RESUMEN
Fibrillar deposits, distinct from amyloid deposits, were demonstrated by electron microscopy in the glomeruli and lung of an Amazonian Woolly monkey (Lagothrix lagotricha) which had died with extensive pulmonary haemorrhage. The renal lesions were typical of fibrillary glomerulonephritis in man, and IgG deposition was also demonstrated in the kidney. The association of renal and pulmonary lesions has been reported previously in man, but this is the first report of fibrillary glomerulonephritis, and a pulmonary-renal syndrome, in non-human animals.
Asunto(s)
Glomerulonefritis/complicaciones , Hemorragia/complicaciones , Enfermedades Pulmonares/complicaciones , Citoesqueleto de Actina/ultraestructura , Animales , Cebidae , Resultado Fatal , Mesangio Glomerular/patología , Mesangio Glomerular/ultraestructura , Glomerulonefritis/patología , Hemorragia/patología , Pulmón/patología , Enfermedades Pulmonares/patología , Microscopía ElectrónicaRESUMEN
Thrombotic microangiopathy is an uncommon complication of cyclosporin immunosuppression following renal transplantation. We present a 15-year-old girl who developed clinical features of acute rejection, but in whom an early biopsy revealed thrombotic microangiopathy, allowing a change to FK506 immunosuppression resulting in excellent graft recovery.
Asunto(s)
Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Glomérulos Renales/irrigación sanguínea , Riñón/patología , Trombosis/inducido químicamente , Trombosis/patología , Adolescente , Biopsia , Capilares/patología , Femenino , Humanos , Inmunosupresores/uso terapéutico , Retratamiento , Tacrolimus/uso terapéuticoRESUMEN
OBJECTIVES: To confirm the expression of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in ductal carcinomas of the prostate, and to analyse p53, Ki67, oestrogen (ER) and androgen (AR) receptors in these tumours. MATERIALS AND METHODS: Paraffin-embedded samples from 12 patients with ductal carcinoma of the prostate were assessed for pattern, mitotic count and the presence of a microacinar carcinoma component. There were six pure ductal and six mixed microacinar and ductal carcinomas. Sections were stained immunohistochemically for the expression of PSA, PAP, Ki67, p53, AR and ER. Clinical data were obtained from case notes. RESULTS: Six of the ductal tumours had a papillary pattern whilst the others had a cribriform appearance. The mitotic rates in the ductal areas were high in the tumours from eight of the 12 patients. PSA and PAP immunohistochemistry were positive in all the cases. No ER immunoreactivity was found in any of the patients. Ten of the ductal tumours showed strong reactivity with AR, the other two were weakly positive; two of the tumours were strongly positive for p53 protein. All the ductal carcinomas expressed Ki67, three having > 25% nuclear marking. One patient who was strongly positive for p53 and had a high Ki67 score survived only one year after diagnosis. Survival ranged from 1 to 13 years after diagnosis. CONCLUSION: This study confirms the expression of PSA and PAP in ductal carcinomas of the prostate. The percentage of tumours expressing p53 was similar to that published for high-grade microacinar carcinomas. The results for Ki67 suggest that ductal tumours have higher scores than microacinar tumours, but further studies are required to ascertain if this is significantly different. As half the patients with ductal tumours had co-existent microacinar tumours, we advise transrectal prostatic biopsies in patients diagnosed with pure ductal carcinomas on transurethral resection specimens, to exclude high-grade microacinar carcinomas. The presence of AR and the lack of ER in all the ductal carcinomas confirms that these tumours are prostatic in origin and should be treated with antiandrogen therapy.
Asunto(s)
Carcinoma/patología , Neoplasias de la Próstata/patología , Fosfatasa Ácida/análisis , Anciano , Anciano de 80 o más Años , Carcinoma/metabolismo , Carcinoma/terapia , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Masculino , Proteínas de Neoplasias/análisis , Orquiectomía , Prostatectomía , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/terapia , Proteína p53 Supresora de Tumor/análisisRESUMEN
Kidneys are innervated by a plexus of nerves around the renal artery, which is disrupted by transplantation. This is a report of a comparison of the nerves in human renal allografts and normal kidneys. There were many sympathetic ganglia around normal renal arteries but none around transplanted vessels, although equal numbers of ganglia were present in hilar tissues of normal and transplanted kidneys. An immunohistological study with an antibody to synaptophysin showed that the number of synapses in transplanted ganglia was severely reduced. Immunohistological studies on allograft kidneys using antibodies to various neurofilament proteins and the Schwann cell marker S100 showed a marked reduction in neurofilament proteins shortly after transplantation with subsequent partial recovery, and a lesser reduction in S100. Renal allografts have structurally abnormal innervation but are not completely denervated.
