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Biomedical subjects

A R Morley

Publications and source records attributed to A R Morley.

At least 73 records · Page 4Linked to original sources
PubMed1982

The natural history of chronic pyelonephritis in the adult.

One hundred and thirty patients with primary chronic pyelonephritis diagnosed radiologically or by nephrectomy, 84 with unilateral and 46 with bilateral disease, have been followed for six to 240 months. The clinical and radiological features of the disease at presentation, together with its influence on pregnancy, have been analysed. Serial observations of bacteriuria, blood pressure and renal function have been made during follow up and the intravenous urogram (IVU) has been repeated after five years in most patients. Although the disease probably starts in early childhood it often presents to the nephrologist in young adults, mainly women, as symptomatic urinary tract infection, hypertension, renal insufficiency or a combination of these features. Though associated with increased morbidity in pregnancy it does not usually interfere with fertility and in this series it did not cause increased fetal loss. Repeated urinary tract infections and hypertension are common events. Proteinuria is usually minimal and when present is associated with hypertension. The disease in most patients with unilateral disease runs a benign course; a poorer prognosis is associated with bilateral disease, hypertension and proteinuria. Since we found no association between frequent urinary infections and declining renal function we suggest that only symptomatic urinary infection should be treated in adults with chronic pyelonephritis.

Adolescent↗
PubMed1981

Membranous glomerulonephritis in transplant kidneys: recurrent or de novo disease in four patients.

Membranous glomerulonephritis in the graft is a uncommon complication of renal transplantation. In the 4 cases we describe, one patient had recurrence of his original disease, but in the other 3 it arose de novo after allografting for focal segmental glomerulosclerosis, cystinuria or secondary amyloidosis. The lesion was accompanied by mesangial changes of lesser degree and by chronic rejection, and it resulted in accelerated loss of graft function. Transmission of host disease to the graft is more likely to occur in patients whose original membranous lesion progressed to renal failure relatively rapidly, while in de novo cases, the antecedent host disease seems often to have been focal segmental glomerulosclerosis. Allograft membranous glomerulonephritis may be less rare than hitherto supposed.

Adult↗
PubMed1980

Nephrotic syndrome with slight proliferative changes in the glomeruli: response to prednisone.

Seven patients with slight but definite proliferative changes in the glomeruli achieved complete remission of the nephrotic syndrome when treated with prednisone. The patterns of response and, in three cases, repeated relapse and response suggested that this was more than a coincidental spontaneous cure. A controlled trial of corticosteroids in patients with slight proliferative glomerulonephritis and severe nephrotic syndrome should be carried out to verify these results.

Adolescent↗
PubMed1980

Scanning electron microscopy in the study of normal, inflamed and neoplastic human urothelium.

Seventy-two samples of human urothelium have been examined by scanning electron microscopy (SEM) and the appearances compared with those of conventional light microscopy. Six main SEM cell types were recognised. None was diagnostic of malignancy; in particular, the presence of surface pleomorphic microvilli was not pathognomonic. However, the relation of the SEM appearance to malignancy and the accepted histological grades and clinical stages of malignancy was such as to warrant further examination.

Epithelium↗
PubMed1979

Plasma renin activity during the development of paracetamol (acetaminophen) induced acute renal failure in man.

Plasma renin activity has been measured daily in 36 patients suffering from self poisoning with acetaminophen. In 3 developing porto-systemic encephalopathy terminal renal failure developed with high plasma renin activity. In 2 who developed acute renal failure without porto-systemic encephalopathy, plasma renin activity was noted to rise before serum creatinine and to return to initial levels after 3 or 4 days while renal failure persisted. Six other patients with similar hepatic damage showed comparable rises in renin without developing renal failure. Our findings are consistent with but do not establish a pathogenetic role for renin in acetaminophen-induced acute renal failure. It is suggested that other factors may act with renin to bring about renal failure.

Acetaminophen↗
PubMed1978

Renal histology and immunopathology in distal renal tubular acidosis.

Renal biospy studies are reported from 10 patients with distal renal tubular acidosis (DRTA). On the biopsies from 6 patients who had associated immunological abnormalities immunofluorescent studies for immunoglobulins, complement, and fibrin were performed. Interstitial cellular infiltration and fibrosis were common findings in patients with and without immunological abnormalities, and were usually associated with nephrocalcinosis and/or recurrent urinary infection. No immune deposits were demonstrated in association with the renal tubules. This study shows that DRTA in immunologically abnormal patients is not caused by tubular deposition of antibody or immune complexes. The possibility of cell mediated immune damage is discussed.

Acidosis, Renal Tubular↗
PubMed1977

Factors affecting the outcome of cadaver renal transplantation in Newcastle upon Tyne.

In an analysis of a series of 186 consecutive first cadaver renal transplants in Newcastle upon Tyne, the most significant finding was the improved graft survival in patients who received pre-transplant blood-transfusion. This apparent benefit was not dependent on the number of units of blood received nor on the interval between transfusion and transplantation. A significant advantage was also shown when there was identity between donor and recipient at the HLA-B locus. This advantage outweighs any disadvantage resulting from the extra time required to transfer kidneys from one centre to another and indeed cold-ischaemia times up to 18 hours did not adversely affect graft survival. It is suggested that the present national distribution of cadaver kidneys in the U.K. is fully justified, but preference should be given to B-locus identity in determining selection.

Blood Transfusion↗
PubMed1977

Addison's disease with renal microangiopathy and renal failure (a new syndrome).

