Laurence E. Earley

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...

Serial Hemodynamics after Renal Allotransplantation in Man

Serial measurements of glomerular filtration rate (GFR), independent and simultaneous clearances and extractions of para-aminohippurate (PAH), radiohippuran, and iodopyracet (Diodrast) were made in 11 adults and one child who received renal transplants from living donors. Measurements were made within 3 hours and repeated two to four times during the following 14 days. Immediately after transplantation, PAH clearance averaged 385 ml/min (range, 218 to 510), GFR averaged 54 ml/min (range, 22 to 87), renal plasma flow (RPF) averaged 672 ml/min (range, 309 to 1424), and marked vasodilatation was present with an average renal blood flow (RBF) of 979 ml/min (range, 435 to 2,114). As observed in other studies, immediate diuresis and natriuresis but no glycosuria occurred. Extraction ratios for PAH (EPAH) were below normal, ranging from 0.59 to 0.94, and those for 125 (or 131)I-hippuran, and 131I-Diodrast were even lower. Extraction ratio for PAH to radiohippuran averaged 1.43 in 17 simultaneous studies. However, RPF measured simultaneously with these agents was the same, indicating a true difference in transport of these substances. The low extraction ratio for PAH, 131 (or 125)I-hippuran and 131I-Diodrast was not related to depression of the maximal tubular transport of PAH and may have been a consequence of vasodilatation and increased RBF. Another observation made on these kidneys was a low filtration fraction which averaged 0.089. These hemodynamic changes did not appear to relate to circulating factors in the anephric recipient since they persisted throughout the 13-day study period in eight patients. In four patients showing transient rejection, GFR and the clearance of PAH and 131I-hippuran decreased proportionately more than RBF. It is concluded that marked vasodilatation and a low filtration fraction are characteristic of uncomplicated renal allotransplantation in man, and that early rejection is expressed by measurable decreases in the clearances of PAH and inulin despite maintenance of RBF. These changes were present prior to clinical evidence of rejection.

Renal Function during Contralateral Arterial or Ureteral Obstruction

Excretory function of one kidney of the rat was reduced acutely by either partial renal arterial occlusion, elevation of ureteral pressure or complete ligation of the renal pedicle. UNa·V by the opposite kidney increased approximately twofold during partial arterial occlusion or elevated ureteral pressure and this was not associated with increased kidney or superficial nephron glomerular filtration rate (GFR). Absolute proximal reabsorption fell during contralateral arterial constriction, parallel to a drop in GFR. The calculated delivery of filtrate out of proximal tubules rose when natriuresis occurred during the experimental maneuvers and decreased parallel to sodium excretion when obstruction or clamping of the opposite kidney was released. Unilateral ligation of the renal pedicle did not result in changes in nephron filtration rate or proximal tubular reabsorption, although urine flow rate rose, attended by a smaller and nonsignificant natriuresis: in this latter circumstance a distal fall in Na transport may be postulated, while the former experimental maneuvers could have caused an increase in Na excretion by a proximal effect. Thus, contralateral natriuresis during partial unilateral reduction in renal function may be due to different factors, specifically related to the experimental maneuver used to lower GFR.