Epithelial cell clusters of distal convoluted tubules in end-stage chronic glomerulonephritis

Differences in the pathologic changes of the proximal convoluted tubules, the cortical segments of the thick ascending limbs of the loops of Henle, and the distal convoluted tubules in the end-stage kidneys with chronic glomerulonephritis were studied by means of both light and electron microscopy. Kidneys with chronic glomerulonephritis were obtained from 8 non-dialyzed patients at autopsy and 9 dialyzed patients at the time of nephrectomy prior to renal transplantation. Epithelial cell clusters with clear cytoplasm, decreases in the luminal and outer diameters of the tubules, and thin basement membranes were observed in both the non-dialyzed and dialyzed kidneys to varying degrees. The epithelial cell clusters were more extensive and distinct in kidneys from patients with a long history of chronic glomerulonephritis and/or long-term hemodialysis. Electron microscopy of the epithelial cell clusters revealed the absence or narrowing of lumens and luminal surfaces that were smooth except for a few short microvilli. Observation of serial sections showed that these epithelial cell clusters were derived from the distal convoluted tubules belonging to obsolescent glomeruli. This form of tubular change is quite different from the well-known atrophy of the proximal convoluted tubules belonging to obsolescent glomeruli in chronic glomerulonephritis.     

The course of chronic glomerulonephritis in chronic opisthorchiasis

AIM: To characterize clinical, functional and morphological features of chronic glomerulonephritis (CGN) running with chronic opisthorchiasis (CO) and to justify dehelminthization. MATERIAL AND METHODS: Clinical, functional and morphological examinations of the kidneys, immunological characteristics were studied in 100 patients with primary CGN and CO (group 1), 30 patients with CGN free of CO (group 2) and 40 patients with long-term CO. RESULTS: CGN in CO runs with frequent rise of creatinine, glomerular filtration and canal reabsorption fall. Pathogenetic therapy with addition of pulse cyclophosphamide in a dose 10 mg/kg and conduction of dehelminthization a year later lead to long-term remission and inhibition of nephrosclerosis development. CONCLUSION: Clinicofunctional and morphological characteristics of the kidneys in mixed pathology necessitate addition of immunosuppressor cyclophosphamide in a dose 10 mg/kg and dehelminthization in combined treatment of patients with glomerulonephritis and opisthorchiasis.     

Urinary enzymatic markers (N-acetyl-beta-D-glucosaminidase) in assessing the tubulointerstitial compartment in chronic glomerulonephritis related to odontogenic foci

Chronic glomerulonephritis is related to focus infection. Odontogenic foci are frequently involved in glomerulonephritis. The relationship with the odontogenic focus infection can be demonstrated by the occurrence or aggravation of the symptoms of glomerulonephritis: proteinuria, haematuria, high blood pressure and oedema. Glomerular impairment in glomerulonephritis occurs together with inflammatory alterations of the tubulointerstitial compartment that can play an important part in the evolution of the disease. Tubular urinary markers can indicate the activation of this compartment during an infection of a focus, an odontogenic focus in our study.     

Systemic enzyme therapy in chronic glomerulonephritis

AIM: To try polyenzyme drug vobenzim in chronic glomerulonephritis (CGN). MATERIALS AND METHODS: 174 CGN patients were randomized into 2 groups. The study group of 39 patients received conventional pathogenetic treatment plus vobenzim (initial dose 18-24, maintenance 12-15 dragees a day). Control group of 135 patients were given only pathogenetic therapy. 67 patients appeared ineligible. RESULTS: 3-6 months after the treatment the response was seen in 61.5% patients of the study and 17.8% patients of the control group. Side effects of vobenzim in CGN treatment were absent. CONCLUSION: Enzyme therapy with vobenzim in CGN is safe and effective.     

Comparison of ARB and ACEI for renoprotection in chronic glomerulonephritis

This 1.5-year prospective study compared the effects of angiotensin II receptor blocker, candesartan(n = 21), and ACE inhibitor(ACEI, n = 23) on proteinuria and renal function in patients with moderate renal impairment due to chronic glomerulonephritis. Blood pressure reductions were comparable between both groups. Proteinuria was significantly reduced from 2.1 +/- 0.4 (mean +/- SE) to 0.6 +/- 0.2 g/day(p < 0.001) with candesartan, and the reduction was significantly larger than with ACEI(p < 0.01). Serum creatinine did not increase with candesartan or ACEI, suggesting the renoprotective effect. Serum potassium increased significantly with both drugs from 6 months. Plasma aldosterone concentrations(PAC) showed a stronger suppression with candesartan(150 pg/ml before treatment and 51 at 1.5 years) than with ACEI(104 pg/ml at 1.5 years). Plasma renin activity with candesartan(1.0 ng/ml/hr before treatment) decreased from 3.9 ng/ml/hr at 6 months to 1.3 at 1.5 years, whereas PRA remained elevated with ACEI. We speculate that the stronger reduction of PAC contributed to suppression of growth of mesangial matrix and the interstitial fibrosis in the candesartan group.