D. Adu

Circulating soluble adhesion molecules in inflammatory bowel disease.

Objective: To determine levels of soluble forms of the cell adhesion molecules (CAM), ICAM-1, E-Selectin and VCAM-1 in relation to prevalence, treatment and disease activity in inflammatory bowel disease. Patients and methods: Plasma was obtained from patients with ulcerative colitis (n=49), patients with ulcerative colitis who had undergone restorative proctocolectomy (n=32, eight of whom had a clinical pouchitis), Crohns disease patients (n=34) and 24 healthy controls. Results: Plasma soluble ICAM-1 levels [medians (ranges in ng/ml)] were significantly higher in patients with active ulcerative colitis [270 (90–510)], pouchitis [415 (310–670)] and active Crohns disease [305 (200–630)]than in those with inactive ulcerative colitis [225 (140–425), P=0.031], non-inflamed ileoanal pouch [260 (140–380), P=0.0004] and inactive Crohns disease [245 (90–520), P=0.045], respectively, and controls. The soluble E-Selectin levels were also significantly higher in patients with active ulcerative colitis [55 (40–140)], pouchitis [90 (45–145)], and active Crohns disease [78 (30–115)] than in those with inactive ulcerative colitis [45 (20–80, P=0.003], non-inflamed ileoanal pouch [45 (20–90), P=0.001] and inactive Crohns disease [48 (25–90, P=0.020], respectively, and controls. Conclusions: The present study suggests that increased levels of soluble ICAM-1 and soluble E-Selectin occur during active inflammatory bowel disease and pouchitis, which may be used as sensitive markers of continuing inflammation.

Renal biopsy findings in hypertensive patients with proteinuria

27 patients with hypertension and persistent proteinuria were investigated by renal biopsy. The 13 patients without structural glomerular abnormalities were younger and had less proteinuria than the other 14, but otherwise the two groups had similar clinical features. 6 of the 14 had diffuse glomerular abnormalities; the other 8 had segmental sclerosing lesions, which were mainly in the hilum of the glomeruli, as seen in states of glomerular overload. Glomeruli in all groups were larger than those in normotensive people. It is possible that hypertension causes glomerular enlargement, proteinuria, and segmental glomerular lesions because of loss of functioning glomeruli due to ischaemia.

Treatment of systemic lupus erythematosus with mycophenolate mofetil

Mycophenolate mofetil is an immunosuppressive drug that is of established efficacy in renal transplantation. It inhibits the de novo pathway of purine synthesis and therefore lymphocyte proliferation. Mycophenylate mofetil has been shown to ameliorate the severity of renal injury in murine models of lupus nephritis. Recent studies suggest that it may also be effective in the treatment of patients with lupus nephritis when used in conjunction with steroids. These observations need to be confirmed in adequately sized randomised-controlled studies.

Prevalence of Chronic Kidney Disease in Hypertensive Patients in Ghana

Chronic kidney disease (CKD) is common in tropical Africa although there are few data on the prevalence of this disorder. Therefore we initiated a multicenter screening study to identify the prevalence and staging of CKD in 712 patients with known hypertension in four polyclinics in Accra, Ghana. We measured estimated glomerular filtration rate by the six-variable modification of diet in renal disease equation and proteinuria by the protein/creatinine ratio. All the subjects studied were Ghanaian. Of the 712 patients studied, the median age was 59 years (range 19–90 years) and 560 (78.7%) of the patients were female. The mean duration of hypertension was 4 years (range 0.1–50). The overall prevalence of CKD was 46.9% (95% CI: 43.2–50.7%); 19.1% had CKD stages 1–2 and 27.8% had CKD stages 3–5. There was no difference in age between patients with or without CKD (p = 0.12). The overall prevalence of proteinuria was 28.9% (95% CI: 25.6–32.4%); 14.7% of subjects had preexisting diabetes mellitus and their prevalence of CKD (55%; 95% CI: 42.4–62.2) did not differ from those without diabetes (46%; 95% CI: 41.9–50.0, p = 0.133). CKD is common in hypertensive patients in Ghana, with a prevalence of 46.9%. This provides justification for the inclusion of this group in CKD screening programs in Ghana.

Autoantibody prevalence and association in inflammatory bowel disease

Objective: To study the prevalence and correlation of the following antibodies with disease activity: antineutrophil cytoplasmic antibodies (ANCA), anti-endothelial cell antibodies (AECA) and anti-epithelial cell (anti-EPI) antibodies. Patients and methods: Sera from the following patients were tested: 41 patients with ulcerative colitis, 30 patients with ulcerative colitis following restorative proctocolectomy (RPC), 30 patients with Crohns disease, 10 disease controls, and 34 healthy controls. Results: ANCA were found in 65 patients (64%) [31 with ulcerative colitis (76%); 21 with ulcerative colitis following RPC (70%); 13 with Crohns disease (43%)]. AECA were found in 33 patients (33%) [15 with ulcerative colitis (37%); 12 with ulcerative colitis following RPC (40%); six with Crohns disease (20%)] and anti-EPI antibodies in 20 patients (20%) [six with ulcerative colitis (15%); six with ulcerative colitis following RPC (20%); eight with Crohns disease (27%)]. A strong association between ANCA and both AECA (P=0.0001) and anti-EPI antibodies (P=0.003) was noted. Significant cross-reactivity was noted between ANCA and anti-EPI antibodies (P= 0.0001), but not between ANCA and AECA (P=0.09) following removal of ANCA from the sera (adsorption) by isolated neutrophils fixed on microtitre plates. The prevalence of these autoantibodies did not correlate with either disease activity or treatment. Conclusion: All antibodies persisted despite total colectomy, indicating that these antibodies do not merely reflect colonic inflammation. The cross-reactivity of ANCA with anti-EPI antibodies could be an important factor which may help to explain the high prevalence of ANCA in ulcerative colitis.