Asunto(s)
Trasplante de Riñón , Riñón/inervación , Estudios de Seguimiento , Ganglios Simpáticos/anatomía & histología , Humanos , Técnicas para Inmunoenzimas , Riñón/metabolismo , Proteínas de Neurofilamentos/metabolismo , Periodo Posoperatorio , Arteria Renal/inervación , Proteínas S100/metabolismo , Sinapsis/ultraestructura , Sinaptofisina/metabolismo , Tioléster Hidrolasas/metabolismo , Factores de Tiempo , Ubiquitina TiolesterasaRESUMEN
OBJECTIVE: To report eight cases of limited Wegener's granulomatosis (WG) affecting the urogenital tract (testis, ureter, bladder, urethra and penis) and to emphasize the importance of the anti-neutrophil cytoplasm antibody (ANCA) test in establishing the diagnosis. PATIENTS AND METHODS: Eight patients (six men and two women, aged 41-77 years) were diagnosed with WG, based on their previous medical history, the ANCA test and by biopsy. RESULTS: In each case, there were difficulties and delay in establishing the diagnosis of WG and starting appropriate treatment. The ANCA test was positive in seven cases and helped in establishing the diagnosis, in conjunction with the confirmation of vasculitis and granulomata by biopsy. CONCLUSION: We advocate ANCA testing in patients presenting with limited urogenital disease in association with a past or present relevant history of arthritis, skin vasculitis and/or biopsies showing necrosis or non-specific inflammation.
Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos/análisis , Enfermedades Urogenitales Femeninas/diagnóstico , Granulomatosis con Poliangitis/diagnóstico , Enfermedades Urogenitales Masculinas , Adulto , Anciano , Femenino , Enfermedades Urogenitales Femeninas/complicaciones , Enfermedades Urogenitales Femeninas/terapia , Estudios de Seguimiento , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/terapia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
There is considerable disagreement regarding the natural history of renal disease associated with thin glomerular basement membranes (TGBM). We followed 43 patients (19 male), mean age 41.6 years (range 19-73) for a mean of 88 months (48-140). TGBM was recognized in adults when glomerular basement membrane thickness, measured from multiple sites in electronmicrographs of renal biopsy tissue as the harmonic mean, was < 320 nm. At presentation, 95% had microscopic haematuria, 12% macroscopic haematuria, 14% loin pain, 28% proteinuria, and 14% hypertension. There was no difference in GBM width between the sexes (male 258 nm vs. female 251 nm) but there was a significant negative correlation between age and GBM width (r = -0.53, p < 0.001), with older patients having the thinnest membranes. Twenty six patients had ultrathin GBM (< 270 nm), of whom 54% had 3+ haematuria vs. 12% of the group with BM > 270 nm (p < 0.01). In the ultrathin group, 71% had loss of anionic charge from the GBM, vs. 17% in those with membranes which were thin but > 270 nm (p < 0.05). Proteinuria occurred more frequently in those with GBM > 270 nm, 65% vs. 8% in the ultrathin group (p < 0.01). Thin GBM were associated with a benign prognosis, as after a mean follow-up of 85 months (48-140), there was no significant change in either serum creatinine or mean arterial blood pressure. Patients with ultrathin GBM had greater loss of GBM anionic charge, which might result in both an alteration of flow characteristics within the glomerular capillaries and also increased fragility of the glomerular basement membrane with likelihood of rupture and resultant macroscopic haematuria.
Asunto(s)
Enfermedades Renales/patología , Glomérulos Renales/ultraestructura , Adulto , Anciano , Membrana Basal/ultraestructura , Biopsia , Femenino , Hematuria/etiología , Humanos , Enfermedades Renales/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To undertake a follow-up study of 472 men who were screened 3 years previously, in general practice, for prostate cancer, and to investigate the efficacy and patient acceptability of a 3-year screening interval. SUBJECTS AND METHODS: Eligible men (n = 472) were sent postal invitations to attend their Health Centre in North Bristol. Serum prostate-specific antigen (PSA) was the initial screening test. Men with PSA > 4 ng/ml (Hybritech) were referred to the Department of Urology for digital rectal examination and transrectal ultrasound +/- biopsy. RESULTS: A total of 132 (28%) men were excluded because of intercurrent illness, death and migration. Two hundred of 340 (59%) men were re-screened. Thirty-seven men had an elevated PSA and were referred as above. Seventeen men had prostatic biopsies, resulting in the diagnosis of six carcinomas; five were localized to the prostate and one was metastatic. In the latter patient, the PSA had risen from 2 to 120 ng/ml over 3 years. CONCLUSION: Serum PSA alone can be used as an acceptable repeat screening test to detect prostate cancer in general practice, but 3-year repeat screening will not always protect the individual against the interval development of metastatic disease.
