Are circulating immune complexes and complement breakdown products useful for the detection of disease activity in nephrology?
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Biomedical subjects
Publications and source records attributed to F Quarello.
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Together with other forms of self-dialysis (including limited assistance and self-service), home dialysis keeps down cost to much lower levels than those ruling within the hospital. Self-management, which is a common factor of various types of extra-hospital dialysis, also enables the patient to fit in better to society and, in the majority of cases, offers complete working rehabilitation by way of deeper consciousness of his disease and of the various treatments for it. Personal experience of home dialysis covering 6 years activity in the sector is reported. 91 patients have been trained in self-management and 65 of these have already been sent home or are about to be. The most important problems tackled over this period are examined and the experience analysed. Particular reference is made to clinical, organizational and management problems. The paper thus forms a practical guide for those wishing to direct their efforts towards a home dialysis programme.
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A series of patients with acute renal failure (ARF) and acute abdomen collected by the St. John the Baptist Hospital's Nephrology and Dialysis Division over the period 1970-75 is examined. A high rate of mortality was noted, due to causes that were mostly independent of ARF Death was often related to failure to resolve acute abdomen. The progression of ARF appeared to be related to that of the abdominal affection with prompt resolution of the latter. These findings suggest that constriction of the afferent arteriole may offer a partial, functional basis for ARF with the corollary that it has a good chance of being reversed, even after protracted periods of anuria. Renal complications associated with disseminated or localised intravascular coagulation appear to be rare. Treatment was best directed to early and frequent dialysis, with surgical resolution whenever indicated, irrespective of the presence of ARF.
Serum samples from 115 patients with various kidney disease were studied by means of precipitation in 3.5% polyethylene-glycol (the PEG test) and by inhibition of agglutination of IgG-coated polystyrene particles induced by C1q, two tests developed for the detection of circulating immune complexes. Positive results were found in acute glomerulonephritis, particularly in its early stages, and also in chronic forms of glomerulonephritis: membranous, focal sclerosing, mesangiocapillary and focal glomerulonephritis. High levels of circulating immune complexes were found in lupus nephritis. In most cases the test results showed a good correlation with the clinical course of the diseases.
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