Clinical investigation of urinary dipeptidyl aminopeptidase IV (DAP IV) activity in patients with primary glomerular diseases

To assess the role of urinary dipeptidyl aminopeptidase IV (DAP IV) in glomerular diseases, we measured urinary levels of DAP IV in 55 patients with chronic glomerulonephritis (CGN), 41 patients with nephrotic syndrome (NS), 21 patients with chronic renal failure (CRF) and 48 normal controls. The urinary DAP IV levels in patients with CGN were significantly higher than those in normal controls and were higher in patients with more active disease. The frequency of normal urinary DAP IV levels in patients with CGN was significantly lower than that of normal urinary N-acetyl-beta-D-glucosaminidase (NAG) levels in those with CGN. The urinary DAP IV levels in patients with NS were the highest among the 3 patient groups. The urinary DAP IV/g.protein ratio was significantly lower in the patients with minimal change nephrotic syndrome than in those with membranous glomerulonephritis or membranoproliferative glomerulonephritis. In both patients with CGN and those with NS, urinary DAP IV levels correlated significantly with the amounts of urinary protein and the urinary NAG levels. The urinary DAP IV levels in patients with CRF were lower than those in patients with CGN and NS who had normal GFR, and there was a significant negative correlation between the urinary DAP IV levels and the serum creatinine levels. We conclude that the measurement of urinary DAP IV is useful for detecting or monitoring glomerular disease.     

Clinical evaluation of lymphoscintigraphy in urological disease

Clinical efficacy of lymphoscintigraphy was evaluated in 31 cases of urological disease. To diagnose metastatic change of malignant tumor, 99mTc-rhenium colloid (5mCi) was administrated from bilateral pedal region. Of these patients 12 had true positive finding, 2 had false positive finding, 2 had false negative finding, and 8 had true negative finding defined by lymphoscintigram and pathological finding. Overall accuracy of lymphoscintigraphy revealed 83% in correlation of pathological finding, 78% in lymphangiography. Accuracy between lymphangiography and pathological finding was 80%. The overall clinical efficacy of lymphoscintigraphy was the same as lymphangiography. The merit of this method was that we can examine easily, painlessly, and frequently.     

Clinical observations of plasma fibronectin in patients with urological malignant disease

Fibronectin (FN) is a high molecular weight glycoprotein widely distributed in the body and has a number of biological activities. Recently, there have been reports on the relationship between plasma fibronectin (pFN) levels and malignant diseases, but the significance of pFN is still unclear. Using immunoturbidimetric assay, we measured pFN levels of 24 healthy controls and 61 patients with urological malignant diseases, and obtained the following results. 1. pFN levels before treatment. 1) pFN level was 379 +/- 60.6 micrograms/ml and 356 +/- 123.7 micrograms/ml in the healthy controls and patients, respectively. There was no significant difference. 2) pFN level in patients with metastases was 320 +/- 92.9 micrograms/ml and had no statistical difference as compared with patients without metastases (371 +/- 132.7 micrograms/ml) and controls, despite the decrease in the mean value. 3) pFN level in patients with poor prognosis (300 +/- 107.8 micrograms/ml) was significantly lower than that in patients with good prognosis (410 +/- 157.2 micrograms/ml) and controls (p less than 0.05). 2. pFN levels during conservative treatments for advanced disease. pFN level in patients with a rapid progressive disease (287 +/- 64.4 micrograms/ml) was significantly lower than that in patients with a slow progressive disease (327 +/- 43.3 micrograms/ml) (p less than 0.01). These data suggest that low pFN level predicts rapid progression of the disease and poor prognosis in patients with a urological malignant disease.     

Immunological evaluation in patients with urological cancers

The immunological competence of 100 patients bearing urological cancers was evaluated by means of skin tests and serum immunoelectrophoresis. Cell-mediated immunodepressions were observed in 93.3% of prostatic cancers, 68.6% of bladder cancers and 38.4% of renal cancers. The immunoglobulin values increased in 80% of prostatic cancers, 31.3% of bladder cancers and in 23% of renal cancers. IgA was elevated in almost all the prostatic growths. In bladder and renal cancers a clear correlation between immunodepression and tumour stage was found. Treatment significantly improved the skin test reactivity in the evaluated patients. Metastases and recurrences occurred more frequently in immunodepressed subjects.     