Asunto(s)
Tamizaje Masivo , Satisfacción del Paciente , Neoplasias de la Próstata/prevención & control , Anciano , Medicina Familiar y Comunitaria , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Factores de TiempoRESUMEN
Wegener's granulomatosis usually affects the upper and lower respiratory tract as well as the kidney. Cardiac involvement is rare, although electrocardiographic abnormalities, coronary artery vasculitis, cardiac arrhythmias, and myocardial infarction have been described. We report two cases of aortic valve disease associated with Wegener's granulomatosis that were progressive despite clinical remission of Wegener's disease in both patients. One patient has undergone successful valve replacement and the other is currently awaiting surgery. Aortic valve histopathology showed myxoid degeneration that was most likely due to previously active vasculitis affecting the vessels of the aortic wall and valvular necrosis with subsequent progressive degeneration of the cusps.
Asunto(s)
Válvula Aórtica , Granulomatosis con Poliangitis/complicaciones , Adulto , Anticuerpos Anticitoplasma de Neutrófilos , Válvula Aórtica/cirugía , Autoanticuerpos/sangre , Biomarcadores/sangre , Granulomatosis con Poliangitis/inmunología , Enfermedades de las Válvulas Cardíacas/etiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patients with rheumatoid arthritis who develop membranous glomerulonephritis associated with gold or penicillamine therapy have been shown to get better when the drugs are discontinued, whereas up to 50% of patients with idiopathic membranous glomerulonephritis develop renal failure. A feature of the lesion in rheumatoid disease is the presence of mesangial immune complex deposits in addition to the basement membrane deposits of classical idiopathic membranous glomerulonephritis. To determine whether the presence of mesangial immune complexes indicates a different renal outcome in membranous glomerulonephritis we studied 3 groups: group A 10 patients with rheumatoid arthritis and drug induced membranous glomerulonephritis with mesangial immune complex deposits, group B 14 patients with idiopathic membranous glomerulonephritis with additional mesangial immune complex deposits and group C 25 patients having classic idiopathic membranous glomerulonephritis with deposits solely in the glomerular basement membrane. After median follow up of 72 months, nephrotic range proteinuria resolved in all cases in group A after drug withdrawal, 93% of group B, but only 60% of group C (groups A + B vs C, X2 = 7.8, p < 0.01). Serum creatinine remains less than 500 mumol/l in all patients in group A, 93% of group B, but only 64% of group C (groups A + B vs C, X2 = 7.6, p < 0.01). Mesangial immune complex deposits were predominantly of the IgM isotype in both the rheumatoid and idiopathic membranous group. The presence of mesangial immune complex deposits suggests either a different pathogenesis or host responsiveness to that found in classic idiopathic membranous glomerulonephritis, and predicts a more favourable renal outcome.
Asunto(s)
Complejo Antígeno-Anticuerpo/análisis , Mesangio Glomerular/inmunología , Glomerulonefritis Membranosa/diagnóstico , Adulto , Anciano , Artritis Reumatoide/complicaciones , Creatinina/sangre , Femenino , Estudios de Seguimiento , Mesangio Glomerular/patología , Glomerulonefritis Membranosa/etiología , Glomerulonefritis Membranosa/inmunología , Humanos , Inmunohistoquímica , Glomérulos Renales/inmunología , Masculino , Persona de Mediana Edad , Pronóstico , Proteinuria/orinaRESUMEN
Six patients with immune-related potassium-losing interstitial nephritis (IRPLIN) are described, and compared with 34 patients with immune-related distal renal tubular acidosis (IRdRTA) and 24 with familial distal renal tubular acidosis (FdRTA). Close similarities were found between IRPLIN and IRdRTA. In our experience, both syndromes are confined to postpubertal women, and are characterized by systemic features of autoimmune disease and a chronic interstitial nephritis which is probably immune-mediated and responsible for the functional tubular defects of the two syndromes. In IRPLIN, a renal potassium-losing state is the main consequence (probably mediated at least in part by renin and aldosterone hypersecretion secondary to renal sodium-losing), and urinary acidification is normal or minimally disturbed; consequently there is no systemic acidosis, and the syndrome is not complicated by nephrocalcinosis or renal bone disease. In IRdRTA, the renal tubular lesion also usually causes potassium depletion, but the most prominent tubular fault is a defect in urinary acidification, which commonly causes metabolic acidosis and often leads to nephrocalcinosis and bone disease. Familial dRTA, in contrast, is equally prevalent in the two sexes and presents at an earlier age than IRPLIN and IRdRTA. Patients with FdRTA and IRdRTA have a similar urinary acidification defect and propensity to acidosis, nephrocalcinosis and bone disease. FdRTA is frequently complicated by renal potassium-losing, but hypokalaemia is less common and less profound than in IRdRTA and IRPLIN, suggesting that immune-related interstitial nephritis has a particular tendency to cause renal potassium-losing.
