The significance of glycated albumin (GA), compared with casual plasma glucose (PG) and glycated hemoglobin (HbA 1c ), was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. The mean PG, GA, and HbA 1c levels were 164.5 ؎ 55.7 mg/dl, 22.5 ؎ 7.5%, and 5.85 ؎ 1.26%, respectively, in HD patients with diabetes (n ‫؍‬ 538), which were increased by 51.5, 31.6, and 17.7%, respectively, compared with HD patients without diabetes (n ‫؍‬ 828). HbA 1c levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the relationship among the three parameters in patients who had diabetes without renal dysfunction (n ‫؍‬ 365), as reflected by the significantly more shallow slope of regression line between HbA 1c and PG or GA. A significant negative correlation was found between GA and serum albumin (r ‫؍‬ ؊0.131, P ‫؍‬ 0.002) in HD patients with diabetes, whereas HbA 1c correlated positively and negatively with hemoglobin (r ‫؍‬ 0.090, P ‫؍‬ 0.036) and weekly dose of erythropoietin injection (r ‫؍‬ ؊0.159, P < 0.001), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA 1c levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartile by HbA 1c level led to better glycemic control in a significantly higher proportions of HD patients with diabetes than those assessed by GA. Multiple regression analysis demonstrated that the weekly dose of erythropoietin, in addition to PG, emerged as an independent factor associated with HbA 1c in HD patients with diabetes, although PG but not albumin was an independent factor associated with GA. In summary, it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA 1c in these patients might lead to underestimation likely as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.

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We reviewed the diagnostic features and clinical course of 140 patients with idiopathic membranous nephropathy who had their index renal biopsies performed at the Mayo Clinic between 1972 and 1984. There were 93 males and 47 females (average age, 50.8 +/- 17 years); 116 patients (83%) had the nephrotic syndrome and 42 (30%) were hypertensive at diagnosis. Eighty-nine patients were not treated with corticosteroid or immunosuppressive drugs and 51 patients were treated mainly with short-term courses of prednisone alone; a minority of patients also received meclofenamate, cyclophosphamide, azathioprine, or chlorambucil. Five-year survival, including patients who received dialysis or a renal transplant, was 85%, 75% at 10 years, and no different from expected survival; there was no difference between untreated and treated groups. Also, there were no differences in the outcomes of renal function and protein excretion between untreated and treated patients. Among 28 patients (20%) who developed end-stage renal disease, 17 showed rapid progression within 2.5 years after diagnosis. Fifteen of the 17 patients were males; all were severely nephrotic and had impaired renal function at diagnosis. Only 1 of 24 patients with nonnephrotic proteinuria at index renal biopsy progressed to end-stage renal disease. Overall, a level of baseline proteinuria of 10 g or more per 24 hours and variable blood pressure control in hypertensive patients were associated with renal progression.

The correlation between renal histology and class specific (IgG and IgM) antibodies to double stranded DNA (dsDNA) and single stranded DNA (ssDNA) was studied by enzyme linked immunosorbent assay (ELISA) in 40 untreated patients with systemic lupus erythematosus (SLE). The levels of IgG antibodies to dsDNA were significantly higher in patients with World Health Organisation class IV nephritis than in those with class I, class II, or class III nephritis. IgG antibodies to ssDNA were higher in patients with class IV than in those with class II nephritis. IgG antibodies to dsDNA showed a close correlation with the histological activity score and the amount of electron dense deposit. IgG antibodies to ssDNA showed only a weak correlation with the renal histological activity score. IgM antibodies to dsDNA and IgM antibodies to ssDNA were not correlated with renal histological features. Patients with moderate to severe nephritis had a lower ratio of IgM antibodies to dsDNA to IgG antibodies to dsDNA than those with mild nephritis. These results indicate that the measurement of IgG antibodies to dsDNA is predictive in evaluating renal histological activity in patients with SLE.