Renal Lesions In Patients Research Articles

Nephrotic syndrome associated with focal segmental glomerulosclerosis in a patient with systemic lupus erythematosus and membranous glomerulonephritis in remission

Renal involvement is frequent in systemic lupus erythematosus (SLE). This lesion, termed lupus nephritis, has been reported clinically in at least 50% of the patients. It is generally assumed that in patients with SLE, renal abnormalities detected clinically are caused by lupus nephritis, especially lupus glomerulonephritis (GN). Thus, renal biopsy is performed not for diagnostic purposes, but rather for determining the type and extent of renal involvement. However, clinically significant renal abnormalities unrelated to lupus nephritis have rarely been described in patients with SLE. The reported case serves to emphasize this consideration. The patient was a 41-year-old woman who presented 11 years previously with severe hypertension, nephrotic syndrome, and a serum creatinine level of 2.9 mg/dL. Renal biopsy showed membranous GN and ischemic damage. After a prolonged remission induced by steroids and cyclophosphamide, the patient presented with nephrotic syndrome and a serum creatinine level of 2.1 mg/dL. Although she was normotensive at that time, there were features of SLE. Repeated renal biopsy showed focal segmental glomerulosclerosis without the changes of membranous GN or any type lupus GN. This case illustrates two interesting observations, ie, resolution of membranous GN and nonlupus renal lesions in patients with SLE.

Correlations among Expression of Glomerular Intercellular Adhesion Molecule 1 (ICAM-1), Levels of Serum Soluble ICAM-1, and Renal Histopathology in Patients with IgA Nephropathy

The purpose of the present study was to evaluate the correlations among expression of intercellular adhesion molecule 1 (ICAM-1) in glomeruli, levels of soluble ICAM-1 (sICAM-1) in sera, and renal injuries in patients with IgA nephropathy. The levels of sICAM-1 in sera from 27 patients with IgA nephropathy and 7 healthy controls were measured by the human soluble ICAM-1 immunoassay. The expression of ICAM-1 in glomeruli was detected by indirect immunofluorescence. We observed marked expression of ICAM-1 in glomerular capillary walls and mesangial areas in patients with advanced-stage, but not in those with mild IgA nephropathy. Since the histopathological changes in the advanced stage of this disease were characterized by diffuse mesangial cell proliferation and tubulointerstitial injury, the expression of ICAM-1 in the glomeruli may be of value in evaluating the degree of renal lesions in patients with IgA nephropathy. However, there was no significant change in the levels of serum sICAM-1 among mild-stage and advanced-stage patients and healthy controls. It appears that the measurement of serum sICAM-1 is not useful in evaluating the degree of renal injuries in patients with IgA nephropathy.

Renal neoplasms amenable to partial nephrectomy: MR imaging.

To determine the magnetic resonance (MR) imaging characteristics of renal lesions in patients who undergo technically successful partial nephrectomy. Between February 1991 and September 1997, 38 patients (41 lesions) who underwent partial nephrectomy at a single institution were preoperatively evaluated with contrast material-enhanced, multiplanar, surface-coil MR imaging. Imaging findings that could affect the decision to perform partial nephrectomy were retrospectively evaluated: tumor size; tumor location; presence of pseudocapsule; suspected tumor invasion of renal sinus fat, renal collecting system, renal vein, or perinephric fat; and morphologic and physiologic status of the contralateral kidney. Correlation was made with surgical and pathologic findings. Thirty-three of 41 lesions (80%) were renal cell carcinomas, five were oncocytic neoplasms (12%), two were hemorrhagic cysts (5%), and one was an angiomyolipoma (2%). Twenty-four of 41 (59%) lesions had pseudocapsules. In most cases, the perinephric fat (n = 38 [93%]), the renal sinus fat (n = 31 [76%]), and the renal collecting system (n = 39 [95%]) were correctly interpreted as being uninvolved by tumor. Renal neoplasms amenable to partial nephrectomy can be identified and characterized with contrast-enhanced, multiplanar, surface-coil MR imaging.

