Bacterial variants in urinary casts and renal epithelial cells.

Casts with numerous and unusually large granules were seen in the urine of a child with renal Fanconi's syndrome. When the urine sediment was sealed under a coverslip for several days, many granules changed to filamentous bacterial variants that segmented and, finally, appeared as streptococcal-like forms. When the patient's blood was cultured by a special method, bacterial variants grew consistently, and frequently reverted to parent coccal forms, although conventional cultures were negative. Variants from blood cultures had the same morphology and staining properties as granules in casts and in cystic structures found within hypertrophied renal pelvic epithelial cells. Cryptic parasitization with bacterial variants probably occurs in many nephropathies. Variants are known to produce toxins and immunogens, which could lead to mesangial and basement membrane deposits as well as to occlusive reactions in the renal microcirculation.

Quantitative renal scintillation camera studies in renal transplantation.

Renal transplant recipients and donors were studied serially with quantitative renal scintillation camera studies utilizing 131I-Hippuran and 99mTc-Iron ascorbate. This study allows for determination of effective renal plasma flow (ERPF), glomerular filtration rate (GFR), filtration fraction (FF), and predicted return in ten minutes. A drop in FF occurred with, or preceded clinical rejection; whereas, an increase in FF occurred with acute tubular necorsis (ATN) caused by preservation injury, aminoglycosides, and following acute rejection. Combined with the other parameters of renal function determined by this technique, FF alterations proved useful in the differentiation of ATN from rejection and in predicting the prognosis of renal homografts.

Vasectomy in rhesus monkeys I. Surgical techniques and gross observations.

Vasectomy and vaso-occlusion techniques were used in 47 male rhesus monkeys to maximize and minimize the amount of sperm allowed to escape from the vas into surrounding tissues for up to seventy-two weeks postoperatively. Body weight changes and blood clinical data indicated that the general health of all the monkeys remained good. Normal seasonal changes in body weights and testicular volumes suggested that there were no disturbances to the endocrine system and that the monkeys remained responsive to seasonal environmental stimuli. Vasectomy appears to cause no short-term deleterious effects in the rhesus monkeys, based on observations made during the seventy-two weeks that these monkeys were study after vasectomy. This conclusion agrees with the findings of other investigators.

Vasectomy in rhesus monkeys. III. Light microscopic studies of testicular morphology.

Rhesus monkeys were randomly assigned to undergo various surgical procedures. The animals were followed from one to sixty-six weeks postvasectomy, at which time they were sacrificed and their tissues prepared for light and electron microscopy. Vasectomy in the rhesus monkey, as in certain other species, appears to be a procedure not attended with widespread testicular atrophy or histologic evidence of impaired spermatogenic potential utilizing the procedures and postoperative periods studied. Why certain animals exhibited focal degenerative changes is unclear; perhaps a certain population, yet to be defined, is more sensitive to such procedures, resulting in testicular alterations. It is important that such a population and such changes be defined to predict more accurately the possibility of successful vasovasostomy and reestablishment of fertility.

Computed radionuclide urogram for assessing acute renal failure.

The computed radionuclide urogram is advocated as a noninvasive diagnostic method for differentiation of the most common prerenal, renal, and postrenal causes of acute renal failure. On the basis of characteristic changes in the effective renal plasma flow rate, the calculated filtration fraction, and the calculated glomerular filtration rate, prerenal conditions such as renal artery stenosis or thrombosis, renal conditions such as acute rejection or acute tubular necrosis, and postrenal conditions such as obstruction or leakage, which are the most common causes of acute renal failure, can be differentiated. In conjunction with morphologic criteria derived from sonograms, a diagnosis with acceptable confidence can be rendered in most instances. Both the computed radionuclide urogram and sonogram are noninvasive and can be used without adverse effects in the presence of azotemia and even anuria. This also makes feasible reexamination at intervals to assess effect of therapy and offer prognostic information.

Novel bacterial structures in human blood: cultural isolation.

Evidence for the existence of a novel bacteriological system has been obtained from osmotically lysed and filtered human blood (membrane filters with a pore size of 0.22 micronm) placed in special culture media. These blood filtrates gave rise to ordinary bacteria for 71% of the blood specimens processed from diseased humans and for 7% of those from supposedly normal humans. Morphologically, the bacteria resembled streptococcal, staphylococcal, and gram-positive filamentous (cocco-bacillary) forms. Prior to the appearance of bacteria in the media, large and small "dense bodies" were microscopically observed but disappeared when ordinary bacteria were apparent, Cultures of of unlysed blood as conventionally performed were negative. These organisms may represent an adaptation of certain bacteria to life in the blood.

