[Results of two year use of dipyridamole and metindol in patients with primary focal and (or) segmental glomerulosclerosis]. / Wyniki dwuletniego stosowania dipirydamolu i metindolu w leczeniu chorych na pierwotne, ogniskowe i (albo) segmentalne szkliwiejace klebkowe zapalenie nerek.

Primary focal or segmental glomerulosclerosis is neuropathy diagnosed in 10% of children and 20% of adult patients with nephrotic syndrome. Immunosuppressive therapy was applied during two years period. The very good clinical results were obtained in 20% and good results in 40% of patients after indomethacin and dipyridamole therapy.

[Immune complexes and C3 and C4 of the complement in urine of patients with glomerulonephritis]. / Kompleksy immunologiczne oraz C3 I C4 dopelniacza w moczu chorych na klebuszkowe zapalenia nerek.

The circulating immune complexes (CIC), urinary immune complexes (UIC), C3 and C4 in urine (UC3 and UC4) in 99 patients with immunologic glomerular diseases: 13 with extracapillaris GN (ExGN), 38 with membranoproliferative GN (MPGN), 33 with mesangial proliferative GN (MesPGN), 5 with focal segmental glomerulosclerosis (FSGS), 5 with membranous nephropathy (MN), and 3 with minimal change nephropathy (MC) were investigated in the study. Depending on the (IS) immunosuppressive treatment all patients were classified into 3 groups. Group I: 61 recently biopsied patients with glomerular disease consisted of patients attending our renal department, group II: 24 patients with biopsy proven glomerular disease IS treated in the past but with GN with restrained disease activity, group III: 14 patients with active glomerulopathy who have been treated for some months. Nephelometry C1q binding test was used for CIC detection and 3.5% polyethylene glycol precipitate for its detection in urine by C1q binding test was applied. Radial immunodiffusion (NANORID) method was used for urine C3 and C4 detection. UC3 were detected in urine from 37% of all patients: in 39% patients of group I (GN at time of diagnosis), 38% of group II (GN with restrained disease activity) and 36% of group III (active GN received immunosuppressive therapy for several months). It suggest that nonimmunological-mechanism induce C3 detected in the rine of such patients. According to histological findings UC3 was detected in 3 patients with ExGN of group I, in patient with ExGN of group II and in about half patients with MPGN from group I and II, in about 25% patients with MesPGN from group I and II. About half patients with MesPGN of group III, one patient with MPGN of group III and a few patients with other histological findings of group I were UC3 positive. Simultaneous excretion of C4 in urine was detected in some UC3 positive patients (in about 5% patients). At the same time in about 50% UC3 positive patients was observed urinary excretion of IC. CIC and UIC were detected in 25% of all patients: in 29% of group I, in 17% of group II, and in 29% patients of group III. According to histological findings CIC was detected in 3 patients with ExGN, in 7 patients with MPGN from 26 of group I, and 3 from 7 with MPGN of group II, and 3 patients with MesPGN of group I and 1 patients with MesPGN of group II, and 33% patients with MesPGN of group III with high proteinuria. These findings suggested that urinary IC reflected the immunological activity of glomerulopathy and their presence in patients urine after IS treatment suggests incomplete response to this therapy while urinary C3 and C4 were connected with urinary protein excretion and may be of importance in tubulointerstitial injury and progression of renal insufficiency.

[Tumor necrosis factor (TNF) and interleukin-6 (IL-6) in patients with glomerulonephritis]. / Czynnik martwicy nowotworu (TNF) i interleukina-6 (IL-6) w klebuszkowych zapaleniach nerek.

Serum and urinary tumor necrosis factor-alpha (SeTNF and UTNF) and interleukin-6 (SeIL-6 and UIL-6) by ELISA method were determined in 99 patients with glomerulonephritis (GN): 13 with extracapillaris GN (ExGN), 38 with membranoproliferative GN (MPGN), 33 mesangial proliferative GN (MesPGN), 5 with focal segmental glomerulosclerosis (FSGS), 5 with membranous nephropathy (MN), 3 with minimal change nephropathy (MC) and in 32 healthy adults. The higher levels of Se TNF than those in the healthy were in 25 patients: in nearly all with ExGN, in 8 with MPGN and in single patients with other GN. In all patients with high SeTNF were many extra renal organs involvement. Measurable levels of UTNF were in 30 patients (30%) (in 12 with ExGN, 9 with MPGN, 7 with MesPGN, 1 with MN, and 1 with FSGS). Most patients with high SeTNF belonged to group I. The higher levels of SeIL-6 than those in healthy were in 17 patients belonging to group I, in which high SeIL-6 were in 3 patients with ExGN, 6 with MPGN, 3 with MesPGN, 2 with MN, and 3 with FSGS. Measurable urinary IL-6 levels were in 27 (27%) patients, mainly in group I, and in single patients in other groups. The majority of patients with ExGN and MPGN from group I and UIL-6 positive suffered from renal insufficiency and histologically had proliferative GN. We conclude that the elevation of TNF alpha and/or IL-6 in plasma may reflect a secondary consequence of immune cells activation while urinary TNF alpha and/or IL-6 may be secreted by activated glomerular cells. Thus, high levels of TNF alpha and/or IL-6 in serum of patients with GN and extra renal organs involvement, peculiary with infections, suggested antibiotics therapy, because infection may stimulated cytokines production and they are important in pathogenesis and progress of GN. High urinary levels of IL-6 and (or) TNF alpha in patients with proliferative GN suggest great disease activity and is useful in the evaluating of IS treatment.

[Anti-neutrophil cytoplasmic antibodies (ANCA) in the glomerulonephritis]. / Przeciwciala przeciw cytoplazmie granulocytów obojetnochlonnych (ANCA) w klebuszkowych zapaleniach nerek.

