Soluble interleukin-2 receptors in chronic renal failure.

A depression of the general immune response in uremia is well documented, and hemodialyzed (HD) patients present deficient interleukin-2 (IL2) secretion. Since soluble IL2 receptors (SIL2R) could affect the immune response through interaction with circulating immune cells, we studied the potential relationship between SIL2R concentration and lymphocyte subsets in 44 HD patients. HD patients present lymphopenia, higher CD4/CD8 ratio. CD16 counts and SIL2R concentrations than controls. A significant negative correlation was found between SIL2R concentration and lymphocyte count (p less than 0.01), and between SIL2R concentration and T4/T8 ratio (p less than 0.01). An increase of SIL2R concentration due to abnormal T cell preactivation in HD patients with nonreused cuprophan membranes could perhaps contribute to cell immunity impairment through IL2 binding and inhibition of T cell activation.

[Comparative study of heparin and a very low molecular-weight heparin in hemodialysis in chronic renal insufficiency]. / Etude comparative de l'héparine et d'une héparine de très faible masse moléculaire en hémodialyse dans l'insuffisance rénale chronique.

In the course of dialysis sessions, we have compared the antithrombotic effect of two heparinization regimens: low molecular weight heparin (CY 222, mean molecular weight: 2,500, Institute Choay, France): 90 anti-Xa units/kg bodyweight as a bolus injection followed by a continuous infusion of 1,000 anti-Xa units/hour (regimen 1); or 300 anti-Xa units/kg as a bolus injection (regimen 3), with a standard heparinization regimen (100 IU/kg regimen 2). Eight patients received the 3 regimens successively. Factor IIa and factor Xa inactivation was measured by a method that uses chromogenic substrates. The frequency of adverse effects, ultrafiltration rates, creatinine and BUN clearances of the 3 regimens were similar, whereas dialyser blood loss was higher in the first regimen. At the dose of 300 anti-Xa units of CY 222 (regimen 3), inactivation of factor Xa was similar to Xa inhibition reached through the conventional treatment (regimen 2) but IIa inhibition was less pronounced.

[Chronic terminal renal failure: an unusual outcome of acute tubulointerstitial nephritis]. / L'insuffisance rénale chronique terminale: évolution inhabituelle d'une néphrite tubulo-interstitielle aiguë.

Recovery of renal function after acute tubular necrosis usually begins within a few days or weeks, provided the patient does not succumb to the complications of uremia or of the precipitating illness. However, some studies suggest a high incidence of permanent renal failure perhaps reflecting the survival of patients who previously died because of less ideal treatment. Recently, we observed a patient with acute tubulo-interstitial nephritis whose course was notably different from the usual pattern since the patient required chronic dialysis. We believe that the cause of this permanent lesion is multifactorial including age, nephrotoxic agents (aminoglycosides, intravenous contrast media) and perhaps immunological mechanism. Treatment with prednisone did not produce improvement in our case and the patient has been treated by maintenance hemodialysis.

Waldenström macroglobulinemia and nephrotic syndrome with minimal change lesion.

A case of Waldenström macroglobulinemia with nephrotic syndrome is reported. Kidney biopsy, revealing only foot process fusion and response to steroid therapy, fits minimal change disease.

[Urinary myelin bodies and the nephrotoxicity of aminoglycosides]. / Corps myéliniques urinaires et néphrotoxicité des aminoglycosides.

In a significant number of cases, the administration of aminoglycosides induces renal failure. Electron microscopy has now shown that the renal lesion is mainly characterised by the appearance of myelin figures (myeloid bodies) in lysosomes of proximal convoluted tubules. These figures are then eliminated by urinary excretion. The search for and quantification of the myelin figures in urinary sediment seems to us to link the renal failure to the administration of aminoglycosides. Our study is based on 75 patients: 54 received aminoglycosides and 21 were controls. In each case myelin figures in the urinary sediment were grouped into one of 6 classes (O to V) according to their quantity. Comparison of the results with clinical factors showed 3 different correlations: 1) between the presence of myelin figures in the urine and the administration of aminoglycosides; 2) between the quantity of myelin figures and the accumulated dose of aminoglycosides; 3) between the quantity of myelin figures and obvious renal failure. The absence of myelin figures in control patients attests to their diagnostic value. Urine analysis to detect myelin figure appears to be a reliable technique in confirming the aminoglycoside's origin of an acute renal failure. It would also aid in determining and evaluating aminoglycoside nephrotoxicity in animal experimentation and human pathology. Since this method is non invasive, repeated studies are possible in man as well as animals.

