Polymorphism of the angiotensin converting enzyme gene and clinical aspects of IgA nephropathy.

To investigate the relationship between the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene and the onset and progression of IgA nephropathy, we studied this polymorphism in 48 patients (21 males and 27 females) with IgA nephropathy and 104 normal controls (51 males and 53 females) using the polymerase chain reaction method. There was no difference in either the genotype or allele frequency of the I/D polymorphism between the patients and normal controls (D allele frequency; 0.303 and 0.325, respectively). But, the mean slope of the reciprocal of the serum creatinine concentration was significantly steeper (p < 0.05) in the patients with the D allele (-0.0104 +/- 0.007 dl.mg-1.month-1) than those without the D allele (-0.0055 +/- 0.008 dl.mg-1.month-1). The mean percentage of the glomeruli with sclerosis or segmental lesions obtained from each renal biopsy specimen was significantly larger (p < 0.02) in the patients with the D allele (49.5 +/- 17.8%) than in those without (33.3 +/- 22.9%). These results suggest that 1. the ACE gene polymorphism is not related to the onset of IgA nephropathy, but 2. the progression of IgA nephropathy may be influenced by the polymorphism which may be involved in glomerular hypertension.

Abrupt-onset diabetes mellitus in the elderly.

We present three elderly Japanese patients with abrupt onset of diabetes mellitus: a 61-year-old male with a complete defect of insulin secretion without insulin resistance, a 60-year-old male with an incomplete defect of insulin secretion associated with insulin resistance, and a 69-year-old female with a complete defect of insulin secretion and insulin resistance. The findings in these cases indicate the heterogeneity in insulin secretion and sensitivity of abrupt onset diabetes mellitus in the elderly. The changes in insulin secretion and sensitivity over time due to glucose toxicity may at least partially explain the heterogeneity.

[A case of IgA nephropathy associated with psoriasis vulgaris].

Nephrotic syndrome due to IgA nephropathy was found in a 45-year-old man with psoriasis vulgaris. He was first diagnosed as psoriasis vulgaris at 20 years age and had exhibited proteinuria since 37 years of age. Recently, he developed nephrotic syndrome with unfavorable progression of psoriasis. The conditions of psoriasis and nephrotic syndrome were consistently parallel, and both diseases responded to corticosteroid therapy. The specimens from renal biopsy showed mesangial proliferative glomerulonephritis and sclerosis with mesangial deposition of IgA. Therefore, we diagnosed this case as IgA nephropathy. Twelve cases with chronic glomerulonephritis associated with psoriasis vulgaris have been published. All biopsied specimens from these cases showed mesangial deposition of IgA. Immune abnormalities have been reported in both diseases. The pathogenesis of psoriasis vulgaris and IgA nephropathy may be related through an immune mechanism.