Edith Grishman

Treatment of Idiopathic Membranous Nephropathy

In a retrospective study of the effect of treatment in biopsy-proved idiopathic membranous nephropathy, 91 adults and 12 children were followed for periods up to 29 years after clinical onset (mean, 6.5 years). Forty-four were treated with corticosteroids, 15 with corticosteroids and immunosuppressants; 44 had no treatment and served as a control group. Clinical cure and improvement were significantly greater in the treated than in the nontreated group (P less than 0.01). The recurrence rate, occurrence of renal failure and probability of death were significantly greater in the nontreated group, although some of these patients eventually showed improvement. Prognosis was better in patients who responded to therapy. These data strongly suggest that steroid therapy is beneficial in patients with membranous nephropathy.

Ultrastructure of Immune Deposits in Renal Glomeruli

Abstract Immunofluorescence microscopy and electron microscopy are mutually complementary in the characterization of immune deposits in renal glomeruli. Deposits differ in [1] composition: various ...

Intraglomerular fibrin, platelet aggregation, and subendothelial deposits in lipoid nephrosis

We have investigated the formation of fibrin, platelet aggregates, and subendothelial deposits in lipoid nephrosis. Fibrin formation was found in 10 cases of active lipoid nephrosis. Platelet aggregates were found in eight cases and subendothelial deposits in nine. Fibrin and platelets were also found in cases of nephrotic syndrome due to other causes, and in glomerulonephritis. Fibrin was generally absent in lipoid nephrosis in remission and in benign recurrent hematuria. It is suggested that what seems to be a lower incidence in females is more apparent than real and that fibrin or related material may be present in a less easily identifiable form. Steroid therapy apparently had no effect on the presence or absence of fibrin. Most instances were associated with elevated serum cholesterol and alpha(2)-globulin. It is suggested that elevated serum lipids as well as the disease process in the kidney play a role in this phenomenon. It is further suggested that intraglomerular fibrin formation could lead to irreversible renal damage in lipoid nephrosis.

Renal Biopsies in Lupus nephritis

31 patients with systemic lupus erythematosus had renal biopsies performed and were followed for up to 14 years. The biopsies were examined by light and electron microscopy. A good correlation was found between the number of electron dense deposits and the progression of renal disease. Patients with massive deposits had poorer prognosis than those with few deposits. Segmental glomerular lesions were usually associated with few deposits. Localization was also important: pure mesangial deposits indicated favorable prognosis, while subendothelial deposits had the opposite effect.

Hodgkin's lymphoma in an adolescent with systemic lupus erythematosus

An adolescent female with systemic lupus erythematosus (SLE) with diffuse proliferative lupus nephritis subsequently contracted Hodgkins lymphoma, mixed ceilularity type. Prior to the diagnosis of Hodgkins lymphoma, hypogammaglobulinemia developed with IgG deficiency. The nephritis, which improved on steroid therapy, remitted entirely after nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) therapy. The hypogammaglobulinemia also remitted after chemotherapy for Hodgkins lymphoma. The literature concerning the association of SLE and Hodgkins lymphoma is reviewed. The significance of this concurrence is discussed in regard to the possible pathophysiology and the clinical management. Cancer 53:142‐146, 1984.

Paraproteinemia and cryoglobulinemia associated with atypical glomerulonephritis and the nephrotic syndrome

Abstract A patient with an atypical from of glomerulonephritis and the nephrotic syndrome, whose serum contained a paraprotein and mixed cryoglobulin and had rheumatoid factor activity, is described. The nephritis was characterized by the presence of numerous intracellular crystals, wire loops and hyaline thrombi in the glomeruli. It appears reasonable to assume that the crystals and other deposits represent precipitated protein, probably related to the paraprotein and cryoglobulin in the serum. It is suggested that the crystals are derived from the paraprotein and that the mixed cryoglobulins (possibly antigen-antibody complexes) give rise to the deposits seen along the basement membrane.

Binding of synthetic double-stranded DNA by serum from patients with systemic lupus erythematosus: correlation with renal histology.

Detection of antibody to double-stranded DNA by direct binding assays has proved useful in clinical management of patients with systemic lupus erythematosus (SLE). Recent confusion regarding specificity of these antibodies for SLE appears to be due, at least in part, to contamination of natural DNA preparations with nondouble-stranded DNA antigens. Measurement of binding of a synthetic, self-complementary DNA copolymer (dAT) rather than of natural DNA (KB) has been shown to obviate some of these difficulties, apparently because of freedom of dAT from nondouble-stranded DNA antigens. Among the advantages found in this way was a higher degree of specificity of antibodies to double-stranded DNA for clinically-judged active lupus nephritis than had been suspected. Since activity of nephritis is difficult to assess clinically, histologic data were sought to confirm these observations. Thirty-two kidney specimens were examined by light and/or electron microscopy. The degree of histologic activity and the amount and location of glomerular electron-dense deposits were semiquantitated blindly. The binding of both dAT and KB DNA was measured by the ammonium sulfate method. Correlation with the amount of electron-defense deposits was highly significant for dAT binding and somewhat less so for KB DNA binding as determined by both parametric and nonparametric statistical methods. Significant correlation with histologic activity was found for dAT but not KB DNA binding. These results are consistent with previous data and suggest that dAT binding may provide a useful, noninvasive means of clinically assessing both nephritis activity and the intensity of glomerular immune-complex deposition as reflected by the amount of electron-dense deposits. If it can be confirmed that the latter provides long-term prognostic information, then dAT binding (and perhaps its reponse to therapy) may also prove of value in this regard.

Clinical Aspects of Membranous Nephropathy.

Excerpt Membranous nephropathy is a primary renal disease characterized by diffuse thickening of glomerular capillaries and massive proteinuria with nephrotic syndrome. It is also known as membrano...

Renal Disease in Acute Rheumatic Fever.

Excerpt Although antecedent streptococcal infection is involved in the pathogenesis of both rheumatic fever and glomerulonephritis, their simultaneous appearance and even their occurrence at differ...