PubMed Health⌕ Search

Biomedical subjects

K Nicholls

Publications and source records attributed to K Nicholls.

15 recordsLinked to original sources
PubMed1992

Lupus nephritis and pregnancy.

Sixty-four pregnancies in 41 women with biopsy proven lupus nephritis between 1965 and 1991 were analysed to record fetal and maternal outcome and identify risk factors for poor outcome. Of 65 fetuses, 22 (34 per cent) were lost (including therapeutic abortions), 19 (30 per cent) were live born but premature (less than or equal to 36 weeks gestation) and 24 (37 per cent) were term. Fetal loss after 20 weeks gestation was 19 per cent. Twelve per cent of 25 fetuses whose birthweight was recorded were small for gestational age. Maternal renal function deteriorated in 19 per cent of pregnancies but was irreversible post-partum in only one woman (2 per cent). Hypertension was recorded in 44 per cent of pregnancies, developed early (less than or equal to 32 weeks gestation) in 28 per cent and was severe in 13 per cent. Treated hypertension predated 17 per cent of pregnancies and in 6 per cent (included in the overall incidence of hypertension) exacerbation occurred during pregnancy despite continued anti-hypertensive medication. Nine women (22 per cent) who developed de novo hypertension in pregnancy had permanent hypertension post-partum. Increased proteinuria was recorded in 48 per cent of pregnancies and was irreversible post partum in 5 per cent. Comparison of pregnancies occurring before or after diagnosis was made by renal biopsy failed to show any significant difference in fetal outcome. Pregnancies occurring after the diagnosis of glomerulonephritis were associated with a significantly lower incidence of maternal hypertension, early hypertension, severe hypertension and increased proteinuria. The presence of the circulating lupus anticoagulant was clearly associated with a significantly high fetal loss rate although the incidence of maternal complications did not differ significantly between mothers positive or negative for lupus anticoagulant.

Abortion, Spontaneous↗
PubMed1991

[IgA nephropathy in Chinese and Australian patients: a comparison between clinical and pathological features].

The clinical and pathological data were compared between 88 Chinese and 88 Australian patients with IgA nephropathy, whose age, sex and course of disease identified by renal biopsy were matched. Statistical differences showed: More Chinese patients had edema and loin pain, while more Australian patients had hypertension, glomerular sclerosis and arterial and/or arteriolar abnormalities; impairment of renal function correlated with crescent body formation and loin pain with severe hematuria were only found in Chinese patients, While correlations between severe hematuria and histological changes, hypertension and glomerular sclerosis, impaired renal function and glomerular sclerosis were only seen in Australian patients. Differences between the two groups in symptoms, histological changes and clinico-pathological correlations suggest that IgA nephropathy is a heterogeneous disease, it may result from more than one factor.

Adult↗
PubMed1990

Plasma exchange in progressive IgA nephropathy.

A therapeutic trial of plasma exchange was performed in 13 patients with documented progressive IgA nephropathy. Comparison of the rate of deterioration in renal function before, during, and after plasma exchange demonstrated significant improvement during plasma exchange. Seven patients had a slowed rate of deterioration by plasma exchange, but achieved a decrease in serum creatinine level. Favourable response was correlated with rapidity of deterioration preplasma exchange (P less than 0.01) and was apparent within 4 weeks of commencing therapy in those patients who responded. There was no overall difference between the deterioration rates pre- and postplasma exchange. In patients in whom creatinine decreased on plasma exchange, the initiation of subsequent dialysis was delayed.

Adolescent↗
PubMed1989

Polymorphs infiltrate glomeruli in mesangial IgA glomerulonephritis.

During episodes of macroscopic hematuria, patients with IgA nephropathy commonly have polymorphonuclear neutrophils (PMNs) as well as fibrin and mononuclear cells in glomerular capillaries. We quantitated PMN and macrophage infiltration in glomeruli of 54 patients with IgA nephropathy in whom renal biopsies were obtained within 30 days of macroscopic hematuria. Control biopsies (N = 22) were from patients with IgA nephropathy and urinary erythrocyte counts below 50,000/ml. PMN monocyte/macrophages were quantitated using the monoclonal antibodies FMC10 and HAM56, respectively. In patients with heavy hematuria, 45.9 +/- 3.4% (mean +/- SE) of glomeruli were positive for PMNs (control 10.5 +/- 2.8%, P = 0.001) with a mean PMN count/glomerulus of 1.10 +/- 0.20 (control 0.13 +/- 0.03, P = less than 0.001). 65.6 +/- 9.7%. Of the glomeruli were positive for monocytes in the heavy hematuria group (control 40.0 +/- 8.4, P less than 0.05) with the mean monocyte count per glomerulus being 1.6 +/- 0.2 (control 0.6 +/- 0.1, P less than 0.01). We conclude that, in the acute phase of mesangial IgA nephropathy, PMN and monocytes are present and presumably participate in glomerular injury.

Biopsy↗
PubMed1989

Advanced glycosylation end-products in experimental murine diabetic nephropathy: effect of islet isografting and of aminoguanidine.

