Hemolytic-uremic syndrome--an outbreak in Sacramento, California.

Between July and November 1982, 14 cases of the hemolytic-uremic syndrome occurred in the Sacramento, California, metropolitan area; 9 of the 14 patients lived within a 7.5-mile radius in northeast Sacramento, 10 were female, 12 were white non-Hispanic and 13 were children with a mean age of 3.6 years. Of the 14 patients, 13 were admitted to hospital; 7 required peritoneal dialysis. The 14th child, a 3-month-old white female infant, was found dead in her crib and had renal histopathologic findings consistent with the hemolytic-uremic syndrome. Of the 13 nonfatal cases, 12 patients had diarrhea before being admitted to hospital. A case-control study involving 11 cases and 22 controls did not show any significant differences in exposure to a variety of possible risk factors including restaurants, specific foods and water supply. Stool specimens were negative for enteric bacterial pathogens by culture and for viruses by tissue culture assay, suckling mouse inoculation and immune electron microscopy; no serologic evidence was found for infection due to enteroviruses, respiratory viruses or arenaviruses. Two of four children tested, however, showed serologic evidence of infection by Vero-cytotoxin-producing Escherichia coli. These 14 cases represent one of the largest reported outbreaks of the hemolytic-uremic syndrome in the United States.

Enhancement of in situ immune complex formation in isolated perfused kidneys in Heymann's nephritis.

A preparation of the putative antibody in HN (Heymann's nephritis) lacking preformed immune complexes, obtained from the acid eluates of kidneys with HN, purified through ion exchange and gel-filtration chromatography, characterized by immunoelectrophoresis, sucrose density-gradient ultracentrifugation, 125I-Clq assay for immune complexes, and specific for the brush border of rat proximal renal tubule was injected intravenously, intra-arterially directly into the left and renal artery of a kidney with intact normal circulation, and into the isolated buffer-perfused kidney, respectively, in three groups of rats. Controls were injected with non-antibody IgG, and antibody absorbed with the specific antigen. Localization of antibody was studied by direct immunofluorescence. Prompt localization of antibody and formation of in situ immune complexes occurred in the isolated perfused kidney. No localization of antibody was seen following the intrarenal arterial injection in the unperfused kidney with intact circulation, and a delay of 5 days was noted for the localization to develop upon intravenous injection. These results show that, in the homologous antibody-induced HN, the preparation of isolated perfused kidney considerably enhances the formation of in situ immune complexes in glomeruli as compared to the unperfused kidney with intact circulation in which the antibody is injected either directly into the renal artery or systemically through a peripheral vein.

Regression of dense deposits in Type II membranoproliferative glomerulonephritis: case report of clinical course in a child.

The clinical course and follow-up of a child who presented with rapidly progressive renal failure due to dense deposit disease is described. The patient showed a dramatic response to immunosuppressive and anticoagulent therapy. Two and a half years later, a follow-up renal biopsy showed regression of the intramembranous dense deposits on electron microscopy. The unusually slow progression of renal failure in this patient has been of interest and its possible relationship with either the disappearance of dense deposits or the initial therapy received are discussed.

Renal transplantation in a child with Burkitt's lymphoma.

An 11-year-old child who was given radiation to the abdomen for Burkitt's lymphoma of the cecum had irreversible renal failure requiring hemodialysis. Because renal transplantation is associated with a greater risk of lymphoma (35 times) even in patients without prior history of cancer, it was feared that the risk of recurrence of lymphoma was considerably greater in this child. However, a cadaver renal transplant given after one year of hemodialysis has functioned exceedingly well for more than five years. There has been no recurrence of the tumor, and the patient is fully rehabilitated and is a normal healthy teenager in all respects. To our knowledge, this the first report of a successful renal transplant in a patient with preexisting Burkitt's lymphoma.

Immunosuppressive activity of two plant steroidal lactones withaferin A and withanolide E.

Withaferin A and withanolide E, two steroidal lactones of plant origin were demonstrated to have specific immunosuppressive effects on human B and T lymphocytes as well as on mice thymocytes. E rosettes and EAC rosette formation by normal human T and B lymphocytes were inhibited by the two compounds at very low concentrations. The formation of mouse red blood rosettes by chronic lymphatic leukemic cells were only inhibited by withaferin A. The functional activity of normal human T lymphocytes as assessed by a local xenogeneic graft versus host reaction was also affected by these two plant steroidal lactones. These experiments demonstrate a specific action of the compound on antigen recognition as well as proliferative capacity of T lymphocytes as well as B lymphocytes.