The effect of age on the character of immune complex disease: a comparison of the incidence and relative size of materials reactive with Clq in sera of patients with glomerulonephritis and cancer

Membranous nephropathy and malignancy

An association between the glomerular disease membranous nephropathy (MN) and malignancy has long been appreciated, but evidence supporting this relationship remains limited, speculative, and, at times, controversial. Reports that the two disease processes often evolve in parallel, as well as the occasional findings of tumor antigens or tumor-reactive antibodies within glomerular immune deposits, are all supportive of an association. However, the diagnosis of both MN and malignancy in the same individual also may be coincidental, especially in an older demographic group in which both diseases tend to occur. This article briefly reviews the proposed pathogenetic mechanisms of idiopathic and secondary forms of MN, as well as the arguments for and against the contention that malignancy-associated MN is itself a distinct clinical entity. In addition, the recent identification of the M-type phospholipase A₂ receptor as a major glomerular antigen in idiopathic MN has the potential to offer fresh tools that might help resolve some of the controversy, and ultimately aid in the decision of how aggressively to screen for malignancy in an individual diagnosed with MN.

Prevalence and prognostic significance of proteinuria in patients with lung cancer

The purpose of the present study was to ascertain the prevalence and prognostic significance of proteinuria in patients with lung cancer. Results of urinary dipstick testing were retrospectively reviewed in 1026 consecutive out-patients with histologically proven primary lung cancer and 475 consecutive out-patients with benign pulmonary disorders. Postoperative urinary dipstick test results were recorded in 243 surgically resected patients. Proteinuria was significantly more frequent in patients with lung cancer than in controls (30.1% vs 8.8%, p < 0.0001). The presence of proteinuria was significantly correlated with advanced disease stage (p < 0.0001). The frequency of proteinuria was significantly higher in patients with small cell carcinoma than in patients with other histologic types (p < 0.01). In the surgically resected patients, preoperative and postresection proteinuria occurred in 25.5% and 10.7% respectively (p < 0.0001). Patients with malignancies and proteinuria had significantly poorer survival than patients with normal urinary protein excretion (p < 0.0001). In a multivariate analysis including TNM stage, histologic type, sex, and age, proteinuria continued to be a significant predictor of reduced survival time. Our results suggest a high prevalence of increased urinary protein excretion in patients with primary lung cancer. Proteinuria may also be an independent predictor of poor survival.

Update on immunology of head and neck cancer

The history of immunotherapy in head and neck cancer is filled with disappointing results and clinical trials of nonspecific immunotherapeutic protocols. Most of these protocols did not concern themselves with some of the possible underlying etiologies of immunosuppression, such as alcoholism, malnutrition, aging, and the oncologic therapies that the patients were undergoing. These factors must be appreciated, and attempts must be made to deal with their devastating effects. It is also becoming increasingly apparent that the humoral immune system does have a major impact on the effectiveness of the cellular immune system, and that the various components of this system need to be more fully understood. The complexity of these interactions will probably not allow for an effective immunotherapeutic protocol to be attained in the near future. It is, however, more likely that the establishment of immunoprognosis and immunodiagnosis may be achieved as these complex interactions are more fully identified and understood.

Development of the nephrotic syndrome in a patient with prostatic carcinoma

Various malignancies have been associated with the nephrotic syndrome. The nephrotic syndrome developed in a 66-year-old man with metastatic prostatic carcinoma. Renal biopsy revealed membranous glomerulonephritis. This may be the first reported case of a clear association of prostatic carcinoma with biopsy-proved membranous glomerulonephritis.

Selective losses of large immune complexes during density gradient ultracentrifugation and an approach for prevention of these losses

Substantial amounts (12.3-40.0%) of model immune complexes became nonspecifically adsorbed to centrifuge tubes during sucrose density gradient ultracentrifugation, and the adsorbed complexes were therefore unavailable for subsequent detection by the C1q solid-phase assay. The adsorption was greater for heavier immune complexes; thus detection of large-latticed complexes was impaired more than detection of small-latticed complexes. Loss of complexes could be prevented by incorporation of 0.05% polyoxyethylene (20) sorbitan monolaurate (Tween 20) into sucrose density gradient solutions and precoating tubes with gelatin. Tween 20 did not alter the immune complex lattice and did not prevent detection of immune complexes by the C1q solid-phase assay. Similar selective losses of immune complexes occurred when serum specimens from 2 patients with circulating immune complexes were analyzed by sucrose density gradient ultracentrifugation; the nonspecific adsorption of serum immune complexes which occurred during ultracentrifugation could be prevented by precoating centrifuge tubes with gelatin and incorporating 0.05% Tween 20 into sucrose gradients.

Immunobiologic staging of patients with carcinoma of the head and neck

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.

Circulating immune complexes in idiopathic glomerular disease

Circulating immune complexes (CIC) could be found in the majority of 271 sera from 131 patients with idiopathic minimal change, membranous and mesangial proliferative glomerulonephritis when a combination of CIC assays detecting different properties of CIC were used. In neither individual patients nor in any of the three groups as a whole did CIC levels reflect the state of the renal lesion. No correlation was found between the class of immunoglobulin in the CIC and that deposited in the kidney. With the exception of minimal change disease in which non-C1q binding IgG CIC predominated, a range of CIC was found in the patients examined. The pattern of CIC detected did not allow different forms of renal disease to be distinguished. IgA CIC could be found in mesangial proliferative glomerulonephritis both with and without IgA deposition and in some patients with membranous and minimal change disease, as well as in a high proportion of sera from 12 patients with the Henoch-Schönlein syndrome. CIC size was estimated in six patients, but only in one did a specific size of complex predominate. The CIC which may be found in the majority of sera from patients with idiopathic glomerulonepohritis provide little information of clinical value; no direct relationship can be demonstrated between the CIC found and the renal lesion.

Circulating immune complexes in colon cancer patient sera

Sera from 29 colon cancer patients and 16 elderly normal controls were compared using the Raji radioimmunoassay and the Clq binding assay. By the Raji assay 11 of 29 cancer patients had evidence of circulating complexes, while by the Clq assay only 4 of the 29 patients had complexes. There was no significant difference between the levels of circulating complexes in the patient or control groups. With respect to individual patients the results obtained by the Raji assay did not correlate with those obtained by the Clq binding assay.