ABSTRACT
IgA nephropathy (IgAN) and Henoch-Schönlein purpura (HSP) are both characterized by IgA-mediated tissue injury, including mesangial proliferative glomerulonephritis. Abnormalities of IgA1 glycosylation are described in IgA nephropathy and HSP nephritis. IgA-antineutrophil cytoplasmic antibodies (ANCA) have been inconsistently described in the serum of patients with HSP. In IgA myeloma, the paraprotein-mediated renal lesion is typically cast nephropathy; IgAN or HSP have only rarely been reported in myeloma even when an IgA paraprotein is circulating in large concentrations. We report the case of a 50-year-old man with IgA myeloma who presented with HSP including nephritis and rapidly progressive renal failure. His IgA1 had altered O-glycosylation in the pattern seen in IgAN and also contained an IgA-ANCA. This case adds further weight to the evidence that IgA1 O-glycosylation abnormalities predispose to mesangial IgA deposition and also that IgA-ANCA may have a pathogenic role in the development of HSP.
Subject(s)
IgA Vasculitis/etiology , Immunoglobulin A/blood , Immunoglobulins/blood , Multiple Myeloma/complications , Nephritis/etiology , Antibodies, Antineutrophil Cytoplasmic/blood , Glycosylation , Humans , Male , Middle Aged , Multiple Myeloma/immunology , Myeloma ProteinsABSTRACT
A case of dothiepin poisoning complicated by cardiogenic shock is described. Hypotension was resistant to conventional inotropes but responded rapidly to high-dose intravenous glucagon. Glucagon should be considered as a useful therapeutic positive inotrope and a potentially antiarrhythmic agent in severe tricyclic antidepressant overdose.
Subject(s)
Antidepressive Agents, Tricyclic/poisoning , Cardiotonic Agents/administration & dosage , Dothiepin/poisoning , Glucagon/administration & dosage , Shock, Cardiogenic/chemically induced , Adult , Cardiotonic Agents/therapeutic use , Drug Administration Schedule , Drug Overdose , Female , Glucagon/therapeutic use , Humans , Injections, Intravenous , Shock, Cardiogenic/drug therapyABSTRACT
Diabetic ketoacidosis (DKA) often presents with hyperkalaemia. We investigated whether it was more likely in patients taking potassium-retaining diuretics. A retrospective survey of all patients (552 cases) presenting in DKA between 1974 and 1984 was undertaken. Initial biochemical data were compared for patients recorded as taking potassium-retaining diuretics (7 cases) at the time of presentation with those taking potassium-losing diuretics (13 cases), and age matched control groups were selected from those who presented in DKA but were not taking diuretics. There was no significant difference in initial serum potassium levels between the diuretic treated groups. The serum sodium was higher in the control group than in the potassium losing group (p = 0.045) and the serum urea significantly lower (p = 0.045). We conclude that potassium-retaining diuretics do not predispose to hyperkalaemia in diabetic ketoacidosis.
Subject(s)
Diabetic Ketoacidosis/complications , Diuretics/adverse effects , Hyperkalemia/chemically induced , Adult , Aged , Aged, 80 and over , Benzothiadiazines , Humans , Middle Aged , Retrospective Studies , Sodium Chloride Symporter Inhibitors/adverse effectsSubject(s)
Diabetes Mellitus, Type 1/immunology , Insulin Antibodies/analysis , Animals , Cattle , Humans , SwineABSTRACT
Insulin binding to monocytes and the counterregulatory hormone response to intravenous insulin was determined in six normal subjects and eight patients with non-insulin dependent diabetes mellitus (NIDDM), before and after seven days treatment with oral diazoxide. In the normal subjects diazoxide had no effect on insulin binding or sensitivity. In the patients with NIDDM diazoxide caused resistance to intravenous insulin with no change in the counterregulatory hormone response or in insulin binding to account for this. Diazoxide appears to cause post-receptor insulin resistance in NIDDM, and it may be a useful tool for studying post-receptor binding events.
Subject(s)
Diabetes Mellitus, Type 2/metabolism , Diazoxide/adverse effects , Insulin Resistance , Receptor, Insulin/metabolism , Adult , Aged , Blood Glucose/metabolism , Fatty Acids, Nonesterified/blood , Female , Humans , Male , Middle Aged , Monocytes/metabolismABSTRACT
Insulin sensitivity and insulin binding to monocytes were determined in seven normal subjects before and after one week's treatment with glibenclamide 2 mg three times daily. Glibenclamide administration produced a 60% increase in maximal specific insulin binding to monocytes. There was no effect on the blood glucose response to an intravenous bolus of insulin but fasting blood glucose was significantly elevated following glibenclamide treatment. Statistically significant changes in the fasting levels of plasma C-peptide and serum proinsulin were not detected.
Subject(s)
Glyburide/pharmacology , Insulin/metabolism , Monocytes/metabolism , Receptor, Insulin/metabolism , Adult , Female , HumansABSTRACT
Twenty four patients with established insulin dependent diabetes treated with twice daily soluble and isophane bovine insulins were changed to equivalent doses of either purified bovine Neusulin and Neuphane (Wellcome) or purified porcine Actrapid and Monotard (Novo) insulins. After 6 months treatment the porcine group showed a 35% fall in insulin binding antibodies and a 14% reduction in insulin dosage. The group changed to purified bovine insulins showed no significant change in insulin binding antibodies and no change in insulin dose. Mean blood glucose and glycosylated serum protein fell in both groups during the study period but there was no significant difference between the two groups.
