Börje Kuhlbäck

Recurrence of renal amyloid and de novo membranous glomerulonephritis after transplantation.

Eleven patients with amyloidosis were treated for terminal renal failure by transplantation, receiving 12 cadaver allografts. In one patient the amyloidosis was primary and in the remaining 10 it was secondary to a chronic inflammatory disease. All of the patients were subjected to one or two fine-needle aspiration biopsies of the kidney graft during a followup of 11 to 68 months. The biopsies of three patients, one with primary amyloidosis and two with ankylosing spondylitis, revealed amyloid recurrence in the graft. These recurrences were diagnosed at 11, 28, or 37 months, respectively. The risk of amyloid recurrence is thus by no means negligible. The present study revealed no factors determining the development of recurrence. In two additional cases, membranous glomerulonephritis was observed in transplant biopsy. Both of these patients had rheumatoid arthritis as the underlying disease and were treated with gold salts before transplantation. It is suggested that an impaired immune response, related to amyloidosis and/ or immunosuppressive therapy, may have favored the formation and deposition of circulating immune complexes.

Serum Uric Acid in Toxæmia of Pregnancy With Special Reference to the Prognosis of the Fœtus

During normal pregnancy certain changes in the concentration of serum uric acid occur. Previously, somewhat conflicting data have been published regarding the changes encountered in the different stages of pregnancy, but recently S t e e n s t r u p (1963) has convincingly shown that hypouricsemia is present in the first and second trimesters of a normal pregnancy, while in the third trimester the uric acid concentration in the plasma is the same as in the non-pregnant individual. During parturition the uric acid concentration in the serum usually rises to hyperuricsemic values, but returns to normal by the third-fifth day of the puerperium. The results relating to serum uric acid in pregnancies accompanied by hyperemesis, toxsemia and pre-eclampsia are less clearcut. However, the majority of authors have reported that the uric acid concentration in the serum is elevated in these conditions, particularly in severe cases of toxemia (Slemons and Bogert , 1917; C a l d w e l l and Lyle, 1921; K i l l i a n and S h e r w i n , 1921; H a r d i n g and D r e w , 1923; P e c k h a m , 1929; S t a n d e r and C a d d e n , 1934; Hayashi , 1956; L a n c e t and Fisher , 1956; C z a c z k e s et al., 1958; Novel1 and d e Haan , 1958).

The Prognosis of the Fœtus in Relation to the Serum Uric Acid in Toxæmia of Pregnancy

The present study was undertaken in order to obtain an idea regarding the concentration of uric acid in the serum in different stages of toxzmia of pregnancy, and in order to find out whether an elevated serum uric acid concentration in late pregnancy is correlated with complications of delivery or with the condition and weight of the baby at birth. The series consists of gz pregnant women showing signs of toxemia of different degrees. The control series consists of 72 normal pregnant women, some of whom had slight emesis. The patients with toxzmia had a normal renal function or very slight renal failure.

Acute Renal Failure In Pregnancy

During pregnancy renal changes and pathological conditions of renal origin sometimes develop, among which toxaemia of pregnancy is the most frequent. But other serious disturbances of renal function occur, which may suddenly complicate an apparently normal pregnancy. In the early stage the chief cause of renal failure is abortion, often criminal. In these cases an infectious, toxic or haemolytic factor is usually also involved ( A n t h o n e et al., rg60; Ramsay, 1964; S m i t h et al., 1965). Renal failure occurring during the late stage of pregnancy is usually due to abruptio placentae ante tempus, atonic uterine haemorrhage or toxaemia of pregnancy (Bull et al., 1955; Merr i l l , 1965; A t l a s and G a b e r m a n , 1958; K n a p p and B o n s n e s , 1960; A l w a l l , 1963, and S m i t h e t al., 1965). This paper deals with the primary cause, the clinical course and the outcome in a series of patients with acute renal complications of pregnancy, hospitalized at the Renal Ward during the years 1961-1965.