[Contrast nephropathy with a non-ionic iodide medium in patients with normal and mildly impaired renal function]

Effects of infusion of a non-ionic contrast medium(iopamidol, 370 mg l/ml) on renal function in a normovolemic state were examined in patients with normal and mildly affected renal function who underwent coronary angiography(CAG). The patients were divided into three groups: group I (n = 69) with serum creatinine(S-Cr) level < 1.0 mg/dl; group II (n = 50) with S-Cr level of 1.0 to 1.3 mg/dl and group III(n = 17) with S-Cr level of 1.3 to 2.0 mg/dl. Patients with S-Cr > or = 2.0 mg/dl were subjected to 3-h hemodialysis immediately after CAG(group HD, n = 11). Serum(S) and urine(U) values of Cr, Na, K, Cl, beta 2-microglobulin(beta 2MG), and U-N-acetyl-beta-D-glucosaminidase(NAG) were measured before and 24 h after CAG. U-NAG and U-beta 2MG were corrected for U-Cr, and fractional excretion of beta 2MG(FE beta 2MG) was determined. Basal U-NAG/Cr, U-beta 2MG/Cr and FE beta 2MG were increased in groups III and HD, suggesting the preexistence of tubular dysfunction. S-Cr was increased significantly only in group I, but there was no change in S-beta 2MG. U-NAG/Cr after CAG was elevated in all the groups, whereas U-beta 2MG/Cr(or FE beta 2MG) was increased only in group III. Greater than two-fold increases of U-NAG/Cr were noted equally in groups I through III. In contrast, the greater than two-fold increase of U-beta 2MG/Cr(or FE beta 2MG) occurred more frequently in group III as compared to the other groups. The incidences of such cases in group HD were similar to those of group III. The half life of serum iodide concentration was significantly shortened by 3-h HD(1.8 +/- 0.3 h vs. 15.9 +/- 3.8 h without HD). In conclusion, patients presenting S-Cr > or = 1.3 mg/dl were at high risk of renal tubular dysfunction even when contrast media was administered in the absence of significant increase in S-Cr. Whether an increase in U-NAG/Cr indicates tubular damage or is merely the result of tubular reabsorption of the agent remains to be clarified. Post-CAG hemodialysis efficiently eliminates contrast medium from the circulation.

Dipyridamole and dilazep suppress oxygen radicals in puromycin aminonucleoside nephrosis rats

BACKGROUND

Reactive oxygen species (ROS) are involved in the pathophysiology of puromycin aminonucleoside (PAN) nephrosis. To elucidate further the role of radicals in PAN nephrosis and the to determine the particular radical species scavenged by dipyridamole (DPM) and dilazep (DZ), we applied chemiluminescence and electron spin resonance (ESR) techniques.

METHODS

Chemiluminescence of glomeruli, which were isolated on day 7 from rats injected with 100 mg kg-1 PAN, was measured with or without scavengers. The inhibitory effects of DPM and DZ on hydroxyl radical adduct formation in the Fenton's reaction were evaluated using ESR.

RESULTS

Chemiluminescence was greater in glomeruli from rats with PAN nephrosis than in the the glomeruli of control rats. This increase was suppressed by superoxide dismutase, catalase, dimethylthiourea and also by DPM and DZ. ESR indicated that DPM and DZ inhibited hydroxyl radical adduct formation with a second-order rate constant of 2.9 x 10(10) and 1.6 x 10(10) (mol L(-1) s(-1) respectively, similar to that of dimethylthiourea.

CONCLUSION

DPM and DZ scavenge hydroxyl radicals, thereby alleviating PAN nephrosis.

[Membranoproliferative glomerulonephritis-like lesion with fibrillary deposition associated with multicentric Castleman's disease]

We report a case of a 65-year-old man presenting with multicentric Castleman's disease (MCD) accompanied by membranoproliferative glomerulonephritis-like lesion with fibrillary deposits. The lesion was characterized by highly organized ultrastructual deposits that were negative for Congo-red stain and for immunoglobulin, light chain and C3. Thus, this renal lesion was considered histologically to be fibrillary glomerulonephritis presenting by light microscopy as mesangiocapillary glomerulonephritis. To our knowledge, among the limited number of cases of renal lesion associated with MCD ever reported, this is the first case of a biopsy-proven fibrillary glomerulonephritis. Serum interleukin 6 (IL-6), known as an indicator of MCD activity and as an autocrine growth factor for mesangial cells, was chronologically measured. Augmentation of urinary IL-6 simultaneously with that of extra renal symptoms of MCD and associated renal disease may indicate an underlying role of this cytokine in the present case. Failure to detect of IL-6 in the glomeruli may support the notion that IL-6 is derived from extrarenal lymphonodi, and not to an in situ product of the glomeruli. However, it may have been related to glomerular injury.

