PubMed · 8155049
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J C Javitt. 1994. Universal coverage and preventable blindness.. https://doi.org/10.1001/archopht.1994.01090160029011
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We correlated serum concentrations of soluble class I HLA antigens (S-HLA-I) with HLA allotypes in 82 unrelated Caucasian and 58 unrelated African-American putatively normal subjects, as well as in 31 individuals with stable, normally functioning liver transplants. Caucasian and African-American subjects with HLA-A23 or HLA-A24 were high secretors of S-HLA-I. We also observed that some HLA-A allotypes associated with high serum concentrations of S-HLA-I were ethnicity specific. HLA-A33 was associated with high S-HLA-I secretion in African-Americans but not in Caucasians. HLA-A29 was associated with high S-HLA-I secretion in Caucasians but not in African-Americans. All liver transplant recipients studied who were high secretors of S-HLA-I postoperatively carried HLA-A24 or HLA-A29. (There were no HLA-A33 or HLA-A23 allotypes in this group.) The "secretor genes," however, may be autogenous or allogenic (i.e., either donor or recipient HLA-A24 or HLA-A29 resulted in the observed high secretor status in liver transplant recipients after transplantation). It is noteworthy that serum S-HLA-I concentrations were low in all subjects with HLA-A2 regardless of whether the HLA-A2 was of recipient or donor origin. This finding suggests that HLA-A2 could have a suppressive effect on S-HLA-I secretion.
In 1993, a total of 2,268,553 deaths were registered in the United State--92,940 more than in 1992 and the highest number ever recorded (1). In addition, life expectancy at birth declined for the first time since 1980. This report characterizes mortality patterns in 1993 (the most recent year for which complete data were available) (1) and compares these with patterns in 1992.
OBJECTIVE: This study was designed to determine whether pregnancy and increasing parity in women with insulin-dependent diabetes mellitus (1) increases the risk for diabetic nephropathy and (2) accelerates the progression of diabetic nephropathy. STUDY DESIGN: The study included women with insulin-dependent diabetes mellitus who enrolled in our diabetes-in-pregnancy trial with a pregnancy that continued beyond 20 weeks' gestation and who were delivered between 1978 and December 31, 1991, to allow for a minimum of 3 years' follow-up. Pregnancy and follow-up information was obtained from the medical records and from our computerized database. For patients followed up elsewhere, information was obtained from their current physicians. Life-table analysis was used to determine (1) the risk for nephropathy developing de novo as a function of duration of disease and the association of this risk with parity and (2) the risk of renal failure developing in women with preexisting nephropathy and its association with parity. RESULTS: The study population included 182 pregnant women with insulin-dependent diabetes mellitus: 46 with overt nephropathy (group F) and 136 without nephropathy (group NF). Pregnancy and increasing parity did not increase the overall risk for nephropathy (44% after 27 years of diabetes). In group NF 10% had nephropathy within 10.1 +/- 4.2 years of the pregnancy. Proteinuria appearing during pregnancy and glycemic control during pregnancy were significantly associated with the subsequent development of nephropathy. In group F 26% had end-stage renal disease after a median period of 6 years from the pregnancy. Pregnancy or increasing parity did not increase the risk for renal failure in women with nephropathy. CONCLUSIONS: Our data support the premise that pregnancy in women with insulin-dependent diabetes mellitus does not increase the risk of subsequent nephropathy and does not accelerate progression of renal disease in women with preexisting nephropathy.