G.M. Bell

IS THE LOIN PAIN AND HAEMATURIA SYNDROME A RENAL MANIFESTATION OF HYPERSENSITIVITY

renal transplantation, 1,3,4 cyclosporin has not been thoroughly studied in the context of its possible interaction with the transfusion effect. A prospective trial would now be difficult because it might be considered unethical to withhold transfusions from transplantation candidates. Our dog model seemed a suitable means of answering this question: experience with this model accords well with the clinical situation5-7 and a special feature is the use of pairs of DLAidentical littermates to evaluate drug therapy. We have studied the effect of combined treatment with cyclosporin and azathioprine and prednisolone in transfused and non-transfused littermates. The two

Occupational Hydrocarbon Exposure and Diabetic Nephropathy

Exposure to hydrocarbons has been implicated in the pathogenesis of glomerulonephritis but its role in the development of diabetic nephropathy remains unknown. Three groups of patients with Type 1 diabetes of over 10 years duration were studied. Group 1 comprised 45 patients (23 F) with no diabetic nephropathy (urinary albumin excretion (AER) –30 mg 24 h−1), group 2 comprised 37 patients (17 F) with incipient diabetic nephropathy (AER between 30–300 mg 24 h−1), and group 3 comprised 31 patients (15 F) with overt diabetic nephropathy (AER >300 mg 24 h−1). The groups were comparable for age, sex, duration of diabetes, recent glycaemic control, social class, and residential area. Patients were assessed blindly by a validated questionnaire and interview for hydrocarbon exposure, consumption of tobacco, analgesic agents, and alcohol. Exposure scores to hydrocarbons derived from the questionnaire were significantly higher in patients with incipient and overt diabetic nephropathy with smoking adjusted odds ratios of 3.6 and 5.2, respectively. The consumption of alcohol, analgesic agents, tobacco, and smoking habits were similar in the three groups. In conclusion, hydrocarbon exposure may be a key environmental factor in the development of diabetic nephropathy in patients with Type 1 diabetes.

Monitoring of endothelial leucocyte adhesion molecule-1 in anti-neutrophil-cytoplasmic-antibody-positive vasculitis.

Soluble endothelial leucocyte adhesion molecule-1 (ELAM-1) has been shown to act as a neutrophil chemoattractant and may also represent a specific marker of endothelial cell damage or activation. Nine patients with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis (p-ANCA: n = 4, c-ANCA: n = 5) were prospectively monitored for disease activity by serial serum ELAM-1, C-reactive proteins (CRPs), von Willebrand factor (vWF) and ANCA levels. Six patients presented acutely with biopsy-proven renal vasculitis. One patient on dialysis, one in remission with stable renal function and one renal transplant patient developed clinical and serological relapse. Seven patients had abnormally high ELAM-1 (>60 ng/ml) levels at presentation. These fell within normal limits a week following pulse methyl prednisolone therapy. This preceded a fall in CRP, vWF and subsequent clinical remission. p-ANCA serology remained positive in 3 cases. One patient relapsed with rising ELAM-1 levels. Two patients developed erroneously positive ANCA serology but serum ELAM-1 remained normal. Six patients with chronic renal impairment of non-vasculitic origin who presented acutely with septicaemia had normal serum ELAM-1 levels (mean +/- SD: 31 +/- 10 ng/ml) at presentation and during the subsequent clinical course. These preliminary findings are encouraging, especially when ELAM-1 is combined with ANCA monitoring in vasculitis. However, further data from larger controlled studies are needed to validate the utility of ELAM-1 in the monitoring of patients with vasculitis.

Angiotensin-converting enzyme inhibitors in diabetics with hypertension : a cautionary note

We report 2 cases of renal failure induced by ACE inhibitors in 2 elderly hypertensive diabetic patients which again draws attention to a potential problem associated with the use of these drugs

Antibodies to collagen IV in the serum of workers exposed to hydrocarbons and volatile organic chemicals

Significant numbers of workers (14%) chronically exposed to volatile organic chemicals commonly found in spray paints had elevated levels of uncharacterized antibodies to collagen IV, a basement membrane protein. No increased frequency of subjects with positive results for anti-glomerular basement membrane antibodies (anti-GBM) was found in this group. These anti-GBM antibodies are directed against a specific epitope on the non-collagenous domain (NC1) of the α3 chain of collagen IV. Anti-GBM antibodies are diagnostic for Goodpastures syndrome that has been reported to occur following acute inhalation of volatile substances. In another group of workers, exposed both dermally and by inhalation to petroleum-based oil mists, 5% had positive results for antiGBM antibodies. We conclude that the measurement of general, uncharacterized antibodies to collagen IV may be a useful indicator of basement membrane damage in workers occupationally exposed to volatile organic chemicals.