Individual renal plasma flow determination in 2 minutes.

A method is described for determining effective renal plasma flow, using the renal counts 1 to 2 minutes after injection and applying background subtraction as a ratio to the total amount of radio-activity injected intravenously with appropriate correction for kidney depth. It appears that this simple approach for determination of effective renal plasma flow within a matter of 2 minutes is accurate and reliable, and should be useful for a number of applications when it is important to determine total and individual renal plasma flow. The approach is recommended as a screening procedure in lieu of the determination of blood urea nitrogen and serum creatinine, with the additional advantages of gross morphology and determination of individual renal plasma flow in an absolute as well as relative manner.

Individual renal plasma flow determination in 2 minutes.

A method is described for determining effective renal plasma flow, using the renal counts 1 to 2 minutes after injection and applying background subtraction as a ratio to the total amount of radioactivity injected intravenously with appropriate correction for kidney depth. It appears that this simple approach for determination of effective renal plasma flow within a matter of 2 minutes is accurate and reliable, and should be useful for a number of applications when it is important to determine total and individual renal plasma flow. The approach is recommended as a screening procedure in lieu of the determination of blood urea nitrogen and serum creatinine, with the additional advantages of gross morphology and determination of individual renal plasma flow in an absolute as well as relative manner.

Novel bacterial structures in human blood. II. Bacterial variants as etiologic agents in idiopathic hematuria.

Novel bacterial structures have been demonstrated in lysed blood filtrates placed in special culture media from patients with idiopathic hematuria. These structures converted rapidly to gram-positive coccal (streptococcal and staphylococcal-like) coccobacillary and filamentous, bacterial forms in vitro from 96 per cent of the patients studied. Blood cultured conventionally yielded negative findings. Although structures (dense bodies) were demonstrated in normal control blood specimens (albeit in lesser numbers) few converted to classical bacteria in vitro (7 per cent). Erythromycin therapy appeared to correlate with disappearance of hematuria and inability to revert rapidly the variant froms to classical bacteria in vitro. It is suggested that continual bombardment of the blood by bacteria entering from the mouth or other sites may lead to the development of variant bacterial parasitism. In an effort to survive the deleterious host effects the organisms may convert to persisting osmotically stable variant bacterial forms (dense bodies). Development of a disease state may be conditioned by some existing or developing abnormality in the host (immunologic, physiologic and/or biochemical). Furthermore, changes (genetic?) that might take place in the organisms per se during their transition to variant forms and adaptation to life in vivo may not allow certain host environments to adapt to these new forms, possibly leading to a pathogenetic role in renal diseases whose etiologies have long been enigmas.

Novel bacterial structures in human blood. II. Bacterial variants as etiologic agents in idiopathic hematuria.

Novel bacterial structures have been demonstrated in lysed blood filtrates placed in special culture media from patients with idiopathic hematuria. These structures converted rapidly to gram-positive coccal (streptococcal and staphylococcal-like), coccobacillary and filamentous, bacterial forms in vitro from 96 per cent of the patients studied. Blood cultured conventionally yielded negative findings. Although structures (dense bodies) were demonstrated in normal control blood specimens (albeit in lesser numbers) few converted to classical bacteria in vitro (7 per cent). Erythromycin therapy appeared to correlate with disappearance of hematuria and inability to revert rapidly the variant forms to classical bacteria in vitro. It is suggested that continual bombardment of the blood by bacteria entering from the mouth or other sites may lead to the development of variant bacterial parasitism. In an effort to survive the deleterious host effects the organisms may convert to persisting osmotically stable variant bacterial forms (dense bodies). Development of a disease state may be conditioned by some existing or developing abnormality in the host (immunologic, physiologic and/or biochemical). Furthermore, changes (genetic?) that might take place in the organisms per se during their transition to variant forms and adaptation to life in vivo may not allow certain host environments to adapt to these new forms, possibly leading to a pathogenetic role in renal diseases whose etiologies have long been enigmas.

Determination of filtration fraction using the gamma scintillation camera.

A simple technique for determining effective renal plasma flow, filtration fraction and filtration rate is described. The determination depends upon the use of 131iodine labeled hippuran and 99mtechnetium labeled iron ascorbate or Sn diethylenetriaminepentaacetic acid. The filtration fraction is determined by dividing the corrected uptake for the technetium compound by the corrected uptake for radiohippuran. The uptake is simply determined by the 1 to 2-minute count over the kidneys with background subtraction and taking into account the amount injected. The technique is simple, quick and appears to be a useful clinical tool.