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The renin-angiotensin-aldosterone system and polycystic kidney disease
374
Notes
in one old person’ home screened. Using polymerase chain reaction (PCR) to amplify proviral DNA from periphera blood mononuclear DNA. seronegative (HTLV1 ELISA). PCR-positive subjects were identified in the old persons’ home. Otherwise, all ELISA-negative community members were also PCR-negative. The data suggest that in a high-risk population, PCR may detect infected individuals which would have been missed by conventional serological means of detection. D Meytes (1) Edith Wolfson Hospital,
HIV-positive, HCV-PCR-positive individuals anti-HCV could not be detected, presumably reflecting degradation of the immune system. HCV was detected in previously available non-sterilised factor VIII concentrates prepared from commercially acquired blood, whereas concentrate prepared from volunteer donations was negative. When the HCV sequence was determined, that found in haemophiliacs (exclusively treated with volunteer donor concentrate) was different from that in the IVDAs and both were distinct from that in the commercial concentrates.
Tel Aviv 58 100. Israel
The rain-aogiotensin-aldosteronesystem kidney disease
CA Ludlam (3) Royal Infirmary of Edinburgh, Edinburgh EH3 9YW. UK
and polycystic
majority (S&75%) of polycystic kidney disease patients are afflicted with hypertension early in the course of their disease prior to loss of renal function. Renal cyst formation with secondary arteriolar attenuation observed in renal angiography suggests that renal ischemia and activation of the renin-angiotensin-aldosterone system may occur. When hypertensive polycystic kidney disease patients and essential hypertensive patients of similar age, gender, racial distribution, renal function, sodium excretion and mean arterial pressures were compared, plasma renin activity and aldosterone concentrations were greater in the hypertensive polycystic kidney disease group in supine and upright positions and following captopril administration. When normotensive polycystic patients and normal control patients were compared, mean arterial pressures and aldosterone concentrations wete greater in the polycystic group, indicating a potential transition to the hypertensive state and early activation of the renin - angiotensin - aldosterone system. In summary, polycystic kidney disease is a disorder with bilateral cyst involvement which, like bilateral renal artery stenosis, involves an interaction of increased sodium retention and renal ischemia induced activation of the renin - angiotensin - aldosterone system. A
A Chapman (2) Universityof Colorado Health SciencesCenter, Denver, CO 80262. USA
Hepatitis C and sequencing in blood products, haemophiliacs and drug users
Increased incidence of lymphoma following the use of OKT3 in cardiac transplantation A sharp increase in the incidence of post-transplantation iymphoproliferative disorder (PTLD) in the cardiac transplant program at Loyola University, Chicago, was found to be temporally and statistically associated with the introduction of OKTs. a monoclonal antibody targeted against human T-cells. The drug is effective in reversing established rejection, and is now also widely used preventively, at the time of transplantation. The value of such prophylactic use remains unclear. PTLD occurs in 2% of cardiac transplants. The frequently fatal clinical course is that of aggressive non-Hodgkin’s lymphoma. PTLD is believed to result from inadequate Tcell control over Epstein-Barr virus driven B-cell growth. Only 1 of 75 patients (1.3%) who had never received OKTs developed PTLD, while 9 of 79 (11.4%) who received the drug developed the disease. After a second course of OKTs, the incidence increased to 5 of 14 (35.7%). Mortality was 70%. In multivariate analyses, only the use of OKTs could be associated with the disease. It was concluded that addition of OKTs to a standard immuno-suppressive regiment increased the risk of PTLD. The mechanism for this may be the increase in total immunosuppression or factors specific to OKTs. It was recommended that the risks and benefits of prophylactic OKT3 be reassessed, and that patients who have received the drug be watched closely for PTLD. Ll Swinnen (4) Loyola University of Chicago, Maywood. IL 60153, USA
In this study the polymerase chain reaction (PCR) has been used to quantitate and characterise the RNA hepatitis C virus in haemophiliacs, intravenous drug abusers (IVDA) and factor VIII concentrates. Of the haemophiliacs, 15 of 21 were PCR-positive as were 7 of 27 IVDAs. This indicates active viral replication in these individuals who all probably have chronic liver disease. Of interest was the observation that in some
A detailed evaluation of lipid, lipoprotein and insulinrelated risk markers for coronary heart disease was undertaken in a cross-section of 1 478 women either not using hormonal contraception, or taking I of 9 different
(I) Lancer (1990) 336. 1533 (2) N &I@ J Mcrl( 1990) 323. 1091
(3) Lancer (1990) 336, 1469 (4) N Engl J Med (1990) 323, 1723
Oral contraceptive induced changes in lipid and carbohydrate metabolism
Notes
in one old person’ home screened. Using polymerase chain reaction (PCR) to amplify proviral DNA from periphera blood mononuclear DNA. seronegative (HTLV1 ELISA). PCR-positive subjects were identified in the old persons’ home. Otherwise, all ELISA-negative community members were also PCR-negative. The data suggest that in a high-risk population, PCR may detect infected individuals which would have been missed by conventional serological means of detection. D Meytes (1) Edith Wolfson Hospital,
HIV-positive, HCV-PCR-positive individuals anti-HCV could not be detected, presumably reflecting degradation of the immune system. HCV was detected in previously available non-sterilised factor VIII concentrates prepared from commercially acquired blood, whereas concentrate prepared from volunteer donations was negative. When the HCV sequence was determined, that found in haemophiliacs (exclusively treated with volunteer donor concentrate) was different from that in the IVDAs and both were distinct from that in the commercial concentrates.
