[Antiphospholipid antibodies in systemic lupus erythematosus: incidence, significance and relation to lupus nephritis]. / Anticuerpos antifosfolípidos en el lupus eritematoso sistémico: incidencia, significación y relación con la nefritis lúpica.

The prevalence of three different types of antiphospholipid antibody in 88 consecutive patients with systemic lupus were 27.2% for lupus anticoagulant (LAC), 31.8% for anticardiolipin antibody (aCL), and 13.6% for falsely positive serologic tests for syphilis (FPSTS). The three tests were correlated, thus confirming the overlapping specificities of this family of antibodies. Although FPSTS was not associated with any particular manifestation of systemic lupus, aCL correlated with thrombosis (p = 0.0001), thrombopenia (p = 0.009), neuropsychiatric features (p = 0.02) and membranous nephropathy (p = 0.001), while LAC correlated with thrombosis (p = 0.001) and hemolytic anemia (p = 0.04). The previously unreported association between membranous nephropathy and aCL might explain some features of the former, particularly the higher incidence of thromboembolic complications and the poorly known relation with renal vein thrombosis.

Interstitial mononuclear cell infiltrates in experimental nephrosis: effect of PAF antagonist.

Rats receiving a single injection of either aminonucleoside of puromycin (PAN, 10 mg/100 g) or Adriamycin (ADR, 7.5 mg/kg) develop heavy proteinuria and tubulointerstitial nephritis. Interstitial mononuclear cells were markedly more intense in PAN- than in ADR-treated rats. The composition of cell infiltrates was characterised in frozen kidney sections using an immunoperoxidase staining method and a panel of specific monoclonal antibodies. The severe mixed cellular lesions observed in the PAN model on day 14 were dominated by ED1+ macrophages, OX6+ Ia-interstitial and OX8+ T-cytotoxic/suppressor cell surface markers. A similar but more discrete ADR-interstitial cell accumulation was observed on day 11 of the experiment. A correlation existed in the PAN model between the severity of interstitial nephritis and the degree of proteinuria. In contrast, there was no such correlation in ADR nephrosis. Administration of PAF antagonist (BN 52021), started on the first day and continued throughout the 4 weeks of the experiment, induced in both ADR and PAN-treated rats a partial reduction in the number of interstitial cell infiltrates. Glomeruli from normal control rats incubated with 3H acetate, substrate for lyso-PAF: acetyl-CoA acetyltransferase and ADR stimulated PAF generation. Although the precise mechanism of interstitial cell accumulation in these two models of nephrosis are still unknown, our results suggest that PAF could be an important factor involved in interstitial cell recruitment.

Characterization of inflammatory cells in autoimmune tubulointerstitial nephritis in rats.

Brown Norway rats immunized with bovine tubular basement membrane (TBM) antigens develop tubulointerstitial nephritis. The composition of the inflammatory cell infiltrate was characterized in kidney tissue sections and cell suspensions obtained from affected kidneys. Anti-TBM antibody deposition in the kidney began 8 days after immunization and was followed on days 8 to 10 by C3 deposits and infiltration of polymorphonuclear leukocytes (PMN). After day 13, the infiltrate became almost exclusively mononuclear in character. On day 13, the inflammatory mononuclear cells recovered by Ficoll-Hypaque centrifugation contained 10% Ig+ cells (B cells), 60% W3/25+ cells (T helper cells), 9% OX8+ cells (T suppressor cells), 9% esterase+ cells (monocytes/macrophages), 4% renal cells, and 8% other unidentified cells. Monocytes/macrophages were prominent only at the latest stages of the disease. The ratio of W3/25+ to OX8+ cells was higher in the kidney than in the spleen or peripheral blood. The sequential accumulation of T cells and then monocytes/macrophages after an initial antibody, complement, and PMN lesion suggests a role for the T cells (selective prevalence of the helper T cell population over that of suppressor T cells) both as inflammatory cells and in progression and regulation of the subsequent stages of injury.

Renal carcinoma: computer analysis of 96 patients treated by nephrectomy.

We submitted to computer analysis 109 items of pathologic, clinical and survival data from 96 patients with renal carcinoma treated by nephrectomy with or without adjuvant therapy between 1956 and 1976. The combined 1, 5 and 10-year calculated survival rates for potentially curable non-metastatic renal carcinoma (stages I, II and III, provided the regional lymph nodes were not involved) were 95, 61 and 47 per cent, respectively, compared to 1, 5 and 10-year survival rates of 61, 5 and 0 per cent, respectively, for stage IV tumors. The cytoplasmic appearance (clear or granular) was not a significant microscopic feature relevant to survival of the patient but the grade of the tumor was predictive of the outcome of disease. Other features of renal carcinoma, particularly invasion of the renal vein and, to a lesser degree, perinephric fat, were not as prognostically significant in this series. In this retrospective study we further analyze the clinical, radiologic, pathologic and survival data of this group of patients.

Non-metastatic hepatic dysfunction associated with renal carcinoma.

A retrospective computer analysis of 102 patients treated for renal tubular carcinoma revealed 7 patients who presented with non-metastatic hepatic dysfunction. Of these 7 patients 5 also had the triad of fever, weight loss and fatigue. Only 1 patient survived more than 10 years after nephrectomy. A review of the literature on non-metastatic hepatic dysfunction revealed a significant interval between onset of symptoms and detection of the underlying renal malignancy, as well as a poor over-all survival rate if the syndrome persisted after nephrectomy.