Letter: Isolated glomerulonephritis with mesangial IgA deposition.
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Biomedical subjects
Publications and source records attributed to N F Jones.
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Urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were assayed in every urine void throughout 24 hours in 17 normal people and in four patients with renal disease. The variation in NAG activity due to changing rates of urine flow was almost eliminated by factoring enzyme activity by the urinary creatinine concentration. Random samples of urine may thus be used for assay. The results of NAG assay in 36 patients with acute and chronic renal diseases showed that NAG was a sensitive indicator of renal damage. This simple test may be valuable in detecting or monitoring renal disease.
Cation transport and electrolyte composition were studied in leucocytes from 17 patients with uncomplicated essential hypertension. Significant increases in cell sodium and water contents, associated with a depression of the rate-constant for active sodium efflux, were found in the hypertensive patients. These abnormalities in cell sodium transport may possibly be related to mechanisms of hypertension.
1. In seventeen patients with untreated essential hypertension the sodium and water contents of leucocytes were significantly increased, whereas the rate constant for ouabain-sensitive sodium efflux was significantly reduced. 2. These abnormalities were not found in fourteen other patients with well-controlled hypertension. 3. Preliminary observations in accelerated hypertension suggest a different pattern of abnormality in leucocyte sodium metabolism.
1. In sixteen patients with severe chronic renal failure the rate constant for total sodium efflux from leucocytes was significantly reduced compared with that in thirty control subjects. This difference lay chiefly in the glycoside-sensitive ('active') moiety of sodium efflux. 2. In sixteen patients receiving regular haemodialysis, the rate constant for total sodium efflux from the leucocyte was significantly greater than in the undialysed uraemic patients though still subnormal. 3. In individual patients, an increase in sodium efflux could be detected as early as 1 week after regular haemodialysis was started. 4. These results are compatible with the existence of a dialysable molecule in uraemic plasma affecting leucocyte sodium transport.
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Three patients with analgesic nephropathy are reported who, in addition to the accepted features of this syndrome, had dilatation of one or both upper urinary tracts due to ureteric or periureteric fibrosis without intraluminal obstruction. We attribute this lesion to analgesic abuse and suggest that any patient with unexplained ureteric fibrosis should be questioned about analgesic consumption. This association also suggests a possible role for analgesic abuse in the pathogenesis of retroperitoneal fibrosis.
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Six patients are described in whom recurrent haematuria was associated with IgA deposits in the glomerular mesangium. These patients conform closely to the nephropathy described by Berger. The condition can only be definitely diagnosed by immunofluorescence techniques. These six patients were diagnosed in one renal unit within 18 months and, despite the absence of reports from British units, this nephropathy is probably not uncommon. No treatment for it is known at present but the prognosis appears to be good in most patients. Renal failure and hypertension have been reported and long-term follow up is necessary to clarify the natural history of the disease.
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