A syndrome comprising Addison's disease, renal microangiopathy and renal failure is described in two patients. The renal lesions manifested despite corticosteroid replacement therapy and were characterized by glomerular damage and thrombo-microangiopathic changes in afferent arterioles and intralobular arteries. Both patients died as a result of their renal disease.

Addison Disease↗
PubMed1977

Idiopathic membranous nephropathy.

The clinical and histopathological features of 37 patients with idiopathic membranous nephropathy are presented. Males were four times as commonly affected as females and the age at presentation ranged from nine to 70 years. The period of observation varied from three months to 23 years. Twenty-eight patients (76 percent) presented with the nephrotic syndrome and nine patients (24 per cent) presented with non-nephrotic proteinuria. At the end of the study, of the patients presenting with the nephrotic syndrome, seven (25 per cent) were in remission, seven (25 per cent) remained nephrotic, nine (32 per cent) showed only proteinuria and five (18 per cent) were dead or on dialysis. Altogether eight patients (28 per cent) developed renal failure. The nine patients who presented with non-nephrotic proteinuria appeared to do better, and none developed renal failure. The occurrence of spontaneous remission makes assessment of benefit from immunosuppressive therapy difficult. However, analysis of our data and a review of the literature suggest that in this condition oral prednisone, cyclophosphamide and azathioprine have no significant therapeutic properties. Histological assessment confirmed the occurrence of mild (Grade 1) changes in patients biopsied soon after presentation, and tubular atrophy increased with the duration of illness. Immunofluorescence confirmed deposition of mainly IgG and complement. Repeat biopsies in 14 patients showed no histological improvement and remission was not accompanied by resolution of histological abnormalities.

Adolescent↗
PubMed1976

Cell proliferation in the prostate complex of the castrate mouse.

Cell proliferation during 100 h of continuous androgen challenge was studied in the seminal vesicle and coagulating gland of Balb/c mice castrated 3 days or 14 days prior to the first daily injection of 250 mug testosterone propionate. Continuous labelling with [3H] thymidine indicated that the seminal vesicle was almost totally responsive to androgen, as early as 3 days after castration, whereas the androgen sensitivity of the coagulating gland increased from 30% at 3 days after castration to 85% at 14 days after castration. In both tissues the magnitude of the proliferative reaction could be related to the extent of cell loss prior to stimulation. The duration of the pre-replicative phase in the response of the seminal vesicle to androgen was 20-25 h both at 3 and 14 days after castration. In the coagulating gland the pre-replicative phase was 40 h at 3 days after castration and 20 h at 14 days after castration. The maximum uptake of [7alpha-3H] testosterone administered to mice 3 days after castration was significantly greater (P less than 0-01) in the seminal vesicle compared to the coagulating gland. At 14 days the seminal vesicle and coagulating gland exhibited a similar capacity for uptake. The in vivo metabolism of [7alpha-3H] testosterone was studied by thin layer chromatography 30 min and 120 min after administration. A high proportion of the radioactivity extracted from all the tissues was associated with highly polar steroids. At 3 days after castration, the seminal vesicle, 2 h after administration of radioactive testosterone, retained a much higher proportion of radioactivity associated with dihydrotestosterone than did the coagulating gland. The localization of steroid in mice 3 days after castration was studied by dry-mount autoradiography at intervals up to 2 h after the injection of [1,2,6,7(n)-3H]-testosterone. A heavier deposition of silver grains was observed over autoradiographs of the seminal vesicle. In the seminal vesicle the grains were primarily located over nuclear areas whereas in the coagulating gland the grains were diffusely distributed over both nuclear areas and over cytoplasmic areas.

Animals↗
PubMed1975

The proliferative response of the coagulating gland of the castrated mouse under continuous androgen stimulation: an experimental and computer simulation model.

The proliferative response of the coagulating gland of the castrated male mouse has been examined during continuous treatment with testosterone propionate. Fourteen days after castration, s.c. daily injections of testosterone propionate were begun. Mitotic (Im) and labelling (IL) index values were obtained at 3 h intervals for up to 100 h after the initial injection. These showed a biphasic response, in which IL reached a maximum at 30 and 70 h, and Im at approximately 45 and 75 h. Fraction-labelled mitoses (FLM) curves were begun 24, 48, and 72 h after the first androgen injection. In each curve the first wave of labelled mitoses rose to 100% and showed a square form indicating little spread in the durations of the G2 and S phases. Values of 7.5, 1.3 and 0.7 h were obtained for the durations of DNA synthesis (ts), the post-synthetic period (tG2) and of mitosis (tm) respectively. In none of the FLM curves was it possible to demonstrate a second wave of labelled mitoses and direct measurement of the cell cycle time (Tc) was not obtained. Continuous tritiated thymidine labelling indices revealed that after a latent period of 25 h, DNA synthesis began and labelling rose rapidly to 80% by 45 h and then more slowly to 95% by 97 h. Cell population changes during androgen stimulation estimated from measurements of total glandular DNA indicated that the number of cells present in the glands remained constant during the first 30 h after stimulation and thereafter increased to approximately 2-3 times the original value. The data are compared with a mathematical model which assumes that the cell population of castrated mice when stimulated passes from a GO compartment through successive waves of DNA synthesis and mitosis. After each cell division the cells may leave or remain in the proliferative cycle. This model has been subjected to computer simulation using the cell cycle parameters obtained in the kinetic experiments. There was good agreement between the stimulation and experimental results in the Im and IL curves, continuous labelling, and total cell number experiments. The simulation of FLM curves was less successful. Although the first wave of labelled mitoses was clearly seen the model predicts a distinct second wave of labelled mitoses. It is concluded that this does not appear because of variation in the duration of G1.

Animals↗