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Biomedical subjects

F P Schena

Publications and source records attributed to F P Schena.

At least 127 records · Page 7Linked to original sources
PubMed1988

Treatment of proteinuric idiopathic glomerulonephritides in adults: a retrospective survey.

PURPOSE: A review of the worldwide medical literature was undertaken to determine whether treatment with currently available drugs has been beneficial in patients with glomerulonephritides. MATERIALS AND METHODS: Thirty-five articles, involving 1,653 adult patients with chronic primary glomerulonephritis with proteinuria and/or nephrotic syndrome, were analyzed. The criteria for inclusion of data were strict, and only complete and well-studied cases were included in the analysis. The papers were grouped into prospective controlled trials, retrospective comparisons of treated and untreated patients, and retrospective studies without an untreated group. RESULTS AND CONCLUSIONS: Analysis of the data shows that patients with minimal change disease clearly benefited from the administration of corticosteroids and/or cytotoxic drugs, since 89 percent and 79 percent of patients had a complete remission in controlled trials and in retrospective studies, respectively. A low incidence of complete and partial remissions was found in the group of patients with focal segmental glomerulosclerosis, proteinuria disappeared in 19 percent, and only 36 percent of these patients had stable renal function after a mean follow-up period of 6.3 years. The incidence of uremia and the number of patients requiring dialysis were very high. In patients with membraneous glomerulonephritis, conflicting results were obtained in controlled trials, retrospective comparisons, and retrospective studies, since a high percentage of complete and partial remissions was present in treated patients from both controlled and retrospective comparisons, whereas the percentage of complete and partial remission in untreated patients increased as the length of the follow-up period increased. Long-term studies carried out on untreated patients confirmed the high percentage of remissions. These data suggest that it is necessary to await future long-term results from controlled trials in order to determine whether or not corticosteroids alone or associated with cytotoxic drugs have a beneficial effect. Finally, the data from patients with mesangiocapillary glomerulonephritis show that therapy appears to have no beneficial effect on renal function. Nephrologists need new drugs that interfere more decisively with the immune process in the pathogenesis of primary glomerulonephritis.

Azathioprine↗
PubMed1988

Long term follow-up of women with hypertension in pregnancy.

The reproductive history and the present health status of 66 patients who had had a pregnancy complicated by hypertension during the period 1972-1982 were retrospectively studied. Hypertension in pregnancy is a poor prognostic factor not only for the future development of hypertension but, also, as it is associated to a very poor reproductive history. Such complications are more frequent in pregnant women with very high blood pressure (greater than 160/100). In fact, in the case of a previous pregnancy, this group of patients had experienced a high rate of abortions (31.7%), premature deliveries (17.8%) and perinatal mortality (21.4%). Moreover, these women are subject to a higher risk (56.5%) of developing hypertension in successive pregnancies. Risk factors for determining the future development of hypertension are: familiar hypertension, the severity of hypertension during pregnancy and pluriparity.

Abortion, Spontaneous↗
PubMed1988

The role of polymeric IgA in complement-mediated solubilization of IgG and IgA immune complexes.

Sera from patients with IgA nephropathy (IgAN) have a reduced capacity to solubilize immune complexes. The in vitro complement-mediated solubilization of immune complexes containing IgG (bovine serum albumin [BSA]-anti-BSA) or IgA (DNP29-BSA-anti-DNP) was decreased, despite normal serum levels of complement. The close correlation between low values for complement-mediated solubilization and high serum levels of polymeric IgA and/or IgA rheumatoid factor indicates that these macromolecules interfere with the process. These findings suggest that polymeric IgA produced during stimulation of mucosae specifically interferes with immune complex solubilization. Further studies are necessary to elucidate the mechanisms. The decreased complement-mediated solubilization in patients with IgAN could be responsible for persistently high levels of immune complexes containing IgA or IgG in the circulation and their continual deposition in the mesangium.

Antigen-Antibody Complex↗
PubMed1988

A multicentre study of flumequine in the treatment of urinary tract infections.

The efficacy and safety of flumequine were evaluated in the treatment of 121 cases uncomplicated (65.5%) and complicated (34.5%) urinary tract infections (UTI) when given as a dose of 400 mg bd. Duration of treatment ranged from 7-15 days, with a mean of 10. Thirty days post-therapy, cure persisted in 92.3% of the patients with uncomplicated UTI and in 53.7% of those with complicated UTI. Relapse or re-infection occurred in 34.1% of the patients with complicated UTI, and in 12.2%, the infecting organism did not respond to treatment. Flumequine was generally well tolerated. In 27.3% of patients gastrointestinal, and neurological disorders and skin rashes developed which in most cases were mild. Only two patients were withdrawn from the treatment. It is concluded that flumequine, administered at 800 mg daily, is highly effective in treating uncomplicated and complicated UTI.

