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Immunosuppressive therapy and clinical evolution were studied in 49 patients (29 females) with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. The mean age of patients at presentation was 55 years, and the mean (+/-SD) follow-up was 43 months (+/-33) (range, 3-140). Among the 49 patients, 10 had biopsy-proven Wegener's granulomatosis, 33 microscopic polyangiitis, 2 Churg-Strauss syndrome, and 4 idiopathic crescentic glomerulonephritis. IgG ANCA autoantibodies were detected in all patients. Induction therapy included pulses and oral administration of methylprednisolone (MP) with oral administration of cyclophosphamide (CP) and plasma exchange in patients with alveolar hemorrhage and serum creatinine (SCr) levels >/= 6 mg/dL. CP was converted to azathioprine (AZA) or mycophenolate mofetil (MMF) after 3-6 months of therapy. Low doses of MP with or without AZA or MMF were administered until the end of follow-up. Therapy institution resulted in remission of disease in all patients. The mean SCr levels decreased from 4.9 mg/dL (+/-2.5) at the onset of the disease to 2.8 mg/dL (+/-1.7) (P > 0.0001), and 3.2 mg/dL (+/-2.3) (P > 0.0001) after 3 and 6 months, respectively. At the end of follow-up, 17 (35%) patients progressed to end-stage renal disease after 34 months (+/-29) (range, 3-98), and 30 (61%) patients maintained sufficient renal function. Two patient deaths were attributed to immunosuppression. Patients with high SCr levels at diagnosis and severe interstitial fibrosis found in renal biopsy had poor renal outcome (P > 0.01 and P > 0.02, respectively). Induction therapy with MP and CP seems to be the regimen of choice in patients with ANCA-associated glomerulonephritis. Early diagnosis and therapy institution as well as long-term treatment lead to acceptable renal survival.

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Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis.

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Reports of serious infections caused by Ewingella americana have been rare. A case of E. americana peritonitis in a patient receiving continuous ambulatory peritoneal dialysis is described. This is the first report of E. americana causing such an infection.

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The role of immunoglobulin (Ig) isotype and affinity of antimyeloperoxidase (MPO) antibodies in the clinical expression of vasculitis (organ involvement, severity and evolution) remains incompletely defined. We have determined the anti-MPO antibody isotypes, as well as the apparent affinity constant (aK) of anti-MPO IgG by using fluid phase MPO inhibition of IgG binding in an MPO specific ELISA. Twenty-eight patients with anti-MPO antibodies and necrotic and crescentic glomerulonephritis, either isolated or associated to various other organ localizations, were analyzed. Serum samples were obtained before treatment and during follow-up. No association was observed between the isotype, the level or apparent affinity of anti-MPO antibodies and the clinical symptoms, severity, and organ distribution of vasculitis, including alveolar hemorrhage. No significant correlation was found between the apparent affinity and the level of anti-MPO IgG. However, the presence of anti-MPO IgM was clearly associated with low affinity anti-MPO IgG and vice versa. Furthermore, in a longitudinal study, high levels of anti-MPO IgM, when present, were observed early in the course of the disease and in some cases preceded the reappearance of anti-MPO IgG during relapses. High affinity anti-MPO IgG were usually present before treatment. Immunosuppressive therapy resulted in decreased apparent affinity and level of anti-MPO IgG. Importantly, anti-MPO IgG level increased during relapses but the affinity of these IgG autoantibodies remained low.(ABSTRACT TRUNCATED AT 250 WORDS)

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The clinical characteristics of 118 patients (60 male) with acute renal failure (ARF) admitted between 1980 and 1991, were retrospectively analyzed and compared with our earlier series of the 1960s. The mean age was 53 years (16-82 years). There was a marked decline in the hypotension-related cases (43% vs. 17%, p < 0.01) and a concomitant increase in the nephrotoxic cases (5% vs. 17%, p < 0.005) in recent years. The number of ARF cases significantly decreased after 1986 (31%) compared to the pre-1986 era (69%, p < 0.001). A complete (35%) or partial recovery (55%) was the rule in the majority of the patients. The overall mortality was 27%, virtually unchanged in comparison to the 1960s (30%). However, a tendency toward lower mortality was seen after 1986 (17%) in comparison to before (32%, p < 0.05). Sepsis and cardiovascular complications were the leading causes of death. Fewer deaths were observed among younger patients (< 30 years, 12.5%) compared to middle-aged patients (30-59 years, 34%, p < 0.05) and to these older than 60s (53.5%, p < 0.002). Also, deaths were rare in patients with only renal involvement (6%), increasing to 30% when 2 vital organ systems were affected (p < 0.005) and to 67% in cases with multiple organ failure (p < 0.001). Early institution of dialysis and the nonoliguric forms of the syndrome seem to be associated with better prognosis. In conclusion, the incidence of ARF has declined in recent years, with a concomitant tendency towards lower mortality. Death rate is mainly determined by the age and the number of organ involvement. Early dialysis seems to contribute to the lower mortality seen in recent cases.

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