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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-one children with idiopathic nephrotic syndrome and minimal changes on renal biopsy were followed during all the disease. The average of follow-up was 37 months, with a range from 12 to 124 months. Recurrent proteinuria was the most important feature during the follow-up; 14 out of the patients showed frequent relapses, but only 2 patients showed major complication (peritonitis, septicemia) during relapses. Frequent relapses appeared most frequently in patients who began the disease before their fourth birthday, showed allergic history, had hypertension and red blood cells in urine, or had recurrent infections and finally, in those where proteinuria reappeared soon after prednisone therapy was ended. Prednisone alone was successful to induce remission, but it did not prevent frequent relapses. The association clorambucil-prednisone allowed lengthening of the period of remission and possibly for this reason the rate of relapses fell during the first 37 months of the follow-up. There are no signs which permit to predict the length of the disease and the frequent relapses can occur even after many years from the beginning of the disease. Special care of these patients avoids major complications.
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PMID:[Longitudinal study in children with the nephrotic syndrome and minimal glomerular lesion]. 75 27

The clinicopathologic correlation of 18 cases of idiopathic nephrotic syndrome (INS) with diffuse mesangial proliferation (MP), (over 3 cells per intercapillary space) showed clinical characteristics similar to INS with minimal glomerular lesions (MGL) in relation to age at onset, sex, period of evolution, intensity of proteinuria, hypercholesterolemia, hypoalbuminemia and edema. However, there was a greater incidence of cases with arterial hypertension, hematuria, azotemic retention and positive glomerular immunofluorescence. Out of the 18 cases, 10 were corticosensitive (group I) and 8 were corticoresistant (group II). Patients of I followed a similar course as those with MGL, while most cases of group II showed proteinuria through observation periods up to 5 years. No differences were found in the initial clinical presentation between these 2 groups. The only item with prognostic value was the intensity of the mesangial proliferation which in group I was of 3 to 5 cells per intercapillary space, while in group II, in the spaces of some glomeruli, there were up to 10 mesangial cells present. These findings suggest the convenience to practice renal biopsy before initiating treatment in children with INS and arterial hypertension, hematuria and/or azotemic retention in order to identify this group of patients that appears to be different from that with MGL.
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PMID:[Idiopathic nephrotic syndrome with diffuse mesangial proliferation]. 75 99

Remission followed prednisolone therapy in 9 out of 21 Nigerian children with the nephrotic syndrome who had highly selective proteinuria (CG/CA less than 15%). Of these, 5 patients have remained well off all treatment during a follow-up of nearly 5 years, 4 have relapsed more than once but have responded to further courses of prednisolone. 3 of 21 with less selective proteinuria also remitted but all relapsed and only one of these has responded again. The other two have relapsed and further courses of prednisolone have not totally abolished their proteinuria though they are asymptomatic and in good health. Toxicity (hypertension, sometimes with encephalopathy and infection) was commoner in the patients with less selective proteinuria treated with steroids than in those with highly selective proteinuria. 3 steroid-sensitive patients who had had repeated relapses became free from relapse off all treatment after a course of cyclophosphamide, given during steroid-maintained remission. All but 2 of the renal biopsies taken were regarded as abnormal. The lesions were less severe in those who responded than in those who did not. There is some evidence to suggest that Plasmodium malariae may be a cause of some of the steroid-sensitive disease, as well as the steroid-resistant.
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PMID:Differential protein clearances and response to treatment in Nigerian nephrotic children. 79 39

Only four cases of immunoglobulin E (IgE) monoclonal "gammapathies" have been reported previously. Discussed here is a 57 year old man who presented with hypertension and the nephrotic syndrome. A monoclonal IgE-kappa component (0.6 mg/ml), which did not appear as an M spike on protein electrophoresis, was demonstrated by immunoelectrophoresis in the serum and urine. The patient's condition deteriorated rapidly due to renal failure, and he died five weeks after the diagnosis was made. Pathologic examination disclosed extensive glomerular lesions, but amyloid was not detected by light or electron microscopy. The possible relationship between the monoclonal gammapathy and kidney impairment is discussed.
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PMID:Monoclonal IgE with renal failure. 79 1

