Effect of long-term aluminum administration on the renal structure of the rat

Kidneys of patients on hemodialysis therapy often undergo structural changes leading to acquired cystic disease. A wide variety of chemical compounds are known to induce experimental renal cystic disease. Since aluminum intoxication has been implicated in the development of encephalopathy, osteomalacia and anemia in uremic patients, this study was designed to investigate whether aluminum administration to normal rats could induce renal morphological changes. Male Wistar rats were divided into three groups; Animals of the Low-dose aluminum (LDA) group received 0.2 mg/day of aluminum, animals of the high-dose aluminum (HDA) group received 2 mg/day of aluminum; the third group consisted of controls (C). Aluminum was injected intraperitoneally as aluminum chloride (6 days a week). 13 weeks later, the kidneys were removed and examined by light and electron microscopy. The findings on eight-microscopic examination were normal in all groups. Electron-microscopic examination was unremarkable in the C and LDA group. In HDA rats, ultrasections of the cortex and outer medulla showed changes in the proximal tubules with increased size and number of lysosomes, osmiophilic granular material inside the lysosomes, vacuolisation of organelles and mitochondrial damage of varying degree. No cystic changes were found.

Acute renal failure in a solitary kidney due to bacterial pyelonephritis

Deterioration of renal function after acute bacterial pyelonephritis is rare. We report on 2 patients with a solitary functioning kidney in whom acute renal failure developed in the setting of acute bacterial pyelonephritis. Following antimicrobial treatment kidney function returned to baseline values. This finding suggests that patients with a solitary functioning kidney are more prone to have renal dysfunction after acute bacterial pyelonephritis.

Pancreatic carcinoma is associated with delayed gastric emptying

Fifteen patients with histologically confirmed pancreatic carcinoma, without evidence of gastroduodenal invasion or obstruction, were prospectively studied to determine the frequency of gastric emptying disorders as determined by a solid-phase gastric emptying study. Nine of these (60%) had gastric emptying curves more than two standard deviations below normal mean values. The majority of patients did not have symptoms of gastric stasis. Nausea and/or vomiting was present in 33% of patients with abnormal gastric emptying and in none of those with normal emptying. Abdominal and/or back pain was present in 8/9 with delayed gastric emptying and in 3/6 with normal emptying. Disordered gastric emptying did not correlate with tumor stage, histology, location, or hyperbilirubinemia. Delayed solid-food gastric emptying may be responsible for the nonspecific abdominal complaints that occur during the course of pancreatic carcinoma, although more frequently, gastroparesis exists on a subclinical level.

Serum galactosyltransferase isoenzyme patterns of cancer patients with liver involvement

The level of galactosyltransferase activity was measured in the serum of 220 patients with a variety of solid tumours. There was a significantly greater proportion of patients with elevated galactosyltransferase in the group with metastatic disease (43%) than for the group with localised disease (16%). Galactosyltransferase was elevated in 69% of patients with liver metastasis compared to 32% of patients with metastatic disease at sites other than liver and this difference was also significant. High resolution agarose isoelectric-focusing was used to determine the 'isoenzyme' pattern of serum galactosyltransferase of 6 patients with liver metastasis and 2 patients with primary hepatoma and these were compared to those of 6 patients with similar primary tumours without liver involvement. There were no qualitative differences in the patterns from the two groups. The average peak height for each of the 19 peaks of activity identified was generally higher in the group with liver involvement, except for those peaks known to contain little or no attached sialic acid. Liver involvement appears not to contribute in any specific way to the altered pattern of serum galactosyltransferase often seen in patients with solid tumours. The tumour rather than the liver is therefore the most likely source of these alterations.

