No abstract

These findings represent further evidence of the association between factor H dysfunction and HUS.

BackgroundClinical and pathologic features that predict outcome have important potential application in patients with pauci-immune necrotizing glomerulonephritis (usually antineutrophil cytoplasmic antibody–associated vasculitis). This study examines the predictive value of simple quantitative renal histologic measurements in a large cohort with extended follow-up.Study DesignCohort study.Setting & Participants390 consecutive patients with pauci-immune necrotizing glomerulonephritis at a single hospital (1983-2002); 90 patients underwent repeated kidney biopsy during follow-up.PredictorsAge and serum creatinine concentration at biopsy, antineutrophil cytoplasmic antibody specificity, percentage of normal glomeruli, percentage of glomeruli with active lesions, and index of chronic damage (quantitative measurement of established cortical damage) in the initial kidney biopsy for all patients. The same factors were assessed in both biopsy specimens for patients undergoing an additional biopsy.Outcomes & MeasurementsEnd-stage renal disease and patient survival.ResultsMortality at 1 and 5 years was 23% and 40%, respectively: standardized mortality ratio, 4.74 (95% CI, 3.62-6.32). End-stage renal disease was reached by 14% and 18% at 1 and 5 years, respectively. In multivariable analysis, serum creatinine level at biopsy and percentage of normal glomeruli in the initial biopsy specimen were the best predictors of kidney survival. C Statistics were 0.80 for creatinine level alone and 0.83 for creatinine level with normal glomeruli. In patients undergoing an additional biopsy, rapid progression in the index of chronic damage and serum creatinine level at the second biopsy were associated with kidney survival in multivariable analysis.LimitationsRetrospective analysis. External validity of the index of chronic damage requires further assessment. Selection bias may influence repeated biopsy analyses.ConclusionsSerum creatinine level at biopsy best predicts kidney survival in patients with pauci-immune necrotizing glomerulonephritis overall.

Aims-To evaluate an immunohistological stain for complement component C9 as a method of detecting early myocardial infarction and to compare this with (1) an enzyme histochemical method and (2) conventional histological staining. Methods-(1) Eight hearts taken at necropsy were stained using the nitroblue tetrazolium/phenazine methosulphate method and an immunohistological stain for C9. (2) Twenty five hearts from cases of suspected or confirmed myocardial infarction and 25 from cases without conventional evidence of infarction were stained for C9 and by haematoxylin and eosin. Results-(I) The histochemical method indicated myocardial necrosis in five hearts and the C9 method in seven, all of which had clinical evidence of myocardial damage or a reason for it. The histochemical method required fresh myocardium, was difficult to use and was difficult to interpret. (2) Of 25 hearts with suspected or confirmed infarction, 24 were stained by the C9 method. Staining with haematoxylin and eosin showed infarction in 16 of these, all with infarcts at least 24 hours old; the other eight had clinical evidence of infarction less than 24 hours old. Tne heart not stained by C9 was from a patient who, on review, had no evidence ofinfarction. Ofthe 25 control hearts, none had infarction on staining with haematoxylin and eosin, but three were stained by the C9 method. These three were from patients with septicaemia or another reason for myocardial damage. Conclusions-The immunohistological method for C9 is a simple, reliable and sensitive method for the detection of early myocardial necrosis that could be used on formalin fixed, paraffin wax embedded necropsy material. This had advantages over a histochemical method and conventional staining with haematoxylin and eosin. (Jr Clin Pathol 1996;49:34-37) Keywords: C9, myocardial infarction.Recent myocardial infarction can be impossible to detect either by direct examination at necropsy or using conventional stains on histological sections. Histochemical techniques can show early infarction, but these are difficult to interpret and rarely used. A method of detection of infarction that could be used on formalin fixed, paraffin wax embedded sections would be of great value.Complement component C9, part of the C5b-9 membrane attack complex of complement, is a reliable marker of complement deposition and can be detected immunohistologically on formalin fixed, paraffin wax embedded sections of renal biopsy specimens.1 This membrane attack complex has also been found in necrotic skeletal muscle fibres2 and in infarcted myocardium.3 We wished to see whether the immunohistological stain for C9 could be used as a routine method for demonstrating recent myocardial infarction, by comparing it with an established histochemical technique, the nitroblue tetrazolium/phenazine methosulphate reaction,4 and against conventional staining with haematoxylin and eosin. Methods HISTOCHEMICAL STUDYTransverse slices, about 1-2 cm thick, were taken from the left ventricle of eight patients at necro...

In many cases, blindness due to diabetic retinopathy can be prevented provided treatment with laser photocoagulation is used at the correct time. A screening programme is required to identify cases of sight threatening retinopathy. An optical practice based diabetic eye screening programme has been established in Dorset. The optometrist undertaking the examination is paid a fee. The findings are recorded on a coded form and sent to the hospital diabetologist who recalls positive cases. Seventy-six optical practices have joined the scheme and 3224 patients have been screened in the first 6 months (Dorset population 655,000). In the Poole area (population 230,000), 1922 patients were screened and 129 (6.7%) were recalled in 6 months. Outcome of 3 months screening, identified 59 recalls. Referral to the opthalmologist was made in 15 cases for potentially sight threatening retinopathy, 14 cases were followed in the diabetic clinic for significant background retinopathy, and 24 cases were returned to the annual screening in the optical practices. Six cases where the patients either failed or were unable to attend were reviewed by the GP. An optical practice based diabetic eye screening programme has been successful in screening a large number of patients.