PubMed Health⌕ Search

Biomedical subjects

A W van den Wall Bake

Publications and source records attributed to A W van den Wall Bake.

At least 19 recordsLinked to original sources
PubMed2001

Hemolytic uremic syndrome after capnocytophaga canimorsus (DF-2) septicemia.

A 66-year-old man developed a hemolytic uremic syndrome (HUS) with acute renal failure, thrombocytopenia, fragmented red cells in the blood film and elevated serum LDH following a capnocytophaga canimorsus (DF-2) infection after a dog bite. He was treated with antibiotics, plasmapheresis and hemodialysis. Although hematologic values improved, the patient remained hemodialysis-dependent for six months. In the literature several cases of renal failure following capnocytophaga canimorsus septicemia have been described, caused by hypotension or disseminated intravascular coagulation (DIC). In our patient there were no signs of hypotension or extensive DIC. A few case reports described HUS and thrombotic thrombocytopenic purpura (TTP) following DF-2 sepsis.

Aged↗
PubMed1998

[Immediate recovery from acute renal insufficiency after abdominal decompression].

A 61-year-old man received an aorto-iliac reconstruction after he was admitted because of a ruptured abdominal aortic aneurysm. Postoperatively, he developed cardiopulmonary insufficiency with anuria. After the intra-abdominal pressure had risen to 40 cmH2O (measured by a urinary bladder catheter), it was decided to perform a relaparotomy. Immediately after abdominal decompression--without correction of any other intra-abdominal pathology--the diuresis increased and several other cardiopulmonary parameters improved significantly. When a critically ill patient shows a rapid increase of the intra-abdominal pressure above a critical level an acute abdominal compartment syndrome may develop. This syndrome consists mainly of potentially fatal cardiopulmonary and renal insufficiency, for which (re)laparotomy with abdominal decompression is the only correct treatment.

Acute Kidney Injury↗
PubMed1996

Renal replacement therapy in the elderly.

BACKGROUND AND METHODS: In a retrospective study the medical records of 122 patients aged over 65 years at the start of renal replacement therapy (RRT) in our dialysis centre were analysed. RESULTS: The mean age at the start of RRT was 72.7 +/- 5.7 years (range 65.0-90.3). Seventy-six percent were treated with haemodialysis, 21% with haemofiltration and 3% with continuous ambulatory peritoneal dialysis. There was no significant difference in survival between the different modes of treatment. The median survival was 23.8 months, the actuarial survival rates at 2, 5 and 7 years were 50, 27 and 18%, respectively. Patients aged between 65 and 75 years had a median survival of 36.4 months, patients above 75 years of 12.5 months (P = 0.009). Patients with tubulo-interstitial nephritis had a significantly longer survival than patients with other renal diseases. When chronic obstructive pulmonary disease or peripheral vascular disease was present, there was a significantly shorter survival. There was no difference in survival between patients with malignancy, cardiac diseases, diabetes mellitus or cerebrovascular diseases before the start of RRT and others. After the start of RRT there was a significant increase of infectious and psychiatric disease. During the study period 70% died, most frequently from cardiovascular causes (28%), discontinuation of dialysis treatment (28%) or infection (19%). CONCLUSIONS: We think that both survival and quality of life in elderly patients during RRT are acceptable, and that neither age nor comorbidity should be a contraindication to RRT.

Age Distribution↗
PubMed1996

Deficient IgA1 immune response to nasal cholera toxin subunit B in primary IgA nephropathy.

Twelve IgA nephropathy (IgAN) patients and 18 controls were immunized with novel protein antigens, cholera toxin subunit B (CTB) via the nasal route and keyhole limpet hemocyanin (KLH) subcutaneously. Antibody secreting cells and antibody response in body fluids were determined by ELISPOT assay and ELISA, respectively. Analysis of variance showed, in contrast to controls (P < 0.001), no CTB-specific IgA response in the nasal washes of patients with IgAN. Significantly lower numbers of CTB-specific antibody-secreting cells in peripheral blood (P < 0.001) and CTB-specific antibodies in plasma (P < 0.005) were found in IgAN, both restricted to the IgA1 subclass. The proportions of CTB-specific IgA1-secreting cells in bone marrow aspirates correlated significantly with the corresponding ratios in plasma, with significantly lower values (P < 0.005) in IgAN as compared to controls. These results support the existence of a "mucosa-bone marrow axis" in humans, but no dysregulation of this axis was found in IgAN. The deficient mucosal IgA immune response to CTB observed in this study after primary mucosal immunization indicates that patients with IgAN have a defective immune response when challenged intranasally. These patients may depend on more frequent and/or prolonged antigen encounter at mucosal sites before efficient mucosal immunity is established. Repeated seeding of antigen-specific cells to secondary lympoid organs could result secondarily in the relative hyperresponsiveness found in IgAN upon reactivation by parenteral immunization.