Relationships of cell proliferation and expression of integrin subunits and type I collagen in skin fibroblasts with renal lesions in patients with IDDM

Previous studies have shown that cultured skin fibroblasts (SFs) from insulin-dependent diabetic mellitus (IDDM) patients with diabetic nephropathy (DN) exhibit both increased proliferation and Na+/H+ antiporter activity. The present study correlated the growth rate and mRNA expression of integrin subunits, extracellular matrix molecules, and transforming growth factor-beta in cultured SFs, with the biopsy determined rate of development of DN lesions ranging from slow to rapid in nine IDDM patients. These varying rates of development of DN lesions were expressed by a mesangial expansion score as estimated by the rate of change in mesangial fraction volume per year. Cultured SF proliferation by direct cell counts positively correlated with mesangial expansion score (r = 0.65; P < 0.05). Expression of cultured SF alpha3 integrin subunit mRNA levels, as well as type I collagen mRNA (P < 0.05 for both), but not transforming growth factor-beta mRNA levels (Northern blot analysis), were also positively correlated with mesangial expansion score. We postulate that these observations of correlations between activities of cultured SFs and the rate of progression of DN lesions may be predictive of the risk to develop clinical DN in IDDM, may be in part genetically regulated, and may be of pathogenetic importance. (Am J Kidney Dis 1998 Feb;31(2):293-300)

Morphine-induced macrophage activity modulates mesangial cell proliferation and matrix synthesis

Glomerular mesangial injury is the predominant renal lesion in patients with heroin addition. We studied the effect of morphine (an active metabolite of heroin)activated macrophages on mesangial cell (MC) proliferation and matrix synthesis. We prepared conditioned media containing either vehicle along (CSP), macrophage secretory products (MSP) and secretory products of morphine treated macrophages (M-MSP), M-MSP increased (P < 0.01) the proliferation of MC when compared with MSP alone. M-MSP increased synthesis of laminin by MC at concentrations of 10 to 50% when compared with cells treated with MSP alone (at 50% concentration, MSP, 126 +/- 19 vs. M-MSP, 312 +/- 14 ng/mg protein, P < 0.001). M-MSP also increased the synthesis of collagen type IV by MC. This effect of M-MSP was attenuated (P < 0.05) by anti-TGF-beta antibodies. Since M-MSP also increased mRNA expression for TGF-beta by MC, it appears that the effected of M-MSP on MC may be mediated through the generation of TGF-beta.

Prevalence of Microscopic lesions in Grossly Normal Renal Parenchyma from Patients with von Hippel-Lindau Disease, Sporadic Renal Cell Carcinoma and No Renal Disease: Clinical Implications

Purpose We sought to describe the earliest renal lesions in patients with von Hippel-Lindau disease to gain insight into the genesis of renal neoplasms in this condition. Materials and Methods Grossly normal renal parenchyma from von Hippel-Lindau disease patients was examined microscopically and compared to findings in similar tissues obtained from patients with sporadic renal cancer and from autopsy subjects with no renal disease. Results Microscopic renal cystic and solid neoplasms containing only clear cell cytological features were found in patients with von Hippel-Lindau disease. Benign cysts with clear cell cytological features were found only in patients with von Hippel-Lindau disease. Benign cysts lined by cuboidal cells with eosinophilic cytoplasm, similar to renal tubular cells, were present only in patients with renal cancer. The extrapolated number of clear cell lesions in an average kidney with von Hippel-Lindau disease was estimated as 1,100 cysts (benign or atypical) with clear cell lining and 600 clear cell neoplasms. Conclusions These findings support the hypothesis that abnormalities in the von Hippel-Lindau gene in a kidney results in the cytological cell type of clear cell renal cancer as the initial product of cellular transformation.

