Tripathi K

Spectrum of renal cortical necrosis in acute renal failure in Eastern India

Renal cortical necrosis is an uncommon cause of acute renal failure. We report 23 cases of biopsy-proven renal cortical necrosis which constituted 6.3% (23/363) of all cases of acute renal failure studied over a period of seven years (1985-92). The patients were divided into two groups: obstetric and non-obstetric. Obstetric complications were responsible for renal cortical necrosis in 15 (65.2%) patients while non-obstetric conditions accounted for the remaining eight (34.8%) cases. The overall incidence of cortical necrosis in obstetric acute renal failure was 15/63 (23.8%) patients, the incidence being nearly equal in early (20.5%) and late (29%) pregnancy. Post-abortum renal failure was the sole cause of cortical necrosis in early pregnancy in the obstetric group. Haemolytic uraemic syndrome (three patients) and septicaemia (two patients) were the main cause of necrosis in the non-obstetric group. The cortical necrosis was diffuse and patchy in 17 and six patients, respectively. The disease had a fatal prognosis in 20 (87%) patients; mortality was due to uraemic complications and infections in the majority of patients. The high frequency of post-abortum renal cortical necrosis in our patients is similar to the experience of other Indian workers.

Pentoxifylline in Management of Proteinuria in Diabetic Nephropathy

K. Tripathi, Reader, Dept. of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005 (India) Dear Sir, We read with interest the article entitled ‘Decreased albuminuria by Pravastatin in hyperlipaedemic diabetics’, in volume 59, No. 4,1991, of Nephron [1]. Recently, we completed a study entitled, ‘Effect of pentoxifylline in the management of proteinuria amongst diabetics’. The study was conducted on 20 patients showing clinical evidence of diabetic nephropathy in the form of overt proteinuria and evidence of diabetic nephropathy with or without compromised renal function. The majority of patients had maturity – onset diabetes (80%) and 20% were non-insulin dependent. Evidence of triopathy (neuropathy, retinopathy and nephropathy) was present amongst 25% of the cases. 50% had diabetes of less than 10 years’ duration where as 25% patients had diabetes of more than 15 years. Most of the patients in the hypertensive group were azotemic, with mean serum creatinine values of 2.6 ± 0.6 mg/dl, whereas, amongst the normotensive group, serum creatinine was normal. All patients had overt proteinuria of more than 1 g/24 h. Amongst the hypertensive group, proteinuria ranged between 2.25 and 900 g/day, whereas, in the normotensive group, it was between 1.05 and 5.10 g/day (fig. 1). After a follow-up of 3 consecutive months with pentoxifylline, 1,200 mg in divided doses/day, there was a significant reduction in mean proteinuria values (hypertensive group: 6.2 ± 2.4 to 3.8 ± 2.1 g/day; normotensive group: 2.9 ± 1.5 to 2.1 ± 1.6 g/day, p < 0.01) (fig. 1). The hypertensive group did not receive antihypertens-ive drugs, and those who developed hypertensive crisis were dropped from the study. There was a significant improvement in the mean glomerular filtration rate (hypertensive group: 40.0 ± 11.9 to 48.1 ± 12.9 ml/min; normotensive group: 74.0 ± 35.1 to 81.9 ± 25.0 ml/min; fig. 2) and also a reduction in blood urea and serum creatinine. The responses were more obvious amongst normotensives than amongst hypertensives.

T Suppressor Cell Index in Transplant Rejection

K. Tripathi, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-5 (India) Dear Sir, Several transplant centres have used the number of the total T cell population as an index of state of cellular immunity, and the use of immunosuppressive therapy causes a profound reduction in total T cell count. The blastogenic response of T cells to phytohaemagglutinin A (PHA) and concanavalin A has been found to be low in the functioning graft [1], and an increase in spontaneous blastogenesis in acute rejection has also been observed [2]. Recently investigation of T lymphocytes has been used to predict acute rejection [3]. We studied the T suppressor cell index amongst 7 patients with acute kidney transplant rejection who promptly responded to high-dose corticosteroid therapy. The T suppressor cell index was reduced to 50% during acute rejection, while in chronic rejection no change was observed. The values were quickly restored after steroid therapy, whereas in chronic rejection no significant changes could be found. Fifteen patients who were transplanted at various advanced centres and developed clinical features of rejection during their follow-up in the outpatient department formed the basis of the present study. The diagnosis was confirmed by ultrasound and computerized tomography. The suppressor cell index was calculated by using the blast tansformation technique [4]. The radioactivity was measured, by using a liquid scintillation counter, as counts per minute (cpm; of PH A-stimulated cell culture at time 0 and at 24 h): Table I. Mean suppressor cell stimulation index