Nephrotic syndrome associated with hepatointestinal schistosomiasis.

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.

Nephrotic syndrome associated with hepatointestinal schistosomiasis

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy

Nodular diabetic glomerulosclerosis without diabetes mellitus.

A 66-year-old white man presented with severe chronic renal failure. He had no past or present symptomatic glucose intolerance nor a family history of diabetes mellitus. Several fasting plasma glucose determinations, hemoglobin Alc and an oral glucose tolerance test were normal. Funduscopic ophthalmoscopy and retinal fluorescein angiography did not demonstrate diabetic retinopathy. The kidney biopsy showed nodular diabetic nephropathy, with increased mesangial matrix, thickened glomerular basement membrane, and afferent and efferent glomerular arteriolar hyalinization. The diagnosis of nodular diabetic nephropathy was made in this patient in the absence of past or present or familial evidence of diabetes mellitus.

Ovine white-liver disease (OWLD) in Norway: clinical symptoms and preventive measures.

During 6 years, altogether 458 twin lambs of the Dala and Rygia breeds with their dams were put on ovine white-liver disease (OWLD) pastures which were moderately, heavily or not cobalt fertilized, or on control pastures 15 km apart. Groups of lambs were untreated, regularly dosed with Co sulphate or vitamin B12, dosed with Co pellets, copper oxide needles (CuO), selenium pellets or Co-Se-Cu glass boli, or had access to Co enriched salt lick. Clinical symptoms in untreated lambs included varying degree of reduced weight gain or loss of weight appearing after 6-12 weeks on pasture, at an age of 10-15 weeks. Additional symptoms were seen 2-4 weeks later, including inappetence, listlessness, and often serous eye discharge and crusty ears. Of the untreated lambs on OWLD pastures 18% died or were eutanized because of OWLD. The condition was preventable by Co or B12 administration, which yielded an average increase of mid Sept. live weights of between 8 and 17 kg. Co fertilization of pastures, use of Co enriched salt lick, or dosing with Co pellets are recommended under practical circumstances. The lambs grazing control pastures were on average 17 kg heavier by mid Sept. than the OWLD lambs. They showed some weight increase on extra Co supply.

Ovine white-liver disease (OWLD). Botanical and chemical composition of pasture grass.

The most important grass species on the ovine white-liver disease (OWLD) pastures (S) were Poa spp., Agropyron repens and Lolium perenne, while the control pastures (H), where lambs grew well, consisted of Poa spp., Festuca rubra and Agrostis tenuis. The soil was more acidic on the H pastures as compared with the S pastures. OWLD grass (S grass) contained marginal to deficient amounts of cobalt during the first 2 months of grazing. During 2 years out of 3, the average Co content was slightly lower in the S grass as compared with the content in the H grass. The lowest average grass Co was, however, found during one year in the H grass, in spite of the fact that the H lambs also this year grew well, and were 13 kg heavier than the S lambs after 3 1/2 months on pasture. Results thus indicate that the H lambs some years were subclinically Co deficient, without developing clinical symptoms or OWLD, and that factors other than marginal/deficient grass Co are of importance as to whether OWLD will develop or not. S grass differed from H grass by having significantly lower copper, molybdenum, manganese and zinc content, lower protein N/amid N ratios and higher aluminium and iron contents. According to the results, marginal to deficient grass Co is essential for development of OWLD, but cofactors play a part.

[Protein/creatinine index in isolated samples of urine for evaluation of 24-hour proteinuria]. / Indice proteína/creatinina em amostra isolada de urina para avaliação da proteinúria de 24 horas.

The correct determination of the 24 hours proteinuria (PU24) in the non-hospitalized patients is frequently subject to collection errors. To overcome this problem it has been proposed the use of the proteinuria ratio (PR), obtained by dividing the concentrations of protein/creatinine in random urine samples. In the present investigation PR and PU24 were correlated in 42 patients (22 male and 20 female), aged between 14 and 63 years. Each patient was submitted to a 2 hours creatinine clearance (Ccr), to determination of PU24 and to evaluation of PR in the urine samples. The measures of PU24 were correlated with the values of PR. On linear regression analysis the equation y = 0,517 + 0,759x was obtained, with r = 0,914, suggesting good correlation between PU24 and PR. Values of r greater than 0,9 were always obtained, independently of the values of Ccr and PU24. The results indicate that PR in random urine samples may be practical and reliable in the follow-up of nephrological patients.