Renal failure from "glue sniffing".
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Acute Kidney Injury↗
Biomedical subjects
A R Clarkson
Publications and source records attributed to A R Clarkson.
IgA glomerular deposits in experimental cirrhosis.
Lewis rats rendered cirrhotic by the administration of carbon tetrachloride developed mesangial and glomerular capillary wall deposits of immunoglobulins (especially IgA) and complement. These rats also had circulating immune complexes and markedly elevated serum IgA concentrations. The model suggests that defective hepatic sequestration of circulating IgA polymers and immune complexes may be responsible for the glomerular deposits. A similar mechanism may account for the high incidence of glomerulonephritis in patients with alcoholic cirrhosis.
Animals↗
Antenatal plasma exchange therapy.
A 22-year-old primigravida with severe mesangiocapillary gomerulonephritis presented at 10 weeks gestation for antenatal care. Delivery of a small health infant was achieved by caesarean section at term. The successful outcome of this pregnancy was attributed to the careful control of anaemia, oedema, and hypertension; and to the use of plasma-exchange therapy throughout the third trimester. The value of plasma exchange therapy in pregnancies which are complicated by renal disease is discussed.
Adult↗
Immunologic studies in IgA nephropathy.
Circulating immune complexes (CIC) were detected in 43.6% of 78 patients with primary IgA nephropathy by the solid-phase Clq radioimmunoassay. The IC were intermediate (9 to 17S) in size and contained IgA, IgG, and less commonly IgM. CIC were often present intermittently, correlating with episodes of macroscopic hematuria. Elevated serum IgA concentrations (38.7%) did not correlate with the detection of CIC. Similar findings were observed in sera samples from patients with Henoch Schonlein purpura and in IgA glomerulonephritis associated with alcoholic cirrhosis and/or portal systemic shunts. The factors responsible for the mesangial localization of the IC are not clear, but elevations in serum antibody titers to respiratory pathogens (mycoplasma pneumoniae, herpes virus, influenza), gut flora (E. coli 07), and bovine serum albumin suggest that common exogenous antigens may be involved in the pathogenesis. Primary defects in either mucosal antigen exclusion or reticuloendothelial IC sequestration are proposed to account for these findings.
Antigen-Antibody Complex↗
Rifampicin associated renal dysfunction during antituberculous therapy.
Intermittent rifampicin therapy has been reported to commonly cause a flu-like illness with chills and fever sometimes associated with acute renal failure. This report describes a fourth case of partially reversible insidious renal damage associated with continuous rifampicin therapy and provides evidence that it is not the results of light chain proteinuria as previously suggested. A retrospective review of data relating to renal function in 89 tuberculous patients indicated that increased plasma urate concentration was commonly associated with ethambutol therapy.
Acute Kidney Injury↗
Vascular IgA deposits in clinically normal skin of patients with renal disease.
Direct immunofluorescent tests for IgA deposits were done on biopsies of normal appearing skin from 49 patients with proven renal disease and 7 healthy individuals, in order to evaluate the method in the diagnosis of IgA nephropathy. Many of the 28 patients with IgA nephropathy had high levels of IgA deposition, often accompanied by notable deposits of IgM, Clq and fibrin, and less frequently by C3 and IgG, in small vessels of the superficial dermis. However, some of the 21 patients with other renal diseases had heavy deposits of IgA, limiting the usefulness of the test as a diagnostic aid.
Antigen-Antibody Complex↗
Kappa light chain glomerulosclerosis in multiple myeloma.
Kappa light chains were demonstrated by immunofluorescence microscopy in the renal basement membranes of 6 of 10 patients with multiple myeloma subjected to kidney biopsy. Nodular glomerulosclerosis was present in 2 of these patients, but the remainder showed only minor light microscopic abnormalities. Deposition of kappa light chains in renal basement membranes may be a frequent cause of kidney disease in multiple myeloma. This deposition may be detected with electron microscopy by the demonstration of granular dense transformation of basement membranes. Occasionally there is systemic vascular deposition of kappa light chains which may be difficult to distinguish from amyloid but lacks a fibrillar character. The tissue effects of light chains in multiple myeloma seem likely to be more extensive than their deposition in renal tubules. There appears to be a greater tendency for kappa light chains to accumulate in renal and systemic basement membranes, but the mechanisms governing this deposition are unknown.
Aged↗
Controlled trial of phenytoin therapy in IgA nephropathy.
IgA nephropathy, a condition thought to cause slowly progressive renal damage, is frequently associated with high serum IgA levels. As phenytoin sodium lowers serum IgA concentrations, a controlled trial of therapy with this drug was conducted over a two-year period in patients with IgA nephropathy. Despite significant depression of serum IgA concentrations in the treatment group, there was no significant change in any other clinical, biochemical or pathological parameter, in either control or treatment groups. Indeed, there was evidence for a slow progression of renal damage in both groups. These observations suggest that the elevated serum IgA concentrations in IgA nephropathy are not of primary pahtogenetic significance but are rather a consequence of a basic abnormality in antigen processing and IgA production.
Adolescent↗
Serum and tissue immune complexes in infective endocarditis.