Parathyroid hormone effect on the fragility of human young and old red blood cells in uremia

Parathyroid hormone (PTH) is elevated in patients with chronic renal failure (CRF) and was suggested to be one of the factors responsible for the anemic syndrome of these patients because it raises the osmotic fragility of the red blood cells (RBC). In the present study, the youngest and oldest RBC were separated from circulating erythrocytes by high-speed centrifugation. The age distribution was described, and the effect of PTH on the different age groups was investigated. Median density (MD) and glutamic-oxaloacetic transaminase (GOT) activity were chosen as age markers. MD (1.0985 +/- 0.00087) and GOT activity (12.49 +/- 2.083 IU/g Hb) of the young uremic cells did not differ significantly from the values of young normal cells (1.0987 +/- 0.00046 and 10.36 +/- 1.174 IU/g Hb, respectively). The MD of the oldest cells, however, was lower (1.1048 +/- 0.00054) and GOT was higher (6.60 +/- 1.1019 IU/g Hb) in the uremic than in the control cells (1.1093 +/- 0.00175 and 3.77 +/- 0.233 IU/g Hb, respectively). These results indicate that the life span of RBC in uremics is shorter than normal and that an enrichment of circulating RBC by young cells occurs in uremic patients. The median osmotic fragility (MOF) of the young cells was lower in both uremic (0.376 +/- 0.006) and control patients (0.378 +/- 0.003) than the MOF of old cells (0.402 +/- 0.005 and 0.392 +/- 0.004, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior uveitis, a presenting symptom in acute interstitial nephritis

Two adult women with idiopathic acute interstitial nephritis (AIN) whose presenting symptom was anterior uveitis are described. On histologic examination of the renal biopsy, eosinophilic infiltrates and mononuclear cells were found. Immunofluorescence was negative. Immunological evaluation showed a slight decrease in the number of T cells with a normal subpopulation ratio. AIN responded to steroid treatment.

Liver granulomas: a possible paraneoplastic manifestation of hypernephroma

A patient with hypernephroma presented with signs of liver dysfunction. Liver biopsy disclosed the presence of granulomas. Extensive search for a known cause of hepatic granulomas was negative. The presence of granulomas in lymph nodes draining the neoplasm, the improvement of liver dysfunction after nephrectomy, and its aggravation preceding overt metastatic manifestation support the existence of a cause and effect relationship between the renal cell carcinoma and the liver granulomatous disease.

Rejection-related nephrotic syndrome associated with massive antiglomerular and antitubular basement membrane deposits

A patient with end-stage renal disease due to nephronophthisis developed nephrotic syndrome following renal transplantation. Renal biopsy revealed rejection glomerulopathy with massive linear deposition of immunoglobulin (Ig) G and complement C3 along the glomerular and tubular basement membranes. The association of nephrotic syndrome with linear deposition of Ig is rare in chronic rejection of kidney allografts. The nephrotic syndrome in this case responded to treatment with plasmapheresis.

Campylobacter pyloridis in peptic ulcer disease: microbiology, pathology, and scanning electron microscopy

After the recent successful isolation of spiral organisms from the stomach this paper presents the bacteriological and pathological correlation of gastric antral biopsies from 51 patients endoscopied for upper gastrointestinal symptoms. Campylobacter pyloridis was cultured from 29 patients and seen by either silver staining of the biopsy or scanning electron microscopy in an additional three. The organism was cultured from 23 of the 33 (69%) patients with peptic ulcer disease and from within this group 17 (80%) of the 21 patients with duodenal ulceration. It was cultured only once from the 12 normal biopsies in the series but from 27 of the 38 (71%) biopsies showing gastritis. C pyloridis was also cultured from five out of seven of the 14 endoscopically normal patients, who despite this had biopsy evidence of gastritis. It was the sole organism cultured from 65% of the positive biopsies and scanning electron microscopy invariably revealed it deep to the surface mucus layer. C pyloridis persisted in the three patients with duodenal ulcers after treatment and healing. The findings support the hypothesis that C pyloridis is aetiologically related to gastritis and peptic ulceration though its precise role still remains to be defined.