Differences between anti-myeloperoxidase- and anti-proteinase 3-associated renal disease

We performed a retrospective study of the clinical features, the pattern of the pre-treatment renal function loss, the renal morphology and the outcome in 92 patients with anti-neutrophil cytoplasmic autoantibodies directed against proteinase 3 (aPR3; N = 46) or myeloperoxidase (aMPO; N = 46). Patients with aMPO had a higher median age than patients with a PR3 (63 and 56 years; P < 0.05). The mean (+/- SD) number of affected organs in the aPR3 group exceeded that of the aMPO group (3.9 +/- 1.4 and 2.2 +/- 1.1; P < 0.01). The prevalence of renal involvement did not differ between patients with aPR3 and aMPO (83% and 67%, respectively; NS). Pre-treatment renal function deteriorated significantly faster in aPR3- than in aMPO-associated renal disease. The kidney biopsies from patients with aPR3 showed a higher activity index (10.2 +/- 3.8 and 7.3 +/- 3.2; P < 0.03) and a lower chronicity index (4.5 +/- 2.6 and 7.0 +/- 3.1; P < 0.02) than biopsies from patients with aMPO. The kidney survival at two years was 73% in patients with aPR3- and 61% in patients with aMPO-associated renal disease (NS). We conclude that renal function generally deteriorates faster in aPR3- than in aMPO-associated renal disease. This goes together with more active renal lesions in patients with aPR3 and more chronic renal lesions in patients with aMPO. Despite these differences, there is no difference in outcomes between both antibody groups.

Heterogeneous nature of renal lesions in type II diabetes.

The nature of renal damage in patients with type II diabetes remains unclear. This study was directed to evaluate pathologic changes in 52 patients affected by type II diabetes with overt clinical nephropathy by conventional and morphometric techniques. The duration of diabetes ranged from 6 to 384 months, urinary protein excretion ranged from 0.9 to 9.2 g/24 h, and serum creatinine ranged from 0.9 to 9 mg/dL. Specimens were examined semiquantitatively by light microscopy, immunofluorescence, and electron microscopy. Glomerular tuft cross-sectional area was measured by a versatile computer system. Pathologic examination revealed three distinct patterns arbitrarily defined as Classes 1, 2, and 3. Class 1 included 19 patients with typical changes of diabetic nephropathy characterized by a high score of glomerulosclerosis (mean score, 2.1), marked glomerular hypertrophy (23,632 microns2), and arteriolar hyalinosis (mean score, 2). There was a positive correlation between glomerulosclerosis and arteriolar hyalinosis scores (P < 0.05). Class 2 included 16 patients showing chronic and aspecific changes. As compared with Class 1 patients, these patients had less glomerulosclerosis (mean score, 1.3) and less arteriolar hyalinosis (mean score, 0.8) but more severe ischemic glomerular lesions (mean score, 1.4) and arteriosclerosis (mean score, 2). Class 3 included 17 patients showing glomerular disease superimposed on diabetic glomerulosclerosis. There were no differences in age, mean duration of diabetes, renal function, urinary protein excretion, and mean arterial pressure among the three classes of patients. This study indicates that renal lesions in patients with type II diabetes manifest in a quite heterogeneous fashion.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency.

Five patients with renal insufficiency were studied with T1-weighted magnetic resonance (MR) imaging before and after intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg) to characterize renal lesions that were detected with nonenhanced computed tomography (CT) and were considered indeterminate. Four patients demonstrated renal lesions that enhanced after gadolinium administration. A total of five lesions in these four patients were surgically resected and found to be renal cell carcinoma at pathologic examination. The fifth patient was spared surgery because a hyperattenuated lesion noted at nonenhanced CT did not enhance with intravenous gadolinium, indicating a benign cyst. Five incidentally occurring benign cysts removed at the time of nephrectomy in two of the patients did not demonstrate enhancement with gadolinium on MR images. Serial serum creatine levels were obtained before and after gadolinium administration in all patients; no changes were noted after gadolinium administration. Gadolinium-enhanced MR imaging is an effective method for characterizing renal lesions in patients with renal insufficiency. At the usual dosage, there appears to be no nephrotoxic reaction in these patients.

