Natural history of "silent" lupus nephritis

Twenty patients with systemic lupus erythematosus but without evident renal involvement previously underwent percutaneous renal biopsy. Findings revealed almost universal pathologic evidence of nephritis. Included were three patients who had diffuse proliferative changes and five who had subendothelial electron dense deposits. Only four patients developed clinical renal disease during the follow-up period while no patient died or required dialysis. Using the Life Table Method, the cumulative percentage of patients free from any clinical renal disease was over 60% at 10 yr from the time of diagnosis of systemic lupus, and at 8 yr from the time of the original biopsy. It is concluded that silent lupus nephritis, regardless of histologic subtype, has a favorable prognosis. These data may not be applicable to patients with similar biopsies who have evidence of clinical lupus nephritis.

Limitations of the antibody-coated bacteria test in patients with neurogenic bladders

A Fairley washout test and antibody-coated bacteria (ACB) test were performed for 35 urinary tract infections in 32 patients with neurogenic bladder dysfunction. The Fairley test result was used as a standard reference and was combined with clinical and ureteral catheterization culture findings when doubt existed. The Fairley test localized 35 infections: 9 to the kidney, 24 to the bladder, and 2 to the prostate. The ACB test results were positive in five of the nine renal infections and negative in four. In three of the four patients with negative results, radiological, clinical, or ureteral culture evidence of upper urinary tract infection supported localization to the upper urinary tract. Of the 26 infections localized by the Fairley test to the lower urinary tract, 20 showed negative and six showed positive ACB test results. Two of the six patients with positive results had prostate infections; the other four had chronic or recurrent cystitis. The ACB test cannot be relied on alone to localize urinary tract infections in patients with neurogenic bladder dysfunction.

[Diagnostic and therapeutic problems in lupus nephritis]

A review of the SLE in the paediatric age in performed to underline the peculiarity of the disease in children: age, frequency, symptomatology, renal histology, clinical course, therapy and correlated side effects are reported according to literature data. The A.A. describe six cases of lupus nephritis, observed in the last few years, which confirm the diagnostic difficulties and the wide variety in the evolution of the disease. A favourable course of the disease was obtained in three cases, with corticosteroid and immuno-depressive treatment (used in association and/or alternatively); a fourth case developed some therapeutic complications among which an avascular bilateral bone necrosis, leucopenia, alopecia and herpes zoster. In two cases the SLE led to chronic renal failure owing to many relapses of the disease, enhanced by therapeutic break or dosage reduction. A careful surveillance of these patients is of fundamental importance in the management of the disease in order to obtain the longer survival and the lesser side effects.

The pathology of mesangial IgA nephritis with clinical correlation

Of 710 patients in whom renal biopsies with immunofluorescence, light and electron microscopic and clinical data were available, 239 had idiopathic mesangial IgA nephritis. In these 239 cases IgA was found alone in 45.7%, accompanied by IgG in 50.1%, IgM in 21.4%, C3 in 82.4% and fibrin in 37.2%. Serum immunoglobulin levels including IgA were not significantly raised and complement C3 activation was via the alternative pathway. There was a wide range of glomerular lesions with minor change, minor change with focal and segmental lesions including sclerosis and mesangial cell hypercellularity, diffuse mesangial cell proliferation and, infrequently, diffuse sclerosing glomerulonephritis. The glomerular leions were related to the stage, duration and severity of the disease. There was also a wide variability of clinical presentations, with asymptomatic and symptomatic microscopic haematuria-proteinuria, macroscopic haematuria, recurrent proteinuria, nephrotic syndrome, acute nephritis, hypertension, and uncommonly as acute renal failure and potassium losing nephritis. No aetiological agent was found, and both the streptococcus and HBsAg could not be identified. The disease(s) was the commonest type of primary glomerulonephritis (33.7%) in Singapore, another geographic area in addition to Japan and France, where this lesion has an apparent high incidence.

[Must renal biopsy be still performed in "lipoid nephrosis"? (author's transl)]

In 52 out of 272 children with one of the following diseases: nephrotic or nephritic syndrome, persistent humaturia and/or proteinuria, renal biopsy was performed on the basis of commonly accepted indications. 18 biopsies were from patients with a clinical picture of lipoid nephrosis and clinical course of "non responders" or "frequent relapsers" types. All of them showed the histologic pattern of minimal changes and had a value of Y index according to ISKCD greater than 0,85. Moreover all patients with minimal changes nephrotic syndrome had a Y index greater than 0.85. If these observations will be confirmed renal biopsy would not later be indicated in children with "lipoid nephrosis".

[Biochemical diagnosis of glomerular and tubulo-interstitial impairments of kidney]

Using polyacrylamide gel disc electrophoresis in presence of sodium dodecylsulfate (SDS) urinary proteins were studied in apparently healthy persons, in patients with chronic glomerulonephritis, chronic interstitial nephritis as well as in patients with myeloma, urine of which contained monoclonic light chains of immunoglobulins. SDS polyacrylamide gel disc electrophoresis is a suitable procedure for differential diagnosis of glomerular and tubulo-interstitial impairments of kidney. In some cases the procedure enables to ascertain not only the type but also severity of the kidney impairment as well as to study dynamics of the disease without a recourse to such invasive methods as kidney biopsy.

[Ultrasonics in the differential diagnosis of space-occupying lesions of the kidney in children]

During the last few years the coordination of ultrasound, radiology and urologic surgery led to the diagnosis and treatment of numerous diseases of the kidney. From 1976 till the beginning of 1979 we were able to diagnose 50 expanding retroperitoneal processes. These were hydronephroses, malignant tumors and enlargement of the kidney due to inflammatory affections ensuing nephrolithiasis as well as urosepsis and shock. The fact that sonography is a harmless, non invasive, simple and often repeatable examination is the most important advantage. Provided that ultrasound diagnosing is performed by an experienced person, there is a good correlation to the common x-ray methods and specially recommended for postoperative controls.

[The value of sonography in the differential diagnosis of pseudotumours of the kidney (author's transl)]

Two hundred and three patients with urographic appearances suspicious of a space-occupying lesion were examined by sonography. Seventy-nine showed normal results; there were 65 cysts, 20 malignant lesions, 20 pseudo-tumours and 19 with other abnormalities such as hydronephrosis, urolithiasis and inflammatory lesions. Pseudotumours are due to varients of the structure of the kidney, which resemble space-occupying lesions in the excretory urogram. The sonogram shows them as low echo, centrally protruding structures arising from the edge of the parenchyma. Angiographically they are islands of parenchyma with normal vessels. Sonography has proved to be a necessary complement to excretion urography and provides a more certain indication for renal arteriography. Angiography can be limited to changes in the parenchyma, since sonography is able to define cystic processes.