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 R Coppo.
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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.
Results observed during short-period dialysis management lasting 8 months in 80 patients are presented. There was no significant change in blood chemistry and clinical pictures, through intra- and interdialytic well-being improved. Six, out of 33 patients and to be transferred from 12 hr per week to more prolonged treatment periods due to the rapid onset of sub-dialysis symptoms. No patients receiving 15 hr per week required such a change. The reasons for failure in these six subjects are discussed, together with the indications for a choice of 12 or 15 hr periods.
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.
A sealed compartment recycling system has been created for use with Extracorporeal commercial filters in order to exploit the negative pressure of the dialysate for purposes of ultrafiltration. The results of in vivo and in vitro tests regarding ultrafiltration and dialysates of urea, creatinine, Hipaque I125 and vit. B12 Co57 are reported. The tests highlighted improved dehydration characteristics in the system compared with the traditional coil technique, while the dialysates of small and medium molecules showed no decrease. The system can profitably be used as an alternative to the open compartment coil system and is particularly interesting because it can be combined with monitors which provide exclusively for the use of closed circuit dialysate instruments.
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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