Disseminated prostatic carcinoma presenting with acute interstitial nephritis and microangiopathic haemolytic anaemia

A 74-year-old man with metastatic prostatic carcinoma developed acute oliguric renal failure, a microangiopathic haemolytic anaemia and thrombocytopaenia. A renal biopsy showed an acute interstitial nephritis but no changes suggestive of the haemolytic uraemic syndrome. He recovered normal renal function after treatment with haemodialysis and prednisone 20 mg daily for five days. Previous assumptions about the renal lesion in patients with malignancy-associated microangiopathic haemolytic anaemia may need review.

A Renal Lesion in Ankylosing Spondylitis

2 patients with ankylosing spondylitis (A Sp) were found to have renal lesions similar to those seen in IgA nephropathy. In 1 patient the changes were extremely severe and progressive and in the other they were mild. Vascular changes were also noted in 1 patient. The findings suggest an immune complex mediated glomerulonephritis and support an earlier report that there may be a specific renal lesion in patients with A Sp. The significance of IgA deposition in the mesangium, and of an increase in the serum levels of IgA in some patients with A Sp is unclear.

The nephrotic syndrome associated with neoplasia: An unusual paraneoplastic syndrome: Report of a case and review of the literature

The nephrotic syndrome complicating malignancy in the absence of renal vein thrombosis, amyloid or neoplastic infiltration of the kidney is an unusual occurrence. A case of diffuse, well differentiated, lymphocytic lymphoma and lipoid nephrosis documented by light microscopy, electron microscopy and immunofluorescent studies is reported. A review of the literature revealed 76 case reports in which the nephrotic syndrome was associated with neoplasia. The most frequently associated neoplasms are Hodgkin's disease, various carcinomas, nonHodgkin's lymphoma and leukemia in descending order. The most frequent renal lesion in patients with the nephrotic syndrome associated with various carcinomas is membranous glomerulonephritis (81 per cent) as opposed to patients with lymphomas or leukemias who have predominantly lipoid nephrosis (60 per cent). The evidence is reviewed suggesting that the lesions in membranous nephropathy are immunologically mediated by tumor or viral antigen-antibody complexes and in lipoid nephrosis perhaps by a defect in T-lymphocyte function.

On renal involvement in systemic lupus erythematosus and other so-called collagen diseases.

AbstractMicroscopic studies of renal lesions in patients with systemic lupus erythematosus, rheumatoid arthritis, thrombotic thrombocytopenic purpura and scleroderma have provided additional information concerning involvement of the kidney in these connective tissue diseases. A detailed description of the nephritis of systemic lupus erythematosiis has been made possible by a technic for serial renal biopsy.Studios microscopic de lesiones renal in patientes con systemic lupus erythematose, arthritis rheumatoide, purpura thrombocytopenic thrombotic, e scleroderma ha producite informationes additional in re le affection del ren in iste morbos del histos conjunctive. Un detaliate description del nephritis de systemic lupus erythematose ha devenite possibile gratias a un technica de biopsias renal in serie.

EFFECTS OF UNILATERAL NEPHRECTOMY IN TREATMENT OF HYPERTENSION

As a result of the experiments of Goldblatt1by which he demonstrates that hypertension can be produced in experimental animals by the application of a silver clamp to one or both renal arteries and of the publication of papers by Longcope2and Weiss and Parker3indicating the role of pyelonephritis in the pathogenesis of hypertension, a new approach to the treatment of hypertension in selected cases was gained, which at that time gave promise of considerable success. Physicians began to search especially for unilateral renal lesions in patients with elevated blood pressure in the hope of relieving the hypertension by removal of the affected kidney. Butler,4in 1937, was apparently the first to report a cure of hypertension by removal of a single pyelonephritic kidney. Since that time many reports have appeared in the literature concerning the treatment of hypertension by unilateral nephrectomy, and many more