Glomerulopathy associated with cytomegalovirus viremia in renal allografts

We investigated the relation between cytomegalovirus (CMV) infection and renal-allograft dysfunction in 14 patients. In seven instances (including two successive transplants in one patient), allograft dysfunction occurred during clinically manifest, viremic CMV infection. In five of these, biopsies revealed little or no tubulointerstitial change but a distinctive, diffuse glomerulopathy characterized by enlargement or necrosis of endothelial cells and accumulation of mononuclear cells and fibrillar material in glomerular capillaries. Two of these allografts recovered their function, both with cessation of high-dose immunosuppression. Biopsies in the other 10 patients revealed predominantly tubulointerstitial changes typical of cellular rejection, and most of these patients did not have viremia. One additional patient, studied prospectively, manifested both forms of allograft injury: tubulointerstitial changes occurring two weeks after transplantation and responding to increased immunosuppression, and CMV-associated glomerulopathy occurring seven weeks after transplantation and responding to decreased immunosuppression. We conclude that viremic CMV infection can cause acute glomerular injury and that recovery may be favored by a decreased in immunosuppressants.     

Development of erosive gingival lesions after use of a home care technique

The use of a periodontal home care regime has been found to induce erosive gingival lesions in some individuals. The purpose of this study was to determine which of the chemical or physical components of the technique might be responsible for the changes observed. Ten normotensive subjects were assigned to two groups. Group I subjects used a dentifrice consisting either of sodium bicarbonate and 3% hydrogen peroxide or 3% hydrogen peroxide alone; the dentifrice was removed with a 5 M NaCl irrigating solution. Group II subjects used the same dentifrices as Group I subjects, but distilled water was used as irrigant instead of 5 M NaCl. Erosive lesions of gingiva developed in all six subjects in Group I using the soda-paste dentifrice and 5 M NaCl irrigant; however, no lesions were found in Group II subjects. The use of a saturated NaCl irrigating solution appears to be injurious to gingiva, possibly as a result of the markedly hypertonic solution dehydrating the epithelium.