Härje Bucht

IGA nephropathy: a retrospective evaluation of prognostic indices in 176 patients.

One hundred and seventy-six patients with mesangial IgA nephropathy have been studied retrospectively. Mean follow up from apparent onset of the disease was 9.3 years and with follow up from the diagnostic renal biopsy of 4.6 years. Our aim was to evaluate the prognostic significance of sex, age and type of symptoms at onset. The degree of proteinuria, presence of hypertension or decreased renal function, histological lesions and IFL pattern at the time of the diagnostic renal biopsy were recorded. 17 of the patients developed End Stage Renal Failure (ESRF) during the study. According to the Logrank test (renal survival) and Cox stepwise proportional hazard model, severity of glomerular mesangial lesions and degree of proteinuria are the most important indicators of a poor prognosis. The significance of all other parameters disappear after correction for histological lesions and degree of proteinuria. Our conclusion is that a semiquantitative light microscopical examination is an excellent prognostic index in IgA nephropathy, as is a simple determination of protein excretion in the urine.

Studies on the renal circulation and renal function in mitral valvular disease. I. Effect of exercise.

In 31 patients with mitral stenosis of varying severity the effect of light, steady exercise during 15 to 17 minutes on renal function and renal circulation has been studied during heart catheterization. The results have been compared with the values obtained at rest in 72 patients with mitral stenosis. Exercise produced a decrease in clearance of para-aminohippurate and sodium excretion and an increase in renal resistance, changes not produced in normal individuals. Cardiac output and pulmonary pressures increased. In patients with right heart failure exercise produced increased pressures but no increase in cardiac output, and only slight changes in clearance but increase in renal resistance and renal venous pressure.

Development of Hypertension in IgA Nephropathy as a Marker of a Poor Prognosis

We have studied 209 patients with IgA nephropathy. 26 were hypertensive at the time of renal biopsy, and 59 patients developed hypertension during follow-up. Survival statistics show that only 45% of the patients will remain normotensive 10 years after renal biopsy. The presence of hypertension at renal biopsy correlated well with the usual parameters of a poor prognosis. The same markers predicted a later development of hypertension in patients who were normotensive at the time of renal biopsy. When hypertension is established, the prognosis is poor. Three years after diagnosis of hypertension, the renal survival was found to be 70% in the 59 patients we have followed. It is also possible that the markers of a poor prognosis actually predict the progression rate rather than the prognosis, because in time, some patients with initially mild manifestations of the disease will progress to end-stage renal failure.

Studies on the Renal Circulation and the Renal Function in Mitral Valvular Disease III. Effect of Valvulotomy

Renal circulation and function were studied simultaneously with pulmonary and systemic hemodynamics in 25 patients with mitral stenosis before and six weeks after valvulotomy. Postoperatively no essential change in renal circulation or function could be demonstrated whether significant relief of pulmonary hypertension had occurred or not. However, results from follow up studies made on 21 patients up to more than three years after operation showed that renal plasma flow could be increased in patients that were hemodynamically improved at the postoperative study. The effect of exercise was investigated in eight patients before and after valvulotomy. In seven the response pattern of renal circulation and function was essentially unchanged regardless of whether improvement in pulmonary pressures and cardiac output did or did not occur. In the eighth patient, the only one with elevated right atrial pressure before operation, the response to exercise improved markedly. Preoperative results obtained on seven patients who died in connection with operation showed that a fatal outcome was not necessarily related to the degree of impairment in renal circulation or function.

The effect of a single intravenous dose of scillaren B on the pulmonary circulation and renal function in patients with rheumatic heart disease.

Abstract 1. 1. The effect of a single intravenous dose of Scillaren B on the blood pressures in the lesser circulation, and the clearance values for inulin and para-aminohippurate as well as sodium excretion were studied in six patients with rheumatic heart disease. 2. 2. Heart rate rapidly decreased, in some cases during the first minute after administration. 3. 3. Pulmonary blood pressures fell rapidly, while cardiac output remained unchanged. Stroke index rose considerably. 4. 4. No effect on clearance values or sodium excretion was noticed. 5. 5. Compared with lanatoside C, Scillaren B acts with shorter latency on pulmonary pressures in patients with mitral stenosis, but does not show any of the prompt, direct renal effects of the digitalis drug. 6. 6. Scillaren B is a swift and potent cardiac drug. The renal action which has been described earlier is secondary to its effect on the heart.

Immunohistology in Human Amyloidosis

Nine patients with primary or secondary renal amyloidosis were studied. Immunohistological examination showed that immunoglobulins and complement were present in the glomerular deposits. The distribution pattern of the fluorescent material was highly suggestive, if not diagnostic, of amyloidosis. Electron microscopy was the most exact diagncstic method.

What Is the Role of Controls in an Outpatient Department on Progression of Renal Disease

Evidence that protein restriction retards the progression of chronic renal failure in man is mostly derived from anecdotic data and retrospective studies with inappropriate controls and inferior methodology for evaluating renal function. Data from a prospective randomized study in Stockholm demonstrate that more frequent clinical follow-ups without changing the dietary intake of protein significantly retards the progression of renal failure and that the degree of retardation is correlated to improvement in blood pressure control.