Biomedical subjects
Publications and source records attributed to C D Short.
A further case of reactive arthritis following Campylobacter jejuni enteritis is reported. The interim results of a small prospective study are discussed. It may be desirable to do serological studies for campylobacter infection in the investigation of mono- or polyarthritis of acute onset.
In a series of 60 patients with idiopathic membranous nephropathy (IMN), 8 subjects, aged 16-65 years at presentation, suffered spontaneous relapse of proteinuria after remissions of 25 months to 30 years. Renal biopsy was performed at the time of relapse in 5 cases and revealed histopathology identical to that of the original lesion. Eight courses of immunosuppressive therapy given to 6 patients did not affect either the appearance or duration of remission or relapse. No patient had a familial tendency to renal disease. Immunogenetic markers, HLA A, B and DR, did not distinguish those who relapsed from other patients with IMN. At the end of the study, 3 patients were in a second remission, one had died of myocardial infarction during relapse, 3 remained nephrotic and one had mild renal insufficiency but no proteinuria. As compared with the rest of the series the overall prognosis was not influenced by the relapses.
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Myeloma and monoclonal gammopathies can affect the kidney in many ways with cast nephropathy and light chain deposition disease being the most commonly recognised histological entities. Renal transplantation in these patients remains controversial both because of the risk of recurrent disease affecting the graft and also because of concerns around the possibility of disease relapse within the patient. We suggest that the histological pattern of disease within the native kidneys is crucial in the overall assessment of these patients for renal transplantation. Those patients in whom renal deposition of light chains is associated with a proliferative glomerulonephritis have a considerably worse graft survival than those presenting with cast nephropathy.