No abstract

Circulating immune complexes, measured by the C1q binding and Raji cell radioimmunoassays, were detected in 16 of 25 (64%) patients with schistosomiasis alone, in all 13 patients (100%) with schistosomiasis infection associated with prolonged bacteremia by salmonella organisms, and in 15 of 18 (83%) patients with visceral leishmaniasis. The C3 levels in the serum of patients with schistosomiasis, with and without prolonged salmonella bacteremia, were significantly lower in those with renal disease. Further, in patients with schistosomiasis alone, the absence of renal involvement was positively associated with C1q binding within the normal range (P = 0.015) and the presence of IgM rheumatoid factor in serum (P = 0.04). In six of eight patients with visceral leishmaniasis treated with a pentavalent antimonial, there was a fall in Raji cell binding, suggesting indirectly that the parasitic antigen may be involved in the pathogenic immune complexes in serum.

To study the clinical course and the predictors of outcome in children and adolescents, 39 patients with nephrotic syndrome and primary focal segmental glomerulosclerosis (FSGS) were followed for a mean of 84.6 months. Thirty-six patients were treated with prednisone, either alone or in conjunction with cyclophosphamide. The clinical course was one of sustained remission in 4 patients, frequent relapse in 13, persistent nonnephrotic proteinuria in 5, and persistent nephrotic syndrome in 17; 2 patients had stable renal failure and 8 had progressive renal failure, 5 of them evolving to end-stage renal failure (ESRF). Resistance to prednisone was recorded in 76.6% of patients. The use of cyclophosphamide plus prednisone was of benefit in 42.8% of patients; 22.2% of the prednisone-resistant patients achieved remission of the nephrotic syndrome. A Kaplan-Meier analysis revealed a survival rate of 92% after 5 years, 86% after 10 years, and 76% after 15 years. Using both univariate and multivariate analysis, persistent nephrotic syndrome was associated with progression to ESRF and the remission of proteinuria with maintenance of renal function. As the outcome of the nephrotic syndrome in FSGS is significantly improved by remission of proteinuria, it is conceivable that immunosuppressive medication may be used in conjunction with prednisone in patients with steroid resistance.

Renal failure is common in patients with glomerular disease. Although renal failure may result from the glomerular lesion itself, it is also observed in patients with minimal glomerular alterations. Degenerative changes and necrosis of the tubular epithelium are common findings in kidney biopsies from these patients. The aim of this work is to examine the association between acute tubular necrosis (ATN) and renal failure in patients with glomerulopathy and to estimate the relationship between the degree of ATN and renal failure in these patients. Data on age, sex, presence of nephrotic syndrome, and renal failure were recorded for 149 patients, who underwent a renal biopsy for the diagnosis of glomerulopathy. The biopsies were reviewed, and ATN, when present, was classified as one of four grades depending on its intensity. The mean age of the patients was 21 ± 16 years. Eighty patients (54%) were male, 43 (42%) had renal failure, 104 (72%) had nephrotic syndrome, and 66 (45%) had minimal change disease or focal segmental glomerulosclerosis. ATN was present in 115 (77%) patients. The frequency of renal failure was directly correlated with the intensity of ATN [odds ratio (OR) of 26.0 for patients with grade 2 lesions and OR of 45.5 for patients with grade 3 lesions]. ATN is a common finding in the biopsies of patients with glomerulopathy. The severity of ATN is directly associated with the frequency of renal failure in these patients.

Twenty-one adult patients with urinary tract infections caused by penicillinresistant bacteria completed treatment with amoxicillin alone or amoxicillin plus clavulanic acid in a randomized double-blind clinical trial. Of the 13 patients treated with amoxicilhin plus clavulanic acid, the absence of bacteriuria within 7 days of therapy was observed in 85%, as compared with only 25% of the 8 patients receiving amoxicillin only. There were no significant side effects nor any clinical, biochemical, or hematological abnormalities related to either treatment. It was concluded that the combination of clavulanic acid and amoxicillin could be useful in the treatment of uncomplicated urinary tract infection caused by penicillinresistant bacteria.Clavulanic acid, a natural product of Streptomyces clavuligerus, is a potent, irreversible inhibitor of a wide variety of 8-lactamase enzymes (5, 7). Although it has little inherent antibacterial activity, it protects the labile penicillins and cephalosporins from destruction by bacterial ,8-lactamase (4, 6, 8, 9, 13). In vitro studies have demonstrated that clavulanic acid possesses a very wide spectrum of inhibition (3), which results in marked enhancement of,-lactam antibiotics against many 8-lactamase-producing organisms (3, 9, 13), including staphylococci and enterobacteria.Urinary tract infections caused by ,8-lactamase-producing species are common and often require treatment with antibiotics which are potentially toxic. Since clavulanic acid protects the ,8-lactam-sensitive antibiotics from enzymatic destruction, it should serve as a useful adjunct to therapy with those agents. Therefore, the purpose of this initial clinical trial was to determine the efficacy and safety of amoxicilhin plus clavulanic acid in the treatment of uncomplicated urinary tract infection caused by penicillin-resistant organisms. MATERIALS AND METHODSTwenty-one patients presenting with uncomplicated urinary tract infections caused by bacteria resistant to both ampicillin and amoxicillin were considered suitable for this trial. Urinary tract infection was defined as the presence of at least 105 bacteria per ml in patients complaining of dysuria, urgency, frequency, and back pain, or by two consecutive urine cultures containing 105 or more bacteria per ml of the same species in asymptomatic patients. There was no attempt to differentiate between upper and lower urinary tract infection for the purpose of this trial. All bacterial isolates were identified by standard procedures (2) and tested for susceptibility with a 10-,.g ampicillin disk by the Bauer-Kirby method (1). If the isolate was found to be resistant to ampicillin, a tube dilution minimum inhibitory concentration (MIC) to amoxicilhin was determined. All patients who were found to have infecting strains with amoxicillin MICs above 10 ug/ml were considered for enrollment in the study. In addition, a further MIC of amoxicilhin was obtained in the presence of 10 ug of clavulanic acid per ml. This concentration of clavulanic acid has been shown to...