[Chronic IgM mesangioproliferative glomerulonephritis]. / Krónikus IgM mesangioproliferatív glomerulonephritis.

In their ten years renal biopsy material authors found nine cases of chronic glomerulonephritides with predominantly IgM deposition in the mesangium which reach the diagnosis of IgM nephropathy. This paper on the basis of a typical case deal with the immunopathology, diagnosis, prognosis and therapy of the disease.

Combined peritoneal and haemodialysis therapy for chronic renal insufficiency.

Twenty-three patients with chronic uraemia were treated for an average of 8.5 months with intermittent peritoneal dialysis. When hypervolaemia developed and/or the volume of low-molecular weight substances increased, the therapy was complemented by one or two sessions of haemodialysis per week. The combined treatment was carried on for 4.1 months on average, in consequence of which the general condition improved, body weight reached the optimum, blood pressure diminished, turned normal and could be controlled by drugs. In the wake of the therapy carbamide nitrogen and creatinine levels dropped significantly, serum total protein and albumin values increased. At the close of the observation period 3 patients remained under combined therapy, 2 had undergone cadaveric kidney transplantation, 18 were transferred to chronic haemodialysis. Thoughts are evolved about the advisability of intermittent peritoneal dialysis and combined therapy in the care for uraemic patients.

[Combination of peritoneal dialysis and hemodialysis in the treatment of chronic renal insufficiency]. / Peritonealis dialízis és haemodializis kombinációja a krónikus veseelégtelenség kezelésében.

In case of 23 patients, who had been treated for 8.5 (2-10) months with intermittent peritoneal dialysis, the peritoneal dialysis was supplemented once or twice a week by haemodialysis for 8.5 months. This combined way of treatment was favourable in cases of hypervolemia and/or of increased level of substances of small molecular weight. The average duration of this kind of treatment was 4.1 (1.5-11) months. In the course of treatment the general condition of the patients improved. When they regained their optimal bodyweight, their blood pressure got normalized or their hypertony decreased or it could be regulated by drug therapy. At the effect of this treatment, the carbamid nitrate and serum creatinin significantly decreased and the serum total protein and albumin levels increased. Two of the patients underwent cadaver kidney transplantation, and 18 of them have been treated by hemodialysis, 3 of them are being treated in this combined way even now. The authors discuss the role of intermittent peritoneal dialysis and that of the combined treatment in the management of uremic patients.

[IgA and IgG antibodies to Chlamydia in IgA nephropathy as well as in mesangiocapillary and membranous glomerulonephritis]. / Chlamydia elleni IgA és IgG antitestek IgA nephropathiás, mesangiocapillaris és membranosus glomerulonephritises betegekben.

It might be supposed that, among the antigens causing chronic immune complex glomerulonephritis (IC GN), there are foreign materials, e.g. bacterial antigens penetrating the mucosal barrier. To put this hypothesis to the test, the presence and titres of IgA and IgG antibodies against Chlamydia (C., one of the most frequent bacteria causing mucosal inflammation) have been studied in the sera of 70 patients with IgA nephropathy (IgA NP), of 25 with mesangiocapillary GN (MCGN) and of 27 with membranous GN (MGN) using a single serovar (L2) inclusion immunoperoxidase assay. Significantly more IgA (titres greater than or equal to 8) and IgG (titres greater than or equal to 32) antibodies were found in the sera of IgA NP and MCGN patients than in healthy controls. These results are compatible with the hypothesis that there are some similarities between the clinical and morphological picture of IgA NP and MCGN. Furthermore, it may be assumed that in renal patients with an active C. infection (high IgG titres with IgA seropositivity) C. antigens may play a role in the production of nephropathogenic IC developing in antibody excess.

Plasmapheresis and peritoneal dialysis in the management of rapidly progressive glomerulonephritis.

Six patients with rapidly progressive glomerulonephritis were given plasmapheresis and peritoneal dialysis by manual technique. At the start of treatment the patients were in renal failure and all but two were practically anuric. Renal biopsy revealed glomerular sclerosis in 4 cases. One of the patients in whom segmental focal fibrosis was found, went into remission. In the other three cases extensive hyaline degeneration was present. One of them was placed on a dialysis program, two died with circulatory failure. In two cases no glomerular sclerosis was found, though extensive changes of the tissues were present. One of these patients went into remission, the other died from respiratory failure consequent upon recurrent pneumothorax and gross pulmonary infiltration. The only chance of success in the management of rapidly progressive glomerulonephritis is offered by the earliest possible diagnosis. In cases of glomerular sclerosis the chances are very poor.

IgA glomerulonephritis: light microscopic and immunohistological studies.

Renal biopsy material of 50 patients suffering from IgA glomerulonephritis was studied by light microscopy, immunofluorescence and occasionally electron microscopy. Associated with a uniform immunohistological pattern mainly focal or diffuse mesangial proliferative glomerulonephritis was found. In addition to the glomerular changes the importance of frequent extraglomerular, mainly vascular and interstitial, alterations is stressed. In arterioles and arteries, deposition of a hyalinous substance was observed. Immunohistology revealed the presence of immunoglobulins and/or C3 in the vessels. In the interstitium fibrinogen/fibrin was often seen, accompanied by chronic inflammatory infiltration and fibrosis.

Double renal biopsy with Menghini needle.

The complications of percutaneous renal biopsy with Menghini needle, performed in 400 cases by the author, are reviewed. Position of the kidney was located by intravenous pyelography and was checked by further radiography if 1. the pyelogram was of inadequate technique, 2. the kidneys were small, or 3. ptotic. In two thirds of the cases the specimens were taken in duplicates, so as to provide sufficient material for light-, electron-, polarization-microscopic and immunofluorescent studies. On the evidence of the present observations the technique of double biopsy involves no higher incidence of complications than the conventional procedure, nor did it cause complications of major severity in the individual cases.

Haemorrhagic pericarditis and cardiac tamponade during chronic haemodialysis.

Three cases of uraemic haemorrhagic pericarditis observed during haemodialysis treatment are described. The condition is explained with uraemic toxicosis, cyclic heparinaemia resulting from dialysis, deficient thrombocyte function, and decreased capillary resistance. The clinical appearance of haemorrhagic pericarditis was not typical in any of the cases. Two patients died, while in one patient partial pericardiectomy was performed with success.