Alcoholic skeletal myopathy, a clinical and pathological study

One hundred and fifty-one inpatients with a history of chronic heavy alcohol intake were examined for evidence of muscle disease. Ninety-two patients (60 per cent) had histologically abnormal biopsies of the quadriceps muscle. The most common abnormality, which was often severe, was type II muscle fibre atrophy. Seven patients (5 per cent) had histological evidence of acute myopathy, one of whom presented with the full clinical picture of acute rhabdomyolysis. Twenty-three patients had cirrhosis, 36 were significantly malnourished and 98 had evidence of a peripheral neuropathy. None of these features, however, were sufficient to account for the muscle abnormalities. There was no clear relationship between musculo-skeletal symptoms and muscle biopsy histology. Serum creatine kinase activity was elevated in only 23 subjects and was an insensitive indicator of subclinical acute myopathy and of chronic alcoholic myopathy. Follow-up studies after abstinence from alcohol invariably showed both objective and subjective improvement of muscle function - often in the absence of any clinical recovery from the peripheral neuropathy. Continued alcohol consumption was accompanied by persistence and often deterioration of muscle fibre atrophy. It is concluded that chronic skeletal myopathy is a frequent consequence of alcohol abuse and may result from a direct toxic effect of ethanol on muscle fibres.

Subcellular fractionation of rectal biopsy homogenates from patients with inflammatory bowel disease

Rectal biopsy specimens from control subjects and from patients with Crohn's colitis, non-rectal Crohn's disease, and acute ulcerative colitis were homogenized in isotonic sucrose and subjected to analytical subcellular fractionation by sucrose density gradient centrifugation. The gradient fractions and tissue homogenates were assayed for marker enzymes for the principal organelles: 5'nucleotidase (plasma membrane), malate dehydrogenase (mitochondria), catalase (peroxisomes), lactate dehydrogenase (cytosol), N-acetyl-beta-glucosaminidase (lysosomes), and neutral-alpha-glucosidase (endoplasmic reticulum). In normal tissue there was a distinct plasma membrane peak at density 1.12 g/ml. In tissue from patients with Crohn's disease the activity was increased approximately twofold even when the rectum showed no evidence of histological involvement. A second plasma membrane component was noted in Crohn's disease at density 1.19 g/ml. The total activity of the mitochondrial enzyme was similar in the various patient groups, but there was evidence of mitochondrial damage. There were no significant alterations in activity and density gradient distributions of catalase or of neutral alpha-glucosidase in the various patient groups, although less membrane-bound lactate dehydrogenase was noted in the patients with inflammatory bowel disease. There was a reduction of both cytosolic and particulate N-acetyl-beta-glucosaminidase in ulcerative colitis and a selective reduction in particulate activity in non-rectal Crohn's disease, demonstrating lysosomal alterations in these disorders. These results indicate selective and specific alterations in the principal subcellular organelles, especially the plasma membrane, lysosomes, and mitochondria, in the inflammatory bowel disease.

Platelet X-ray microanalysis in patients with chronic renal failure

The platelet element content was determined by semiquantitative X-ray microanalysis in 6 patients with chronic renal failure. The patients showed a different degree of thrombocytopathy expressed by impaired adhesiveness, epinephrine-induced aggregation and platelet factor 3 availability. The microanalysis indicated significantly increased quantities of phosphorus and copper in patients' platelets. Sodium and zinc showed a decrease in about half of the patients, whereas iron was significantly increased in at least 50% of the patients. Magnesium and potassium did not show any difference from the control. The results of sulfur, chlorine and calcium did not reveal a consistent pattern.

Intraocular pressure in uremic patients on chronic hemodialysis

Intraocular pressure (IOP) was measured before and after hemodialysis in 30 uremic patients receiving regular treatment. Osmolality, blood pressure and weight before and after dialysis were also determined. Low IOP of 11.4 +/- 2.7 and 11.5 +/- 3.1 mm Hg was found in the left and right eye, respectively. Following hemodialysis osmolality, blood pressure and body weight decreased significantly but IOP did not rise significantly. This study suggests that there is only a remote possibility for severe IOP increase following hemodialysis in uremic patients on chronic treatment.

