Circulating immune complexes (CIC) were detected in 43.6% of 78 patients with primary IgA nephropathy by the solid-phase Clq radioimmunoassay. The IC were intermediate (9 to 17S) in size and contained IgA, IgG, and less commonly IgM. CIC were often present intermittently, correlating with episodes of macroscopic hematuria. Elevated serum IgA concentrations (38.7%) did not correlate with the detection of CIC. Similar findings were observed in sera samples from patients with Henoch Schonlein purpura and in IgA glomerulonephritis associated with alcoholic cirrhosis and/or portal systemic shunts. The factors responsible for the mesangial localization of the IC are not clear, but elevations in serum antibody titers to respiratory pathogens (mycoplasma pneumoniae, herpes virus, influenza), gut flora (E. coli 07), and bovine serum albumin suggest that common exogenous antigens may be involved in the pathogenesis. Primary defects in either mucosal antigen exclusion or reticuloendothelial IC sequestration are proposed to account for these findings.

The aim of this study was to determine the immunohistochemical distribution and quantification of crystal matrix protein (CMP). CMP, a 31 kDa glycoprotein, is the principal macromolecule found in calcium oxalate crystals generated in human urine, and is a potent inhibitor of crystal aggregation. A polyclonal rabbit anti-human CMP antibody was used to examine renal tissue by immunohistochemical techniques and light microscopy (N = 45). Twenty-five other human organs were similarly assessed. Quantification was performed using a visual analogue scale. CMP was visible as cytoplasmic staining in the epithelial cells of the TALH and the distal convoluted tubule including the macula densa in a subgroup of nephrons. CMP was not identified elsewhere in the urinary tract or in the extrarenal organs examined. Despite a trend indicating that the kidneys of normal men had more CMP than those of normal women, the difference failed to reach significance (P = 0.11). There was, however, more CMP in the stone formers group compared with either normal men (P < 0.01) or normal women (P < 0.01). This protein may be an important determinant of calcium oxalate kidney stone disease.

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Objective To review the association of transient diabetes insipidus and acute fatty liver of pregnancy. Design A retrospective study. Setting Six women presenting with polyuria and polydipsia in the third trimester or in the immediate postpartum period, referred over a two and a half year period; five out of six were primigravida. All had raised liver transaminases and biopsy‐proven acute fatty liver of pregnancy. Four out of six also had pre‐eclampsia. Subjects Tertiary referral centre. Main outcome measures There were no maternal deaths and only one fetal death. Desamino‐cys‐1‐D‐arg‐8‐vasopressin administration produced a reduction in urine output in all five women to whom it was administered. In all cases symptoms had resolved by the end of the fourth postpartum week. Three of the women have had subsequent pregnancies uncomplicated by either transient diabetes insipidus or acute fatty liver of pregnancy. Conclusions The association of transient diabetes insipidus and acute fatty liver of pregnancy appears more common than previously recognised. Both may be part of the spectrum of pre‐eclampsia.

Summary:Idiopathic glomerular enlargement has previously been described in a number of indigenous populations, including Australian Aborigines. This study had three aims: (1) evaluate three methods for estimating mean glomerular tuft and renal corpuscle volume; (2) assess the effects of fixation on glomerular dimensions; and (3) estimate glomerular tuft and renal corpuscle volume in clinical biopsies from Australian non-Aboriginals, Aboriginals and Aboriginal inhabitants of the Tiwi Islands (Bathurst Island and Melville Island, Northern Territory, Australia). First, glomerular volume was determined in initial transplant biopsies from 17 non-Aboriginal males (30-50 years) using three methods: the Cavalieri method, a stereological method that requires serial sectioning of glomeruli and knowledge of section thickness, but requires no knowledge or assumptions of glomerular size or shape (the gold-standard method); the stereological method of Weibel and Gomez that employs a single section but requires assumptions of glomerular size distribution and shape; and the maximal profile method, with which the largest glomerular profile in a single section is identified, and used to calculate the volume of the parent glomerulus (assuming glomerular sphericity).Estimates for glomerular tuft volume were (mean SD): Cavalieri method (2.08 5 0.37 x lo6 pm3); Weibel and Gomez (2.55 f 0.63 X lo6 pm'); maximal profile method (3.09 + 0.66106 pm3). Taking the Cavalieri estimate to be accurate, the maximal profile method is seen to grossly overestimate mean glomerular tuft volume, whereas the Weibel and Gomez method overestimated tuft volume by 23%. Both methods considerably overestimated mean renal corpuscle volume. In the study of fixation and glomerular dimensions, we found that glomeruli in clinical biopsies fixed in formalin were larger (47% for glomerular tuft and 25% for renal corpuscle) than the glomeruli in biopsies fixed in formol mercury/Dubosq Brazil. This result emphasizes the importance of standardizing the histological technique in quantitative studies of glomeruli. Finally, the Weibel and Gomez method was used to estimate mean glomerular volume in formalin-fixed clinical biopsies from 80 non-Aboriginal Australians, 78 non-Tiwi Aboriginals and 72 Tiwi Aboriginals. Mean glomerular tuft volumes were: 3.12 1.46 x lo6 pm3, 4.91 5 2.59 X lo6 pm3 and 4.79 * 2.08 x lo6 pm3, respectively, (for biopsies with four or more profiles). Mean glomerular tuft volume in the two Aboriginal populations was significantly (P < 0.001 in each case) greater than that in the non-Aboriginals. These data indicate that there is pronounced glomerulomegaly in Australian Aborigines.