Circulating anti-DNA immune complexes in active lupus nephritis
Article Abstract:
Lupus nephritis is a kidney disease that occurs in patients with systemic lupus erythematosus (SLE), an autoimmune disorder. It is a serious kidney disease and involves histologically detectable changes. A reliable method of identifying lupus nephritis early in its course of development would be helpful, particularly in cases where a biopsy cannot be obtained. The detection of circulating immune complexes (CIC), which are antigen/antibody complexes, may offer one such diagnostic clue, but identifying CICs associated specifically with lupus nephritis is not easy. Antibodies against DNA (anti-DNA CIC) have been particularly implicated. In this study, blood from three groups of patients was evaluated for the presence of anti-DNA antibodies expressing either 0-81 Id or NE-1 Id, idiotypes that are present on CICs in lupus patients. Forty-seven patients had active lupus nephritis; 28 had active SLE without kidney disease; and 40 had other types of SLE. Results from blood tests were compared with results from kidney biopsies. Anti-DNA CICs expressing 0-81 Id or NE-1 Id were found specifically in patients with active lupus nephritis, and much less often in patients without lupus nephritis, even when active SLE was present. The 0-81 Id idiotype was never found in active SLE patients without lupus nephritis. Diffuse proliferative glomerulonephritis (DPGN), a condition associated with the worst prognosis for lupus patients, was present in 20 of 27 patients with anti-DNA CICs. Patients without anti-DNA CICs were much less likely to have DPGN. Eighty percent of 24 patients with lupus nephritis with anti-DNA CICs also expressed the 0-81 idiotype in kidney glomeruli (the part of the kidney affected in nephritis), indicating that the presence of the complexes in the circulation may be associated with their deposition in the glomeruli. The clinical significance and pathologic role of the CICs are discussed. These complexes were not found in one third of the patients with lupus nephritis, indicating that they are not the only cause of immune deposits in the glomeruli of SLE patients. However, anti-DNA CICs do appear to be associated with DPGN in such patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Pasteurella multocida: zoonotic cause of peritonitis in a patient undergoing peritoneal dialysis
Article Abstract:
The bacteria Pasteurella multocida is commonly found in the upper respiratory tract of animals; human infection with this bacteria is most often transmitted by animal bites. A case is described of a 54-year-old man with advanced kidney disease who contracted P. multocida infection after his cat bit into tubing of dialysis apparatus. The man was being treated by peritoneal dialysis, a procedure in which blood is filtered to remove toxic wastes. In peritoneal dialysis, the dialysis fluid is infused into the peritoneal (abdominal) cavity, permitted to remain there for a couple of hours, and then removed. The patient had a history of hypertension, which led to kidney failure and the need for dialysis treatment. Six months after starting peritoneal dialysis at home, the patient developed fever, chills, nausea, vomiting, abdominal pain, and clouded peritoneal dialysis fluid. Bacteria were detected in the dialysis fluid and identified as P. multocida. The patient was treated in the hospital with the antibiotics vancomycin and gentamicin, and his symptoms resolved within 72 hours. He was discharged and continued treatment with the antibiotic cefazolin for a couple of weeks. The patient's wife reported that they had two cats, and one had bitten into the dialysis tubing the evening before the patient was admitted. Patients undergoing peritoneal dialysis should be advised not to perform the dialysis procedure in the presence of the pets, such as cats and dogs. In addition, if a cat or dog bites into the dialysis tubing, the patient should be given antibiotics to prevent the development of P. multocida infection and inflammation of the abdomen. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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