Karyomegalic nephropathy: an uncommon cause of progressive renal failure.

Background: Karyomegalic nephropathy, first identified in 1974, represents an increasingly recognized, but perhaps underdiagnosed condition associated with interstitial nephritis. It undoubtedly leads to end-stage renal disease requiring renal support.

Methods And Results: We present a series of six cases of karyomegalic nephropathy.

Effects of erythropoietin therapy on the lipid profile in end-stage renal failure.

To evaluate the effects of erythropoietin (EPO) therapy on the lipid profile in end-stage renal failure, we undertook a prospective study in patients on both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). One hundred and twelve patients (81 HD, 31 CAPD) were enrolled into the study. Lipid parameters [that is, total cholesterol and the LDL and HDL subfractions, triglycerides, lipoprotein (a), apoproteins A and B], full blood count, iron studies, B12, folate, blood urea, aluminium and serum parathyroid hormone were measured prior to commencement of EPO therapy.

HLA-DR and -DQ genotyping in anti-GBM disease.

Anti-GBM disease has been associated with the HLA genes of the major histocompatibility complex (MHC) in previous serological studies, with an increased incidence of HLA-DR2 in patients. In this study, 36 patients with anti-GBM disease were genotyped by restriction fragment length polymorphism (RFLP) analysis using cDNA probes for DRB, DQA, and DQB. The frequency of HLA-DRw15(Dw2), a split of DR2, was significantly increased in the patients compared with the controls (63.

Thin-membrane nephropathy--a common cause of glomerular haematuria.

Thin-membrane nephropathy recently has been described as a cause of glomerular haematuria. The prognosis of the condition is unclear but it generally is considered to be benign. In a series of 92 patients with glomerular haematuria, thin-membrane nephropathy was found to be a common cause, occurring in 26 (28%) patients.

Fibrillary glomerulonephritis--a report of two cases.

Two patients with an uncommon form of glomerulonephritis are described. The main clinical features were hematuria and proteinuria associated with normal renal function. The glomerular lesions consisted of mesangial hypercellularity and capillary wall thickening.

The pathogenesis of renal osteodystrophy: role of vitamin D, aluminium, parathyroid hormone, calcium and phosphorus.

Biochemical data and bone histology from 44 haemodialysis patients was compared using an histologic technique capable of evaluating separately the individual components of osteodystrophy. Hyperparathyroid bone disease was diagnosed by an elevated osteoclast count, and in advanced disease there was also fibrosis and woven bone. Osteomalacia, defined as an impairment in the rate of bone mineralisation, was present in two distinct forms: osteomalacia type I, characterised by wide osteoid seams, and osteomalacia type II, characterised by extensive thin, inactive osteoid.

Acebutolol in mild to moderate hypertension: a double-blind crossover study.

The effect of acebutolol (Sectral) was compared with that of placebo in 30 patients with mild to moderate hypertension who were receiving a thiazide diuretic. Ten patients did not complete the study. In the remaining 20 patients, acebutolol (mean dose, 910 +/- 408 mg/day) produced significantly greater reduction both in supine and in erect systolic and diastolic blood pressure over 16 weeks than placebo plus chlorothiazide P less than 0.

Hydrallazine with beta-blocker and diuretic in the treatment of hypertension. A double-blind crossover study.

Thirty-seven hypertensive patients were treated with cyclopenthiazide, oxprenolol and hydrallazine. Blood pressure was controlled in 31 patients and a subsequent double-blind crossover study in 27 patients comparing hydrallazine with placebo confirmed the efficacy of hydrallazine in combination with diuretic and beta-adrenergic-blocking agent. The combination was effective in patients with renal hypertension and renal impairment.

Oxolinic acid in the treatment of urinary tract infections.

Oxolinic acid was successfully used in eradicating bacteriuria in 86% of a highly selected group of 42 patients with chronic and recurrent urinary infections. Thirty-eight (92%) of patients had underlying renal abnormalities, 19 (45%) had impaired renal function. Emergence of resistant organisms in 3 patients (7%), and a high incidence of side effects necessitating withdrawal of treatment in 12 patients (29%), limit the usefulness of this agent to special situations.

Labetalol compared with prindolol plus hydraliazine in the treatment of hypertension: a double-blind cross-over study.

The hypotensive action of labetalol, a new drug with alpha-adrenoceptor and beta-adrenoceptor blocking action, was compared with that of a combination of prindolol and hydrallazine. Fourteen patients with mild to moderately severe hypertension completed a double-blind cross-over study with treatment periods of eight weeks. Both treatments were effective and, in the doses which were used, produced clinically significant lowering of blood pressure (reduction of mean blood pressure by more than 10 mm Hg) both in clinic and in home blood pressures in 12 of the 14 patients.

Multinucleated giant cells in antiglomerular basement membrane antibody-induced glomerulonephritis.

Inflammatory giant cells were found in close association with glomerular basement membrane in a case of rapidly progressive glomerulonephritis. It is suggested that this finding is due to an alteration in properties of the glomerular basement membrane most probably brought about by circulating antibody to basement membrane.

Controlled trial comparing co-trimoxazole and methenamine hippurate in the prevention of recurrent urinary tract infections.

To study the effects of continous low doses of antibacterial agents after eradication of bacteriuria in patients with recurrent urinary tract infection, 31 patients with documented recurrent urinary tract infection were allocated alternately to treatment with either co-trimoxazole (400 mg of suphamethoxazole and 80 mg of trimethoprim each night) or methenamine hippurate (1 g each night). The majority of patients (79%) had underlying radiological abnormalities of the renal tract, but normal renal function (the mean serum creatinine level was 1.05 mg per 100 ml).

Effects of intravascular clotting on the activation of the complement system: The role of the platelet.

Total hemolytic complement activity and the third component of complement were found to be significantly depressed in vivo in rabbits following the induction of disseminated intravascular coagulation by both thrombin and thromboplastin. Production of severe thrombocytopenia by the administration of platelet antiserum prior to the infusion of thrombin or thromboplastin partially prevented complement activation. The data show that, when clotting is triggered, complement activation takes place and that platelets are required to some extent for this reaction.

Goodpasture's syndrome: normal renal diagnostic findings.

A patient with Goodpasture's syndrome is described in whom pulmonary manifestations were dramatic, but in whom renal abnormalities were minor and only found on fluorescent and electron microscopy. His urine showed no proteinuria and no increase in cells in quantitative counts, and renal function was normal. It is suggested that there may be an indication for carrying out renal biopsies in patients with idiopathic pulmonary haemosiderosis and that this may lead to an early diagnosis of Goodpasture's syndrome.