Serial circulating immune complex (IC) determinations were performed in 24 patients with infective endocarditis (IE) using the solid phase Clq, solid phase conglutinin and 3.5% polyethylene glycol precipitation assays. Circulating IC were detected in 67% of IE patients at presentation, but in only 7% of valve lesion controls. Serial determinations produced a 75% prevalence of IC in IE. The presence of circulating IC correlated with "subacute" disease, the presence of tissue deposits of immunoglobulin and/or complement components and with certain extravalvular manifestations (immune complex type glomerulonephritis cutaneous vasculitis and musculoskeletal manifestations). Effective therapy was associated with a fall in circulating IC levels, an effect which was well demonstrated by 3 patients in whom IC rapidly fell to zero following artificial valve replacement. The results support a role for circulating IC in the pathogenesis of this disorder, and suggest that serial IC determinations are useful in following clinical progress, particularly in culture negative endocarditis.
Adult↗
Serum immune complexes and disease.
The solid phase Clq radioimmunoassay was used to detect immune complexes in sera from patients with systemic lupus erythematosus (14/25), rheumatoid arthritis (4/5), vasculitis (5/15), infective endocarditis (2/2), acute rheumatic fever (2/3), pre-eclamptic toxaemia (0/14), lung cancer (3/7), glomerulonephritis (26/98) and renal transplant patients (0/5). The best correlation with disease activity was seen in systemic lupus erythematosus and infective endocarditis where serial immune complex determinations were clearly of value in monitoring therapy. The findings in primary glomerulonephritis indicate only a limited usefulness of the assay in that serum immune complexes were detected in a minority (22/73) of patients with glomerular immune deposits. In particular the data do not support a role for Clq fixing immune complexes in the pathogenesis of membranous glomerulonephritis or in pre-eclamptic toxaemia.
Antigen-Antibody Complex↗
Plasmapheresis in glomerulonephritis.
Plasmapheresis together with immunosuppressive drug therapy has been used in the treatment of 17 patients with glomerulonephritis [Goodpasture's syndrome (4), systemic lupus erythematosus (4), mesangiocapillary glomerulonephritis (2), glomerulonephritis associated with cirrhosis (2), nonspecific mesangial proliferative glomerulonephritis (3), Henoch-Schoenlein purpura glomerulonephritis (1) and glomerulonephritis associated with infective endocarditis (1)]. Use of the Haemonetics Model 30 blood cell separator, exchanging two liters of plasma with 5% albumin in Hartmann's solution has provided a safe, effective but relatively expensive procedure, capable of producing a marked reduction of fibrinogen, complement components, anti-glomerular basement membrane antibody and immune complex concentrations. Removal of one or more of these factors is felt to be at least partly responsible for the improvement in renal function and clinical well-being demonstrated in patients with Goodpasture's syndrome, systemic lupus erythematosus and other forms of glomerulonephritis associated with the presence of circulating immune complexes.
Adolescent↗
Concomitant IgA nephropathy and cyclical neutropaenia.
A case of concomitant cyclical neutropaenia and IgA nephropathy, a previously undescribed combination is reported. The patient has recurrent aphthous ulceration, and haematuria occurs with these episodes. The diagnosis of cyclical neutropaenia was based on the clinical features and serial peripheral blood studies, and a renal biopsy studied by light, electron and immunofluorescence microscopy in conjunction with the clinical features established the diagnosis of IgA nephropathy. Elevation of serum immunoglobulin, with a disproportionate elevation of IgA was found. The features of this case emphasise the importance of infection as an initiating event in the pathogenesis of IgA nephropathy, and they provide further evidence for the formation of poorly soluble immune complexes as a likely pathogenetic mechanism.
Agranulocytosis↗
Metformin associated lactic acidosis.
A case of lactic acidosis occurring in association with inappropriate and excessive metformin therapy and a high serum metformin concentration is described. In the other 23 cases of metformin associated lactic acidosis reported to December 1977, renal, cardiovascular and liver disease were common. Although metformin is less likely to cause lactic acidosis than phenformin, neither drug should be prescribed in the presence of renal, hepatic or cardiovascular disease.
Acidosis↗
The kidney in pregnancy, pre--eclampsia, renal failure and glomerulonephritis.
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Acute Kidney Injury↗
Phenistix in screening.
Screening procedures have achieved notoriety in recent years because of their ability to detect diseases in their early phases and also because of their expense. This paper describes a little-known but simple urine screening test which, if used judiciously, may help with diagnosis and treatment, and yet remain relatively inexpensive.
Analgesics↗
Paraquat poisoning is not necessarily fatal.
This paper describes a case of deliberate ingestion of paraquat successfully managed with gastric lavage, forced diuresis, haemodialysis, gastrointestinal purgation and the adminstration of specific adsorbents.
Adult↗
Persistent acute renal failure with renal artery stenosis: cure following reconstructive arterial operation.
A case of acute renal failure is reported in which renal function returned after surgical correction of renal artery stenosis to the sole functioning kidney. Acute renal failure associated with renal vascular lesions is reviewed. Although often clinically apparent vascular obstruction may be asymptomatic and should be considered in cases of prolonged acute renal failure.
Acute Kidney Injury↗
Pneumocystis carinii pneumonitis successfully treated with trimethoprim-sulphamethoxazole.
Pneumocystis carinii pneumonitis was diagnosed on lung biopsy in an immunosuppressed patient. Therapy with trimethoprim-sulphamethoxazole led to a rapid clinical recovery with no side-effects being observed.
Aged↗