Yasuji Mizumura

Acute Interstitial Nephritis with Bone Marrow Granulomas and Uveitis

A case of interstitial nephritis with bone marrow granulomas and uveitis was presented. A 53-year-old woman was found to be uremic in the course of rheumatoid arthritis. The renal biopsy revealed acute interstitial nephritis with eosinophilic infiltration. She also had bone marrow granulomas and uveitis. These findings were compatible with those of the syndrome described by Dobrin et al. The etiology and the pathogenesis of this syndrome remain unknown. However, the elevation of the erythrocyte sedimentation rate, raised levels of serum immunoglobulins, presence of circulating immune complexes and decreased T-cell population observed in this patient suggest the involvement of immunological disorders.

Membranoproliferative Glomerulonephritis Associated with Chronic Hepatitis B in Adults: Pathogenetic Role of HBsAg

Two adult cases of membranoproliferative glomerulonephritis (MPGN) associated with chronic hepatitis B were reported. Serum HBsAg, HBeAg and anti-HBc were positive. Glomerular changes were essentially the same in both patients and consistent with MPGN type III. Immunofluorescence microscopy revealed diffuse granular and lumpy deposits of IgG, IgA, IgM, C1q and C3 along glomerular capillary walls and in mesangial areas. Granular deposition of HBsAg was observed along capillary walls and in mesangial areas, and the staining patterns were similar to those of immunoglobulins and complements in both patients. Glomerular deposition of HBeAg, however, was negative in one case, and only slight and segmental in the other case. These findings suggest that HBsAg rather than HBeAg may play a role in the pathogenesis of MPGN associated with hepatitis B virus infection in adults.

Effect of the Antiplatelet Agents Ticlopidine and Dipyridamole on Experimental Immune Complex Glomerulonephritis in Rats

The effect of the antiplatelet agents ticlopidine and dipyridamole on immune complex glomerulonephritis in rats was evaluated. Bovine serum albumin (BSA) nephritis was induced in rats with subcutaneous immunization and intravenous dosage of BSA. Ticlopidine and dipyridamole were administered for 4 weeks before and for 7 days after onset of proteinuria. It was shown that both ticlopidine and dipyridamole could reduce the development of proteinuria when administered before the onset of proteinuria. Ticlopidine also reduced the amount of urinary protein after onset of proteinuria, and may thus be more effective against urinary protein excretion. When the antiplatelet agents were administered before onset of glomerulonephritis, blood urea nitrogen and serum creatinine levels were significantly lower, and glomerular hypercellularity and mesangial widening were milder in animals treated with ticlopidine than in controls. Glomerular deposition of BSA was less intense in treated animals than in nontreated controls. Thus, ticlopidine as well as dipyridamole was found to inhibit the development of proteinuria and glomerular alteration. It is suggested that ticlopidine could be more effective than dipyridamole against the development of immune complex glomerulonephritis in rats.

Membranous Glomerulonephritis Associated with Enterococcal Endocarditis

An autopsy case of membranous glomerulonephritis associated with enterococcal endocarditis was reported. Although enterococcal antigen was not identified in glomerular deposits, the eluate from the patient’s renal tissue was shown to specifically recombine with cells of the enterococcus isolated from his own ante mortem blood. Hypocomplementemia, circulating immune complexes and antienterococcal antibodies were also observed. These findings suggest that enterococcus-related immune complexes played a role in the pathogenesis of glomerulonephritis associated with enterococcal endocarditis in this patient.

GLOMERULAR DEPOSITION OF IgA IN EXPERIMENTAL HEPATIC CIRRHOSIS

Wistar rats rendered cirrhotic with carbon tetrachloride excreted significant proteinuria and hematuria. Serum levels of IgA and IgG were significantly elevated in cirrhotic animals. They showed mild mesangial proliferation and immunofiuorescent studies revealed deposits of IgA and IgG predominantly in mesangial areas and along capillary walls. These findings were very similar to those seen in patients with hepatic cirrhosis or IgA nephropathy. The deposits of IgA were also found in hepatic tissue from cirrhotic animals. The intensity and distribution of glomerular IgA deposits were not diminished after treatment with acid buffer. These results suggest that glomerular IgA are IgA polymers and decreased hepatic clearance of hepatic IgA polymers may be responsible for the glomerular deposition of IgA. ACTA PATHOL. JPN. 35: 561–567, 1985.

