Biomedical subjects
Publications and source records attributed to A V Moorthy.
A mechanical device was successfully used in therapeutic renal artery occlusion in a patient with renal amyloidosis and massive proteinuria (25 g/day). The serum albumin level increased from 1.8 to 3.4 g/dL after cessation of proteinuria. There has been no evidence of peripheral embolization, hypertension, or infection of the infarcted kidney for the past 20 months following the procedure.
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We reviewed the clinical and renal biopsy information of 115 patients who presented with renal disease after the age of sixty years. The major clinical presentations were renal insufficiency in 57 patients, nephrotic syndrome in 35 patients, and hematuria with variable amounts of proteinuria in 23 patients. Crescentic glomerulonephritis, diagnosed in 19 patients, was the most common cause of renal insufficiency. Membranous glomerulonephritis and minimal change nephrotic syndrome were noted in 15 and 9 patients, respectively. While patients with crescentic glomerulonephritis had an unfavorable outcome, patients with minimal change nephrotic syndrome and diffuse proliferative glomerulonephritis had a benign course. We conclude that even in the elderly, the natural history of renal disease is similar to that of younger patients, and the clinical course appears to depend on the nature of the underlying renal disease.
Patients with crescentic glomerulonephritis and anti glomerular basement membrane antibody typically experience a rapidly progressive course. Remission and relapse in renal disease are unusual. We report two patients with this syndrome who remitted following immunosuppressive therapy and relapsed 20 and 48 months later, respectively. The pathogenesis of relapse is discussed. It is different from the initial insult in that antiglomerular antibody may not be important.
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An 86-year-old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal-sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
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We evaluated oral 1,25-vitamin D3 for as long as 26 months in six prepubescent children with renal osteodystrophy previously treated with vitamin D2. Therapy was given at 14 to 41 ng per kilogram per day to correct hypocalcemia and reverse bone disease. Serum levels of 1,25-vitamin D3 were initially reduced at 15 +/- 5 pg per milliliter (mean +/- S.E.M.) and after treatment rose to 54 +/- 13. Serum calcium rose from 7.5 +/- 1.6 mg per deciliter (mean +/- S.D.) to 9.8 +/- 0.6 after one month (P less than 0.02). Alkaline phosphatase activity fell from 536 +/- 298 to 208 +/- 91 IU per liter after 12 months (P less than 0.05). Serum immunoreactive parathyroid levels fell from 900 +/- 562 microliter eq per milliliter 411 +/- 377. Healing of rickets and subperiosteal erosions was found. Remineralization of bone was demonstrated by the photon absorption technic. In four patients growth velocity, evaluated for 12 months before and after therapy, increased from 2.6 +/- 0.8 to 8.0 +/- 3.2 cm per year. Growth velocity per year increased from less than third percentile in each to the 10th to 97th percentile after therapy. Height increment ranged from 27 to 113 per cent of that expected for change in chronologic age and 40 to 114 per cent expected for change in bone age after therapy. This trial demonstrates that oral 1,25-vitamin D3 can reverse renal bone disease and increase growth in uremic children.
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Patients with systemic lupus erythematosus lacked suppressor T cell function. Suppressor cell activity was induced in cells from many of these patients by incubation with thymosin or cultured thymic epithelium. These results suggest that thymic manipulation may be a useful therapeutic modality in this disease.
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Plasma from 7 patients with minimal-change nephrotic syndrome (M.C.N.S.) (lipoid nephrosis) confirmed by renal biopsy inhibited the blastogenic response of lymphocytes to the mitogen phytohaemagglutinin (P.H.A.) and to allogeneic lymphocytes in mixed lymphocyte culture. Plasma from 14 patients with nephrotic syndrome due to other glomerular diseases did not have this effect. 5 of the 7 patients with M.C.N.S. achieved remission; 4 with prednisone and 1 spontaneously. While in remission, plasma from these 5 patients no longer inhibited the response of lymphocytes to P.H.A. These findings suggest a pathogenic relation between M.C.N.S. and cell-mediated immunity.