Selective urological evaluation in men with febrile urinary tract infection.

OBJECTIVE: To investigate the prevalence and clinical importance of urological abnormalities in men with community-acquired febrile urinary tract infection (UTI). PATIENTS AND METHODS: In this prospective study, 85 men (median age 63 years, range 18--86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto-urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography. RESULTS: The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow-up after one month, or early recurrent symptomatic UTI. CONCLUSION: Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.     

Urinary excretion of dipeptidyl aminopeptidase i.v. in patients with renal diseases

Enzymuria is a frequent finding in patients suffering from various kidney diseases. The present study was undertaken to evaluate the clinical value of the determination of tubule-brush-border-associated dipeptidyl aminopeptidase IV (DAP IV) in the urine of patients with acute and chronic tubulointerstitial nephritis (n = 12), chronic glomerulonephritis (n = 15), essential arterial hypertension (n = 30), after kidney transplantation (n = 20), and of healthy control persons (n = 68). DAP IV was measured in spontaneously voided mid-stream morning urine ("second morning urine"), and was expressed as enzyme activity in units/liter. In order to account for variations due to urine concentration without collecting 24-hour specimens, a urinary DAP IV/creatinine ratio (DCR) was calculated. Furthermore, patterns of proteinuria were assayed by SDS-polyacrylamide gel electrophoresis. Urinary DAP IV activity of healthy controls was 4.94 +/- 0.12 U/l (DCR: 0.46 +/- 0.30 U/mmol creatinine) with only small day to day variations. Urinary DAP IV activity in patients with tubulointerstitial nephritis was significantly higher (15.5 +/- 15.6 U/l, p less than 0.05 vs controls; DCR: 1.67 +/- 0.97 U/mmol creatinine, p less than 0.001 vs controls). In patients with chronic glomerulonephritis urinary DAP IV activity was 9.6 +/- 5.6 U/l, p less than 0.05 (DCR: 1.22 +/- 0.75 U/mmol creatinine, p less than 0.05 vs controls). Increased urinary DAP IV activity in patients with chronic glomerulonephritis was associated with a mixed glomerulo-tubular pattern of proteinuria (as determined by SDS-PAGE).(ABSTRACT TRUNCATED AT 250 WORDS)     

Upper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management

To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively.Detrusor leak point pressure (DLPP) over 40 cm H₂O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) ≤ 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP ≥ 40cmH₂O and decrease in FBC ≤ 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.     

The clinical value of urinary polyamine analysis in urological disease

To study the clinical usefulness of the determination of urinary polyamine levels, voluntary urine of several urological diseases including 56 bladder tumor patients was analyzed by high performance liquid chromatography. The obtained values were adjusted by the concentration of urinary creatinine and expressed as the unit of mumol/g creatinine (mumol/g Cr) From the measurement of 8 normal adults, the normal upper limit of each polyamine was decided by mean + 2SD, and the limit for total polyamine was 59.1 mumol/g Cr, putrescine 38.1 mumol/g Cr, spermidine 16.6 mumol/g Cr and spermine 9.2 mumol/g Cr, respectively. In the patients with non-neoplastic benign urological disease, the polyamine levels were statistically not different from those of the normal adults. In the case of bladder tumor, the urinary levels of total polyamine, putrescine and spermine were significantly elevated compared with the control group. The true positive rate of this determination in bladder tumor patients was 26/56 (46%) by total polyamine level, 21/56 (38%), by putrescine level, 11/56 (56%) by spermidine level and 16/56 (29%) by spermine level. Grade or stage of the bladder tumor did not have any significant correlation with the urinary polyamine level. This determination would not be included in routine clinical examinations due to the difficulty of measurement, difference of urine sampling and lack of high sensitivity and specificity.     

