James Shorey

GLOMERULONEPHRITIS WITH DEPOSITION OF AUSTRALIA ANTIGEN-ANTIBODY COMPLEXES IN GLOMERULAR BASEMENT MEMBRANE

Abstract A patient with persistent Australia (Au) antigenaemia after post-transfusion hepatitis developed membranous glomerulonephritis. Immunofluorescent staining of kidney tissue revealed glomerular deposits of IgG, complement C 3 , and Au antigen in a pattern characteristic of immune complex deposition. These findings suggest that Au antigen was involved in the formation of immune complexes whose glomerular deposition initiated the pathologic process leading to the development of diffuse membranous glomerulonephritis.

Etiology of Liver Disease in Renal-Transplant Patients

The etiology of 72 episodes of liver disease that developed in 62 of 162 renal-transplant recipients was evaluated. Infection with hepatitis B virus was a minor problem, and none of our patients had evidence of infection with hepatitis A. Cytomegalovirus infection was ubiquitous in the population and probably accounted for many episodes of acute liver disease. This agents role in causing chronic hepatitis is less secure. Infections with other viruses including Epstein-Barr virus, adenovirus, and the herpes viruses were only rarely associated with hepatic disease. Azathioprine was responsible for some episodes of acute cholestasis but could not be incriminated as a direct cause of chronic disease. A cause could be identified for the majority of episodes of acute hepatic dysfunction, but the cause of most of the chronic hepatitis remains undetermined. It is likely that infection with non-A, non-B hepatitis virus accounts for much of this serious, often fatal, complication of renal transplantation.

Hepatotoxicity of Mercaptopurine

The appearance of jaundice in patients with acute leukemia treated with mercaptopurine has been described in several reports and attributed to a toxic effect of the therapeutic agent on the liver.1-6A number of possible causes of jaundice unrelated to therapy exist in the leukemia patient, and it is difficult to be certain whether all reported instances are indeed produced by the drug. Nevertheless, it is generally accepted that mercaptopurine is potentially hepatotoxic. Recently, we have observed jaundice develop in two nonleukemic patients during therapy with mercaptopurine. Because of increasing current interest in the use of purine analogues for treatment of a variety of diseases, we are reporting our observations in order to direct attention to this important therapeutic complication. Patient Summaries Patient 1. —A 45-year-old man was admitted to Parkland Memorial Hospital on Dec 14, 1966, for evaluation of jaundice. He had been well until July 1964 when

A Prospective Trial of Steroid Therapy in Severe Viral Hepatitis The Prognostic Significance of Bridging Necrosis

A prospective, double-blinded, randomized trial of corticosteroid therapy in patients with severe acute viral hepatitis has been conducted. At the same time, we have examined the prognostic significance of the presence of bridging necrosis in liver biopsies obtained from such patients as well as the predictive value of certain serologic markers. Forty-two of the 77 patients admitted to the trial were shown to have bridging necrosis on their initial biopsies. Two patients progressed to death with massive hepatic necrosis, while 5 patients developed chronic liver disease. A complicated course could not be predicted by the initial biopsy findings nor by any of the serologic markers assessed. We could not identify any clinical or epidemiologic features with prognostic impact. No advantage was demonstrated to be associated with the use of corticosteroids early in the course of severe viral hepatitis.