James Hopper

The Association of Cancer and the Nephrotic Syndrome

Excerpt Within recent years there has been increasing interest in malignant tumors with systemic manifestations resembling several of the auto-immune diseases. In a recent review, Greenberg, Divert...

RED CELL, PLASMA, AND BLOOD VOLUME IN HEALTHY WOMEN MEASURED BY RADIOCHROMIUM CELL-LABELING AND HEMATOCRIT*

In a previous study of 201 healthy men (1), red cell volume (Vrbc) was measured by a modification of Sterling and Grays radiochromium method (2), and whole blood and plasma volumes (Vwb and Vpl) were derived from venous hemiatocrits. The influence of factors other than body size on the variance of the data was studied, and standards for predicting normal volumes were derived. The present report describes a similar examination of 101 women.

Red cell, plasma and blood volume in healthy men measured by radiochromium (Cr51) cell tagging and hematocrit: influence of age, somatotype and habits of physical activity on the variance after regression of volumes to height and weight combined.

Methods employing radioactively tagged red cells have been widely adopted for measurement of blood volume. However, in comparison with the work which has been done with the dye (1-5) and carbon monoxide (6) methods, little attention has been given to the establishment of mean values for men and women or to study of the variance encountered among healthy subjects. Most clinical investigators have collected their own control data, based often on study of relatively few or not entirely healthy subjects (7-13). A rather large scatter of data around mean prediction values has been found by all workers, regardless of methods employed, when values for whole blood volume (Vwb), red cell volume (Vrbc) and plasma volume (Vpl) are related to body weight, height, or combinations of these measures (1-5, 13, 14). Some of this variation presumably results from differences in body composition, since blood volume correlates both with body density (5, 15) and with lean body mass (16, 17). However, it has not been shown that predictions based on total body mass are less accurate than those based on lean body mass, which requires a separate measurement (15, 16). Consideration of fat thickness and girth measurement, in addition to height and weight, was found by

Interstitial nephritis in Sjögren's syndrome.

Abstract Renal histologic changes were studied by biopsy in eight patients with Sjogrens syndrome and at autopsy in one. Renal lesions consistent with interstitial nephritis were present in six of...

Diagnostic Import of Virus-Like Particles in the Glomerular Endothelium of Patients with Systemic Lupus Erythematosus

Abstract Examination of existing files of electron photomicrographs of renal biopsies showed virus-like intracellular inclusions in glomerular endothelial cytoplasm from 29 of 30 patients with an unequivocal diagnosis of systemic lupus erythematosus and in none of a group of 37 with a variety of nonlupus renal lesions. The virus-like particles were found in the glomerular endothelium of two patients with discoid lupus and histologically normal-appearing glomeruli. In both these patients systemic lupus, including nephritis, subsequently developed. The particles were found also in four of six cases of suspected but not proved systemic lupus. Renal-biopsy material from two patients who had positive L.E.-cell preparations while receiving hydralazine did not contain the virus-like particles. This study does not establish the nature or etiologic import of these particles but indicates that their presence is diagnostically helpful in systemic lupus regardless of the extent of histologic or functional involvement...

Membranous Nephropathy: Predictors of Terminal Renal Failure

By univariate analysis of patients with membraneous nephropathy, terminal renal failure was associated with male sex, a large amount of proteinuria, low serum albumin concentration, low creatinine clearance rate, high serum creatinine concentration, and high systolic blood pressure, but was not associated with age or prednisone treatment. In a multivariate life table analysis that controlled for all these factors simultaneously, the risk of developing terminal renal failure was significantly independently associated only with sex, serum albumin concentration, and prednisone treatment, being higher in men, lower in those treated with prednisone, and inversely related to serum albumin. Except for the minimal electron-dense deposition, the electron microscopic findings had no predictive value.

Membranous nephropathy: its relative benignity in women.

By means of renal biopsy and light, immunofluorescence, and electron microscopy, a diagnosis of membranous nephropathy (MN) was made in 100 patients. The nephrotic syndrome was present in 83 of these patients. 65 of the patients were men and 35 were women. The average period of follow-up was 99.8 months. As judged by the incidence of death and of improvement or complete healing, the women fared better than the men, whether given high-dose alternate-day prednisone therapy or not. The incidence of improvement or complete healing in the patients given prednisone was higher than the reported for patients who were not given corticosteroids. We have shown that occurrence of MN is more frequent in women than men and the course of MN is more benign in women than in men; alternate-day prednisone therapy appears to be beneficial in patients with MN.

Crescentic glomerulonephritis associated with nonrenal malignancies.

A review of 80 patients with the renal biopsy diagnosis of idiopathic glomerulonephritis with extracapillary proliferation (crescentic GN) disclosed 7 cases with a coexistent nonrenal malignancy; 6 carcinomas and 1 lymphoma. In a control group of 80 patients with the renal biopsy diagnosis of minimal change or focal segmental glomerulosclerosis, only 1 case of coexistent malignancy was found (chi-square = 4.74, p less than 0.05). All of the malignancies occurred in patients older than 40 years of age and the prevalence of malignancy in patients with crescentic GN over the age of 40 was 20%. Light microscopy, immunofluorescence, and electron microscopy revealed fibrin deposition in all cases and no evidence of anti-GBM or immune complex disease. 3 patients experienced a rapidly progressive course while renal function improved in 4 patients following treatment of the underlying malignancy. The pathogenic mechanisms leading to crescentic GN in patients with malignancy are unknown; however, the high prevalence of malignancy in crescentic GN patients older than 40 along with the improvement during the treatment of the underlying malignancy suggests an etiological relationship.

Membranous nephropathy in patients with rheumatoid arthritis: relationship to gold therapy.

Of 90 patients with membranous nephropathy proved by biopsy, 8 (8.9%) had pre-existing rheumatoid arthirtis. Four of these eight patients received systemic treatment with gold. Two others received only token amounts of gold. In two patients who received gold, the renal lesions did not occur until months after discontinuance of gold therapy. We found that clinically significant renal lesions (lesions associated with proteinuria) in patients with rheumatoid arthritis were more likely to be membranous nephropathy than occult amyloidosis or adult lipoid nephrosis. The membranous lesion in patients with rheumatoid arthritis may be difficult to identify by light microscopy, and, although special strains can be helpful, the pathology is frequently sufficiently subtle to require immunofluorescence and electron microscopy for definitive diagnosis. We postulate that chrysotherapy may not be the cause of membranous nephropathy in patients with classic rheumatoid arthritis in whom gold has been used. Whether it merely exacerbates a lesion already present in these patients, or whether it plays little or no role in the development of membranous nephropathy is an unsettled question. Our data lead to think that RA can induce MN and that gold is not the primary inciting agent.

Hypovolemic Shock and Hypotension as a Complication in the Nephrotic Syndrome: Report of Ten Cases

Excerpt Clinical descriptions of circulatory insufficiency in the nephrotic syndrome are few despite the established observation that a reduction in blood volume is found in this disease state (1-1...