Biomedical subjects
Publications and source records attributed to H J Goldsmith.
Bovine tuberculosis is now rare in the western world. We report a case of bovine genitourinary tuberculosis causing obstructive renal failure. This combination does not appear to have been previously reported.
Dialysis disequilibrium due to cerebral oedema still causes a significant degree of both morbidity and mortality. We discuss the management of 5 such cases and demonstrate the improved stability during treatment with continuous veno-venous haemofiltration. This may be due to the improved osmotic stability during haemofiltration with a resultant decrease in the osmotic gradient across the blood-brain barrier.
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Renal disease in Churg-Strauss syndrome is generally thought to be benign in nature, thereby distinguishing this rare condition from other necrotizing vasculitides. We report a case in which acute renal failure developed during the aggressive vasculitic phase of the illness requiring dialysis therapy. After one week of daily haemodialysis treatment the patient had become encephalopathic associated with marked peripheral eosinophilia. Treatment with prednisolone resulted in a marked improvement in both clinical condition and renal function.
We report an increase in the incidence of anti-glomerular basement membrane antibody nephritis in the Mersey Region over the 13 months from September 1984 to October 1985. During this period anti-glomerular basement membrane antibody nephritis was diagnosed in 10 patients: seven cases occurred between 1 June and 31 October 1985. We could identify no common infective agent or history of toxic exposure. Although outbreaks of parvovirus infection were reported in the region during this period, no patient had serological evidence of recent infection with parvo- or other virus. The only atypical feature was the high incidence of allergic rash which was seen in four of six patients treated with antibiotics before admission. Only two patients recovered sufficient renal function to make dialysis unnecessary. Both had a longer duration of prodromal symptoms, lower levels of circulating anti-glomerular basement membrane antibody antibodies and histological evidence of less aggressive disease.
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We report the case of a patient with atypical bullous pemphigoid and haemoptysis in whom circulating IgG skin basement membrane zone antibodies were demonstrated. Six years later she developed acute renal failure due to Goodpasture's syndrome. This is the first case to raise the possibility of a link between epidermal and glomerular basement membrane antibodies.
A 34-year-old woman with scleromyxoedema failed to respond to initial treatment with cyclophosphamide or psoralen-UVA photochemotherapy (PUVA). She developed neurological symptoms which resolved after five 4 l plasma exchanges performed on successive days, together with pulse methylprednisolone therapy. Subsequent treatment was with oral prednisolone and cyclophosphamide. She had had no further episodes of neurological dysfunction 8 months after plasma exchange, and the appearance of the skin had improved almost to normal. The complications and difficulty in management of scleromyxoedema are discussed.
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In patients with chronic renal failure the use of the relatively new dialysis technique of continuous ambulatory peritoneal dialysis (CAPD), unlike other forms of dialysis, is consistently associated with an increase in Hb concentration, but the mechanism remains obscure. We measured Hb, haematocrit, S-erythropoietin and Hb-oxygen affinity in 3 groups of patients with chronic renal failure. (1) Untreated patients starting on haemodialysis. (2) Patients on intermittent peritoneal dialysis changing to CAPD. (3) Patients from the above 2 groups receiving renal transplants. In addition, red cell mass, plasma volume and red cell survival were measured in (2), before starting CAPD and at 6 months. There were distinctly different patterns of change in Hb concentration, Hb-oxygen affinity and S-erythropoietin in the 3 groups of patients. The increase in Hb concentration with CAPD is due to both a fall in plasma volume and an increase in red cell mass, with an increase in red cell survival. There was no change in Hb-oxygen affinity or serum erythropoietin concentration. The improvement in red cell mass and survival may be related to increased clearances of substances with mol. wt.s between 500 and 5000 daltons which accumulate in renal failure (uraemic middle molecules).
We report two cases of angiofollicular lymph node hyperplasia of the hyaline-vascular type. The patients were atypical in having systemic complications, which are much more commonly seen in the plasma cell variant of this disorder. In each case, the diagnosis was established some years after the initial presentation. Both patients presented with unusual systemic manifestations. The exact mechanism underlying the associated features is unknown, but these cases provide some evidence that the disease is primarily a vascular proliferative or inflammatory disorder. All manifestations of the disease responded to the administration of prednisolone with rapid reduction of dosage to less than 10 mg daily. Maintenance therapy may be required to prevent relapse.
Seventeen of 20 (85%) patients on RDT for six to 13 years were found to have acquired renal cysts. There was a significant positive association between Hb and duration of RDT. The extent of cyst was positively and significantly correlated with the latest Hb and years on dialysis. There was also a significant positive correlation between size and years on dialysis only approached statistical significance. There was no correlation between kidney size and latest Hb. Complications in patients with acquired renal cysts appear to resemble those of familial polycystic disease with the added risk of neoplasia.
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