Asunto(s)
Acidosis Tubular Renal/metabolismo , Enfermedades Autoinmunes/metabolismo , Hipopotasemia/etiología , Nefritis Intersticial/metabolismo , Acidosis Tubular Renal/genética , Acidosis Tubular Renal/inmunología , Adolescente , Adulto , Anciano , Enfermedades Autoinmunes/genética , Enfermedades Autoinmunes/inmunología , Femenino , Humanos , Hipopotasemia/metabolismo , Riñón/metabolismo , Riñón/patología , Masculino , Persona de Mediana Edad , Nefritis Intersticial/genética , Nefritis Intersticial/inmunología , Concentración Osmolar , Potasio/metabolismoRESUMEN
Histological assessment and DNA flow cytometry have been performed on 15 kidneys containing primary adenocarcinomas which had invaded the renal vein. Comparison of morphological variables showed that samples of the intravenous tumour were more commonly composed of granular cells (53 per cent) than were samples from the main tumour mass (16 per cent), and were also of higher nuclear grade. In 7 of 14 kidneys, DNA studies showed either a higher S-phase fraction (five cases) or DNA aneuploidy (two cases) in tumour cells lying within the renal vein. The mean S-phase fraction was also shown to increase in higher nuclear grades. Thus, both morphological and biological differences exist between invasive tumour cells lying within the renal vein and those in the main tumour. This is a useful model for the investigation of venous invasion and may give a better prediction of the metastatic potential of renal cell carcinoma.
Asunto(s)
Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Venas Renales/patología , Carcinoma de Células Renales/genética , Carcinoma de Células Renales/secundario , ADN/análisis , Citometría de Flujo , Humanos , Neoplasias Renales/genética , Neoplasias Renales/secundario , Ploidias , PronósticoRESUMEN
Reports of malignant tumors in enterocystoplasties have recently been accumulating. To date no case of benign tumors has been recorded. We present a case of villous adenoma in a sigmoid colocystoplasty. The possible etiological factors and pathogenesis are discussed, and recommendations are made about followup.
Asunto(s)
Adenoma/etiología , Derivación Urinaria/efectos adversos , Adenoma/patología , Colon/cirugía , Humanos , Masculino , Persona de Mediana Edad , Vejiga Urinaria/cirugíaRESUMEN
C1q deposits are usually found in association with other complement components and immunoglobulins in proliferative glomerulonephritis and may predominate in systemic lupus erythematosus (SLE). We report the clinical outcome of four patients who developed a nephrotic syndrome associated with C1q nephropathy unrelated to SLE. On presentation the mean urinary protein loss was 6.8 g/24 h (range 4-10), and renal function impaired, mean serum creatinine 201 mumol/l (150-400). Over a mean follow up period of 6.5 years (1.7-19), all four patients improved, three spontaneously and one treated with steroids and cyclosporin, to a current urinary protein loss of 0.3 g/24 h (less than 0.2-0.9) and serum creatinine 98 mumol/l (68-115). C1q nephropathy was confirmed in each biopsy by conventional immunohistology. C1q deposits were demonstrated within the glomerular basement membrane of three biopsies and the mesangium in two samples. One patient had been categorized on light- and electron-microscopy as having mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one proliferative glomerulonephritis with focal segmental glomerulosclerosis, and one diffuse proliferative glomerulonephritis with both subendothelial and mesangial dense deposits. In view of the expected progressive nature of the underlying renal histopathological appearance, the presence of predominant C1q deposits would appear to be associated with a better clinical outcome.