[A case of anti-basement membrane (BM) mediated disease presenting renal and pulmonary symptoms by divergent timing]

A case of 49-year-old man with anti-GBM antibody and who manifested pulmonary and renal symptoms at divergent times. Thirty-six years previously, renal disease with unneglectable degree of proteinuria was noticed. One month before admission, he was found by chance to have elevated serum creatine (Scr); 3.4 mg/dl. At admission, his Scr was 13.7 mg/dl and Hb 12.7 g/dl, TP 5.2 g/dl with 3+ proteinuria and no glucosuria. He was a heavy smoker and remained so while admitted. Renal biopsy presented fibrocellular crescents in 100% of glomeruli with striking tubulointerstitial involvement. Immunofluorescence showed linear IgG deposition along the glomerular capillary wall. Hemodialysis was instituted, and after 13 hospital days, anti-GBM antibody at admission was high at 128 U, with negative PANCA. Plasmapheresis was also performed, but on the next day pulmonary hemorrhage occurred with a concomitant rise of anti-GBM to 250 U. Thus, steroid pulse therapy was conducted in combination with plasmapheresis. Pulmonary hemorrhage subsided along with lowering of anti-GBM (48 U), but renal failure persisted. The patient died of septicemia. Based on the clinical course of the case, the term "anti-BM mediated disease" may more properly delineate the entity of the disease rather than the classical eponym "Goodpasture's disease" which requires coexistence of pulmo- and renal manifestations for definition.

Histochemical localization of copper in various organs of brindled mice after copper therapy

Copper (Cu) distribution in various organs of brindled mice (BM), an animal model of Menkes disease, was studied histochemically and by atomic-absorption-spectrophotometry 7 months after Cu injections. The results were compared with those of untreated BM. In the treated BM brain, a diffuse reduction in Cu-related staining of neurons and astroglia was still evident, though it had improved to some extent. The reduction was noticeable in the thalamus, brain stem and cerebellum, although intensely stained capillaries were noted occasionally in the retrosplenial and mediobasal temporal areas, including the hippocampus. In the treated BM liver, near normalization of Cu distribution was observed. In the treated BM intestine, the main localization of Cu accumulation was in histiocytes/macrophages in the lamina propria, while in the untreated BM it was in the absorptive and secretory epithelial cells. In the treated BM kidney, there was no clear improvement in Cu distribution. These histochemical results were consistent with the data obtained by the spectrophotometric assay. Electron microscopic histochemistry of affected renal tubular epithelial cells revealed numerous silver grains, which represent Cu++ localization, distributed only within the cytoplasm outside organella and nucleus. This suggests impaired intracellular Cu transport from cytosol to organella, which in the kidney is refractory to the Cu therapy adopted.

[Recent trends in estimating energy expenditures in Japan]

Estimating energy expenditures for daily activities has become an important issue in the promotion of individual health. From this point of view, the variety of estimation methods and their characteristics applied in many countries were surveyed. Then the essential bases used to estimate energy expenditures with the relative metabolic rate (RMR) method and the active energy expenditure rate (Ea) method, which were originally developed and used in Japan, were substituted for daily activities recorded by means of time study, and illustrated. Subsequently, a newly introduced method based on heart rate was explained with its variations and problems followed by practical reports on some populations in Japan. Methods using questionnaires or other devices were also described.

