Nephrotic syndrome associated with hepatointestinal schistosomiasis.

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.

Nephrotic syndrome associated with hepatointestinal schistosomiasis

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy

Nodular diabetic glomerulosclerosis without diabetes mellitus.

A 66-year-old white man presented with severe chronic renal failure. He had no past or present symptomatic glucose intolerance nor a family history of diabetes mellitus. Several fasting plasma glucose determinations, hemoglobin Alc and an oral glucose tolerance test were normal. Funduscopic ophthalmoscopy and retinal fluorescein angiography did not demonstrate diabetic retinopathy. The kidney biopsy showed nodular diabetic nephropathy, with increased mesangial matrix, thickened glomerular basement membrane, and afferent and efferent glomerular arteriolar hyalinization. The diagnosis of nodular diabetic nephropathy was made in this patient in the absence of past or present or familial evidence of diabetes mellitus.

Polyamine effects upon N-methyl-D-aspartate receptor functioning: differential alteration by glutamate and glycine site antagonists.

Polyamines such as spermidine potentiate activation of the N-methyl-D-aspartate (NMDA)-type excitatory amino acid receptor. The goal of the present study was to investigate interactions between the putative polyamine binding site and previously described sites for glutamate and glycine. Binding of the high-potency PCP receptor ligand [3H]MK-801 to well-washed rat brain membranes was used as an in vitro probe of NMDA receptor activation. Spermidine concentration-response studies were performed in the absence and presence of both glutamate and glycine, with and without D-(-)-2-amino-5-phosphonovaleric acid (D(-)-AP-5) or 7-chlorokynurenic acid (7Cl-KYN). Incubation in the presence of spermidine alone induced a 20.4-fold increase in [3H]MK-801 binding with an EC50 value of 13.3 microM. The mean concentration of spermidine which induced maximal stimulation of binding was 130 microM (n = 10, S.E.M. = 24.66, range = 25-250 microM). Glutamate (10 microM) decreased the EC50 value for spermidine-induced stimulation of [3H]MK-801 binding to 3.4 microM. Glycine (10 microM) did not significantly alter either maximum spermidine-induced [3H]MK-801 binding or the EC50 value for spermidine-induced stimulation of [3H]MK-801 binding. Incubation in the presence of the specific glutamate antagonist D(-)AP-5 attenuated [3H]MK-801 binding in a glutamate-reversible fashion. The competitive glycine antagonist 7Cl-KYN decreased maximum spermidine-induced [3H]MK-801 binding in a glycine-reversible fashion. In addition, 7Cl-KYN increased the EC50 value for spermidine-induced stimulation of [3H]MK-801 binding while D(-)AP-5 was without effect.(ABSTRACT TRUNCATED AT 250 WORDS)

[Protein/creatinine index in isolated samples of urine for evaluation of 24-hour proteinuria]. / Indice proteína/creatinina em amostra isolada de urina para avaliação da proteinúria de 24 horas.

The correct determination of the 24 hours proteinuria (PU24) in the non-hospitalized patients is frequently subject to collection errors. To overcome this problem it has been proposed the use of the proteinuria ratio (PR), obtained by dividing the concentrations of protein/creatinine in random urine samples. In the present investigation PR and PU24 were correlated in 42 patients (22 male and 20 female), aged between 14 and 63 years. Each patient was submitted to a 2 hours creatinine clearance (Ccr), to determination of PU24 and to evaluation of PR in the urine samples. The measures of PU24 were correlated with the values of PR. On linear regression analysis the equation y = 0,517 + 0,759x was obtained, with r = 0,914, suggesting good correlation between PU24 and PR. Values of r greater than 0,9 were always obtained, independently of the values of Ccr and PU24. The results indicate that PR in random urine samples may be practical and reliable in the follow-up of nephrological patients.

[Primary IgA mesangial nephropathy (Berger's disease): clinico-pathological study]. / Nefropatia mesangial primária da IgA (doença de Berger): estudo clínico-patológico.

From 1976 to December 1984 IgA nephropathy (IgAN) was diagnosed in 40 patients at the Nephrology Division of the Hospital das Clínicas, São Paulo University. In order to estimate the incidence of the disease in our city, we reviewed the kidney biopsies of the year 1984: IgAN constituted 6.5% of all biopsies of primary glomerular nephropathies. Of the 40 patients 67.5% were males and 32.5% females. Their age varied between 4 and 49 years and 72.5% were in the 2nd and 3rd decades of life at the beginning of the disease. From the racial standpoint, 82.5% of the patients were white, 10% were yellow and 7.5% black. The most frequent clinical manifestation, presented by 62.5% of patients, was macroscopic hematuria in close association with an acute infectious process. In the remaining 37.5% of cases the clinical picture of the disease was very variable, and did not evoke the diagnosis of IgAN. The initial laboratory investigation showed proteinuria in 92.5% of patients; it was under 1g/24h in 40%, it ranged from 1 to 3g/day in 37.5% and was over 3.5g/24h in 15% of them. Hematuria was present in all 40 cases and the red cells displayed moderate dismorphism. Glomerular filtration rate, evaluated by creatinine clearance in 39 patients, was over 90 ml/min/1.73m2 in 70%, ranged between 50 and 89 ml/min/1.73m2 in 7.5% and was under 25 ml/min/1.73m2 in 20% of them. Total complement CH50 was found normal in 79.4% and was slightly reduced in 20.6%. The C3 fraction showed slight reduction in 9.5% and C4 was found normal in all instances. Serum IgA was increased in 21% of the cases. All patients were submitted to percutaneous renal biopsy. Proliferative mesangial lesions were found in 82.5% of cases; they were focal in 42.5% and diffuse in 40%. In 15% of the patients, the glomeruli were entirely normal on light microscopy. In one case they were crescent-shaped, exhibiting 82% of the glomeruli this form. The immunofluorescence findings were quite uniform, with granular deposits occupying only the mesangium, with a global and diffuse distribution in all glomeruli. IgA was the dominant immunoglobulin deposited in the 40 cases and C3 was also found in the same localization and distribution in all biopsies, generally with a lesser intensity than IgA. IgG was present in 85% of cases and IgM in 32.5% of the biopsies, in the majority of them with the intensity of traces.(ABSTRACT TRUNCATED AT 400 WORDS)