Tel Aviv 58 100. Israel
The rain-aogiotensin-aldosteronesystem kidney disease
CA Ludlam (3) Royal Infirmary of Edinburgh, Edinburgh EH3 9YW. UK
and polycystic
majority (S&75%) of polycystic kidney disease patients are afflicted with hypertension early in the course of their disease prior to loss of renal function. Renal cyst formation with secondary arteriolar attenuation observed in renal angiography suggests that renal ischemia and activation of the renin-angiotensin-aldosterone system may occur. When hypertensive polycystic kidney disease patients and essential hypertensive patients of similar age, gender, racial distribution, renal function, sodium excretion and mean arterial pressures were compared, plasma renin activity and aldosterone concentrations were greater in the hypertensive polycystic kidney disease group in supine and upright positions and following captopril administration. When normotensive polycystic patients and normal control patients were compared, mean arterial pressures and aldosterone concentrations wete greater in the polycystic group, indicating a potential transition to the hypertensive state and early activation of the renin - angiotensin - aldosterone system. In summary, polycystic kidney disease is a disorder with bilateral cyst involvement which, like bilateral renal artery stenosis, involves an interaction of increased sodium retention and renal ischemia induced activation of the renin - angiotensin - aldosterone system. A
A Chapman (2) Universityof Colorado Health SciencesCenter, Denver, CO 80262. USA
Hepatitis C and sequencing in blood products, haemophiliacs and drug users
Increased incidence of lymphoma following the use of OKT3 in cardiac transplantation A sharp increase in the incidence of post-transplantation iymphoproliferative disorder (PTLD) in the cardiac transplant program at Loyola University, Chicago, was found to be temporally and statistically associated with the introduction of OKTs. a monoclonal antibody targeted against human T-cells. The drug is effective in reversing established rejection, and is now also widely used preventively, at the time of transplantation. The value of such prophylactic use remains unclear. PTLD occurs in 2% of cardiac transplants. The frequently fatal clinical course is that of aggressive non-Hodgkin’s lymphoma. PTLD is believed to result from inadequate Tcell control over Epstein-Barr virus driven B-cell growth. Only 1 of 75 patients (1.3%) who had never received OKTs developed PTLD, while 9 of 79 (11.4%) who received the drug developed the disease. After a second course of OKTs, the incidence increased to 5 of 14 (35.7%). Mortality was 70%. In multivariate analyses, only the use of OKTs could be associated with the disease. It was concluded that addition of OKTs to a standard immuno-suppressive regiment increased the risk of PTLD. The mechanism for this may be the increase in total immunosuppression or factors specific to OKTs. It was recommended that the risks and benefits of prophylactic OKT3 be reassessed, and that patients who have received the drug be watched closely for PTLD. Ll Swinnen (4) Loyola University of Chicago, Maywood. IL 60153, USA
In this study the polymerase chain reaction (PCR) has been used to quantitate and characterise the RNA hepatitis C virus in haemophiliacs, intravenous drug abusers (IVDA) and factor VIII concentrates. Of the haemophiliacs, 15 of 21 were PCR-positive as were 7 of 27 IVDAs. This indicates active viral replication in these individuals who all probably have chronic liver disease. Of interest was the observation that in some
A detailed evaluation of lipid, lipoprotein and insulinrelated risk markers for coronary heart disease was undertaken in a cross-section of 1 478 women either not using hormonal contraception, or taking I of 9 different
(I) Lancer (1990) 336. 1533 (2) N &I@ J Mcrl( 1990) 323. 1091
(3) Lancer (1990) 336, 1469 (4) N Engl J Med (1990) 323, 1723
Oral contraceptive induced changes in lipid and carbohydrate metabolism