Is Serum Transforming Growth Factor beta-1 Superior to Serum Creatinine for assessing Renal Failure and Renal Transplant Rejection.

A sustained overexpression of Transforming Growth Factor beta1 (TGF beta1), a cytokine has been implicated in the pathogenesis of fibrosis of kidney leading to end stage . The main aim of present study was to find the utility of TGF beta1 and serum creatinine in differentiating chronic renal failure (CRF) from acute renal failure (ARF), renal transplant rejection (Tx Rej) and stable renal transplant (Tx Stb) and to study has attempted histopathological correlation of rejection cases with TGF beta1 and serum creatinine. TGF beta1 was determined by using ELISA and serum creatinine was done by autoanalyser. In normal healthy controls (NHC), in majority of cases (80.0%) TGF beta1 was below 25 ng/ml while in 6.0% cases it was upto 34 ng/ml. Rise of TGF beta1 was significant in CRF patients as compared to ARF and NHC (p<0.05) .In rejection cases, TGF beta1 level was significantly raised as compared to NHC and stable graft cases (p<0.05). In rejection cases, it was raised above 40 ng/ml in only 50% cases. In two cases inspite of more than 70% glomerular fibrosis, the patient had TGF beta1 level of only 5 ng/ml and in other three cases of acute cellular rejection the level was 70, 35 and 28 ng/ml respectively.Contrary to it serum creatinine was raised above 2 mg/dl in all cases of transplant rejection but in stable transplant cases in majority (70.6%) it was below 1.5 mg/dl and in 5 cases it was between 1.5 – 1.9 mg/dl.Thus the study suggests that TGF beta1 may not be a good marker for chronic transplant rejection, as it does not correlate well with glomerular fibrosis, probably it is more associated with interstitial inflammation but it can differentiate CRF from ARF if cut off of 40 ng/ml is taken.

Mesangioproliferative glomerulonephritis: an important glomerulonephritis in nephrotic syndrome of young adult.

Mesangioproliferative glomerulonephritis (MesPGN) consists 10% of the total renal biopsy of glomerulonephritis. Aim of the present study was to find out clinicopathological changes in MesPGN and differences between diffuse and focal variety. MesPGN was seen mostly in young adults with mean age of 28.63 years for males and 26.3 years for females. Male predominance was noted (M:F ratio - 1.4:1). About 70.83% patient presented with edema feet, followed by hypertension (29.19%), fever (16.66%), oliguria, nausea and vomiting (10.41%). Urine analysis in 50 patients revealed that 70% patients presented with nephrotic-range proteinuria, 36% patients with microscopic hematuria and 56% patients with leukocyturia. Statistically, no significant difference was found in clinical features of diffuse and focal MesPGN. Microscopic comparison between diffuse and focal variety showed that significant increase of focal glomerular basement membrane thickening, focal endothelial cell proliferation, focal smooth muscle hyperplasia, hyaline sclerosis and vasculitis was more common in diffuse variety. In focal variety, Capillary loop congestion, periglomerulitis, cloudy swelling and vacuolar degeneration in tubules were significantly more as compared to diffuse variety. Details of the clinical features, special laboratory tests and histological details revealed that diffuse variety had systemic diseases, which included Wegner's granulomatosis, microscopic polyangitis, Henoch's schonlein purpura, systemic lupus erythematosus (two cases) and one case each of Kimura's disease, pyelonephritis and tuberculosis. Only one case of focal MesPGN showed tuberculosis. Thus, our study concludes that MesPGN is an important cause of nephrotic syndrome among young adults. Secondly, search for some other diseases should be made and thirdly, if biopsy shows focal mesangial cell proliferations in minimal change glomerulonephritis (MCGN), it should be diagnosed as focal MesPGN rather than MCGN because these cases show recurrences.

Myeloma in young age.

Total 14 cases of myeloma in young age group (<40 years) have been reported out of 178 cases of myeloma in a time period of 7 years (1993-1999). Males predominated overfe males. Like adult myeloma, patients presented mostly with the backache, pain in pelvis, lower spine and weakness in about 60% of cases followed by swelling of bone in 40% of cases. One case presented with bleeding gum, malena and hepatosplenomegaly and was diagnosed as plasma cell leukemia. Radiological examination revealed lytic lesion in almost all the cases with fracture femur and rib in 28.57% of cases. Anaemia and raised ESR was noted in all the cases. Myeloma typing revealed IgG myeloma in 10 cases, light chain myeloma in 3 cases and IgA myeloma in one case. None of the patient was traceable after 2 years. Thus our study concludes that myeloma in the young age in India occurs in increased frequency and clinically presents just like adult and elderly myeloma, but serologically are predominantly of IgG type. There is also an increased frequency of solitary plasmacytoma as compared to adult myeloma.

Evaluation of cellular immunity in diabetic uraemics by cutaneous response to recall antigens and 2:4 dinitrochlorobenzene and T-cell rosette formation.

