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Biomedical subjects

D R Turner

Publications and source records attributed to D R Turner.

At least 109 records · Page 6Linked to original sources
PubMed1982

Pathology of interstitial nephritis induced in guinea pigs by exoantigens.

Histological and immunofluorescent assessment of the kidney, renal core cultures, and determination of circulating antibodies were carried out in Hartley guinea pigs with a selective delayed-type hypersensitivity state (DTH) and acute interstitial nephritis induced and elicited by exoantigens. The results show that the normal tubule-vascular structure of the kidney, the simplicity of the molecular structure of the exoantigens and the modification of the native form of the exoantigens, when it is presented to the kidney in the elicitation phase of the DTH reaction, are factors which may reduce the cellular response in the normal renal parenchyma. The cytological events over a 48-hour period are not different to those which have been described in DTH reactions in extrarenal tissues. Exoantigens can induce renal lesions evoking an acute interstitial nephritis picture in animals with selective DTH at a time when there are neither circulating antibodies nor deposition of immunoglobulins or infection in the renal parenchyma.

Animals↗
PubMed1982

Corynebacterium hofmannii infection after renal transplantation.

A case of malakoplakia affecting the entire urinary tract is described. The patient had received a cadaveric renal transplant and had required particularly heavy immunosuppression because of recurrent rejection episodes. Heavy hematuria developed, and this was followed by obstruction at the vesico-ureteric junction. Despite adequate drainage via a nephrostomy, the graft ceased functioning, and was explanted. Although appropriate antibiotics were given, the patient died. The organism responsible for triggering the malakoplakia was Corynebacterium hofmannii, and this is only the third report of this organism as a human pathogen. However, other coryneform bacteria have been reported as being pathogenic in immunosuppressed subjects, and should be sought when more common organisms cannot be cultured in such patients showing signs of infection.

Adult↗
PubMed1982

Significance of mesangial IgM deposition in "minimal change" nephrotic syndrome.

During a 6-year period, 64 patients with a nephrotic syndrome, shown histologically to result from minimal change nephropathy, were studied for a mean of 4.5 years. Fifty of the patients showed no glomerular immunoglobulin on immunofluorescent or immunoperoxidase study, but 14 had mesangial deposits of IgM. The onset characteristics, response to treatment, and long-term course were similar in the two groups. We conclude that IgM deposition in the mesangium in patients with minimal change nephrotic syndrome is of no prognostic value, and our data do not suggest that this group of patients, although a histopathologic entity, represent a clinically distinct group.

Adolescent↗
PubMed1981

Age-related variations in human lymphocyte DNA.

The molecular weight of DNA from human peripheral lymphocytes has been measured on alkaline sucrose density gradients. The number average molecular weight (MN) of DNA is found to decrease as the age of the donor increases. This result is discussed with reference to lesions in DNA, both repairable and non-repairable, which may accumulate with age.

Adolescent↗
PubMed1981

Recurrence of focal segmental glomerulosclerosis in renal allografts.

Thirty-one renal allografts placed in 25 recipients with renal failure from biopsy-documented focal segmental glomerulosclerosis (FSGS) were reviewed. These represent all of the cases with this renal histology transplanted over 13 years. Recurrence of the lesion was demonstrated histologically in five recipients. A nephrotic syndrome occurred in all five patients and failure of the graft in two. Of 20 recipients who did not show a nephrotic syndrome, allograft histology in 12 did not show FSGS in any. From these data and a review of the literature, the risks of transplantation in patients with FSGS are assessed. Recipients under the age of 15 and with a course into renal failure of less than 3 years show recurrence in about 50% of cases. Of this 50%, about one-half will lose their grafts from the recurrence within 5 years, but some may show good function for many years, despite proteinuria or a nephrotic syndrome.

Adolescent↗
PubMed1981

Lymphocyte DNA in aplastic anaemia.

Using ultracentrifugation on alkaline sucrose density gradients the DNA of lymphocytes from 14 patients with aplastic anaemia and 23 controls was studied before and after exposure to bleomycin, an agent known to cause strand breaks in DNA. Before exposure to bleomycin the DNA from aplastic patients had more strand breaks than the DNA from the controls of similar ages. Following exposure to bleomycin an abnormal number of DNA strand breaks was produced in 10 of 14 patients and this molecular evidence of drug sensitivity correlated well with the sensitivity of the proliferating lymphocytes to bleomycin in tissue culture. Furthermore, two relatives of patients with aplastic anaemia showed similar abnormality of DNA before and after exposure to bleomycin and increased sensitivity to bleomycin in tissue culture. These results suggest that an abnormality of DNA structure and/or repair may be present in some patients with aplastic anaemia.