The juxtaglomerular apparatus was histoplanimetrically studied in renal biopsies of 65 cases of membranoproliferative glomerulonephritis and 64 cases of minimal proliferative intercapillary glomerulonephritis (MPI) ("minimal changes"). The juxtaglomerular cell complex (JGC complex) consisting of the epithelioid cells (granular cells) and the Goormaghtigh's cells (agranular or lacis cells) was significantly enlarged in the nephrotic syndrome. 10 to 14 days' duration of the nephrotic syndrome was shown to be sufficient to bring about an enlargement of the JGC complex. After a successful treatment of the nephrotic syndrome with steroids, there was no enlargement of the JGC complex. The enlarged JGC complex persisted despite steroid treatment in the steroid-resistant nephrotic syndrome, although a mild suppressive effect of steroids on the size of the JGC complex was observed. There was no significant relationship between hypertension and the size of the JGC complex. Creatinine retention tended to be associated with an enlargement of the JGC complex. The macula densa was not enlarged in the nephrotic syndrome, in contrast to the enlarged JGC complex.
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PMID:The size of the juxtaglomerular apparatus in glomerulonephritis with the nephrotic syndrome: a morphometrical study of renal biopsies. 80 4

Morphometrical and clinical investigations were performed in 34 patients with the so-called hypercellular form of focal glomerulosclerosis (FGS), i.e., a form showing clear diffuse mesangial hypercellularity beside focal sclerosis with the light microscopy. This form was compared with focal glomerulosclerosis without remarkable mesangial hypercellularity, with mild mesangioproliferative glomerulonephritis (gn), as well as with normal kidneys. The results were as follows: 1. Morphometrically both the increase in relative mesangial volume as well as in mesangial cell count is statistically significant in the hypercellular form compared with the nonhypercellular form and with controls. Comparison with mild mesangioproliferative gn shows no difference. 2. Even the so-called nonhypercellular form contains more mesangial matrix and mesangial cells than the controls. 3. The frequency of the hypercellular form is higher in males and in older patients. 4. All of our patients with hypercellular FGS had at the time of biopsy manifested nephrotic syndrome. The frequency of additional clinical symptoms (hematuria, hypertension, renal insufficiency) corresponds with the nonhypercellular form, but is different in mild mesangioproliferative gn. 5. Therapeutic response and prognosis is worse in the hypercellular form. The hypercellular form of FGS has to be separated from the nonhypercellular form as a defined entity.
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PMID:Diffuse mesangial cell proliferation in focal sclerosing glomerulonephritis. 82 13

A specific relationship between P. malariae and the nephrotic syndrome, originally postulated on epidemiologic evidence, has been substantiated by clinical, pathologic and immunologic observations. It would appear that quartan malaria causes an immune complex nephritis in some individuals that, once established, is sustained by mechanisms not yet fully explained but which may involve an autoimmune process. Evidence to support an immunologic pathogenesis of the renal lesions is provided by the presence of immunoglobulin, complement (C3) and quartan malarial antigen in biopsy specimens studied by immunofluorescence microscopy. In early cases in which some patients respond to treatment, fluorescence is coarsely granular but in late cases in which patients are unresponsive to treatment, fluorescence tends to be diffuse. Renal histology is distinctive and does not conform to any of the categories included in the conventional classification of the nephrotic syndrome in childhood. The basic lesion consists of thickening of glomerular capillary walls, leading to eventual obliteration of capillary lumina, and accompanying mesangial sclerosis leads ultimately to total glomerular sclerosis. A unique feature of electron microscopy is the presence of small lacunae scattered throughout the thickened capillary basement membrane. Histologic grading for severity of lesions shows positive correlation with response to treatment and immunofluorescence appearances. Prognosis is, in general, poor. The large majority of patients do not respond to treatment with prednisolone, azathioprine or cyclophosphamide, and prednisolone administration causes severe hypertension and other serious complications in a high proportion of patients.
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PMID:The quartan malarial nephrotic syndrome. 82 46

