1/34. biopsy-proven resolution of immune complex-mediated crescentic glomerulonephritis with mycophenolate mofetil therapy in an allograft.We report biopsy-proven resolution of immune-complex-mediated crescentic glomerulonephritis (ICMCGn) using mycophenolate mofetil (MMF). Therapy with steroids and cyclophosphamide failed twice in a 39-year-old white man who developed ICMCGn in his native kidneys, and subsequently in a human lymphocyte antigen-identical renal allograft. When he developed ICMCGn in a second, now cadaver, allograft, he was treated with steroids and MMF instead. His serum creatinine (Cr) improved from 4.4 mg/dL to 2.1 mg/dL. A biopsy 21 months later showed him to be free of glomerular disease. MMF is known to be an effective immunosuppressant. In our patient, ICMCGn, a notoriously difficult entity to treat effectively, seemingly resolved with MMF therapy. We suggest that MMF may be effective in the treatment of immunologically mediated pre-end-stage renal disease (ESRD). It should be considered in any posttransplantation setting where the original cause of organ failure is known to be immunologically mediated and likely to recur.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/34. Autologous immune complex nephritis associated with sickle cell trait: diagnosis of the haemoglobinopathy after renal structural and immunological studies.A renal tubular epithelial antigen (RTE)--anti-RTE autologous immune complex nephritis associated with sickle cell anaemia (SS) has been reported, but immune complex nephritis has never been described in patients with sickle cell trait (SA). During investigation of a child with "asymptomatic proteinuria" cryoprecipitable complexes of RTE-anti-RTE were detected in the serum and granular deposits of RTE, immunoglobulins, and complement localised on the glomerular basement membranes. Morphological and ultrastructural studies showed increased mesangial matrix, sickled red blood cells in the glomeruli and vessels, and tubular and interstitial abnormalities. These findings prompted haemoglobin electrophoretic studies, which showed previously undiagnosed haemoglobin SA in this patient and her family. These observations suggest that nephritis mediated by similar immunopathogenic mechanisms may be associated with SS and SA haemoglobinopathy. Under some conditions patients with sickle cell trait may experience haemodynamic and oxygenation abnormalities, which may be aetiological factors in the immune complex nephritis associated with SS disease.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/34. nephrotic syndrome associated with fanconi syndrome. Immunopathogenic studies of tubulointerstitial nephritis with autologous immune-complex glomerulonephritis.The nature of renal lesions in a patient with simultaneous onset of the fanconi syndrome and nephrotic syndrome was investigated by immunologic studies of the patient's serum, cryoproteins, and renal tissue. Acute severe tubulointerstitial nephritis and generalized segmental glomerulonephritis were present. Renal tubular epithelial (RTE) antigen, IgG, and Clq were localized in the glomerull and proximal tubules. Cryoprecipitates containing RTE antigen and anti-RTE antigen were isolated from the patient's serum antibody to RTE antigen was detected in the serum of the patient. However, antibody to tubular basement membrane was not found in the cryoproteins or serum. The unusual simultaneous presentation of these two syndromes in our patient possibly represents a common etiology: tubular damage with release of RTE antigen and subsequent development of immune-complex glomerulonephritis mediated by renal tubular epithelial antigen and antibody to this antigen.- - - - - - - - - - ranking = 7keywords = antigen (Clic here for more details about this article) |
4/34. Rational management of uveitis.Endogenous uveitis is an important cause of blindness in young adults. The need for a comprehensive search for an aetiological 'antigen' is stressed. A source of adjuvant, disturbance in host immunology and any associated syndromes are also sought. Treatment then involves elimination of 'antigen', suppression of host hypersensitivity and the enhanced vascular permeability, and improvement of host resistance. The value of antihistamine and antiserotonin drugs in successful treatment is emphasised.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/34. Immune-complex disease with unilateral renal vein thrombosis.The sequence of events in the relationship between membranous nephropathy and renal vein thrombosis is controversial. We postulate that occasionally, the thrombosis may precede the nephropathy and that release of autologous antigens from renal tissue damaged by occlusion of the vein may incite an autologous immune-complex disease. In a case of membranous nephropathy associated with renal vein thrombosis, renal tubular epithelial antigen (RTE) was localized in the glomerulus, along with the host immunoglobulins and complement components. Cryoproteins isolated from the serum contained RTE and anti-RTE. In addition, immunoglobulin eluted from the diseased glomeruli showed antibody activity to RTE. The membranous nephropathy was demonstrated to be secondary to an autologous immune-complex nephritis. Although the sequence of events is inconclusive, it is possible that the renal vein thrombosis preceded and was involved in the etiopathogenesis of the autologous immune-deposit nephropathy.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