Adult↗
PubMed1981

Systemic lupus erythematosus with nephritis.

Thirty-six patients with the onset of symptoms of systemic lupus erythematosus before age 20 years (23 aged less than 15 years at onset) were studied during a 15-year period. All had clinical evidence of nephritis. They were followed for a mean of 5 years (range 6 months to 13 years) or until death. Survival was calculated to be 77% at 10 years for those aged less than 15, and 74% for those aged less than 20, from the onset of clinical nephritis. At referral, renal function was already impaired in two-thirds of patients. Renal biopsies showed mild focal or proliferative changes in 19% of patients, membranous lesions in 11%, and diffuse proliferative lesions in 70%. Three (8%) patients died during follow-up, all from sepsis, and 3 (8%) others required chronic haemodialysis for terminal renal failure. The prognosis even of severe lupus nephritis in childhood and adolescence has improved in recent years. Side effects of treatment remain an important cause of death and morbidity.

Adolescent↗
PubMed1981

Presentation and course of primary amyloidosis of the kidney.

The case histories of nineteen patients who were seen in one renal unit between 1966 and 1978 and who were found to have primary amyloidosis are reviewed. Most were aged more than fifty and presented with the nephrotic syndrome without particular diagnostic features although electrophoresis of plasma and urine revealed abnormal immunoglobulins in a minority. Treatment was generally only symptomatic and most patients died within six months of diagnosis usually from renal failure. At the time of writing only the two patients treated by maintenance haemodialysis are still alive.

Aged↗
PubMed1981

The long-term outcome of idiopathic membranous nephropathy.

Thirty-five consecutive patients with renal biopsy appearances of idiopathic membranous nephropathy, who were initially studied between 1960 and 1969, were reevaluated in 1979 to determine (a) the long-term outcome of idiopathic membranous nephropathy, and (b) whether any clinical or biopsy features at onset would permit prediction of long-term outcome. After fifteen years, actuarial analysis showed that approximately half the patients would be in remission; the rest dead or on dialysis/transplantation programs. Entry into renal failure, in those who ran this course, started at three years after diagnosis and continued steadily for at least another ten years. Likewise, remission was seen as early as one year from onset, but patients were still going into remission after thirteen years of proteinuria. No feature in the glomeruli predicted outcome, but interstitial and vascular changes were seen more frequently in those whose disease persisted or worsened. No onset feature predicted a poor outcome reliably, but younger patients did better than older, and all three children with initial macroscopic hematuria went into remission.

Adolescent↗
PubMed1980

Breast tissue inclusions in axillary lymph nodes.

This report describes a female of 54 years with a past history of repeated breast biopsies all showing benign epithelial hyperplasia. The patient subsequently had a simple mastectomy and axillary lymph node biopsy. No evidence of malignancy was found in the specimen but there were numerous foci of epithelial hyperplasia in the breast and one axillary lymph node was extensively replaced by similar tissue. The danger of mistaking benign inclusions in lymph nodes for metastatic malignancy, particularly in tissue examined by cryostat section, is emphasized. The possible aetiology of such lesions is briefly discussed.

Axilla↗
PubMed1979

An evaluation of the immunoperoxidase technique in renal biopsy diagnosis.

An evaluation of the use of horseradish peroxidase labelled antisera against IgG, IgM, IgA and C3 compared with corresponding antisera labelled with fluorescein isothiocyanate has been carried out on renal biopsy material from 200 patients with renal disease. A disparity between the two methods was observed in 10-19% of the readings according to the antigen being demonstrated. The majority of differences recorded would not have influenced the executive diagnosis. Where the immunological results could have influenced the executive diagnosis, 5 probable false results were obtained using innumofluorescence and 4 with immunoperoxidase. Immunoperoxidase has the advantage over immunofluorescence in that it provides a permanent preparation which can be reviewed months or years later. In addition it provides more accurate localization of the immune deposits since the section can be counterstained with Mayer's hemalum and viewed by conventional light microscopy. In view of these advantages we recommend that serious consideration should be given to using immunoperoxidase in place of immunofluorescence for the examination of renal biopsy material.

Biopsy↗
PubMed1979

Systemic lupus with nephritis: a long-term study.

