[Relationship between initial diagnosis and long-term prognosis in lupus nephritis].

UNLABELLED: To clarify the outcomes of patients with lupus glomerulonephritis (LGN), we performed a retrospective study of 31 patients (27 females and 4 males) with LGN between January 1975 and June 2006. All these 31 patients fulfilled the SLE criteria of the American College of Rheumatology evaluated by pathohistological diagnosis using renal biopsies. According to 2003 ISN/RPS classification, we reclassified all initial renal biopsies as class II 16%, class III 16%, class IV 48%, and class V 19.5%. Activity and chronicity indices were also calculated according to the scores proposed by Austin et al. All patients were treated by oral corticosteroids in induction therapy, then subsequeatly 18 patients (61%) were treated with intravenous methylprednisolone pulse therapy, and 16 patients with immunosuppressive agents (58%). Clinical remission rate was 94% by induction therapy and 13% by recurrence rate. Patient survival rate was 85% at 10 years and 76% at 20 years. Renal survival rate was 96% at 10 years and 86% at 20 years, 100% at 10 years and 80% at 20 years in ClassIV-G. In the multivariate Cox hazard analysis of the clinicopathologic factors, serum creatinine was selected as the most significant risk factor for death and/or end-stage renal failure (p=0.036). In addition, the chronicity index was also a significant risk factor for renal survival of LGN. CONCLUSION: This retrospective analysis of LGN showed better outcomes than expected. Overall, early diagnosis and suitable initial therapy may improve the renal survival of LGN in both groups of patients.

A case report of an adult with severe hyperlipidemia during acute lymphocytic leukemia induction therapy successfully treated with plasmapheresis.

Plasmapheresis for the treatment of hypertriglyceridemia has previously been performed in patients with sudden onset severe hypertriglyceridemia and acute pancreatitis; however, only a few reports of this procedure have been published. We report here on a case showing severe hypertriglyceridemia during asparaginase (Asp) treatment for acute lymphocytic leukemia (ALL), and give an overview of a lipid-lowering apheresis therapy. To prevent the complication of pancreatitis due to hypertriglyceridemia, we performed plasma exchange (PE) three times using fresh frozen plasma. PE remarkably reduced both serum triglyceride and total cholesterol levels from 5430 mg/dL to 403 mg/dL and from 623 mg/dL to 204 mg/dL, respectively. The causes of severe hyperlipidemia in this patient were considered to include: the Asp treatment for ALL, and a genetic background with a heterozygote of familial lipoprotein lipase (LPL) defect syndrome, because the patient's plasma LPL level after intravenous heparin injection was low at 137 ng/mL. Hence, PE using fresh frozen plasma may be useful not only to remove lipoproteins, but also to supply defective factors, such as LPL, in similar cases.

Proteomic analysis of serum, outflow dialysate and adsorbed protein onto dialysis membranes (polysulfone and pmma) during hemodialysis treatment using SELDI-TOF-MS.

AIMS: Alterations in the profiling of peptides and proteins in the serum, outflow dialysate and adsorbed protein on the dialysis membrane were investigated. METHODS: Alterations in the protein profiling of routine hemodialysis using polysulfone (TS-UL) and PMMA (moderate flux membrane of polymethylmethacrylate: BK-U) in 8 patients and that of adsorption onto polysulfone and PMMA membranes in 4 patients were evaluated by SELDI-TOF-MS and ProteinChip array. Mass-to-charge ratios (m/z) between 2,000 and 120,000 were analyzed. RESULTS: The protein with a relative intensity of m/z 11,730 measured by SELDI-TOF-MS was present in a small amount in the outflow dialysate and in a large amount in adsorption (identified as beta2-microglobulin) onto PMMA membrane. Unexpectedly, 68 molecular masses of peptides that were adsorbed more onto polysulfone than onto PMMA membrane were observed. There were more peptides less than m/z 11,730 adsorbed onto polysulfone membrane than onto PMMA membrane. Dominant peaks, m/z 6,629 and 6,431 adsorbed onto polysulfone membrane were identified as apolipoprotein CI and truncated apolipoprotein CI, respectively. 37 proteins with molecular weights larger than m/z 11,730 showed greater filtration through PMMA membrane than through polysulfone membrane. 149 molecular masses that were adsorbed onto PMMA or more onto PMMA membrane than onto polysulfone membrane were observed. CONCLUSION: This experiment suggests that membrane adsorption is an important mechanism for the removal of middle-molecular-weight proteins by hemodialysis using not only PMMA membrane but also polysulfone membrane. Adsorption of peptide or protein onto a dialysis membrane may depend not only on the membrane material, but also on the peptide or protein.