Acute eosinophilic interstitial nephritis with bone marrow granulomas: Report of a case

Abstract A 44-year-old man had renal failure, acute eosinophilic interstitial nephritis, and bone marrow granulomas. There was no anterior uveitis or peripheral lymphadenopathy. No etiologic agents became apparent. This case appears to be an abortive form of the new syndrome reported by Dobrin, Vernier, and Fish ( Amer. J. Med. , 59 , 325, 1975). Immunofluorescent study did not reveal the known linear or granular pattern along tubular basement membrane, but IgA in the small vessel walls. Steroid treatment led to some improvement of renal function.

Role of bradykinin potentiation in the antihypertensive effect of captopril in conscious rabbits with two-kidney, one-clip hypertension.

The role of bradykinin potentiation in the antihypertensive effect of captopril was assessed in conscious rabbits with two-kidney, one-clip hypertension. On the 35th day after clipping the renal artery, a bolus injection of bradykinin 0.2 μg/kg was repeated at 15-min intervals three times before and for 180 min after the administration of captopril 0.5 mg/kg. The magnitude and duration of captopril-induced hypotension were more marked in hypertensive rabbits than in controls. The bradykinin-induced hypotension was markedly enhanced by captopril. However, the bradykinin potentiation by captopril was not correlated with its vasodepressive effect. On the other hand, a close relationship (r = 0.825, p < 0.001) was observed between plasma renin activity and the maximum reduction in blood pressure induced by captopril. The experiment performed after sodium depletion for 7 days revealed that the bradykinin potentiating effect of captopril was not affected by sodium depletion. Therefore, it is concluded that the vasodepression by captopril does not necessarily depend on its bradykinin potentiating action and that the latter is not influenced by the renin-angiotension system or fluid volume depletion.

Effects of Captopril on the Renal Hemodynamics during Aprotinin Infusion in Anesthetized Dogs

The effect of captopril (SQ 14,225) on the renal hemodynamics, cortical plasma flow (CPF) and noncortical plasma flow (NCPF), was studied in sodium-replete anesthetized dogs during aprotinin infusion. Mean blood pressure (MBP) increased by aprotinin (p less than 0.05) and decreased by captopril (p less than 0.02). Renal vascular resistance (RVR) tended to increase by aprotinin and decreased from 1.29 to 0.86 mm Hg/ml/h (74.7%) by captopril (p less than 0.05). Renal vein renin activity (RRA) inclined to decrease by aprotinin and increased from 17.8 to 47.2 ng/ml/h (278.2%) by captopril (p less than 0.05). Although the administration of captopril alone did not alter the renal hemodynamics despite the reduction of MBP, captopril made a recovery of renal plasma flow (RPF), CPF and NCPF which had decreased by aprotinin. Especially, CPF showed a significant recovery from 45.4 to 55.6 ml/min (123.6%) by captopril (p less than 0.02). These results indicate that the inhibition of endogenous angiotensin made a preferential increase in CPF and suggest that the renin-angiotensin system plays a major role in the effect of captopril of the renal hemodynamic changes.

The Radioisotope Renogram-Its Clinical Application in the Field of Internal Medicine

われわれはrenogramの新しい評価法を提唱し, その内科的応用について検討した。われわれがrenal function index (RFI) と仮称した評価法の特長は3つのsegmentを総合的に評価しうること, 計算が簡単であること, 長時間のrenographyを必要としないことなどである。健常者のRFI値の平均は0.36±0.04, その左右比は0.98±0.15であり, 再現性もほぼ満足しうるものであった。両側性 (系統的) 腎疾患についてRFIとRPFとの相関を求めると+0.81と高度の相関がえられた。したがって, RFI値からRPF値をある程度推測することが可能である。renogramはまた偏腎性疾患発見のための検査法としてIVPおよびaortogramと同様欠くことができないものである。dehydration時のrenogramはhydration時のそれと比べてRFI値は低下するが, 特定の疾患にとくに著しいという傾向はなかった。また, Rontyl投与後のrenogramではRFI値の低い本態性高血圧症にその改善がみられる傾向があった。