Sialic acid content of erythrocytes in uremic patients. Correlation with the age distribution of erythrocytes as assessed by glutamic oxaloacetic transaminase determination

In a previous study we suggested that an enrichment in young red blood cells (RBC) should occur in the erythrocyte population of uremic-anemic patients. This change in RBC age distribution together with the fact that young cells were reported to be richer in sialic acid would provide an explanation for the observed lack of difference in sialic acid content between patients' and controls' whole erythrocyte populations in spite of an increased neuraminidase activity found to be present in patients' serum. To verify this assumption glutamic oxaloacetic transaminase (GOT) activity, which is an erythrocyte age index, and sialic acid were determined in low and high density fractions separated by centrifugation of packed cells representing young and old RBC, respectively, from two groups of 8 individuals with chronic renal failure and two groups of controls. GOT was determined also in whole erythrocyte populations. Mean GOT activity was significantly higher in the young fractions compared to the old of both patients' and control RBC (14.9 vs. 7.8 and 12.4 vs. 7.5 IU/g Hb). Activity of the whole RBC population was significantly higher in uremics as compared to controls (11.7 vs. 5.6 IU/g Hb) which is compatible with a lower median erythrocyte age. Mean sialic acid was higher in the young fractions as compared to the old (42.7 vs. 35.3 nmol/10(9) cells in controls and 48.9 vs. 43.0 nmol/10(9) cells in patients). These differences together with an enrichment in young cells would compensate for the eventual loss of sialic acid in the whole population resulting from an increased neuraminidase-like activity in patients' serum.

Effect of hyperparathyroidism on cardiac function in patients with end-stage renal disease

Heart studies were carried out in 7 patients with end-stage renal disease (ESRD) who underwent parathyroidectomy for secondary hyperparathyroidism. The studies, which included echocardiography and equilibrium radionuclide angiography (ERNA), were performed prior to parathyroidectomy and 2 weeks, 3 months, and 6 months following it, on a nondialytic day. Heart rate decreased from 89.3 +/- 1.3 to 81.4 +/- 1.5 min-1 (p less than 0.001) following parathyroidectomy and returned to the initial level at 3- and 6-month examination. Cardiac output decreased from 3170 +/- 68 to 2943 +/- 57 ml/min (p less than 0.01) following parathyroidectomy and returned to basal level on 3 and 6-month determinations. End-diastolic dimension (EDD), end-systolic dimension (ESD), septal and posterior wall thickness and shortening fraction (SF) as measured by echocardiography were normal prior to parathyroidectomy and remained unchanged following it. Left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes measured by ERNA did not change following parathyroidectomy. This study suggests that hyperparathyroidism has little effect on cardiac performance and, except for a short-lived decrease in heart rate and cardiac output, parathyroidectomy does not affect cardiac performance when performed in patients with preoperatively normal cardiac output.

Effect of cimetidine on granulocyte-macrophage colony formation by normal and chronic renal failure bone marrow cells

The effect of cimetidine, an antihistaminic blocker of the H2 receptors, on the development of granulocyte-macrophage colonies (GMC) was examined in vitro on bone marrow cells from healthy individuals and chronic renal failure (CRF) patients. The drug caused a dose-dependent decrease in the number of GMC from bone marrow samples in both healthy subjects and patients, being much more expressed in the latter group. The addition of urea to bone marrow cultures of healthy subjects increased the inhibition of colony formation caused by cimetidine alone. CRF or control serum added to normal bone marrow cells enhanced the colony growth which was significantly more expressed when using a CRF serum sample.

Should cholecystography or ultrasound be the primary investigation for gallbladder disease?