Administration, Intranasal↗
PubMed1995

Immunoglobulin A subclass measurement in serum and saliva: sensitivity of detection of dimeric IgA2 in ELISA depends on the antibody used.

The existence of two IgA subclasses in humans has been reliably shown by biochemical, immunochemical and genetic means. IgA is unique among immunoglobulins in the regular occurrence of both monomeric and polymeric forms. In order to be able to study the relationship between monomeric and polymeric IgA1 and IgA2 concentrations in the circulation and mucosal compartment i.e. secretions, it is essential that the methods used are not biased by the molecular size of the IgA under investigation. We validated IgA and IgA subclass measurements in serum and saliva by sandwich enzyme-linked immunosorbent assay (ELISA). Coating reagents were specific mAbs against IgA (clone 4E8), IgA1 (clone 69-11.4) or IgA2 (clone 16-512-H5 and clone IF8.58). Pooled normal human serum and purified dimeric IgA1 (d-IgA1) or IgA2 (d-IgA2) myeloma proteins were used to standardize the assays. Polymeric and monomeric forms of IgA in sera from volunteers and patients with myelomatosis were assayed in fractions separated by high performance liquid chromatography (HPLC). Dithioerythritol (DTE) was used to determine the influence of the quarternary structure of IgA on its detection by mAbs. We found that mAbs 4E8, 69-11.4 and 16-512-H5 reliably measured d-IgA, d-IgA1 and d-IgA2 respectively, independent of the standard employed. Clone IF8.58 underestimated the concentration of d-IgA2 (correction factor +/- 2) with increased sensitivity in the presence of DTE. This difference is probably explained by the composition of the immunogen against which the mAb was raised. We conclude that no reliable conclusions can be made concerning the subclass ratio in biological fluids unless the monoclonal antibodies used have been appropriately validated.

Antibodies, Anti-Idiotypic↗
PubMed1994

Suppression of the immune response by nasal immunization.

Intranasal immunization results in both a mucosal and a systemic immune response in humans. Intranasal tetanus toxoid immunization in humans causes an increased serum IgA1 antibody response to tetanus toxoid following a subsequent intramuscular immunization. We hypothesized that intranasal priming with a novel protein antigen, keyhole limpet hemocyanin (KLH), would similarly result in an up-regulated systemic IgA response after a subsequent systemic immunization. To test this hypothesis, five healthy adults received a primary series of intranasal KLH immunizations followed 3 months later by a subcutaneous KLH immunizations Eight healthy adults received only a subcutaneous KLH immunization and served as controls. The nasal immunization resulted in a brisk and sustained serum IgM, IgA, and IgG antibody response and a mucosal IgA response. The subcutaneous immunization alone resulted in a serum antibody response and the development of delayed type hypersensitivity by skin testing. When the nasally primed subjects received a subsequent subcutaneous immunization there was a decline in the serum concentration of IgA and IgG antibodies to KLH. In addition, the nasally primed subjects failed to develop delayed type hypersensitivity to KLH following subcutaneous immunization. These data suggest that the nasal mucosa can induce a mucosal and systemic response; however, it may also suppress a subsequent immune response to systemic immunization.

Administration, Intranasal↗
PubMed1994

Binding of dimeric and polymeric IgA to rat renal mesangial cells enhances the release of interleukin 6.

The mesangium plays a crucial role in processes of inflammation in the kidney. Since deposits of IgA in the mesangium in patients with IgA nephropathy suggest a role for IgA in the inflammatory process, we investigated whether IgA is able to bind to cultured rat mesangial cells (MC) in vitro and induce activation of MC. As a source of IgA, monomeric (mIgA), dimeric (dIgA) and polymeric IgA-alpha-DNP (pIgA) rat monoclonal antibodies were used. FACS analysis indicated binding of dIgA and pIgA to MC while only a small percentage of the cells exhibited binding of mIgA. Additional experiments employing radiolabeled IgA revealed a time- and dose-dependent binding of 125I-dIgA and 125I-pIgA with 6 x 10(6) binding sites for dIgA with an affinity of 5.5 x 10(6) M-1 and 7.2 X 10(6) binding sites/cell for pIgA with an affinity of 1.2 x 10(6) M-1. As compared to 125I-dIgA and 125I-pIgA, little binding of 125I-mIgA to MC occurred; the binding of dIgA and pIgA was not influenced by excess cold BSA, IgG or asialofetuin. Since some studies have suggested that fibronectin might interact with IgA, the binding of IgA to MC in the presence or absence of fibronectin or the RGD fragment was also analyzed. However no influence of fibronectin or the RGD fragment on binding of dIgA and pIgA to MC was observed. As a measure for activation of MC by IgA, the production of IL-6 by MC was analyzed. Dimeric IgA and pIgA both induced a dose-dependent increase of IL-6 production by MC.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Intraperitoneal immunization of human subjects with tetanus toxoid induces specific antibody-secreting cells in the peritoneal cavity and in the circulation, but fails to elicit a secretory IgA response.

