Effect of haemo- and peritoneal dialysis on the cell-mediated immune response in chronic uraemia.

Lymphocytopenia, decreased spontaneous rosette formation, and a decreased T lymphocyte count have been found in patients with non-uraemic glomerulonephritis (71 cases) and in different stages of uraemia (68 cases). In chronic glomerulonephritis and in the early stage of uraemia, cell-mediated hypersensitivity (lymphocyte migration inhibition) to glomerular basement membrane (GBM) characteristic of glomerulonephritis could be demonstrated. Hypersensitivity disappeared in the terminal stage of uraemia indicating endogenous immunosuppression.

Satellite peritoneal dialysis.

In 29 cases of chronic renal failure 1325 peritoneal dialyses were performed between January 1, 1976 and April 31, 1978. The technique of peritoneal dialysis, the general lines of supervision and follow-up, the results and shortcomings of the procedure are discussed. Peritoneal dialysis is regarded as an alternative to haemodialysis in chronic renal failure. On ground of the favourable observations, organization of satellite PD services on a large scale, parallel with the expansion of other services (haemodialysis, renal transplantation), is advocated.

Inter-hospital mobile oesophago-gastro-bulboscopy emergency service.

Oesophago-gastro-bulboscopy was performed in 102 cases of acute massive haematemesis and/or melaena in different hospitals or clinics in the town of Pécs, the condition of the patients having been in general incompatible with transport to the endoscopic laboratory. The aetiology of the bleeding was clarified in 90 cases, it remained unidentified in 8 cases, though it was successfully localized. Fibreoptic endoscopy is regarded as an essential tool of early aetiological diagnosis of upper digestive tract bleedings even in centres lacking modern equipment.

The role of hepatitis B surface antigen in the pathogenesis of glomerulopathies.

The frequency of hepatitis B surface antigen (HBsAg) has been studied in the sera and renal biopsies of 276 patients with various forms of glomerulonephritis (GN), the nephrotic syndrome and other nephropathies. Using a modified Hepanosticon method, HBs antigenemia was detected in 32 of 196 patients (16.3%) with immune complex (IC) GN and the nephrotic syndrome. Indirect immunofluorescence revealed HBsAg in 33 renal biopsy tissue specimens (16.8%). HBsAg was found in the sera of four of the 80 remaining patients with other renal diseases (5%), and in the renal biopsy tissues of another four (5%). Antibody against HBsAg could only be demonstrated in the serum of one glomerulonephritic patient. The sera of 18,799 normal blood donors were used as controls; of these 186 (0.99%) had positive tests for HBsAg. It is concluded that, in some patients with GN and the nephrotic syndrome, HBsAg-containing IC may be implicated in the development and/or progression of the disease.

IgA glomerulonephritis. Mesangial IgA deposition without systemic signs (Berger's disease).

Renal biopsy specimens from 204 patients with glomerulonephritis or nephrotic syndrome have been studied. In ten of the patients not suffering from acute poststreptococcal glomerulonephritis, systemic lupus erythematosus or Schönlein-Henoch syndrome, diffuse, selective mesangial IgA deposition was observed. Clinically, persistent microscopic haematuria, mild proteinuria and, except in one patient, normal renal function were found. Light microscopically the histological picture was dominated by a diffuse or focal increase in volume of the mesangial matrix, and mild mesangial cell proliferation. Exceptionally, there was also crescent formation. Immunofluorescence revealed large IgA, IgG and C3 deposits, as well as small IgM and fibrinogen deposits in the mesangial glomeruli. The authors' assumption that immunocomplexes containing a secretory component might be implicated in the pathomechanism of Berger's disease, could not be proved.

Blood coagulation abnormalities in the Schönlein-Henoch syndrome in adults.

23 adult patients with Schönlein-Henoch's syndrome were observed between 1965 and 1976. Nephropathy was noted in 18, gastrointestinal bleedings in 13, thrombosis of legs in 4, cases. Haemostasis was studied in the successive phases of the process on 185 occasions altogether. The studies included four different capillary tests, thromboelastography, the Gerendás coagulogram, determination of partial thromboplastin time and two platelet-function tests. Additional renal biopsy was performed in 10 cases, mesocolon and skin biopsy in one case each. The results of at least one of the capillary tests were found positive in each of the patients in some stage of the process. The coagulation status was marked by hyperocagulability either in itself or combined with laboratory signs of hypocoagulability. Immunohistological study of the biopsy specimens revealed glomerular fibrin deposits in 7 cases. On the evidence of the follow-up studies the laboratory tests may be used for the assessment of the activity of the process. The alternatives of local intravascular coagulation (LIC) or of compensated diffuse intravascular coagulation (DIC) are offered for the interpretation of hypercoagulability.

Blood coagulation defect in Masugi nephritis.

The platelet count and the coagulation pattern have been studied on the basic of nine laboratory tests in Masugi nephritis of the delayed type. Platelet consumption was found to constitute the initial manifestation of Masugi nephritis. The prenephritic stage and the manifestation of nephritis were invariably associated with hypercoagulability, as reflected by a loss of the spontaneous fibrinolytic activity of plasma, together with an elevation of the fibrinogen level and an increase in maximal thrombus elasticity. At the onset of nephritis the platelet count declines again. The hypercoagulability is attributed to intravascular coagulation in the kidney.

Care of the patient in autoimmune renal disease. Assessment of clinical and immunological activity.

174 patients suffering from various autoimmune and renal diseases have been followed up for periods of one to four years. Repeated assessment of clinical and immunological activity is indispensable for therapy, prognosis and rehabilitation. Determination of microscopic haematuria by the Addis count proved to be the best indication of clinical activity. Immunological activity was assessed by the CH50, C3 and immunoconglutinine tests, the titer of the anti-glomerular basal membrane antibodies and the inhibition of leucocyte migration. Depending upon the nature and stage of the disease one or more positive tests indicated activity of the pathological process. Consequently, the simultaneous application of several methods is recommended for assessment of immunological activity in autoimmune renal diseases.