The effects of islet isografting and of aminoguanidine on the accumulation of advanced glycosylation end-products (AGE) in renal basement membranes were studied in Streptozotocin (STZ)-induced diabetes mellitus in female BALB/c mice. The characteristic autofluorescence of glycosylated collagen was used to quantitate AGE. We studied the effect of islet isografting using 3 groups of mice, sacrificed at age 13 to 15 months: group A, untreated diabetes (STZ 250 mg/kg intravenously at age 6 to 8 weeks); group B, untreated diabetes for 7 months, then successfully grafted with cultured islet cells; and group C, age-matched normal control animals. At sacrifice, AGE were measured in digests of renal basement membranes as collagen-linked fluorescence/unit of hydroxyproline. Group A animals had significantly greater renal basement membrane glycosylation than did the other 2 groups, (group A median 88.0 arbitrary units/mumol hydroxyproline, range 30.2 to 127.5; group B median 19.4, range 5.1 to 56.8; group C median 2.9 range 0-13.5; p = .001 A versus B). To study the effect of aminoguanidine, 4 groups of animals were used: group 1, untreated diabetics (STZ 250 mg/kg intravenously at age 6 to 8 weeks); group 2, diabetics treated with aminoguanidine 50 mg/kg intraperitoneally daily; group 3, age-matched control animals, and group 4, age-matched controls treated with aminoguanidine. At sacrifice after 7 months, AGE were measured in digests of renal basement membranes as collagen-linked fluorescence/unit of hydroxyproline. Aminoguanidine significantly attenuated the accumulation of AGE in diabetic mice (group 1 median 47.2 arbitrary units/mumol hydroxyproline, range 16.1 to 56.0; group 2 median 24.4, range 5.0 to 37.7; group 3 median 13.6, range 0 to 30.3; group 4 median 10.8, range 2.1 to 17.2; p less than 0.01, groups 1 versus 2). These results indicate that further basement membrane glycosylation is prevented by restoration of euglycemia by islet grafting after a significant duration of diabetes, and that aminoguanidine prevents AGE accumulation despite hyperglycemia.

Animals↗
PubMed1989

Expression of complement 3 receptors (CR1 and CR3) on neutrophils and erythrocytes in patients with IgA nephropathy.

Expression of C3 receptors (CR1 and CR3) on neutrophils (PMN) was measured in 26 patients with IgA nephropathy (IgA N), 17 normal persons, and 8 patients with non-IgA glomerulonephritis (non-IgA GN) by fluorescence activated cell sorting after labeling with monoclonal antibodies. Mean channel fluorescence for both CR1 and CR3 on PMN was significantly higher in IgA N patients than in either control group (p less than 0.01). (CR1 mean +/- SD 42.5 +/- 10.4 in IgA N, 31.7 +/- 11.5 in normal controls, 27.8 +/- 9.0 in non-IgA GN; CR3 94.0 +/- 16.5, 75.0 +/- 16.6 and 76.7 +/- 15.6, respectively.) No differences were found between the two control groups or between IgA N patients with normal and impaired renal function. These results imply that PMN are activated in IgA N patients. The expression of CR1 and CR3 of PMN may be upregulated by immune complexes (ICs), enhancing both phagocytosis of C3b- or iC3b-coated particles, and absorptive pinocytosis of soluble ICs containing C3b or iC3b. Erythrocyte CR1 and CR3 expression was measured by ELISA and found to be slightly but significantly lower in IgA N patients than in the other 2 groups (CR1 85.3 +/- 28.4 in IgA N, 113.1 +/- 28.8 in normal controls, 109.4 +/- 28.2 in non-IgA GN, p less than 0.02; CR3 80.9 +/- 20.0, 100.4 +/- 19.9, 101.2 +/- 24.9, respectively, p less than 0.05).

Adult↗
PubMed1987

Antithymocyte globulin therapy for pure white cell aplasia.

Severe neutropenia due to selective loss from the bone marrow of cells of the entire neutrophil maturation sequence developed in a patient with Goodpasture's Syndrome and was associated with serious infections complicating continuous ambulatory peritoneal dialysis. Involvement of T-lymphocytes in the process affecting the neutrophil series was implicated by the relation between recovery from neutropenia and treatment with antithymocyte globulin (ATG). Azathioprine and corticosteroid administration failed to sustain recovery from neutropenia induced by ATG. It is concluded that ATG can provide a nonmyelotoxic form of therapy for pure white cell aplasia whose effectiveness is independent of responsiveness to other immunosuppressive agents.

Adult↗
PubMed1985

"Malignant" IgA nephropathy.

Most patients with mesangial IgA nephropathy who run a progressive course usually do so over a period of 10 to 20 years. This paper describes the course of three young men with similar presenting features and biopsy findings who progressed to end-stage renal failure in less than 4 years from presentation, even though initially all had serum creatinine levels that were in the normal range. They presented with macroscopic hematuria, which has previously been regarded as an indicator of a favorable prognosis, and all three had loin pain, constantly elevated urinary erythrocyte counts, and crescents in renal biopsies. In two cases, treatment appeared to be associated with stabilization of renal function, but deterioration to end-stage renal failure occurred rapidly after treatment was ceased.

Adolescent↗
PubMed1979

Massive adrenal haemorrhage complicating adrenal neoplasm.

Two patients presented to hospital with clinical features of acute retroperitoneal haemorrhage. In each case, laparotomy revealed massive adrenal haemorrhage, and histological evidence of underlying neoplasia was eventually found.

Adrenal Cortex Neoplasms↗