The urological evaluation and management of patients with myelodysplasia

The urological evaluation and results of management of 183 myelodysplastic patients are presented. Our management protocol stresses upper tract and infection status surveillance during the early childhood years, and a clean intermittent catheterisation programme with pharmacological manipulation of detrusor and sphincter function as the optimal later management. Continence failures are few and are manageable by sphincter prosthetic surgery or bladder augmentation. Urodynamic results are valuable in children with difficult incontinence or poor upper tracts. The intermittent catheterisation programme reduces the incidence of symptomatic urinary infections in these patients, but the incidence of asymptomatic bacteriuria is high. The adverse results of supravesical diversion in myelodysplastic children rarely justify its use.     

Clinical evaluation of piperacillin in the urological field

The sensitivity of 249 etiological bacterial strains causing inflammation isolated from patients with infections of the urogenital tract who were under treatment on an in-patient basis in our Department was examined by the Disc (3 concentration) assay method. Piperacillin (PIPC) was employed for prophylactic treatment in 18 patients against postoperative infections and for therapeutic treatment in 3 patients against complicated infections of urogenital tracts. The results of these studies are reported along with some discussion on the utility of PIPC in the urological field. The frequency of detection of bacteria isolated from the patients on their admission into our hospital was in the decreasing order of Streptococcus Sp., Proteus Sp. and E. coli Pseudomonas aeruginosa and Klebsiella Sp. also were noted in some of the patients. Pseudomonas aeruginosa, nonfermentative Gram's-negative bacilli (NF- GNB ), and Streptococcus Sp. were detected in many of the patients who had had an operation or who had been in hospital for a long time. The sensitivity of E. coli, Proteus Sp., Streptococcus Sp. and Pseudomonas aeruginosa was invariably more than 80%, while that of NF- GNB was more than 50%. PIPC was used for prophylactic treatment of patients against infections at the postoperative stage in the urogenital field. Out of 18 cases, it proved to be markedly effective in 14 cases and moderately effective in 4 cases. There was no poorly effective case. PIPC was employed for treatment in 5 cases complicated infections of urogenital tracts. There was no markedly effective case, and 2 moderately effective and 3 poorly effective cases resulted according to the UTI efficacy evaluation standards However, its bacteriological efficacy could be identified in all the treated cases. Therefore, PIPC is a valuable prophylactic antibiotic agent against infections after an operation in the urological field. It may also prove valuable in the therapeutic treatment of complicated infections in the urogenital tracts. PIPC has a relatively large margin of safety in terms of side effects as in the case of conventional penicillin group antibiotics.     

Clinical experience of urological surgery of the patients with hemostatic disorder or hemolytic disease]

This report deals with clinical experience of urologic surgery of patients with hemostatic disorder or hemolytic disease. In the past 5 years from May 1986, 14 operations were conducted in our clinic on 13 patients, consisting of 4 with von Willebrand disease (vWd), 1 with hemophilia B, 4 who had warfarin administration, 3 with essential thrombocythemia and 2 with spherocytosis. Almost all patients were treated hematologically before the urological operations. Except in 1 case, the post-operative course was favorable and under hematologic control. Massive bleeding in 1 case was obviously attributable to over-dosage of warfarin. It is difficult to determine the optimal dose of warfarin under an unstable hemostatic condition during the operation and recovery periods. However, it is possible to carry out urologic surgery for these patients under appropriate hematologic control, and ESWL was safely performed without medical treatment on 3 patients; 1 with vWd, 1 treated with warfarin and 1 with spherocytosis.     

Clinical evaluation of chorei-to and chorei-to-go-shimotsu-to in patients with lower urinary tract symptoms

Chorei-to was administered orally to 30 patients who complained of lower urinary tract symptoms without pyuria. Efficacy rate of pollakisuria was 92.9%, miction pain 85.8%, and voiding discomfort 85.7%. Total efficacy rate was 76.0%. No untoward effect was observed. Therefore, Choreito was thought to be an effective drug for the patients with lower urinary tract symptoms. Patients with the same symptoms tried Choreito-go-shimotsu-to, and its efficacy rate turned out to be 80%, but untoward effect such as epigastraligia was observed on 2 patients. These 2 drugs are thought to be effective on patients suffering from lower urinary tract symptoms.