[An autopsy case of neuronal type Charcot-Marie-Tooth disease (HMSN type II) with nerve deafness and psychiatric symptoms]

The clinical and pathological findings of a 41-year-old male patient with atypical Charcot-Marie-Tooth disease were reported. There were 3 cases of subarachnoid haemorrhage, 2 nerve deafness and 2 hereditary motor and sensory neuropathy (HMSN) in his family. He had suffered from progressive nerve deafness since 5 years old and gait disturbance since 37 years old. He had been admitted to the psychiatric hospital 3 times because of hallucinatory-delusional state and behavior abnormalities. Neurological examinations at 39 years old revealed that he had mental deterioration (IQ 66), nerve deafness, diffuse muscle atrophy, most marked distally, sensory disturbance, areflexia, positive Romberg's sign, orthostatic hypotension, dysphagia and slurred speech. MCV of median nerve was 27.8 m/sec, and SCV was not evoked. EEG revealed nonspecific dysfunction of the brain. He died of ileus-like condition at 41 years old. General autopsy showed haemorrhagic infarction of the jejunum and ileum due to compression of the superior mesenteric artery and vein by an adhesion band of connective tissue formed after previous appendectomy. Neuropathological examinations revealed axonal degeneration and loss of myelinated fibers with schwannosis of anterior and posterior spinal nerve roots as well as peripheral nerves. The posterior roots were more severely affected than the anterior ones. Ganglion cells of the posterior root ganglia showed remarkable degeneration and loss. There was severe degeneration of the posterior columns, especially in the gracilis, of the spinal cord. Nerve cells in the anterior horns and Clarke's columns also displayed conspicuous atrophy or central chromatolysis followed by gliosis. There was slight degeneration of the posterior spinocerebellar tracts.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronological observations of histological changes, cytochrome oxidase activity and copper level in the brain of the postnatal brindled mouse

Neuropathological and enzyme-histochemical studies were performed on brindled mouse hemizygotes (BMs) and normal littermates at the age of 2 days, 7 days, 11 days and 14 days, together with an investigation of their tissue copper levels. A greatly increased copper concentration was confirmed in the kidney and intestine and a greatly reduced concentration in the liver and brain of BMs. The copper concentration in the brain increased gradually with age in the normal littermates, whereas this did not occur in BMs. There was no significant difference in the tissue copper concentration between the cerebrum and the cerebellum-brainstem in BMs or in normal littermates. Light and electron microscopy of the BM brain revealed progressive neuronal degeneration in association with increased mitochondrial changes (ballooning and crista disintegration). Enzyme histochemical examinations demonstrated a progressive comparative decrease (i.e., an increased difference from normal) of cytochrome oxidase activity in the BM brain. These data suggest that progressive degeneration of the brain in Menkes' disease is attributable to mitochondrial degeneration caused by a comparative decrease of both copper concentration and cytochrome oxidase activity in the brain.

[Results of the special physical examination of workers in a vanadium plant (author's transl)]

Special physical examinations were made in order to find out the actual status of damages to health that had broken out in a factory collecting V2O5 from iron sand; and the following results were found: 1. Pharyngitis and bronchitis were found in 25% of the workers exposed to vanadium, but neither pneumonia nor hepatitis was observed. 2. Among the subjective and objective symptoms, respiratory irritation and discoloration of the tongue were frequent. 3. Black spot-like pigmentations gathering in a zonal form 1-2 mm wide in the transitional part and oral mucosa of the upper lip were found. Prevalence rate of this sign was 14.3% in the workers exposed to vanadium. 4. The mean valus of total serum protein and the serum cholesterol in the exposed workers were lower than those in the controls. The difference in the values between both groups is statistically significant. 5. Both the mean values of vanadium concentrations in vurine and its creatinine ratios in the exposed workers were twice to three times those in the controls; however, these parameters decreased to about one third in two months by improving the health and environmental control-measures. 6. Draft items to be checked in special physical examinations of workers handling vanadium have been proposed.

[An investigation of the environment in a certain vanadium refinery (author's transl)]

An investigation of the environment of the working place was made as part of the investigation of damages to health that had broken out in a certain vanadium refinery; and the following conclusions were obtained: When the atmospheric dust volume and V2O5 concentration by unit working step were measured with a high volume air sampler, V2O5 exceeded the threshold limit value given by ACGIH in the P.O. flake production step, while the measurement of V2O5 concentration during one-shift working hours with a low volume air sampler gave 64.3 micrograms/m3 even in the grinding step where the maximum concentration was found, and values under 10 micrograms/m3 in all the other steps. Such concentrations may be considered to have been derived from the fact that P.O. casting in accomplished in a short time, and that the fume and dust that are transiently produced at high concentrations are dispersed outdoors by spontaneous ventilation. Damages to health such as a high prevalence of green tongue appeared to have resulted from failure in exercising elementary sanitary care such as imperfect facilities for safety and sanitation, and failure to thoroughly enforce wearing of masks.