Immunoadsorbent apheresis eliminates pathogenic IgG in childhood lupus nephritis

BACKGROUND: It is suggested that the highly cation-charged fraction of the IgG and IgG3 subclasses may play a pathogenic role in lupus nephritis. In contrast, immunoadsorbent therapy using a sodium dextransulfate fixed cellulose gel column-low invasive selective immunoadsorbent apheresis therapy (SDSC-IAT) has been applied to lupus nephritis with favorable results. However, elimination using pathogenic IgG by SDSC-IAT has never been investigated. METHOD: Two patients with diffuse proliferative lupus nephritis were treated using SDSC-IAT concomitant with immunosuppressive therapy. The eluates from the SDSC, and the patients' serum obtained before and just after SDSC-IAT were subjected to an IgG charge analysis using isoelectric focusing and immunoblotting, and also to laser nephelometry assay, which is used for measuring IgG subclass concentration. Indirect immunofluorescence staining was performed to detect IgG subclass deposition in the glomerulus. RESULTS: Both of the patients had an immediate decrease in anti-double-strand DNA antibody and in the circulating immune complex with a following clinical improvement. Repeated biopsies demonstrated improvement of glomerular lesions with a marked reduction of IgG and C3 deposition. The IgG of the SDSC eluates consisted of highly cation charged (isoelectric points: 9-10) fractions. In addition, IgG3 was specifically removed from the patients' serum using an SDSC among the IgG subclasses. The subclass of deposited IgG in the glomeruli showed IgG3 predominance. CONCLUSION: SDSC-IAT specifically removed the highly cation charged fractions of IgG and IgG3 from the patients' serum and the elimination of these fractions may have resulted in clinical improvement.     

Renal Cell Carcinoma in a Solitary Kidney Treated by Partial Nephrectomy --Case Report and Review of Japanese Literature

Renal cell carcinoma in a solitary kidney is rather rare. Wepresent a case of this condition occurring in a 50-year-oldman. He was treated by partial nephrectomy and temporary hemodialysisfor postoperative acute renal failure. Perusal of the literaturereveals that in situ partial nephrectomy, if possible, seemsto be a reasonable treatment of choice for renal cell carcinomain a solitary kidney. This is the fifth case ever reported inJapan.     

A Case of Amelanotic Malignant Melanoma of the Female Urethra

We report a case of amelanotic malignant melanoma of the femaleurethra. The clinical course was unusually long and complicatedby asynchronous resectable metastases to the lung and the brain.The patient died of generalized metastasis in spite of successfulresection of the metastatic lesions and postoperative chemotherapy,two years and five months after the first presentation. To thebest of our knowledge this is the second reported case of amelanoticmelanoma in the female urethra.     

Pathological improvement of IgA nephropathy and Henoch-Schönlein purpura nephritis with urokinase therapy

The pathological findings of 13 patients with immunoglobulin A (IgA) nephropathy or Henoch-Schönlein purpura nephritis before and after urokinase (UK) administration were investigated retrospectively. The mean activity index value decreased significantly at the time of the second biopsy compared with that of the biopsy before UK treatment. The mean chronicity index value, which was considered to reflect the renal outcome, before and after UK treatment did not change significantly, although it improved significantly in six patients. Immunofluorescence microscopy showed that the immune deposition of C3 decreased, but that of IgA and fibrin-related antigen were unchanged, by UK therapy. These results suggest that UK may prevent the mesangial proliferation associated with IgA nephropathy and Henoch-Schönlein purpura nephritis not only by its fibrinolytic action, but also by other mechanisms, such as digestion of the mesangial matrices.     

Apical secretion of rat submandibular tissue kallikrein continues in the absence of external stimulation: evidence for a constitutive secretory pathway

Sequential samples of saliva evoked by low frequency parasympathetic nerve stimulation were collected from cannulated submandibular ducts of anaesthetized rats following periods of varying length without stimulation. After such rest periods the first samples of saliva were found to contain much higher levels of tissue kallikrein (rK1) activity and protein than the ensuing samples from the same stimulation period and the latter contained levels similar to those found previously in parasympathetically-evoked saliva. rK1 activity in first samples increased with the length of the preceding interval, indicating that a continuous secretion of rK1 occurs from ductal cells into glandular lumina and accumulates there in the absence of stimulation or fluid secretion. The protein secretory pattern following rest pauses was unaffected by α-adrenergic receptor blockade and a high percentage of the proteinase activity was resistant to soya bean trypsin inhibitor, showing that the secretion was not caused by exocytosis of storage granules from ductal cells and therefore was likely to be a result of a constitutive secretion of newly synthesized enzyme. The pattern of continuous secretion into lumina detected for total protein in the absence of stimulation, suggests that other secretory proteins may also be secreted similarly but at different rates.     

Villous Adenoma in the Large Bowel Following Ureterosigmoidostomy: A Case Report and Review of the Pertinent Literature

This report presents a case of colonic adenoma which developedafter ureterosigmoidostomy. A 71-year-old man was initiallytreated by total cystectomy and ureterosigmoidostomy for transitionalcell carcinoma of the bladder in 1970. In 1983, a routine checkuprevealed urinary occult blood. A barium enema x-ray showed apolypoid lesion in the sigmoid colon. Colonoscopy confirmedthe presence of the polyp adjacent to the ureteral stoma. Thebiopsy findings were interpreted as villous adenoma with severeatypia. This tumor was removed endoscopically. This is the seventhcase report of neoplasia occurring in the sigmoid colon afterureterosigmoidostomy in Japan. Review of the pertinent literatureindicates that patients who have undergone this type of urinarydiversion have an increased risk of development of large bowelneoplasia. Adequate and regular surveillance of these patientshas been suggested in order to help in early detection.     

Survival of Patients with Tumors of the Renal Pelvis and Ureter: A Retrospective Study

A review of 27 patients with renal pelvic tumors and ureteraltumors admitted to the Tsukuba University Hospital was performedretrospectively. Nineteen cases of renal pelvic tumors and elevencases of ureteral tumors were submitted to the study. Thesepatients were treated mainly by surgery. The rates for 1-year,3-year, 5-year and 10-year survival were 88.5%, 57.6%, 40.3%and 20.2%, respectively. No obvious relationship between prognosisof renal pelvic tumor and that of ureteral tumors was seen.Pathologically, there was a correlation between the grade andthe stage of the tumor. Prognosis was related to the stage ofthe tumor, but not to the grade of the tumor. Clinically, thepatients with positive urinary cytology had a poorer prognosis.It was considered that no relationship existed between the preoperativeclinical stage and the postoperative pathological stage. Consequently,the former is not considered a prognostic factor. We have been performing mainly radical nephroureterectomy withregional lymphadenectomy since 1975. The patients who receivedthe operation with regional lymphadenectomy or with adjuvantchemotherapy had a better prognosis. It is concluded that lymphadenectomyis a valuable operation for improving prognosis.