Seventy-one patients with systemic lupus erythematosus and clinical evidence of nephritis were seen during a 15-year period, and followed for a mean of seven years. Survival was calculated to be 76 per cent at five years and 57 per cent at ten years from onset of clinical nephritis; and 80, 65, 55 and 55 per cent five, ten, fifteen and twenty years from onset of clinical lupus. Renal biopsies showed mild or focal lesions in 30 per cent of patients, membranous lesions in 14 per cent and diffuse proliferative lesions in 55 per cent. However, there was no difference in the long-term outcome of the different histological groups. Nineteen patients (27 per cent) died during follow up, eleven from renal failure, six from sepsis and two from cerebral lupus. Death in renal failure is now usually a late event in lupus, even in patients with clinical evidence of severe nephritis. The prognosis of even severe lupus nephritis is now better than formerly reported. Reducing the dose of corticosteroid drugs, by the use of cytotoxic drugs such as azathioprine may have diminished the mortality from cardiovascular complications. Side effects of treatment, however, remain an important cause of death and morbidity.

Adolescent↗
PubMed1978

Relapsing polychondritis with crescentic glomerulonephritis.

Relapsing polychondritis is rare and its cause is unknown. The tissues affected are those with a high glycosaminoglycan content, such as cartilage, the aorta, the sclera and cornea, and parts of the ear. Symptoms can usually be controlled with oral steroids, but when there is coexistent progressive crescentic glomerulonephritis quadruple chemotherapy may be used. Three cases of the clinical syndrome of relapsing polychondritis were studied in which rapidly progressive cresentic glomerulonephritis developed. In two the patients appeared to respond to aggressive treatment with immunosuppressive agents and anticoagulants. The multisystemic nature of the disease, the renal lesions, and the response to treatment all suggested that the condition might be related to periarteritis nodosa.

Adult↗
PubMed1978

The long-term prognosis of patients with focal segmental glomerulosclerosis.

Forty consecutive patients whose biopsies showed focal and segmental sclerosis were studied for 6 to 16 years to establish the long-term prognosis of this group of patients. By the end of a decade 21 were dead, on regular dialysis or transplanted; only one death was unrelated to renal failure. A further 8 patients had a GFR of less than 60 ml/min/1.73 m2. Only 11 patients had normal renal function, and of these eleven only four had no urinary abnormality. Actuarially calculated survival was 75% at 5 years, 50% at 10 years, and 38% at 15 years. There was no difference between the 28 adults and the 12 children in terms of evolution. Patients with a nephrotic syndrome at presentation had a poorer prognosis than those never nephrotic. Twenty nephrotic patients were treated with prednisone, and 14 of these with cyclophosphamide in addition. One patient responded with loss of proteinuria within two months to both drugs, and another lost proteinuria when treated with cyclophosphamide. Thirteen patients received allografted kidneys; a nephrotic syndrome recurred in three patients, with histological evidence of recurrent disease in two.

Adolescent↗
PubMed1978

Focal segmental sclerosis or scarred focal proliferative glomerulonephritis?

We have made a blind retrospective analysis of 334 renal biopsies, each containing more than 10 glomeruli, from adults and children with glomerulonephritis, in order to assess the clinicopathological significance of segmental lesions. These were defined as endocapillary proliferation and/or sclerosis involving capillary loops, and a less than half the glomerular tufts. On optical microscopy of paraffin-embedded material, 57 biopsies containing segmental lesions were independently classified by two observes as "focal proliferative glomerulonephritis" or "focal segmental glomerulosclerosis". These results were then reviewed with immunofluorescence, electron microscopic and clinical data and an "executive" diagnosis reached. Scarred focal proliferative glomerulonephritis could not be reliably distinguished from focal segmental glomerulosclerosis by optical microscopy alone. Some cases of focal proliferative glomerulonephritis are not associated with systemic disease and may have negative immunofluorescence findings, and we were unable to distinguish scarring in these patients from the lesion of focal segmental glomerulosclerosis with any of the tools at our disposal. Some patients with scarred focal proliferative glomerulonephritis showed profuse proteinuria, a nephrotic syndrome and progression to renal insufficiency. These cases cannot therefore be differentiated from focal segmental glomerulosclerosis by their clinical features. It would seem that the morphological lesion of focal segmental glomerulosclerosis should be regarded as focal segmental glomerular scarring from a variety of insults, rather than a distinct disease entity.

Adolescent↗