The conclusions drawn from a prospective survey of 500 patients examined by cholecystography (OCG) and ultrasound (UCG) are presented. First, both procedures were found to be highly accurate in detecting calculi, with false-negative rates of 1%. Secondly, if OCG is abandoned in favour of UCG, most acalculous adenomyomatosis (and many polyps) will not be diagnosed. If acalculous as well as calculous disease is regarded as clinically important, fluoroscopic OCG is the examination of choice. However, if a clinician wishes solely to find or exclude stones the investigations are equally accurate. Thirdly, since some calculi and some acalculous disease will be missed by either technique, serious consideration should be given to the further investigation of all gallbladders considered normal by either examination. A protocol is described which, though unorthodox, enables a decision on the status of the gallbladder to be made on a single visit to the radiology department.

Generation of superoxide anions during phagocytosis by monocytes of uremic patients

The phagocytic activity of monocytes from 15 uremic patients was estimated by the superoxide anion test. There was a significant decrease in the ability of monocytes from these patients to produce superoxide anions in comparison with monocytes obtained from healthy subjects. Addition of urea to monocytes from healthy subjects caused a marked reduction in their ability to produce superoxide anions, while addition of creatinine did not cause any effect. Monocytes from patients with renal failure of glomerular origin were found to produce less superoxide anions than those from patients with other types of renal diseases.

Neuraminidase-like activity in sera of uremic anemic patients

A shortened life of erythrocytes in uremia has been suggested as one of the causes of anemia in this condition. Since partially desialylated erythrocytes are promptly removed from the circulation, we examined whether sera from renal failure patients would exhibit increased neuraminidase activity which could be held responsible for this phenomenon. Sera of 22 patients with end stage renal failure were examined for neuraminidase activity by assessing their effect on desialylation upon incubation at 37 degrees C for 2 and 1 h, respectively, of erythrocytes of healthy donors matched for blood group and of fetuin as substrate. As deduced from the residual content of sialic acid of erythrocytes and of the amount of sialic acid released from fetuin, the results showed a statistically higher neuraminidase-like activity of patients' sera as compared to sera of healthy individuals. It is suggested that increase in neuraminidase activity could be one of the factors involved in the mechanism of generation of anemia in uremia by acting on erythrocytes, rendering them more prone to sequestration by the liver and spleen.

Chronic alcohol excess is associated with selective but reversible injury to type 2B muscle fibres

Patients drinking more than 100 g alcohol/day for longer than three years develop atrophy of striated muscle fibres. This predominantly affects type 2B fibres which are dependent on anaerobic glycolytic metabolism. Atrophy of type 1 and type 2A fibres, which in addition use aerobic mitochondrial respiration, only occurs in the most severe cases and then only to a lesser degree. Abstention from alcohol reverses the changes in muscle which slowly return to normal. Selective injury to type 2B fibres indicates that search should be made for an alcohol-induced biochemical lesion affecting the anaerobic glycolytic pathways of the muscle fibre.

Epithelial patchy necrosis in Crohn's disease

Electron and light microscopic studies of the intestinal epithelium in Crohn's disease demonstrated localized areas of damage to the superficial epithelium, occurring without accompanying acute inflammation. In a blind study of rectal biopsy specimens from seven patients with Crohn's disease, four with ulcerative colitis, and four normal controls, this finding of patchy necrosis without acute inflammation was observed exclusively in four of the seven cases of Crohn's disease.

Acquired cystic disease and tumors in kidneys of hemodialysis patients

During the period 1975-81, autopsies were performed in 15 patients who had been treated by long-term hemodialysis and who had no clinical or family history of polycystic disease. Ten of the patients were found to have bilateral cystic disease of the kidneys. In 3 of the 10 patients with cystic kidneys, tumors were found: a solid tubular adenoma in one, multiple bilateral papillary adenomas in another, and clear cell tubular carcinoma in the third. Hemorrhages were not detected in any of the patients. The results of our study confirmed that patients on hemodialysis have a very high incidence of acquired cystic disease and are at high risk of developing neoplasms in their contracted kidneys.