[Unusual muscular manifestations in a case of Horton's disease]. / Manifestations musculaires inhabituelles au cours d'une maladie de Horton.

The authors report the case of a 66-year-old woman with temporal arteritis. The unusual muscular involvement consists in proximal muscle wasting, electromyographic changes and increased muscle enzyme levels. The improvement of these objective manifestations under steroid therapy allows to include them in the systemic spectrum of temporal anteritis. Attention is drawn to the infrequency of such objective manifestations published in the literature on temporal arteritis or polymyalgia rheumatica.

[Prostacyclin versus regional heparinisation during haemodialysis (author's transl)]. / Comparaison de la prostacycline et de l'heparinisation régionale au cours de la séance d'hémodialyse.

Ten patients with terminal renal failure underwent two haemodialysis sessions: one with regional heparinisation, the other with prostacyclin (PGI2). The values compared included duration of dialysis, amount of fluid perfused, weight loss, coagulation in the dialyser, side-effects, changes in electrolyte, urea, creatinine and blood gases values and changes in blood count and differential platelet function was included in coagulation studies. The only statistically significant differences recorded concerned weight loss during dialysis (inferior with PGI2) and number of leucocytes after dialysis (superior with PGI2).

[Cystic lymphangioma of the adrenal gland causing arterial hypertension]. / Lymphangiome kystique de la surrénale responsable d'une hypertension artérielle.

The authors report a new cases of cystic lymphangioma of the adrenal diagnosed at the time of investigation of systemic hypertension which became normal after the lesion was treated surgically. The place of these lymphangiectasis cysts amongst adrenal cystic lesions, their clinical manifestations, methods of diagnosis and treatment are envisaged.

[Deposits of unusual structure in lupus glomerulonephritis]. / Dépôts de structure inhabituelle dans une glomérulonéphrite lupique.

The authors report a case of Lupus nephritis shown by ultrastructural analysis of subendothelial, mesangial and especially subepithelial deposits formed by aggregates of electron-dense straight tubular structures 20 to 30 nm in diameter. These unusual structural deposits, always identical, are observed in 4 biopsies performed over 8 years during the management of Systemic Lupus Erythematosus in a young woman. They are compared to the usual "Fingerprint" deposits of Systemic Lupus Erythematosus and to the geometric type deposits of cryoglobulinemic glomerulonephritis.

[Subclinical glomerulonephritis with dense deposits in the course of partial lipodystrophy (author's transl)]. / Glomérulonéphrite latente à dépôts denses dans les basales au cours d'une lipodystrophie partielle.

In a young woman with partial lipodystrophy accompanied by hypocomplementemia related to circulating C3NF activity, renal biopsy revealed dense deposits in the basement membranes of the glomerular capillaries without any evidence of urinary syndrome. This early form was not revealed by light microscopy and was confirmed only by ultrastructural examination. The morphological characteristics are similar to those occurring in renal grafts. The authors point out that subclinical forms of glomerulonephritis must be considered in cases of lipodystrophy and hypocomplementemia.

[Corticosteroid-therapy of giant cell arteritis after gastric acute ulceration induced by indometacin. Interest of H2 receptor antagonist (author's transl)]. / Corticothérapie d'une maladie de Horton après perforation gastrique aiguë par l'indométacine. Intérêt des anti-H2.

The authors report corticosteroïd-therapy of giant cell arteritis of a woman who presented a gastric ulceration induced by indometacin. They point out interest of H2 receptor antagonist coupled with steroid-therapy.

[Kidney polycystic disease as the major feature in three adults with congenital hepatic fibrosis. 3 cases (author's transl)]. / Polykystose rénale, principale expression de la fibrose hépatique congénitale. 3 observations.

Congenital hepatic fibrosis is nearly always associated with ectasia of collecting tubules of the kidneys. This abnormality usually remains silent. In this study we report three cases of adult's CHF with associated renal failure treated by hemodialysis. In all three cases, renal injuries were indistinguishable from those found in adult-type of polycystic disease. The kidneys of our third patient, who underwent two nephrectomies at a 14-years interval, showed ectasia of the collecting tubules with only a few cortical cysts. The second one showed numerous large cysts and only a few ectatic tubules. Our data indicate that: renal failure can complicate the CHF course in adults. Uremia can be the pressenting feature; polycystic kidneys in CHF are microscopically different from those found in adult-type, they might be considered as the final stage in ectasia of collecting tubules.