6/34. herpes simplex virus type 1 and human immunodeficiency virus type 1 antigens in platelets from a hemophilia b patient with human immunodeficiency virus type 1-related thrombocytopenia.We analyzed platelet-associated antigens from a hemophilia b patient with human immunodeficiency virus type 1 (hiv-1)-related thrombocytopenia. Two bands appeared at 31,000 and 37,000 daltons in the platelet lysate after reaction with autologous serum in SDS-PAGE and Western blots. The band at 37,000 daltons was obtained using anti-herpes simplex type 1 (HSV-1) rabbit antiserum. Doublet bands at 36,000 and 37,000 daltons also appeared after reaction with HSV-1 seropositive human serum. The band at 31,000 daltons appeared after reaction with anti-hiv-1 rabbit serum. These results suggest that the platelet-associated antigens in this patient are components of both HSV-1 and hiv-1 antigens. In addition, acyclovir decreased his PAIgG level and increased his platelet count, and zidovudine increased his platelet count. Thus, we concluded that each of the platelet-associated antigens is partially responsible for the thrombocytopenia by causing deposition of immune complexes in this patient.- - - - - - - - - - ranking = 8keywords = antigen (Clic here for more details about this article) |
7/34. Acute immune complex disease associated with hepatitis. Etiopathogenic and immunopathologic studies of the renal lesion.Immune deposit glomerulonephritis has been associated with hepatitis b antigenemia. Immune complexes of this antigen and its antibody have been implicated in the pathogenesis of the renal disease. A boy had acute immune complex disease with glomerulitis in which cryoprecipitable complexes of HbsAg and its antibody were isolated from serum. HbsAg was concentrated in the cryoprecipitate and localized in a granular pattern along the glomerular basement membrane in association with immunoglobulins. Glomerular fixed antibody was eluted and shown to be directed against HbsAg. The level of antibody activity to HbsAg was higher in the eluate than the serum, suggesting immunopathogenic specificity of the antibody. The study demonstrates that the nephritis was mediated by immune complexes of HbsAg and its antibody, and the presence of immunoglobulin on the kidney did not represent trapping from the circulation.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
8/34. gold nephropathy: serologic data suggesting an immune complex disease.Servlogical tests preformed on a patient with gold-induced nephropathy revealed a multitude of immunological phenomena preceding the onset of proteinuria. These included formtaion of tissue antibodies, rheumatoid factors and circulating immune complexes. An antigen sharing immunological determinants with DOC-extractable tissue antigens was released into circulation before and during proteinuria. Precipitating antibodies against this circulating antigen were found in one serum sample obtained 6 weeks before the complication was diagnosed. In this serum specimen, antibodies were also found which combined with saline extracts, DOC extracts containing the ubiquitous tissue antigen (UTA), and preparations obtained from various human organs by extraction at 100 degrees C followed by precipitation at 71% ethanol concentration (BE preparations). Most of the activities disappeared before the onset of proteinuria. The possible significance of these phenomena in the pathogenesis of nephropathy is discussed.- - - - - - - - - - ranking = 4keywords = antigen (Clic here for more details about this article) |
9/34. Immunologic considerations in renovascular hypertension.For decases certain diseases, such as glomerulonephritis, polyarteritis nodosa, scleroderma and serum sickness, have been linked with autoimmune pathogenesis. During recent years a host of additional diseases traditionally thought to have some genetic predisposition but with obscure etiology have been suspected of being autoimmune in nature. Rheumatoid arthritis, diabetes, myasthenia gravis and thyroiditis are diseases of widely divergent organ systems, yet may well have common pathways of pathology via immune complexing mechanisms. Herein we present evidence supporting the concept that renal artery stenosis (occurring primarily in association with the middle aortic syndrome or after renal transplantation) is of immune etiology. Although the specific antigenic agent is still to be defined there is growing acceptance of the theory that medium and large vessels are subject to autoimmune vasculitis in many aspects similar to the autoimmune affections of small vessels. Several cases are presented. Some of these suggest an immune reaction by the natural history but without evidence of immunochemical reactants in the involved vessels, presumably because active disease was arrested at the time to study. In other cases immunofluorescent preparations demonstrate reactants in the walls of the vessels to document the hypothesis more convincingly.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/34. Evidence for immune complexes involving anti-lymphocyte antibodies associated with hypocomplementaemia in chronic lymphocytic leukaemia (CLL).Unmeasurable total haemolytic complement (C) was observed in serum of a patient with untreated chronic lymphocytic leukaemia and recurrent non-hereditary angioedema. Analysis of C components immunochemically demonstrated a marked reduction of C1q and C1s inhibitor, undetectable C1r, C1s and an elevated B. Haemolytic C1, C4 and C2 were less than 5 percent of normal, functional C1s inhibitor was absent. Cryoglobulin and C1q precipitins were present in the serum. Of special interest was the presence of high levels of cold-reactive antilymphocyte antibody, determined by both C-dependent cytotoxicity and indirect immunofluorescence. The antibody exhibited specificities for both autologous lymphocytes and lymphocytes from normal donors; cytotoxic activity for autologous leukaemia cells was removed by absorption with normal isologous tonsil lymphocytes. Specific enrichment of this antibody relative to the serum level was demonstrated in the cryoglobulin and its isolated 19S fractions. Free lymphocyte surface antigen was also demonstrated by gel diffusion using specific rabbit antilymphocyte antiserum. These data strongly suggest the presence of pathogenetically significant circulating complexes of lymphocyte surface antigen and specific antibody in certain patients with CLL.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
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