IgD multiple myeloma with renal involvement: case report.

IgD multiple myeloma is a unique type of multiple myeloma which is characterized by increased serum IgD and IgD type M-component in immunoelectrophoresis. It frequently shows renal involvement but it is a rare form of myeloma. The distinctive features of IgD myeloma are the dominance in males, high frequency in younger persons, and the uncertain appearance of M-component in serum electrophoresis. We experienced 3 cases of IgD multiple myeloma with renal failure which required hemodialysis before IgD myeloma was diagnosed. It is important to consider IgD myeloma when treating the patients with renal involvement of unknown origin.

[Disturbance of the autonomic nerve system in patients with chronic renal failure--represented by variation coefficient of R-R intervals in the ECG as a parameter].

Autonomic nerve dysfunction in patients with chronic renal failure has of late become an issue to be investigated. R-R intervals in resting electrocardiograms were measured to evaluate activities of the cardiac parasympathetic nerve system. A total of 140 patients with chronic renal failure were studied to be compared with 20 normal controls (cont.) and 39 with diabetes mellitus (DM). Of these patients 15 were subjected to conservative treatment (CRF), while 125 patients were undergoing hemodialysis due to chronic renal failure-100 of them derived from chronic glomerulonephritis (HD) and 25 from diabetes mellitus (DM.HD). The variation coefficient of the R-R interval (CVRR) was measured after the subject patients had rested for over 15 minutes before a dialysis session. The mean CVRR were 2.15 +/- 1.25% in CRF group, 2.36 +/- 1.37% in HD and 1.37 +/- 0.99% in DM.HD. These values were significantly lower than in control group (4.70 +/- 2.64%). On the other hand, the value in DM.HD group, as shown above, was significantly lower than in HD. In CRF group the CVRR values lowered as residual renal functions decreased. No significant correlations between CVRR S and the duration of hemodialysis treatment were noted among the groups. In HD group the CVRR S were significantly lower in patients with hypotensive tendency during hemodialysis than in those who enjoyed good control of blood pressure. These results suggest that the measurement of CVRR S can be of help in evaluating autonomic nerve dysfunction in patients with chronic renal failure.

[Anemia in patients on continuous ambulatory peritoneal dialysis (CAPD)].

Inhibitors of erythropoiesis found in the blood of uremic patients have been implicated as some of the causes of anemia in chronic renal failure. As a treatment to remove the inhibitors, continuous ambulatory peritoneal dialysis (CAPD) is thought to be more effective than hemodialysis. Some researchers have reported that CAPD has improved anemic state in hemodialysis patients. However, there have been some cases of severe anemia seen in CAPD patients. To access the effect of the CAPD, we have performed serial examination on hemoglobin (Hb) and hematocrit (Ht) in 5 uremic patients under CAPD treatment. Hb levels in 4 and Ht in 3 of 5 patients have been known to be increased. One patient was shown to have no increment on the levels of Hb and Ht. On the other hand, further investigation has been down to access the effect of the recombinant human erythropoietin (r-HuEPO: Chugai pharmaceutical) on anemic patients, in whom no effect was noticed by treatment of CAPD. One severe anemic patient, who had been undergoing the treatment of CAPD for two years, was given r-HuEPO intravenously. The patient showed the increment on the levels of Hb and Ht, and the decreases on the levels of serum iron and ferritin. However, the patient has developed hypertension. In conclusion, CAPD was known to be not always effective for the increment of Hb and Ht, while r-HuEPO was very effective for the improvement of severe anemia in CAPD patients which enabls them to lead better social life for them.

Monocyte-mediated suppression of mitogen responses of lymphocytes in uremic patients.

In the present experiment, we investigated the mechanism of the suppressed mitogen responses of peripheral blood mononuclear cells (PBMC) from uremic patients. We used phytohemagglutinin (PHA) and concanavalin A (Con A) as T cell mitogens, pokeweed mitogen (PWM) as a T cell-dependent B cell mitogen, and Staphylococcus aureus Cowan I (STA) as a T cell-independent B cell mitogen. PBMC from uremic patients showed significantly suppressed responses to PHA (p less than 0.05), Con A (p less than 0.05) and STA (p less tha 0.01) compared with those from healthy controls, but there was no significant difference in PWM response. However, these suppressed responses to PHA and Con A were markedly restored by depletion of phagocytic cells from PBMC. Although STA responses were also restored markedly in uremic patients, some patients still showed lower responsiveness to STA indicating the possibility of functional B cell defects. To further clarify the mechanism of the suppressed responses to mitogens, PBMC or nonphagocytic cells from uremic patients were cocultured with control T cells in the presence of PHA, or the effects of adherent cells from uremic patients on PHA responses of autologous or allogeneic control T cells were studied. From these experiments, it was suggested that the suppressed responses of PBMC to mitogens in uremia were mediated by monocytes.