Asunto(s)
Complemento C1q/metabolismo , Síndrome Nefrótico/inmunología , Adulto , Anciano , Femenino , Glomerulonefritis/inmunología , Glomerulonefritis/patología , Glomerulonefritis Membranoproliferativa/inmunología , Glomerulonefritis Membranoproliferativa/patología , Glomerulonefritis Membranosa/inmunología , Glomerulonefritis Membranosa/patología , Glomeruloesclerosis Focal y Segmentaria/inmunología , Glomeruloesclerosis Focal y Segmentaria/patología , Humanos , Enfermedades del Complejo Inmune/inmunología , Enfermedades del Complejo Inmune/patología , Masculino , Persona de Mediana Edad , Síndrome Nefrótico/patología , PronósticoRESUMEN
Urinary excretion of tissue kallikrein is reduced in essential hypertension. Although a similar finding has been reported in spontaneously hypertensive rats (SHR), only a few studies have been concerned with the amount of enzyme within the kidney both at the time of onset and during progression of the hypertension. We have performed an ontogenic study on the renal parenchymal values and immunoreactivity of tissue kallikrein in Okamoto SHR aged 4-78 weeks. Additionally, these two parameters were analysed in human biopsies taken from patients with hypertensive nephropathy. The enzymatic activity of renal tissue kallikrein (active and total; specifically antagonized by anti-tissue kallikrein antibodies), increased from 4 to 52 weeks in SHR when compared to normotensive Wistar Kyoto (WKY) rats; this increase was associated with a significant increase in blood pressure. In contrast, 78 weeks SHR and human biopsy tissue showed a substantial reduction in tissue kallikrein values. Also, both renal tissues showed a reduction in immunoreactivity in the cells of the connecting tubules that specifically store the enzyme. In advanced hypertension the observed reduction in tissue kallikrein was probably secondary to a loss of distal tubular mass, as a result of tubular atrophy and fibrosis. The greater values for renal tissue kallikrein in the kidney and reported reduced urinary excretion during the early phases of spontaneous hypertension may be explained by a primary defect in the mechanisms that regulate release of tissue kallikrein from the connecting tubule cells.
Asunto(s)
Hipertensión/metabolismo , Calicreínas/metabolismo , Enfermedades Renales/metabolismo , Animales , Presión Sanguínea , Femenino , Humanos , Inmunohistoquímica , Calicreínas/análisis , Riñón/química , Riñón/metabolismo , Masculino , Ratas , Ratas Endogámicas SHR , Ratas Endogámicas WKYRESUMEN
The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.
Asunto(s)
Medicina Familiar y Comunitaria , Tamizaje Masivo/métodos , Neoplasias de la Próstata/prevención & control , Anciano , Antígenos de Neoplasias/sangre , Biopsia , Estudios de Evaluación como Asunto , Humanos , Masculino , Tamizaje Masivo/organización & administración , Tamizaje Masivo/normas , Persona de Mediana Edad , Palpación , Proyectos Piloto , Valor Predictivo de las Pruebas , Próstata/patología , Antígeno Prostático Específico , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , UltrasonografíaRESUMEN
Granulomatous prostatitis may result from tuberculosis and fungal infection and has been described following prostatic surgery. In most cases, however, the aetiology is unknown, although it may be due to a reaction to extravasated or altered prostatic secretions. We have investigated cells (macrophages, lymphocytes), serum proteins (fibrinogen, alpha 1-antitrypsin) and prostatic epithelial products (prostatic-specific antigen and prostatic acid phosphatase) in diffuse granulomatous prostatitis (3 cases), focal periacinar prostatic granulomas (9) and focal prostatic infarcts (5), using an immunohistological technique. T-lymphocytes and macrophages are present in diffuse and focal granulomatous prostatitis, but few B-lymphocytes occur. Fibrinogen-related antigen is absent from granulomas, but a small amount is present within infarcts, whereas plentiful alpha 1-antitrypsin was detected both in granulomas and infarcts. Significant reduction in prostatic-specific antigen and acid phosphatase reactivity occurs in granulomatous prostatitis. This suggests that cytokines derived from activated macrophages and T-lymphocytes may be exerting a cell regulatory effect and altering cell secretions, as well as causing destruction of the prostatic epithelium.
