A Study of Glomerullar Minimal Lesion and Minimal Mesangial Proliferation with or without Nephrotic Syndrome; Pathologic, Immunopathologic and Clinical Correlations

A total of 394 cases of minimal lesion were reviewed and reassessed clinically and by laboratory investiga- tion, for 4 years from 1979 to 1982. Association with nephrotic syndrome is significantly higher in the cases with histologically normal-appearing mesangium than in the cases with mesangial proliferation. In 43% of the cases of minimal lesion, a minimal but prominent mesangial deposit of Immunoglobulin M with or without C3 deposit was found, and frequently accompanied with nephrotic syndrome, which is not sufficient to accept the condition as a specific disease entity such as "IgM Nephropathy" in our present study. Minimal lesion with a minimal but unmistakable deposit of lgA on the mesangium was noted less frequently and was accompanied or unaccompanied by nephrotic syndrome, a condition which call for an investigation clarify the characteristics and the extent of lgA(Berger's) nephropathy. Response to steroids in minimal lesion nephrotic syndrome was better in children and in the cases without mesangial proliferation, but was unrelated to either hematuria or immunoglobulin deposit. However, the cases with mesangial proliferation are significantly lesser in therapeutic response. Transformation to another morphological type of original glomerular change during follow-up was not observed in 4 available cases of minimal lesion nephrotic syndrome. Henoch-Sch nlein purpura was seen more commonly in children, and lgA(Berger's) nephropathy more commonly in adults.

Acute Renal Failure due to Potassium Bromate Poisoning

Poisoning due to potassium bromate, cold wave neutralizer for permanent waving solution in hair styling, is rarely encountered and only few cases are as a cause of acute renal failure reported in medical literature. Recently, we saw a 18 year-old-female patient, hair stylist, who was admitted to Severance Hospital due to acute renal failure after accidental ingestion of potassium bromate. This is the first known case of acute renal failure due to potassium bromate poisoning in Korea.

Silent Aortic Regurgitation

Aortic regurgitation is a common valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart disease, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decreascendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular disease, Segal et al (1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic reguritation in patients with predominent mitral disease has begun to be appreciated recently, especially as commisurotomies for the relief of mitral stenosis are performed more frequently. Nowadays eventhough the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved. This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortography at Severance Hospital from January, 1970 to August, 1976. 1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency. 2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical heaving, and left ventficular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram. 3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade I, and 10 patients being grade II on cineaortogram.

Mesangial IgA/IgG Deposit Glomerulonephritis

Percutaneous renal biopsy was performed on a 34 year old male patient with mild proteinuria and microhematuria. Histopathologic examination showed a focal mesangiopathic glomerulonephritis, simulating a "minimal change" disease pattern by light microscope. Granular deposits of IgA, C3, IgG, IgM, and fibrinogen were present in the glomerular mesangial area by immunofluorescent technique. A special prevalence of IgA was found. The intensity of immunofluorescent staining was correlated with the mesangial proliferative reaction by light microscopy. Electron microscopy showed electron dense granular deposits in the mesangial areas. The glomerulonephritis in this patient was related with the IgA antibody associated mesangial immune complex deposit disease mediated by the classic complement pathway. This glomerulonephritis is known to have a good prognosis. The antigenic nature, the reason of predominant immune deposits in the mesangium, and the mechanism of a special prevalence of IgA and IgM immunoglobulin classes are discussed, and special attention to the value of immunofluorescent study of renal diseases, with a review of the literature, is given.