Lupus nephritis. Experience with 230 patients in a private practice from 1950 to 1980.

Nephritis developed in 230 of 609 private patients with systemic lupus erythematosus (SLE) (38 percent) followed up from 1950 to 1980. Eighty-seven percent of patients with nephritis were female; 71 percent were Caucasian. They were observed a mean of 10 years. Five- and 10-year survival rates were 80 percent and 65 percent, with improvement to 86 percent and 76 percent in the last decade. Normalization of urinary sediment and protein levels, blood pressure and serum albumin levels correlated with improved survival and tended to occur during the first year. Life-threatening complications of SLE were more common after the onset of nephritis but decreased as renal function worsened. Infection was the most frequent cause of death in the last decade. Forty-four patients received nitrogen mustard; 55 percent of the courses were followed by significant improvement in renal function and reduced steroid dosage. Control of the disease was associated with improved long-term survival of patients with SLE.

Systemic lupus erythematosus--survival patterns. Experience with 609 patients.

Six hundred nine private patients with systemic lupus erythematosus were followed up for a mean of ten years. Ninety percent were female; 79% were white. Three hundred sixty-nine received diagnosis before 1970, and 234 after. Three hundred seventy-nine did not have nephritis; 230 did. The overall ten-year survival was 79% (87% without nephritis, 65% with nephritis). Male patients did consistently worse than female patients. No overall white vs nonwhite difference was noted. The presence of nephrotic syndrome at the onset of nephritis was a poor prognostic sign, but its development later was not. Patients younger than 16 years without nephritis have an excellent prognosis. One hundred twenty-eight patients died (82 with nephritis, 46 without nephritis). The most common causes of death were renal disease and sepsis. Improved survival of this series may reflect closer follow-up, better nutritional status, and treatment at earlier stages of disease.

Glomerular IgE deposits in patients with lupus nephritis.

The presence of glomerular IgE deposits (IgE+) and its prognostic significance were examined in 241 patients with various renal diseases. 24 patients (10%) had IgE+, and nephrotic syndrome was present in 22 (92%). 17 of the 24 patients with IgE+ had lupus nephritis. These patients were compared with another group of 32 patients with lupus nephritis, but without IgE deposits (IgE-). Light and electron microscopy showed more severe pathological changes in those with IgE+ than in patients who were IgE-. The number of patients who displayed deterioration in renal function was greater in the former group than in the latter (70 vs. 31%). Our results show that (1) nephrotic syndrome is very common among patients with IgE+; (2) the incidence of IgE deposits in lupus nephritis patients is high (35%) and the incidence of lupus nephritis among patients with IgE deposits is 71%, and (3) the presence of IgE deposits in patients with lupus nephritis may carry a bad prognosis. It is suggested that immunofluorescent studies of renal biopsies should include the evaluation of IgE deposition.

Long-term course of chloroquine retinopathy after cessation of medication.

Seven patients with chloroquine retinopathy were examined ten years after their therapy with chloroquine or hydroxychloroquine, or both, had been discontinued and an additional five patients with chloroquine retinopathy were similarly examined from two to eight years after their therapy had been discontinued. Visual acuity, visual fields, and ophthalmoscopic examinations were compared to those performed at the time therapy was discontinued. These long-term observations confirmed the previously published observations based on short-term studies that chloroquine retinopathy tends to remain stable after therapy is discontinued, although a few patients in the early stages of retinopathy may show regression and occasionally a patient with a more advanced stage of the disease may show progression.

Familial systemic lupus erythematosus.

Pedigrees were obtained from 340 patients with systemic lupus erythematosus (SLE). Two hundred ten (62%) of the patients were from the wards of Lupus Clinic at the Los Angeles County-University of Southern California Medical Center, and 130 (38%) were from a private practice. Forty-one (12%) of the 340 patients with SLE had affected relatives: five had two and 36 had one affected relative. Ten (30%) of the 33 male patients and 31 (10%) of the 307 female patients had relatives with SLE. Examination of the individual pedigrees included examples of possible autosomal dominant, autosomal recessive, and sex-linked dominant and recessive inheritance. When all the pedigrees were considered as a group, multifactorial inheritance was suggested.

