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 G Piccoli.
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Neutrophils (PMN) appear to be involved in inflammatory phenomena as a result of direct interaction with immune complexes (IC). In SLE glomerulonephritis IC are fixed in vivo on the PMN surface through the receptors for FC fragments of complexed immunoglobulins and complement. Phagocytic properties are lost and immunological lysosomal release in vitro is markedly reduced by virtue of receptor occupation. The elimination of neutrophil cationic proteins (NCP) in urine is an expression of PMN lysosomal constituent release.
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.
A case of immune-complex glomerulonephritis with membrano-proliferative patterns in a patient with mixed IgG-IgM cryoglobulinemia has been investigated; particular attention has been payed to histological immunofluorescence, histochemical and electron microscopical findings in order to elucidate the nature of the intraluminal thrombi. The so called thrombi, strongly positive for IgG and IgM with the immunofluorescence, appeared to be clusters of mononuclear cells which, for their ultrastructural and histochemical (non-specific esterase activity) patterns have been considered as monocytes. They showed cytoplasmic vacuoles containing microtubular structures; the latter have been detected free in the capillary lumina and in the basement membranes as well. These structures have been considered as the ultrastructural counterpart of the IgG-IgM immune-complexes responsible of the nephropathy. Monocytes have been hypothesized to play a pathogenetical role, acting as cleaners of the cryoprecipitate from the capillary lumina.
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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