GLOMERULAR TISSUE INJURY IN IgA NEPHRITIS

The glomerular lesions In 129 cases of IgA nephritis were analyzed. The development of glomerular injury occurred in two ways, one being a chronic mesangial depositive and sclerosing lesion commonly found in most glomeruli, and the other an acute but local injury initiating from the local peripheral glomerular basement membrane abnormality, i.e., thinning and/or splitting, which was seen at least in one third of all cases. The activation of the local coagulatory process could add segmental glomerular changes including small crescents, adhesion, and local tuft necrosis to the mesangial lesion. ACTA PATHOL. JPN. 33; 367–380, 1983.     

Steroid Therapy in IgA Nephropathy: A Prospective Pilot Study in Moderate Proteinuric Cases

Forty-three patients with IgA nephropathy whose proteinuriapersisted between 1.0 and 2.0 g/day were assessed in an uncontrolledpilot study of steroid treatment. Fourteen patients receivean initial dose of 40 mg/day of prednisolone, followed by gradualreduction of the dose over an average period of about 19 months.After discontinuation of corticosteroids, they were treatedwith non-steroid anti-inflammatory drugs and/or anti-thrombocytedrugs to the end of the study. Another 29 patients receivednon-steroid anti-inflammatory drugs and/or anti-thrombocytedrugs throughout the study. Fourteen patients treated with steroidsexperienced considerable reduction in proteinuria and maintainedrenal function over 81 months. In 29 patients treated with non-steroidanti-inflammatory drugs and/or anti-thrombocyte drugs alone,proteinuria did not decrease and renal function deterioratedsignificantly during 60 months. At the end of the study, differencesin degree of proteinuria and in levels of renal function betweenthe steroid and non-steroid groups were statistically significant.In addition, these differences became more distinct in patientswith initial creatinine clearance values 70 ml/min or more inboth groups. These results suggest that treatment with steroidsin IgA nephropathy may be beneficial, especially in the earlystage of the disease.     

Low levels of apoptosis and proliferative activity in colorectal villous tumors: Comparison with tubular tumors

In order to clarlfy the cell kinetics of colorectal villous tumors (VT), 21 villous adenomatous areas and 12 carcinomatous areas within villous adenomas were investigated for proliferative activity and apoptosis and compared with a series of 41 tubular tumors (TT), demonstrating elements of intramucosal carcinomas as well as tubular adenomas (so-called carcinoma in tubular adenoma). Proliferation was estimated in terms of KI-67 labeling indices and mitotic indices, and apoptosis was assessed by DNA nick-end labeling to give apoptotic Indices. Apoptotic indices of villous adenomatous and carcinomatous regions were significantly lower than the values for their tubular counterparts. Kl-67 labeling indices were also significantly lower for adenoma components. Apoptotic indices, Ki-67 labeling indices and mitotic Indices increased with atypia raised in tubular adenoma components. Correlations of mitotic indices with apoptotic indices, Ki-67 labeling Indices with apoptotic indices and mitotic Indices with Ki-67 labeling indices were found for each villous tumor group and tubular tumor group, and the apoptosis and proliferation ratios for villous tumors were relatively low, suggesting a tendency for greater growth due to less cell deletion. Although this is only one of the biological features of villous tumor groups, it might play a major role in generation of malignancy.