SIM MARYThe 20-kD homologous resttiction Factor (HRK20). which is identical to CD59, is a membraneassociated protein uhich inhibits ihc reaction orC9 lo furni mcmbr;ine attaek complex (MAC) of homologous complement^.. In various human glomerular diseases depo.sition of complement components is frequently seen and MAC is reported to associate with immune deposits. Using a specitic monoclonal antibody. Il"5.ai!ainst HRI-20. we attempted to study ihe loeali/ation of MR F20 in human glomerulonephrilides and to compare the kxrali/ation of HRF2() with those ol" immune deposits and MAC. The frozen sections ol' kidney specimens were fixed in acetone at room temperature before staining. In normal kidneysandkidney specimens from the patients with minimal change nephrotic syndrome, membranous ncphropathy. and IgA nephropath\. HRF20 was strongly ItKali/ed in the periluhuktr capillaries and along Bowman's capsules. A weaker bui well-defined staining was obtained ill the iiiL'sangial area and faini staining was seen along the glomerular capillary walls. In contrast, glomerular capillary walls were rather strongly stained in the cases wiih diHuse lupus nephritis whieh had subendothelial dense deposits. These data suggest Ihai HRF2O(CD59) is present in the human glomeruh and iis expression is enhanced under certain conditions such as luptis nephriiis.

We studied the long-term outcome of 268 patients suffering from diabetic end-stage renal disease (DM-ESRD) treated with long-term haemodialysis between 1978 and 1991, with special emphasis on visual acuity as well as the heterogeneity of DM-ESRD. The 50% patient survival on haemodialysis was 60 months. Visual disturbances were found in 73.1% (392/536) of eyes at the start of haemodialysis. Chronological assessment of visual acuity demonstrated the stabilization of visual acuity and 87.1% (364/418) of eyes were stable, 4.8% (20/418) were improved, and 8.1% (34/418) were aggravated in the long term respectively. The change of visual acuity was frequently seen in the short term, and rapid shifts of body fluid to correct overhydration induced abrupt changes of glycaemic control as well as retraction of macular oedema. Hence it might be one of the factors affecting rapid change of visual acuity in the short term. Meanwhile, long-term deterioration of visual acuity resulted from either hypertension unresponsive to medical treatment or poor glycaemic control. Some DM-ESRD patients had only background retinopathy at the start of haemodialysis and these were likely to have the nephrosclerotic glomerular lesion. They were old, not nephrotic and had a mild degree of diabetes during the predialysis stage. Thus, DM-ESRD patients seem to have some heterogeneity in their clinical characteristics, and old DM-ESRD patients with only background retinopathy have the appearance of diabetic macroangiopathy rather than microangiopathy.

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MCA44 is a monoclonal antibody (mAb) to guinea-pig decay-accelerating factor (DAF) and, using this mAb, tissue distribution of guinea-pig DAF was studied by immunofluorescence. Guinea-pig DAF was found to be expressed not only on the vascular endothelium but also on different types of cells, such as the tubular epithelium of the kidney, epidermal cells of the skin and synovial lining cells. As there was no significant reduction in staining intensity with MCA44 following treatment with phosphatidylinositol-specific phospholipase C, many guinea-pig DAF molecules expressed in these tissues may be of the transmembrane form.

Our findings are the first demonstration that Notch signal activation in inflammatory cells may be involved in the pathophysiological mechanism underlying Buerger's disease.