had chronic nephritis, but in neither did the diagnosis appear likely, nor was it confirmed. They both had unusual clinical features in common with the patient described in the present paper. Horton and Emmett (1932) report the case of a woman of 61 with a history of increasing nausea for one year with occasional attacks of vomiting. The patient was alert, and physical examination was essentially nega tive except for lipodystrophy affecting the legs. There were no symptoms or signs suggesting uraemia. On admission the blood urea was 400 mg. per 100 ml. After five weeks on a diet containing 25 g. of protein and 3-4 litres of fluid daily, the blood urea fell to 60 mg. per 100 ml. It was stated that pus cells, grade III, were present in the urine, l;ut no mention of urine culture was made. The renal lession was diagnosed as chronic diffuse glomerulonephritis after the possibility of poly cystic kidneys had been considered and dismissed, as no enlargement of the kidneys could be found on abdo minal palpation. Berger (1932) reported the case of a woman aged 26 who developed lipodystrophy at the age of 3years. Pyelitis occurred at 6 and another attack a year later. At the age of 19 the blood pressure was found to be raised and albumin was present in the urine. A diag nosis of acute exacerbation of chronic nephritis was made. Following a severe reaction to vaccination, the patient for a short time passed into uraemic coma. During the next seven years she remained well, and clinical examination at the end of this period was essen tially negative except for the lipodystrophy. The blood urea was then 21 mg. per 100 ml. Igersheimer (1948) described the case of a patient who had lipodystrophia progressiva, bilateral with aberrant renal arteries, and other congenital abnor malities.

Glomerular filtration rate and renal blood flow in patients with chronic diffuse glomerulonephritis during pregnancy.

Glomerular filtration rate and renal blood flow in patients with chronic diffuse glomerulonephritis during pregnancy.

Effect of Febrile Plasma, Typhoid Vaccine and Nitrogen Mustard on Renal Manifestations of Human Glomerulonephritis

SummaryAdministration of plasma from patients acutely ill with pneumococcal and streptococcal infections failed to decrease proteinuria or induce diuresis in 2 patients with chronic diffuse glomerulonephritis.Induction of the pyrogenic reaction was accompanied by decrease in proteinuria on 2 occasions in one patient. We are inclined to attribute this result to the concomitant decrease in the rate of glomerular filtration.Therapeutic doses of HN2 reduced proteinuria but diuresis failed to occur in 2 patients with advanced chronic diffuse glomerulonephritis with marked renal functional impairment. However, in one patient with minimal renal functional impairment, administration of HN2 was followed on 2 separate occasions by diuresis, marked reduction in proteinuria and concomitant increase in filtration rate, a combination of effects consistent with a return of glomerular function towards normal.†Our observations indicate that reversal of renal manifestations of human glomerulonephritis can be induced by HN2...

The effect of pregnancy and renal function in women with pre-existing essential hypertension and with chronic diffuse glomerulonephritis: Wellen, I., Welsh, C. A., and Taylor, H. C.: J. Clin. Investigation 23: 742, 1944

The effect of pregnancy and renal function in women with pre-existing essential hypertension and with chronic diffuse glomerulonephritis: Wellen, I., Welsh, C. A., and Taylor, H. C.: J. Clin. Investigation 23: 742, 1944

An unusual case of glomerular nephritis with uremia

This case presents one of maximum renal insufficiency as shown by a persistent high urea nitrogen nonprotein nitrogen ratio. This ratio which normally averages 40 per cent has on several occasions been as high as 92 per cent. The highest blood pressure reading obtained was 126/82, and this is a definite, though moderate, elevation for a child nine years old. There was present a fairly severe secondary anemia, which responded best to the second blood transfusion. At no time was there any evidence of edema, a fact which can probably be accounted for by the fact that there has at no time been any depletion in the plasma proteins. That he is in a uremic state is shown by the tremendous nitrogenous retention in the blood, a persistent low carbon dioxide combining power of the blood, retention of inorganic phosphates, and a very high creatinine content. All of this evidence pointed to a chronic diffuse glomerulonephritis. The exact etiology in this case is uncertain. However, we can presume, from the history of repeated low-grade upper respiratory infections and periodic malaise covering almost five and one-half years, that the prime cause of his nephritis lay in these early episodes. He now looks fairly well, except for his pallor and is at home leading a moderately normal life in spite of the evidences of the blood chemistry, which is that of a uremic individual. This case presents one of maximum renal insufficiency as shown by a persistent high urea nitrogen nonprotein nitrogen ratio. This ratio which normally averages 40 per cent has on several occasions been as high as 92 per cent. The highest blood pressure reading obtained was 126/82, and this is a definite, though moderate, elevation for a child nine years old. There was present a fairly severe secondary anemia, which responded best to the second blood transfusion. At no time was there any evidence of edema, a fact which can probably be accounted for by the fact that there has at no time been any depletion in the plasma proteins. That he is in a uremic state is shown by the tremendous nitrogenous retention in the blood, a persistent low carbon dioxide combining power of the blood, retention of inorganic phosphates, and a very high creatinine content. All of this evidence pointed to a chronic diffuse glomerulonephritis. The exact etiology in this case is uncertain. However, we can presume, from the history of repeated low-grade upper respiratory infections and periodic malaise covering almost five and one-half years, that the prime cause of his nephritis lay in these early episodes. He now looks fairly well, except for his pallor and is at home leading a moderately normal life in spite of the evidences of the blood chemistry, which is that of a uremic individual.