Five patients on continuous ambulatory peritoneal dialysis (CAPD) were immunized intraperitoneally with tetanus toxoid (TT) through an indwelling catheter. Four control patients on CAPD received the same dose of TT intramuscularly. Before immunization, virtually no anti-TT antibody-secreting cells (AbSC) were detected by the enzyme-linked immunospot (ELISPOT) assay in peripheral blood or peritoneal fluid from patients of either group. One to 2 weeks after immunization, high frequencies of TT-specific AbSC were detected in the circulation and peritoneal cavity. More than 80% of those cells were of the IgG isotype, with IgA accounting for most of the remainder. Patients receiving TT by the i.p. route showed significantly higher frequencies of specific IgG and IgA AbSC in the peritoneal cavity than patients immunized intramuscularly. Frequencies of AbSC in peripheral blood did not significantly differ between the two groups. Immunization with TT by both routes resulted in a significant increase of IgG anti-TT antibodies in serum, saliva and peritoneal fluid. A significant IgA antibody response was seen only in serum and peritoneal effluents. Therefore, i.p. immunization of human subjects with TT elicited both a localized response in the peritoneal cavity as well as a systemic response in serum, but did not induce a salivary IgA response.

Adult↗
PubMed1994

Immunological studies of IgA nephropathy in blacks reveal elevations of serum IgA2 as well as IgA1.

Although IgA nephropathy (IgAN) is recognized worldwide as the most common primary glomerulonephritis, the prevalence of this disease among American blacks is strikingly low despite the frequency of other renal disorders. We have previously described the clinical features of 27 black patients enrolled in a multicentre IgAN database; in this paper we report several immunological parameters of the disease in this population. Quantification of serum immunoglobulins revealed significantly higher concentrations of total IgA, IgA1 and IgA2 (P = 0.0001, 0.002 and 0.005 respectively) in the patients, but no significant increases in IgG or IgM. Examination of immunoglobulin synthesis by peripheral blood lymphocytes indicated relatively few differences in the secretion of immunoglobulins by patients compared to healthy American blacks. The spontaneous production of total IgA, IgA1, and IgA2 in patients was depressed compared to the control subjects (P = 0.02, 0.04, 0.03,), yet the ratio of IgA1:IgA2 was normal. Stimulation with pokeweed mitogen enhanced secretion of immunoglobulin in both subject groups. However, a significantly greater IgA1:IgA2 ratio was noted in the patients (P = 0.002). Circulating immune complexes containing C3 and IgA as well as C3 and IgM were elevated in the patients (P = 0.0006, 0.0003 and 0.02, respectively). These immunological aberrancies did not correlate with clinical manifestations of disease. These data suggest the immune abnormalities of black IgAN patients are similar to, but not identical with, those of white patients.

Adult↗
PubMed1994

Therapy of proliferative lupus glomerulonephritis: a prospective trial in The Netherlands.

Proliferative glomerulonephritis is a severe clinical manifestation of systemic lupus erythematosus, and it remains a major determinant of morbidity and mortality in this disease, despite the progress that has been made by treating patients with a combination of corticosteroids and cytotoxic drugs. Earlier controlled clinical trials have demonstrated the superior efficacy of a combination of pulse cyclophosphamide with steroids over treatment with steroids alone. However, cyclophosphamide carries a substantial risk of short-term and long-term toxicity in this predominantly young population, and previous trials have not convincingly shown any benefit over the milder treatment with a combination of azathioprine and steroids. We propose to conduct a Dutch multicentre trial to test whether similar renal survival can be achieved with an azathioprine-based regimen, compared to the widely used cyclophosphamide treatment, with a possibly lower risk of adverse effects.

Azathioprine↗
PubMed1993

Shared idiotypes in mesangial deposits in IgA nephropathy are not disease-specific.

The antigenic specificity of the mesangial IgA in IgA nephropathy (IgAN) remains unknown. Because shared antigenic specificities may be reflected in the usage of shared idiotypes, we prepared five monoclonal anti-idiotypic antibodies (MoAbs) specific for the mesangial IgA eluted from the kidney of an IgAN patient. All five MoAbs reacted with the same idiotype, which proved to be of a public nature. Although the idiotype could be identified in the mesangial deposits of the majority of IgAN patients studied, it was not specific for the disease because it was also found in the glomerular deposits of other types of glomerulonephritis. The idiotype was also expressed in polyethylene glycol precipitates of sera and in pokeweed mitogen-induced plasma cells from both IgAN patients and healthy controls. The conclusion that no disease-specific idiotypes are present in the renal eluate was further supported by the failure to produce polyclonal anti-idiotypic antibodies by immunizing a rabbit with the eluted mesangial IgA. Our results support the concept that mesangial IgA deposits in IgAN are of a polyclonal nature.

Antibodies, Monoclonal↗