Signs Of Renal Disease Research Articles

Urinary albumin excretion during exercise in juvenile diabetes. A provocation test for early abnormalities.

Urinary albumin excretion during exercise was measured with a radioimmunological method in a group of 13 young male diabetic patients and in a comparable control group. The duration of diabetes was 2-18 years; they had no proteinuria (Albustix¿) and no other signs of renal disease. There was no difference in the basal albumin excretion. In the diabetics the average albumin excretion was doubled during exercise at 600 kpm/min for 20 min, from 9.1 mug/min to 18.7 mug/min (P less than 0.005). No significant change was seen in the controls. These results strongly suggest that abnormal glomerular filter properties are present in patients with relatively short duration of diabetes - that is, in patients who are known to have thickened glomerular basement membrane. The exercise provocation test may be useful in other fields of renal pathophysiology.

Anaphylactoid Purpura: III. Early Morphologic Glomerular Changes

Renal biopsy samples from five patients with systemic signs of anaphylactoid purpura but no or minimal signs of renal disease were examined by light and fluorescence microscopy. Electron microscopic studies were performed on the renal tissue specimens of two patients. Fibrin deposition without associated immunoglobulin deposits was a prominent feature in renal lesions seen by the immunofluorescent technic. Occasional unidentified subendothelial deposits, presumably fibrin, were observed using electron microscopy. Light microscopic examination did not reveal significant abnormalities. The limited data presented suggest the possibility that alterations of the coagulation system may be of pathogenetic importance in the renal disease of anaphylactoid purpura.

Acute nephritis and streptococcal sore throat: a prospective study in general practice.

The evidence linking acute nephritis and infection of the throat or skin with certain types of group A beta-haemolytic strepto cocci is of three kinds : (1) studies of streptococcal disease when acute nephritis was more prevalent than usual, (2) cultures from the throats of established cases of acute nephritis, and (3) serological studies of such cases for type-specific antibodies. Examples of the first are the reports of Manser and Wilson (1952), Reed (1953), Kleinman (1954), Seigel et al. (1955), Stetson et al. (1955), and George et al. (1958). Studies of established cases of acute nephritis have been reported by Rammelkamp and Weaver (1953), Wertheim et al. (1953), Wilmers et al. (1954), Hardin et al. (1956), and Bernstein and Stillerman (1960). Two investigations on the production of type-specific antibodies are noteworthy?those of Cullhed et al. (1959) and of Earle and Jennings (1959). The strain most often found in association with acute nephritis is type 12, but types 4, 25, and 49 are also thought to be nephritogenic. The evidence provided by these varied reports is incomplete and open to objections. The epidemics studied may not reflect the experience of normal communities. Strains isolated from established cases of acute nephritis may differ from the original Infecting organisms, as reinfection with a different type is known to occur (Ravenswaay, 1944, Rantz et al., 1945). In assessing the significance of such isolations it is essential to know the prevalence of different types in the community from which the cases are drawn. There are, however, few reports on the rela tive incidence of different types in acute pharyngitis in normal populations ; what evidence there is suggests that type 12 is widely prevalent (Siegel et al., 1961 ; Mitchell, 1962 ; Valkenburg et al., 1963). Moreover, the literature abounds in anomalies. Acute nephritis is said to be twice as common in males (Seegal et al., 1935 ; Earle and Seegal, 1957), though there is no evidence that infection with nephritogenic types shows a similar sex incidence. Only a minority of those infected by type 12 streptococci actually develop acute nephritis, and the incidence following type 12 infections varies (Rammelkamp, 1957). Other types have been isolated from cases of acute nephritis (Wertheim et al., 1953 ; Goldsmith et al., 1958 ; Mitchell, 1962). Urinary abnormalities without other signs of renal disease, while com moner and more notable after type 12 infections, may also occur after infection with other types, or after non-streptococcal infections (Stetson et al., 1955). Only one of the reports quoted was a prospective study, and this was carried out in a military camp where acute nephritis was already prevalent (Stetson et al., 1955). The only example of such a study in a normal community that we were able to find up to 1958 was reported by Rammelkamp et al. (1952) in a group of 60 families, and one other (Goslings et al., 1963) has since appeared. We report here a prospective study in a normal community : in a small town and the neighbouring countryside, virtually the whole population of which is under our care. In 1959 this population numbered approximately 14,000 persons ; the study began on 28 January of that year and continued for 12 months.

Amyloidosis in familial Mediterranean fever. An independent genetically determined character.

Renal disease occurs frequently in familial Mediterranean fever (F.M.F.) and is of grave prognostic significance. Mamou and Cattan, the first to recognize this, published detailed case histories and noted the familial pattern of occurrence.1In 1952 we diagnosed amyloidosis as the cause of nephrotic syndrome in one of our patients, and autopsy confirmed the diagnosis. Since other cases of F.M.F. with signs of renal disease were already under observation, we considered the possibility of an inherent relationship between F.M.F. and amyloidosis.2,3Since then, all autopsied cases of F.M.F. reported in the literature have disclosed amyloidosis,4-6further strengthening this possibility. If we consider that in F.M.F. amyloidosis appears, most unusually and almost uniquely, as a part of a genetic disorder,7-9it seems important to report our experience in a series of cases in various stages of renal disease who have been observed over many years. Material Our

Erythrocyte sedimentation in anaemia.

Above all else, these 135 deaths of diabetic children within the last six years?11.2% from tuberculosis, 8.8% from diabetic coma, and 51.9% from renal disease?show that the diabetic with onset of disease in childhood should be followed more closely. Only in this way can needless deaths be avoided. Continuity of treatment is essential. Roentgenograms of the chest should be taken yearly. A constant awareness for evidences or incipient signs of renal disease must be maintained. Research should be concen trated on the kidney in the young diabetic. The impor tance of post-mortem examinations cannot be too strongly emphasized. To preserve in comfort and prolong the lives of diabetic children the need is paramount for inexpensive and attrac tive opportunities, in children's and adolescents' camps, and especially in hospitals, of reviewing their physical con dition and promoting morale and zeal for the continuing control of their diabetes.