Development of systemic lupus erythematosus in a patient on hemodialysis.

A case of systemic lupus erythematosus (SLE) that developed 2 years after beginning hemodialysis is reported. The patient had not been given any drug implicated in the production of SLE. She had been treated with deferoxamine, an in vitro inhibitory of DNA synthesis. The difficulty of the diagnosis is emphasized. Clinical improvement after prednisone treatment was impressive. SLE may appear even in patients receiving hemodialysis, despite immunological depression derived from chronic uremia.

Renal failure in temporal arteritis.

We report a case of biopsy-proven temporal arteritis and polymyalgia rheumatica with improved clinical symptoms with steroid treatment but with subsequent renal failure while on steroids. Kidney biopsy showed focal segmental necrotizing glomerulonephritis with crescents and small-vessel vasculitis. Treatment with methylprednisolone and cyclophosphamide achieved normalization of renal function. We emphasize the importance of kidney biopsy because of its therapeutic implications. The previous literature concerning renal disease in temporal arteritis is discussed.

Differentially regulated cell surface expression of leukocyte adhesion receptors on neutrophils.

To elucidate the molecular mechanisms accounting for hemodialysis-induced neutropenia, the regulation of plasma membrane expression of leukocyte adhesion glycoproteins was investigated by both flow cytometry and immunoprecipitation techniques. The members of the LFA family of integrins, Mac-1/Mo1 (CD11/CD18) and gp150/95 (CD11c/CD18), involved in adhesion of myeloid cells to endothelia and other substrates, were found to be overexpressed on the plasma membrane of neutrophils from patients undergoing hemodialysis with a Cuprophane dialyzer, whereas no change was observed in the expression of LFA-1 (CD11a/CD18). By contrast, dialysis with Cuprophane membranes, as well as in vitro treatment with different activating agents, induced a downregulation on the expression of both the Leu-8/LAM-1 antigen, the human neutrophil peripheral lymph node homing receptor, and the CD43 major sialoglycoprotein involved in leukocyte homotypic adhesion. Kinetics studies showed that these up- and downregulatory processes of antigen expression occur very rapidly, correlating with maximal neutropenia. Recovery of initial levels of expression of CD11b/CD18 and Leu-8/LAM-1 adhesion molecules was observed after one hour of hemodialysis. However, the basal expression of CD43 was not restored by that time. The coordinated upregulation of CD11b and CD11c and downregulation of LAM-1 and CD43 adhesion receptors provide molecular mechanisms for understanding leukoaggregation, adherence to endothelia, and extravasation of neutrophils ultimately leading to the hemodialysis-induced neutropenia.

Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome.

To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF wee preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age offer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall morality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.