Adolescent↗
PubMed1988

Increased plasma levels of immunoreactive human atrial natriuretic factor in primary IgA nephropathy.

The plasma concentration of the immunoreactive (IR) human atrial natriuretic factor (hANF) was measured in 17 patients with primary IgA nephropathy (IgAN) (9 normotensive and 8 hypertensive subjects without impairment of renal function). Furthermore, correlations with the renin-angiotensin II-aldosterone system and hemodynamic alterations were studied. The mean value of IR-hANF was significantly (p less than 0.002) higher in normotensive IgAN patients (68.2 +/- 14.6 pg/ml) than in controls (48.8 +/- 11.5 pg/ml), while it was slightly and not significantly elevated in hypertensive IgAN patients (58.5 +/- 8.4 pg/ml). In the latter the mean plasma renin activity (PRA) was significantly increased (0.92 +/- 0.30 ng/ml/h; p less than 0.002), while in normotensive IgAN patients (0.68 +/- 0.58 ng/ml/h) no difference was observed. Plasma aldosterone levels showed the same behavior pattern as those of PRA. Hemodynamic studies showed that the mean values of the cardiac index (CI) were significantly (p less than 0.002) high in both normotensive (3.55 +/- 0.5 l/min/m2) and hypertensive (3.32 +/- 0.47 l/min/m2) patients, while a significant reduction in the total peripheral resistance index (TPRI) in normotensive (2171 +/- 349 dyn/s/cm-5/m2; p less than 0.02) and a significant increase in hypertensive (2959 +/- 440 dyn/s/cm-5/m2; p less than 0.05) patients were observed. The mean arterial pressure (MAP) had a positive correlation with the TPRI and an inverse correlation with the IR-hANF.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Serum profiles of the regulatory complement proteins during the progression of renal damage in human glomerulonephritis.

Persistent activation of the complement system after escape from control by the regulatory proteins results in an excessive release of split products with inflammatory properties. Serum levels of the regulatory proteins of the complement system (Cl-INH, H, I and AT III) were assayed by the radial immunodiffusion technique in 521 serum samples from 124 patients with idiopathic chronic glomerulonephritis divided into two groups: 81 cases with normal renal function (NRF), and 43 cases with deteriorated renal function (DRF). Significant high mean levels of Cl-INH, H, I and AT III were found in patients with NRF, when they were compared with DRF patient groups. Positive correlations between the regulatory proteins and the corresponding complement components were found in patients with NRF, whereas they were reduced considerably in patients with DRF. Serial measurement of the control proteins showed a decay of the levels of Cl-INH, H and I in patients with progressive impairment of renal function. The presence of high levels of regulatory proteins suggest that a control mechanism may occur in patients with NRF; measurement of these proteins could, therefore, be of prognostic value, as the presence of high levels are indicative of a block of the complement system.

Antithrombin III↗
PubMed1986

Plasma fibronectin levels in patients with chronic uremia.

Plasma fibronectin (FN) concentration was measured in patients with idiopathic glomerulonephritis (GN) with or without impaired renal function, in uremic patients undergoing periodic hemodialysis and in renal transplant patients before and after an acute rejection crisis. Results show normal FN levels in idiopathic GN and in renal transplant patients with normal renal function, while significantly lower levels were found in GN with severe renal damage, in uremia before and after dialysis, and in renal transplant patients during acute and chronic graft rejection. Significant correlations between high serum creatinine values and low plasma FN levels were found in renal transplant patients. These findings suggest that the kidney may influence FN levels in the blood since acute (rejection crisis) and chronic renal failure (uremia) cause low concentrations of this protein, while levels tend to return to normal values in patients with uremia after renal transplantation. We hypothesize that the normal kidney removes or perhaps degrades some substances or hormones that may control the release or synthesis of FN. These substances are not dialyzed by cellophane membranes since low plasma FN levels persist after periodic hemodialysis. Only the renal graft provokes an increase of FN in the blood stream.

Adult↗
PubMed1986

Increased immunoglobulin-secreting cells in the blood of patients with active idiopathic IgA nephropathy.