Ninety nine patients with biopsy-proven diagnosis of immunologic glomerular disease were included in this study: 13 with extracapillaris glomerulonephritis (ExGN), 38 with membranoproliferative GN (MPGN), 33 with mesangial proliferative GN (MesPGN), 5 with focal segmental glomerulosclerosis (FSGS), 5 with membranous nephropathy (MN), and 3 with minimal change nephropathy (MC). Sera of these patients were tested for the presence of anti-neutrophil cytoplasmic antibodies (ANCA) by standard indirect immunofluorescence (IIF). Specific antiproteinase 3 (anti-Pr 3) and anti-myeloperoxidase (anti-MPO) by ELISA were assayed in ANCA-positive patients. ANCA were detected by IIF and ELISA in sera from 28 patients (28%). Of the 28 patients, 3 had cytoplasmic ANCA (c-ANCA), while 25 had perinuclear pattern (p-ANCA). Two c-ANCA positive patients with anti-Pr3 belonged to group I (GN at time of diagnosis). Another c-ANCA positive patients suffering from GN belonged to group II (GN with restrained disease activity). Of the 25 p-ANCA positive patients, 23 belonged to group I, 1 to group II, and I to group III (active GN received immunosuppressive therapy for several months). Majority of ANCA positive patients with GN were complicated by extrarenal organs involvement. One c-ANCA positive patient had ExGN and two patients had MesPGN. Of the 25 p-ANCA positive patients, 7 had ExGN, 10 MPGN, 4 MesPGN, 2 FSGS, and 1 had MC. Five p-ANCA positive patients with ExGN were temporary dialysis-dependent. One of them died due to cardiac infarction, one became dialysis-dependent, there of them (treated also with plasma exchange) responded favorably to this treatment and after 3 to 12 months had life-sustaining renal function (s-creatinine < 265 umol/L; < 3 mg%). Renal-limited disease had 3 p-ANCA positive patients (anti-MPO) with ExGN another ANCA positive patient had extrarenal organs involvement. The majority of patients with low titer of ANCA by IIF and low concentration p-ANCA by ELISA had different morphological GN, in most cases MPGN. All c-ANCA positive patients had extrarenal organs involvement, mainly respiratory tract. One of them was dialysis-dependent, and two responded favorably to immunosuppressive therapy. It is concluded that the IIF and ELISAs for anti-Pr3, and anti-MPO have an acceptable performance and are useful in the diagnostic of patients with vasculitis. Vasculitis can be primary in patients with pauci-immune crescentic GN, or secondary to other disease processes including immune complex-mediated GN. IS treatment (methylpredisolone + cyclophospamide) of ANCA positive patients with renal insufficiency nad normal or enlarged renal size is favourable. In the patients with extrarenal organs involvement and without improvements in renal function, however, requirement of plasma exchange is considered.

[Autoantibodies against neutrophil cytoplasm and their significance in the classification of systemic vasculitis]. / Autoprzeciwciala przeciw cytoplazmie granulocytów obojetnochlonnych i ich znaczenie w klasyfikacji ukladowych zapalen naczyn.

In this article new informations about systemic vasculitis were reviewed. Evaluation of ANCA and their antigen specificity is of a great help in classification of systemic vasculitis. Among idiopathic systemic vasculitis anti-serine proteinase antibodies are found in Wegener granuloma, anti-MPO antibodies in Churg-Strauss syndrome and in polyarteritis nodosa. Antibodies against other components of PMNL granules still remain unknown. The main purpose of this review was to underline incidence of systemic vasculitis and the meaning of ANCA in the diagnosis and classification of these diseases.

[The importance of interleukin 6 (IL-6) in pathogenesis and diagnosis of renal glomerular diseases]. / Znaczenie interleukiny 6 (IL-6) w patogenezie i diagnostyce klebuszkowych chorób nerek.

IL-6 synthesized by various types of cells and has multiple biological functions. In the kidney, IL-6 is synthesized by mesangial cells and acts as an autocrine growth factor. IL-6 was demonstrated in the glomerular mesangium and in the urine of patients with proliferative glomerulonephritis, suggesting that it has an important role in the pathogenesis of renal glomerular diseases.

[Antibodies against neutrophil cytoplasm and their role in pathology and diagnosis of systemic vasculitis]. / Przeciwciala przeciw cytoplazmie granulocytów obojetnochlonnych i ich rola w patologii i diagnostyce ukladowych zapalen naczyn.

Experimental data and clinical observations suggesting the role of antibodies against neutrophil cytoplasm in pathology and diagnosis of systemic vasculitides have been presented. There are no data indicating that ANCA specificity allow to distinguish diverse forms of necrotizing vasculitis. However, detection of ANCA has a diagnostic interest since it is a key to the diagnosis of vasculitis in complex clinical settings where diagnosis is not obvious. ANCA may be useful in monitoring the course of the disease and effects of treatment.

[The role of cellular immunity in the pathogenesis of glomerulonephritis]. / Rola odpornosci komórkowej w patogenezie klebkowych zapalen nerek.

In this article, experimental data and clinical observations suggesting the role of cell-mediated immunity in pathogenesis of primary glomerulonephritis have been presented. Serum anti-GBM antibodies have been observed in glomerulopathies mediated by anti-glomerular basement membrane antibodies with the presence of immunoglobulins in glomeruli and in their eluates. The lymphocytes from patients with glomerular disease show cell-mediated immune reactivity against GBM antigens. Cell-mediated immune mechanisms with involvement of mononuclear cells and polymorphonuclear leukocytes may participate in the pathogenesis of various forms of glomerulonephritis and contribute to prompt deterioration of renal function.