Immunopathology, extent and course of glomerulonephritis with crescent formation

Ten out of 66 cases of glomerulonephritis (GN) with variable crescent formation appeared to be of post-streptococcal origin. Immunofluorescent studies of biopsies from 42 of the patients showed findings suggestive of immune complex glomerular injury in 86% whilst there was no evidence of immunologic or nonimmunologic injury in the remainder. Anti-GBM GN was not demonstrable, although it can not be certain that there were no cases amongst the patients whose biopsies were not examined by immunofluorescence. Conservative measures were adequate for the treatment of cases with less than 50% crescents. In the others, with greater than or equal to 50% crescents, appreciable improvement was observed with anticoagulation, immunosuppression and dialysis. The mortality was 30% in cases with 50-80% and 65% in cases with greater than 80% crescents. No appreciable difference in survival was observed between post-streptococcal and idiopathic cases. The single most important factor in prognosis, regardless of etiology, appeared to be the extent of crescent formation. Tubulo-interstitial damage was contributory. Necrotizing angiitis, present in 4 cases, affected the course adversely.

Cicatrical Pemphigoid

This is the first case report of cicatrical pemphigoid from India. The patient was a 58 year old rnale who--developed tense, dome shaped vesicles in the oral mucosa, followed 18 months later by blisters on the skin which healed by scarring, Symblepharon developed in both the eyes 23 months after the onset. Histologically, the split was subepuermace and direct immunofluorescent; subepidermal test on the patient's serum for IgG antibodies is negative.

Spectrum of rapidly progressive (crescentic) glomerulonephritis in northern India

36 consecutive patients whose biopsies showed significant extracapillary proliferation in the face of rapidly declining renal function were reviewed between 1967 and 1979. About 30% of the patients belonged to the pediatric age group with a male:female ratio of 2.5:1. Oliguria/anuria, hematuria, and progressive renal insufficiency were present in all cases. There was evidence of 9 cases being poststreptococcal, 2 SLE, 1 Henoch-Schönlein purpura, 2 possibly viral and 1 staphylococcal. Histologically, 29 cases had more than 60% crescents, 5 between 50 and 60% and 2 cases a little less than 50%. 28 cases were fatal in less than 10 months. 2 were lost of follow-up. 6 survivors with reversal of renal functions had 3 common factors to note, namely an antecedent disease, less crescents both in number and size, accompanied by fewer interstitial changes and early treatment. Rebiopsy in 2 survivors showed regression of histologic severity.

Tuberculosis in maintenance haemodialysis patients. Study from an endemic area

One hundred and fifty patients requiring maintenance haemodialysis were investigated to determine the incidence and pattern of tuberculosis. Twenty patients were found to have tuberculosis, giving an incidence of 13.3 times that of the general population. The most frequent clinical presentations of tuberculosis in these patients were pyrexia, pleural effusion and lymphadenopathy. Diagnostic difficulties were encountered in 7 patients in whom therapeutic trial with anti-tubercular drugs had to be undertaken. Two patients died from tuberculosis. Five patients received renal transplants after initial treatment of tuberculosis.

Biochemical studies of the isolated rat glomerulus and the effects of puromycin aminonucleoside administration

Using analytical subcellular fractionation techniques in combination with enzymic microanalysis, studies have been performed on the enzymology and organelle pathology of isolated glomeruli from normal rats and from animals with puromycin aminonucleoside nephrosis. There was a marked decrease in 5'-nucleotidase (plasma membrane) activity 2 days after puromycin aminonucleoside administration. In contrast, catalase (peroxisomes) and N-acetyl-beta-glucosaminidase (lysosomes) showed a significant rise during the first 6 days of treatment. By 10 days most marker enzymes showed a significant decrease in activity. The glomeruli were homogenized in isotonic sucrose and extracts were fractionated by isopycnic centrifugation on linear sucrose gradients in the Beaufay automatic small-volume zonal centrifuge. The properties of the principal organelles were characterized. ed. After 10 days of puromycin aminonucleoside treatment there were no marked differences in the centrifugal properties of these organelles. Morphological correlations with the biochemical changes are discussed and it is suggested that the plasma membrane changes represent the primary site of puromycin aminonucleoside damage.