Peripheral blood lymphocytes from 33 patients with idiopathic IgA nephropathy (IgAN) and 15 healthy controls were stimulated in vitro by Protein A from Staphylococcus Cowan I; immunoglobulin (Ig) production was measured by a reverse hemolytic plaque assay to evaluate the quantity of cells secreting Ig. In addition, serum Ig levels, circulating IgG, IgA and IgM immune complexes (ICs) and the Fc and C3b receptor mediated phagocytosis of peripheral monocytes were measured. The laboratory findings in different phases of the disease were compared. The mean level of IgA-plaque forming cells (IgA PFC) in IgAN patients with normal renal function was significantly higher (p less than 0.001) than the mean control value. In contrast, they were reduced significantly in those patients who were subjected to periodic hemodialysis (p less than 0.001). Disease activity produced a significant increase in IgG PFC and IgA PFC, high IgG and IgM serum levels, high circulating IgG ICs, and low C3b-mediated phagocytic function of the peripheral macrophages. These findings demonstrate that IgAN is associated with an increased number of IgG and IgA-secreting cells in the peripheral blood of patients during the active phase of the disease and that the concurrent presence of high levels of circulating Ig ICs may be responsible for the gross hematuria, as their deposition in the glomeruli could activate the complement system.

Adolescent↗
PubMed1985

Effects of plasma-exchange on complement-mediated solubilization of circulating immune complexes in patients with systemic lupus erythematosus.

In an uncontrolled clinical trial the effects of plasma-exchange (PE) on the capacity of the serum to solubilize circulating immune complexes were studied in patients with active systemic lupus erythematosus. Four patients were treated with immunosuppressive therapy alone, while others were also treated by PE over a period of four to seven weeks. Plasma was replaced by fresh frozen plasma in the final part of each procedure. All patients showed evidence of clinical improvement at the time of treatment. Furthermore, PE was demonstrated to reduce drastically the number of relapses. An improvement of the capacity of solubilize immune complexes in vitro associated with a persistent fall in the levels of the circulating immune complexes was observed in patients treated with PE. This suggests that fresh frozen plasma improves the clearance of immune complexes and reduces the frequency of relapses. In our experience, clinical improvement and/or resolution of the symptoms seems to be related to the decrease in serum immune complex levels, while clinical relapses seem to parallel the behaviour of complement-mediated solubilization.

Adolescent↗
PubMed1983

Circulating immune complexes in infected ventriculoatrial and ventriculoperitoneal shunts.

Distinguishing infected from noninfected ventriculoatrial (VA) or ventriculoperitoneal (VP) shunts is prognostically and therapeutically important. Eighty-seven serum samples from twenty-seven patients with VA or VP shunts were studied for the presence and quantification of circulating immune complexes. Eighty-three percent of the samples from infected shunts presented circulating immune complexes. Mean values of immune complexes in patients with infected shunts were significantly higher than in those without infection. In febrile, septicemic patients with few clinical symptoms, immune complexes were present, and their measurement in serial serum samples was a significant diagnostic aid. If circulating immune complex levels are not detectable, a shunt infection is less likely to be present.

Adult↗
PubMed1983

Plasma exchange in systemic lupus erythematosus.

Plasma exchange (PE) was performed in 8 of 14 patients with systemic lupus erythematosus (SLE) PE was instituted as an additional therapy during active disease in patients who did not respond to conventional therapy. The best results were obtained in plasmapherized patients; in fact, immune complex serum levels disappeared rapidly, whereas anti-DNA antibodies decreased slowly. The changes observed indicate that PE may be beneficial, especially when it is associated with drugs that can block antibody rebound. A variety of "technical factors" may influence PE therapy which therefore must be monitored appropriately.

Adrenal Cortex Hormones↗
PubMed1983

Characterization of the circulating immune complexes in acute and chronic liver diseases.

The composition of immune complexes (IC) found in 28 patients with HBsAg positive and negative acute and chronic hepatitis was analysed. Components were defined in PEG-precipitated material isolated by preparative ultracentrifugation on linear sucrose density gradients and analysed by the Ouchterlony plate technique and by the radioimmunoassay of hepatitis B virus markers. Sedimentation rate ranged from 8 to 19s in the serum of patients with chronic hepatitis, whereas heavier IC (greater than 19s) were present in the active phase of the disease. The participation of hepatitis B virus in acute hepatitis was shown by the presence of its antigens. In contrast, a low incidence of vital components was seen in IC of chronic active hepatitis and liver cirrhosis. Thus, other causes must contribute to the formation of IC in chronic liver disease.

Acute Disease↗