The soluble interleukin-2 receptor (SIL-2R) levels in 46 patients with primary nephrotic syndrome were examined. The values in the nephrotic patients exceeded those in healthy controls (p <0.05), and were the same at the nephrotic and non-nephrotic stages. The serum interleukin-2 (IL-2) levels in the nephrotic patients were low and did not correlate with the serum SIL-2R levels. Only at the nephrotic stage were the latter closely correlated with the serum IgG (p<0.001) but not with the serum IgA or IgM. The SlL-2R production by phytohemagglutinin stimulated peripheral blood lymphocytes (PBL) in the nephrotic patients was less at the nephrotic and non-nephrotic stages than that in the healthy controls. The IgG production by pokeweed mitogen stimulated PBL was low at the nephrotic stage but not at the non-nephrotic stage. Based on these findings, it is suggested that SIL2R determinations should prove useful in clarifying the relationship between cellular and humoral immunological disorders in nephrotic syndrome.

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Thromboelastography was carried out to examine the coagulation and fibrinolytic systems in experimental nephrotic rats following treatment with daunomycin . The daunomycin rats showed augmentation of ma on thromboelastography . The response to the plasminogen activator, urokinase, on thromboelastography differed between the daunomycin and control rats . Most daunomycin rats failed to reveal any fibrinolytic effect of urokinase on thromboelastography . Experimental nephrotic rats induced by daunomycin may thus possibly develop hypercoagulability and exhibit a depressed fibrinolytic activity.

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The serum levels of IgA class antibodies against autologous IgG Fc and Fab fragments were measured by ELISA in 62 patients with primary IgA nephropathy (IgAN) and 20 normal healthy volunteers. Both antibodies were significantly higher in the patients (P<0.01). The total IgA levels were correlated with those of IgA anti-IgG Fc antibodies (IgA anti-Fc) (rs= 0.57, P<0.001), but not with those of the IgA anti-IgG Fab antibodies (IgA anti-Fab). A histopathological comparison revealed that the sera of patients with severe glomerulonephritis had significantly higher levels of IgA anti-Fc than those with milder lesions (P<0.01). On the other hand, no correlation was observed between the serum levels of IgA anti-Fab and the histopathological severity. A comparison before and after treatment in 12 patients demonstrated a significant decrease of IgA anti-Fc (P<0.01) and an increase of IgA anti-Fab (P<0.05) after the treatment. Size analysis in serial sera from 3 patients was performed using HPLC under neutral (pH=7.0) and under acid (pH=3.5) buffer conditions. A markedly increased ratio of both antibodies with the polymeric form was observed in the active phase. In the remission phase, the amounts of acid-dissociable polymeric form IgA anti-Fc were decreased. In contrast, high levels of polymeric form IgA anti-Fab continued to be observed in 2 patients at this phase. These results suggest that abnormally stimulated production of IgA class autoantibodies especially with the polymeric form against both IgG Fc and Fab fragments, occurs in IgAN, involving separate regulation with differing reactions to treatment and a distinct relationship between IgA anti-Fc and active histopathological lesions.

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The effect of an oral adsorbent (AST-120) was examined in rats with daunomycin-induced chronic renal failure. Sixteen pairs of daunomycin rats which had similar levels of proteinuria at 4 weeks after being injected with daunomycin were selected. One rat of each pair served as a control and was fed on a standard diet, while the other rats were fed on a diet containing AST-120. The blood creatinine and blood urea nitrogen (BUN) were significantly lower in the rats fed with AST-120 than in the controls. Moreover, the life span of the rats fed with AST-120 was significantly prolonged as compared to that of the control rats. These findings suggest that oral administration of AST-120 may help to prevent rapid deterioration of renal function in experimental chronic renal failure induced by daunomycin in rats.

