Office of Inspector General U.S. Department of Health and Human Services. An overview.

It has become increasingly important for physicians to be aware of the various legal liabilities regarding licensure they face in the daily practice of medicine. This includes issues related to fraud, waste and abuse. It has become a common refrain that physicians promote significant abusive and possibly fraudulent practices. This article describes the organization, function and work plans of the Office of Inspector General, Department of Health and Human Services. A structural guideline is presented based upon conviction and recovery rates to allow physicians to understand the scope of the problem in greater depth.

Predictors of one year outcome in lupus nephritis: the importance of renal biopsy.

The short-term prognosis of lupus nephritis was evaluated by assessing serum creatinine 12 months after renal biopsy in 87 patients with lupus nephritis. On univariate analysis, significant clinical and laboratory predictors of this outcome included clinical signs of renal injury (serum creatinine, 24-hour urinary protein, prolonged renal disease, nephrotic syndrome, serum albumin), as well as thrombocytopenia, older age, and coexisting illness or hypertension at the time of biopsy. On renal biopsy, diffuse proliferative nephritis, higher activity, chronicity, or tubulointerstitial scores, or subendothelial or subepithelial electron dense deposits predicted a higher serum creatinine 12 months after biopsy. A clinical predictive model was developed which included as independent predictors serum creatinine, age, platelet count and 24-hour urinary protein. Any one of three biopsy variables added information to the clinical prediction model: a marked quantity of subendothelial deposits (p = 0.02), a higher activity index score (p = 0.02), or the presence of diffuse proliferative lupus nephritis (p = 0.05). However, the relative predictive accuracy of the clinical model did not improve with the addition of any of the biopsy variables. The value of renal biopsy in lupus nephritis is discussed based on the ability of biopsy information to confirm the prognosis, to add new predictive information for a group of subjects, and to improve predictive accuracy for individual patients.

The clinical and renal biopsy predictors of long-term outcome in lupus nephritis: a study of 87 patients and review of the literature.

The prognostic markers in 87 consecutive patients with lupus nephritis who underwent renal biopsy are reported for five clinically relevant long-term outcomes--renal insufficiency, renal failure, death due to renal systemic lupus erythematosus, death due to non-renal SLE and death due to SLE, both renal and non-renal. We have demonstrated that a number of previously neglected or rarely studied predictors were important prognostic markers. These included the duration of renal disease before biopsy, overall severity of SLE, as well as the presence of vasculitis, hypertension or a comorbid ailment. Furthermore, the study confirms the predictive importance of serum creatinine, 24-h urinary excretion of protein, C3, and of the activity and chronicity indices on biopsy. However, overall a simple measure of tubulointerstitial disease was the best predictor obtained from biopsy. Prognostic models based on clinical data alone were developed for each of the five outcomes. The models amplify our clinical understanding of lupus nephritis. Markers of renal severity were most important in predicting renal outcomes such as renal insufficiency and renal failure. Prognostic factors less directly related to renal disease (comorbidity and vasculitis) were important predictors of fatality. A marker of immunologic disease activity (C3) was a valuable predictor for many of the outcomes. Thus markers of disease severity reflecting organ damage due to SLE and other comorbid conditions could be combined with markers of immunologic activity to predict a variety of outcomes of relevance to a clinician. When biopsy data obtained by light or electron microscopy were evaluated for their ability to add new predictive information to the clinical models, only a limited value for biopsy was noted. It is likely that this reflected the close correlational relationships between clinical and biopsy variables, the strong clinical models generated, and the inclusion in the clinical models of the previously neglected clinical variables, duration of renal disease before biopsy and the presence of vasculitis or comorbid disease.

A review of nephrotic syndrome associated with chronic lymphocytic leukemia.

Four patients had the nephrotic syndrome and chronic lymphocytic leukemia (CLL), which may be pathogenetically related. Membranoproliferative glomerulonephritis appears to be the most common glomerular lesion in patients with CLL. Available evidence suggests that nephrotic syndrome associated with CLL is often related to immune-complex disease. It is also possible that disorders of immunoglobulin production and cellular immunity contribute to renal disease in patients with CLL.

Fibronectin (LETS) does not support epithelial cell spreading.

The dependence of epithelial cell spreading on fibronectin-containing media has been investigated, using purified human plasma fibronectin, and two in vitro assays: (1) epidermal outgrowths from measured pieces of mouse ear skin, and (2) spreading of dissociated cells from trypsinized guinea pig epidermis. Using these systems, appreciable spread occurred in media containing whole plasma and plasma deficient in fibronectin but no significant spread occurred in media enriched only in fibronectin. Returning fibronectin to deficient plasma did not enhance or reduce optimal cell spreading. These studies suggest that the factor(s) in human plasma which supports epithelial cell spreading in vitro is not fibronectin and that the chemistry of epithelial and fibroblast cell spreading is different.