Catabolic synergism: a cooperation between the availability of substrate and the need for nitrogen in the regulation of arginine catabolism in Saccharomyces cerevisiae.

The simultaneity of the presence of substrate (inducer) and the absence of a better nitrogen nutrient causes a strong cooperative effect (catabolic synergism) on arginase production. This effect is shown to operate by a specific mechanism. carg A+ 0h mutation (Dubois et al., 1978) identifies an element of this process located near the arginase structural gene and acting in cis. This mutation produces constitutivity for synergism in addition to constitutivity for induction (this last effect is produced alone by cargA +0- operator constitutive mutation). The receptor of the signal for the presence of substrate is the same as for induction. cargA + 0h mutation allows to make further distinction between the promotion of arginase synthesis caused by nitrogen limitation and nitrogen starvation.

Small inclusions in the cytoplasm of leukocytes in LE cell tests.

Small homogeneous basophilic and eosinophilic particles varying in size from 0.7 to 3.0 micra were seen in cytoplasm of monocytes and polymorphonuclear cells of leukocytes in LE cell tests. The aim of this investigation was to determine their frequency and diagnostic significance. Inclusions were found in one-third of LE cell tests on patients with rheumatic diseases and were not observed in normals. In 19.1% of 161 patients with SLE, they were present before LE cells were found. Sixty-eight% of patients who had particles had SLE, 8% had rheumatoid arthritis with LE cells, and 3% had nonrheumatic diseases.

Renal damage in systemic lupus erythematosus with normal renal function.

Renal biopsies were performed on 12 patients with definite systemic lupus erythematosus (SLE) with normal renal function. Three had had previous nephropathy which responded to treatment, with return of urinalysis and function to normal. Specimens were studied using light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM). Mild to moderate abnormalities were found in all patients. Changes by LM (primarily hypercellularity) were found in 11 specimens (no glomeruli were obtained in one) and classified as inactive. IF studies were positive in eight of the 12 biopsies with either focal or diffuse distribution of IgG, IgM, and/or C3. EM changes were observed in all cases and were of mild to moderate severity. They included focal to multifocal glomerular hypercellularity, basement membrane thickening, foot process fusion, and mesangial and intramembranous electron dense deposits. No subepithelial or subendothelial deposits were found. Microtubular structures were present in three specimens. These data suggest that careful study of renal biopsy specimens may reveal evidence of kidney involvement in all patients with SLE.

Non specific induction of arginase in Saccharomyces cerevisiae.

Some aminoacids metabolically and structurally unrelated with arginine catabolic compounds induce arginase. This effect designated as non specific induction procedes by a mechanism distinct from three others acting on the synthesis of arginase : specific induction, nitrogen catabolite repression and catabolic synergism.

Dermatoglyphic study of systemic lupus erythematosus.

Dermatoglyphic patterns were analyzed from two races of patients with SLE: a Mexican-American series of 27 females with SLE and 28 matched controls, and a Caucasian series of 28 females with SLE and 26 matched controls. Eighty-five measurements and 23 indices were analyzed. From these data, eleven parameters were statistically significant, four separating the Mexican-American SLE group from their controls and seven separating the Caucasian SLE group from their controls (P values less than 0.002 to less than 0.05). Only two parameters were significantly different between the two normal series, but nine parameters differentiated the Mexican-American SLE from the Caucasian SLE groups. A multiple linear discriminant function was computed using the most significant parameters. A misclassification rate of 25-30% was observed between patients and matched controls. Dermatoglyphic patterns have been shown to be genetically controlled. These data suggest a genetic abnormality associated with SLE.

Antinuclear antibodies in chronic psychotic patients treated with chlorpromazine.

The authors found a significantly higher incidence of antinuclear antibodies (ANA) and positive lupus erythematosus cell tests in chronic psychotic patients who received 400 mg a day or more of chlorpromazine (CPZ) for at least 7 weeks than in those who had taken 50 to 300 mg a day for varying periods or those who had received no CPZ for at least 3 months. Despite the high incidence of ANA, there was no observed development of lupuslike syndrome. The authors suggest that CPZ in high doses may induce ANA in humans.