Pregnancy complicated with Bartter's syndrome: a case report.

Bartter's syndrome is a rare renal disorder, and since there are few case reports of Bartter's syndrome complicating pregnancy are few, the changes of electrolytes and hormonal metabolism during pregnancy are unknown. We describe and discuss the course of pregnancy complicated with Bartter's syndrome.

[Excellent antiproteinuric effect by LDL apheresis in a case with severe renal dysfunction due to focal segmental glomerulosclerosis].

We report here a 19-year-old man with intractable nephrotic syndrome due to focal glomerulosclerosis (FGS) treated by low-density lipoprotein apheresis (LDL-A). The patient had been receiving several drugs, including steroids, cyclophosphamide, mizoribine and deoxysparguarine, for the past ten years, but the nephrotic syndrome was resistant to these drugs. Although the initial renal biopsy specimen showed minimal change-type lesions, the second biopsy specimen obtained 6 years later revealed typical FGS findings accompanied by lipid deposition (apoB) and macrophage infiltration (CD68) in the involved area. LDL-apheresis was performed ten times per course using a dextran sulfate cellulose column (Liposorba LA-15) as the LDL absorber and polysulfone hollow-fibers (Sulflux) as the plasma separator, processing a total of 3,000 ml of plasma during each apheresis. After treatment the serum levels of LDL and total cholesterol decreased to 50% and 58% of their initial levels, respectively. Immediately after the first course of treatment, the renal dysfunction did not improve, but a decrease in urinary protein was observed (from 43.7 g/day to 8 g/day). Two months later, because urinary protein increased and renal function decreased (Ccr 7 ml/min), a second course of treatment was started. However, his renal dysfunction did not improve and urinary protein did not decrease. In conclusion, in FGS with-progressive renal failure, renal histological findings of positive APO-B, CD68 (macrophage) in sclerotic lesion may be indications of effective LDL-apheresis.

[Correlation of PCR results to detect HCMV with clinical course of kidney transplant recipients].

Peripheral blood leukocyte (PBL) specimens and urine specimens of 18 renal transplant patients were examined weekly or biweekly for the presence of human cytomegalovirus (HCMV), using polymerase chain reaction (PCR) technique, shell vial procedure and culture. In 11 out of 18 patients, HCMV was detected from either or both of PBL and urine within one to three months after transplantation. HCMV DNA was detected by PCR for a longer period of time, in comparison to the shell vial procedure, showing that PCR was more sensitive. However, only 3 patients showed symptomatic HCMV infection with pyrexia leukocytopenia and liver dysfunction, whose PBL and urine specimens were positive for HCMV by both of the methods. In these 3 patients, HCMV was detected for a longer period of time, whereas in the other asymptomatic patients, it was detectable for only one or two weeks. Moreover, using DNA obtained from PBL in symptomatic phase, HCMV major immediate early (MIE) gene was detected by PCR after amplification for fewer cycles, whereas DNA obtained from these 3 patients in the asymptomatic period or at the end to active HCMV infection, and from other asymptomatic patients, it was detectable after 30 cycles of amplification.