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Urea kinetic modeling (UKM) was carried out to evaluate the water control in patients undergoing long-term hemodialysis. In 21 patients on chronic dialysis, the results of two different determinations of the total body water, i.e. by the deuterium oxide (D₂O) method and by UKM, were compared. A correlation was observed with Y=0.98X+ 5.9 (P<0.01, r=0.91) for males and Y=0.97X+6.2 (P<0.01, r=0.90) for females, indicating that UKM is useful for determining the total body water. In addition, the 21 patients were classified into two groups based on their ECG findings, and UKM was performed in the two groups for comparison. The values of the total body water were 68.5±4.0% and 68.6±6.2% of body weight, respectively, with no significant difference between them. However, the CTR was 50.2±2.8% and 46.2±4.4%, respectively. Thus, not only X-ray examinations but also UKM should be carried out to determine the standard weight (SW-DW) in the presence of cardiac dysfunction. Instructions for water control were given when the total body water exceeded 73% during the UKM measurements over 5 years, which allowed an optimal total body water to be maintained thereafter. The possible influence of erythropoietin (EPO) was also examined by performing UKM in 8 cases receiving EPO and 7 cases without EPO. No noticeable difference was observed between the two groups. 17 patients using a polyacrylonitrile (PAN) membrane were further divided into those with and those without EPO to evaluate the possible influence of the PAN membrane-EPO combination. As a result, no significant difference was demonstrated, suggesting that UKM can be satisfactorily performed under such conditions. In 11 patients on chronic dialysis, the levels of α-human atrial natriuretic peptide (α-hANP) were measured pre-and post-dialysis to examine the relationship between the change in α-hANP and rate of weight loss (%). A significant correlation was observed with Y=12.8X + 5.1(P<0.05, r=0.68). In conclusion, UKM was found to be useful for evaluating the water control and for assessing the optimal dialysis in patients receiving long-term hemodialysis.

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A 59-year-old man with long-standing rheumatoid arthritis (RA) developed renal dysfunction, proteinuria and hematuria. Neither gold nor penicillamine had been given. Light microscopy of a renal biopsy specimen revealed membranous nephropathy with crescents of various stages . The possible pathogenesis of such an unusual combination of membranous nephropathy and crescents in RA is discussed.

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We present here a case of young adult-onset primary systemic amyloidosis with AA protein. A 29-year-old male presenting with macrohematuria was transferred to our hospital because of aggravation of renal function. Amyloid protein was detected in the bladder, stomach and thyroid. The amyloid protein proved to be AA type by potassium permanganate histochemical analysis. Since secondary amyloidosis was excluded by the laboratory data and there was no family history of amyloidosis, a diagnosis of primary systemic amyloidosis with AA protein was reached. Although the patient was prescribed dimethyl sulphoxide, his renal function worsened with gastrocolic symptoms and a bleeding tendency. Hemodialysis (HD) was then initiated. After starting the HD, the patient's general condition recovered and subsequently the patient on treatment with maintenance HD was discharged.

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A case of lupus nephritis showing rectal erosion with cytomegalovirus infection is described. The patient revealed nephrotic syndrome. She complained of skin ulcer with livedo reticularis on the right breast, purpura with thrombocytopenia, hepatic dysfunction, and bloody stool. Renal biopsy demonstrated diffuse proliferative lupus nephritis with prominent wire loops. Intestinal fiberscopy showed rectal erosion which was a cause of bloody stool, and rectal biopsy revealed cytomegalic inclusions characteristic of cytomegalovirus infection. Immunosuppression due to combined therapy with prednisolone and mizoribine could have led to reactivation of latent cytomegalovirus infection, resulting in the rectal erosion with bloody stool.

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The pharmacokinetics and optimum dose for maintenance of disopyramide (DP) which is effective against arrhythmia were studied in patients with chronic renal failure (CRF, n=10), who had a creatinine clearance (Ccr) less than 30ml/min. The plasma concentrations (PC) of DP and mono-isopropyldisopyramide (MDP) an active metabolite of DP, were measured by high performance liquid chromatography. Samples from patients and controls were obtained at 0, 1, 2, 3, 4, 6, 8, 12, 24, 33, and 48 hr after oral administration (OA) of 100mgDP. The pharmacokinetic parameters were calculated using a two-compartment model. In CRF, the plasma half life (T_1/2) of DP was 5.25 to 22.42 hr (average is 12.45 hr) and that of MDP was 5.09 to 131.66 hr (average is 16.9 hr). In normal controls, the T_1/2 of DP was 6.05 hr, but that of MDP could not be determined the available sensitivity of measurement . T_max was 3.11 hr at the total PC of DP and MDP, and C_max was 2.48 g/ml on average . In conclusion, the present study revealed that: (1) the PC of a mixture of DP and MDP should rise following OA of DP every 8 or 12 hr in CRF; (2) it is necessary therefore to monitor the accumulation of MDP after rolling OA of DP; and (3) OA of DP every 24 hr can maintain an effective PC.

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