An intensive study of the course of lupus nephritis has been undertaken in 88 patients in whom strict morphologic criteria were utilized in classification. All were treated with steroid, and 17 received cytotoxic drugs in addition. Focal proliferative lupus nephritis generally follows a benign course except in the occasional instances when transition to the diffuse proliferative or membranous forms occurs. Membranous lupus nephritis, when characterized by persistent nephrotic syndrome, leads slowly to renal failure, but this progression is aborted in the one-third in whom remission of the nephrotic syndrome can be achieved. A fatal outcome occurs within five years in the majority of those with diffuse proliferative lupus nephritis and the nephrotic syndrome, often in association with necrotizing renal vasculitis, severe hypertension and accelerated renal failure. A small number with the diffuse proliferative form have a remission and then show only mesangial abnormalities, usually, however, with the appearance of glomerular sclerosis. Progressive glomerular sclerosis is observed in some patients and may be a sequel of the remission of the diffuse or focal proliferative lesions, or it may represent still another form of lupus nephritis. Mesangial immune deposits with or without proliferation, at times in the absence of clinical renal disease, are observed early in the course of systemic lupus erythematosus (SLE) and may proceed to the diffuse proliferative or membranous forms. The present observations serve to emphasize the importance of strict morphologic classification in the comparison of different treatment regimens for lupus nephritis. In view of the grave prognosis of established diffuse proliferative lupus nephritis, which probably evolves from a mesangial involvement common to all patients with SLE from its onset, early therapy may be the key to the management of lupus nephritis.
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PMID:Lupus nephritis. Clinical course as related to morphologic forms and their transitions. 83 80

The cases of 23 nephrotic children in whom percutaneous renal biopsies or postmortem studies showed focal and segmentary sclerosis were reviewed. It was more common in males and the average age at the onset was 6 years. The main symptoms were edema, hematuria and unspecific general manifestations. On admission, nephrotic syndrome was present in 91% of the cases and in a lesser proportion, edema hematuria and high blood pressure were found. The lesion was diagnosed at the first biopsy in 19 cases and in 4, subsequent biopsies or postmortem studies supported the diagnosis. Only 9 out 21 patients treated showed response to steroids and 5 of the resistant cases were given cyclophosphamide, but only one responded. They were checked at different periods of time ranging from 7 months to 10 years and by the end of the study, 11 patients were still under control showing normal renal function in six of them; 4 other cases showed mild renal insufficiency and in the remaining one, there was moderate renal insufficiency. Two died. A good correlation was evident between response to steroids and conservation of renal function. The findings are compared to those from other authors and emphasis is placed on the need to suspect the entity when a nephrotic syndrome with minimal changes is resistant to steroids, or when persistent hematuria is present; also, in cases showing initial lesions of tubular atrophy or interstitial fibrosis.
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PMID:[Focal sclerosing and segmentary nephropathy in children]. 84 9

A 37-year old male with a history of idiopathic nephrotic syndrome, hypertension, severe headaches and transient ischemic attacks developed ischemic colitis with stricture formation of the spelnic flexure. Eschemic changes were secondary to vascular lesions involving the middle colic artery and mulitple smaller arteries and arterioles. The vascular lesion is localized to the intimal layer with proliferation of spindle-shaped cells indentical to the gastrointestinal lesion of malignant atrophic papulosis (Degos' disease). The patient had no skin biopsy, or history of skin lesions. This case represents ischemic colitis in a patient with malignant atrophic papulosis with either absent or unrecognized skin lesions.
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PMID:Ischemic colitis and malignant atrophic papulosis. 87 Nov 16


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