Twenty diabetic uraemics and twenty two healthy matched controls comprised the material for this study. Cell mediated immunity was assessed by estimation of T-cell rosette percentage and cutaneous response to recall antigens--purified protein derivative, candida antigen and 2:4 dinitrochlorobenzene. Results analysis revealed depressed cell mediated immunity in diabetic uraemics in the form of impaired cutaneous response to recall antigens and reduction in T cell rosette percentage, in comparison to controls.

Ascorbic acid status in uremics.

Plasma levels of ascorbic acid (AA) and dehydroascorbic acid (DHA) were estimated in 27 patients of end stage renal failure (ESRF) on standard conservative therapy (group A) and 9 patients of ESRF on maintenance haemodialysis (MHD; group B). Fourteen healthy subjects matched for age and sex served as control (group C). The dietary intake of vitamin C was significantly decreased in group A than in group B compared to control. Similarly, plasma AA was significantly lowered to 0.801 +/- 0.283 mg per cent in group A compared to 1.421 +/- 0.47 mg per cent in control. While it was just lowered to 1.058 +/- 0.272 mg per cent in group B. Although plasma level of DHA was raised to 0.243 +/- 0.486 mg per cent and 0.166 +/- 0.54 mg per cent in groups A and B respectively, the increase was not statistically significant. In our present study, the DHA/AA ratio was found to be inversely proportional to the plasma AA. Further, this ratio has been claimed to be a better indicator of overall reducing atmosphere (i.e., profile of vitamin C) of the body.

Hepatic changes during short-term haemodialysis.

Twenty five patients with end stage renal disease were studied to find out the biochemical and hepatic morphological changes during short term haemodialysis. Asymptomatic hepatomegaly was seen in 32% of cases, transaminase elevation in 28% and positive Australia antigen in 12% of cases. Histopathological changes were observed in all the 12 patients in whom liver biopsy was done. Ten patients (82%) exhibited multiple abnormalities. The commonest findings were fatty change (8 patients); hepatic congestion, focal necrosis, Kupffer cell hyperplasia (6 patients each); and portal triaditis (5 patients).

Pre-cancerous lesions of stomach.

Total 39 cases of carcinoma stomach were noticed out of 142 malignant tumours of GIT (27.46 percent). Histologically maximum cases were of diffuse type (56.41 percent) followed by intestinal type (35.89 percent) and indolent mucoid carcinoma (7.69 percent) of the stomach. The surrounding epithelium showed lot of changes in the intestinal type of carcinoma stomach. About 78.57 percent showed intestinal metaplasia, 14.28 percent of these cases showed chronic gastric ulcer and severe dysplasia (carcinoma in situ) and another 14.28 percent revealed villous adenoma with carcinoma in situ. In contrast to this, in diffuse variety, only 13.63 percent cases revealed intestinal metaplasia, 27.27 percent showed basal cell hyperplasia, stratification of the epithelium of crypts and diffuse infiltration of mucosa by malignant cells and 4.54 percent showed atrophic gastritis also. In mucoid carcinoma all cases had basal cell hyperplasia and stratification of crypts. Hence these conditions should be taken as premalignant lesions of stomach and should be cured in proper time.

Clinicopathological studies of carcinoma oesophagus with special reference to changes in surrounding epithelium.

A total 17 cases of carcinoma oesophagus were studied in a period of 2 years. Ten patients (58.82%) were males and rest were females. Maximum cases (64.70%) were seen in 5th and 6th decades. Majority of the patients belonged to low socio-economic group (47.05%) followed by middle socio-economic group (41.17%). Dysphagia was present in all cases, followed by weight loss 52.94% and other symptoms. Cancer was equally distributed in middle third and lower third of the oesophagus (41.18% in each group) only in 3 cases it was in upper third of the oesophagus. Histologically 70.5% tumours were squamous cell carcinoma, 17.64% were adenocarcinoma and 11.76% were undifferentiated carcinoma. Surrounding epithelium in 17.64 per cent cases showed chronic oesophagitis, 4 cases (23.52%) showed acanthosis and dysplasia, and two cases revealed carcinoma in situ. Hence findings of oesophagitis, acanthosis, dysplasia, carcinoma in situ suggest that oesophagitis and acanthosis may be considered as precancerous lesions.

Bedside urinalysis in untreated leprosy patients.

The study included 53 patients of untreated leprosy attending University Hospital, Banaras Hindu University during study period of 1 1/2 years. The various types of leprosy included 9,14,16 and 14 cases of tuberculoid, borderline, lepromatous and leprosy with type II reaction respectively. Majority of the patients were below the age of 49 years with male preponderance. 66.04% of patients came from the rural area. Painful micturation (dysuria) (13.20%) was the commonest urinary complaint recorded on enquiry. Specific gravity of urine did not show any change. Abnormal proteinuria was noted in 16.98%, 11.32%, 7.54% and 3.77% of patients of leprosy with reaction, lepromatous, borderline and tuberculoid group respectively. Significant haematuria, pyuria and epithelial cells were noted in all the groups. Haematuria was recorded in focal segmental Glomerulonephritis (GN), mesangioproliferative and diffuse endocapillary Glomerulonephritis (GN) incidence of which was 7.89%, 7.89% and 5.26% respectively in the biopsy tissue. Significant pyuria was noticed in all the groups except minimal change GN.