Asunto(s)
Granuloma/inmunología , Próstata/inmunología , Prostatitis/inmunología , Fosfatasa Ácida/análisis , Anciano , Anciano de 80 o más Años , Antígenos de Neoplasias/análisis , Fibrinógeno/análisis , Células Gigantes/inmunología , Granuloma/metabolismo , Granuloma/patología , Humanos , Inmunohistoquímica , Linfocitos/inmunología , Macrófagos/inmunología , Masculino , Persona de Mediana Edad , Próstata/química , Próstata/patología , Antígeno Prostático Específico , Prostatitis/metabolismo , Prostatitis/patología , alfa 1-Antitripsina/análisisRESUMEN
Three patients with inverted papilloma of the ureter are described. A range of histological features was seen, including one showing malignant change. This condition, which is probably more common than previously thought, can be successfully treated by conservative surgery and close follow-up.
Asunto(s)
Carcinoma de Células Transicionales/patología , Neoplasias Primarias Múltiples/patología , Papiloma/patología , Neoplasias Ureterales/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We have localised atrial natriuretic factor (ANF) in the human kidney by immunocytochemistry and radioimmunoassay. ANF is specifically visualised in the distal convoluted tubule cells and the intercalated cells of the connecting tubules and collecting ducts of the human nephron. The number of immunoreactive cells and tissue values for the peptide were compared between samples from normal kidneys and biopsies obtained from hypertensive patients, in whom the tissue ANF immunoreactivity was found to be reduced. Specific experiments are necessary to establish whether renal ANF is synthesised de novo or captured through endocytosis by the renal tubular cells. The possible functional roles of renal ANF are discussed.
Asunto(s)
Factor Natriurético Atrial/análisis , Riñón/análisis , Anciano , Anticuerpos/análisis , Factor Natriurético Atrial/inmunología , Biopsia , Femenino , Humanos , Técnicas para Inmunoenzimas , Calicreínas/inmunología , Riñón/citología , Riñón/patología , Enfermedades Renales/patología , Túbulos Renales/patología , Masculino , Persona de Mediana Edad , Nefronas/patología , Proteínas/análisisRESUMEN
Antiglomerular basement membrane (anti-GBM) disease is characteristically described with linear deposition of IgG along the GBM. We report two unusual cases of IgA and IgM anti-GBM disease associated with diffuse thinning of the GMB, and review the literature on atypical immunoglobulin species in this disorder. Both patients were male, aged 55 and 49 years, and presented with isolated microscopic haematuria, neither having shown evidence of impaired renal or pulmonary function on follow-up for 4 and 6 years respectively. Renal histology revealed minor focal mesangial changes only, but immunoperoxidase preparations demonstrated intense linear staining of the GBM with IgA in one case, and IgM with C3 in the other. On electron-microscopy there was diffuse thinning of the GBM in both cases, mean thickness 220 and 295 nm respectively (normal range 350-450 nm). Antinuclear antibodies were not detected and their glucose tolerance tests were normal. Assays for circulating IgG anti-GBM antibodies using indirect immunofluorescence (IF) and radioimmunoassay (RIA) were negative in both patients, although IgA anti-GBM antibodies with specificity confirmed by inhibition studies were identified in the first case. Thin GBMs in these patients may expose the Goodpasture antigen to toxic or infectious insults, thus altering its antigenic profile and promoting this unusual immune response.
Asunto(s)
Enfermedades Autoinmunes/inmunología , Inmunoglobulina A/inmunología , Inmunoglobulina M/inmunología , Enfermedades Renales/patología , Glomérulos Renales/inmunología , Membrana Basal/inmunología , Membrana Basal/patología , Humanos , Isoanticuerpos/análisis , Enfermedades Renales/inmunología , Glomérulos Renales/patología , Masculino , Persona de Mediana EdadRESUMEN
We have identified a tissue kallikrein in polymorphonuclear (PMN) leucocytes of normal human blood and bone marrow by immunocytochemistry, radioimmunoassay and enzymology. Immunoreactive tissue kallikrein was visualized in the mature neutrophil leucocytes and in immature forms such as metamyelocytes and myelocytes. No tissue kallikrein was detected in eosinophil leucocytes, lymphocytes, macrophages, megakaryocytes and platelets. So far, we have failed to observe immunoreactivity to tissue kallikrein in basophils. The presence of tissue kallikrein in extracts prepared from PMN leucocytes isolated from peripheral blood was demonstrated by immunodiffusion, dot-blotting and by radioimmunoassay. The kininogenase and amidase activity of the extracts resembled that of tissue kallikrein in being resistant to soya bean trypsin inhibitor and sensitive to trasylol. The amidase activity attributable to tissue kallikrein was completely inhibited by specific antisera.