1063 pressure about 15 mm Hg. At first, the fetuses reacted by bradycardia and moderate hypertension (mean arterial bloodpressure 80-100 mm Hg) maintained during !--11 h, followed by hypotension. The central venous pressure hardly changed during the procedure. We suggest that the breakdown of the fetal blood/brain barrier to albumin is due to a combination of the initial moderate hypertension and severe vasodilation during asphyxia.7 The permeability of the blood/brain barrier to albumin in asphyxiated babies would facilitate the transport of bilirubin from plasma to neurones and thus explain the increased susceptibility to kernicterus. Department of Neonatology, Rigshospitalet,
Copenhagen, Denmark
Department of Anaesthesia, Winnipeg, Canada
Health Sciences Centre,
Department of Clinical Physiology, Bispebjerg Hospital, Copenhagen
H. C. LOU
oids
can
Division of Nephrology Ospedale Policlinico, 20122 Milan, Italy
and
Dialysis,
C. PONTICELLI A. TARANTINO P. PIOLTELLI F. INVERNIZZI
Medical Clinic IV, University of Milan
W. A. TWEED G. JOHNSON
AUTOLYMPHOCYTOTOXIC ANTIBODIES AND KIDNEY TRANSPLANTATION
M. JONES
on chronic hxmodialysis may have in their lymphocytotoxic antibodies which react with their own lymphocytes. Kidneys have been transplanted successfully in patients with autolymphocytotoxins despite a positive crossmatch with the lymphocytes of the kidney donor.’Among 132 patients we found autolymphocytotoxic antibodies in 9.
SIR,-Patients
N. A. LASSEN
HIGH-DOSE METHYLPREDNISOLONE PULSES IN ACTIVE LUPUS NEPHRITIS
SIR,-Dr Levinsky and his colleagues (March 12, p. 564) reported a rapid reduction of immune-complex levels and clinical improvement in two patients with active lupus nephritis after administration of high-dose methylprednisolone. We can confirm the efficacy of intravenous steroid pulses in exacerbations of this disease. Six women with diffuse proliferative lupus nephritis and severe clinical symptoms and immunological signs of activity were
and his colleagues that intravenous high-dose sterhave an immunosuppressive action as well as an antiinflammatory effect seems confirmed. Active lupus nephritis is a serious disease which often requires a dangerous protracted course of large doses of oral steroids. A very short course of high-dose intravenous methylprednisolone could be a promising alternative, both improving the results and reducing the side-effects.
Levinsky
given methylprednisolone pulse therapy (1000 mg/day
for 3 days) followed by oral prednisone (0-5-1 mg/kg/day). Double-stranded D.N.A. binding and serum C3, C4, and Clq levels were assessed before treatment and serially for 4-8 weeks. In all the patients clinical symptoms (fever, joint pains, malaise, and rash) soon improved. Serum-creatinine levels returned to normal in patient A and fell in another patient (E) who had chronic renal failure. In two patients with stable renal failure before the treatment (C and F) and in the two with normal renal function the serum-creatinine did not alter. Moreover, the percentage of d.S.-D.N.A. binding fell, and serum levels of C3, C4, and Clq rose. In some cases this effect was rapid, in others it was less dramatic, and, particularly for the complement components, normal values were reached slowly. These results show that methylprednisolone pulse therapy can have a useful role in reversing clinical signs of activity in lupus nephritis. Since this improvement is accompanied by an important lowering of d.S.-D.N.A. binding and by a later increase of serum complement components, the suggestion by Dr 7. Häggendal, E., Johansson, B. Acta neurol scand. 1972, 48, 265.
serum
Because these antibodies interfere with the selection of cadaver
kidneys, giving a positive cross-match with all donors, we tried to remove the autolymphocytotoxins without eliminating the antibodies reactive with lymphocytes of unrelated individuals. We found that, at 4°C, autolymphocytotoxic antibodies could be adsorbed onto autologous erythrocytes. Eluates from these erythrocytes were then prepared at 37°C in saline, and the autolymphocytotoxic activity was recovered in the eluate. In 7 of the 9 patients, the autolymphocytotoxins reacted only with the patient’s B lymphocytes at 22°, 30°, and 37°C. In 2 patients, autolymphocytotoxins were additionally reactive with an enriched T-lymphocyte population at 15° and 22°C. We do not know why adsorption onto autologous erythrocytes removed the autoantibodies and we are now investigating this problem. In one patient ’Sephadex G-100’ chromatography of the serum demonstrated that the autoantibody was of the IgG class. In most of the patients the titre of the lymphocytotoxic antibodies was stable for more than a year. No correlation has been found between presence of the autolymphocytotoxins and the cause of renal failure, neither were there signs of autoimmune disease in the patients. Kourilsky et aJ.3 have reported that patients with glomerular diseases may have a positive direct antiglobulin test with anti-complement serum. All our patients had positive direct 1. 2.
Cross, D. E., Greiner, R. R., Whittier, F. C. Transplantation, 1976, 21, 307. Stastny, P., Austin, C. L. ibid. p. 399. 3. Kourilsky, O., Poyau-Lemaux, C., Lucas, J. P., Neuilly, G., Richet, G. Lancet, 1974, ii, 683.
EFFECT OF METHYLPREDNISOLONE PULSE THERAPY ON D.N.A. BINDING, SERUM COMPH.M) NJ SERUM-CREATININE IN SIX PATIENTS WITH ACTIVE LUPUS NEPHRITIC
COMPONENTS,
AND
Copenhagen, Denmark
Department of Anaesthesia, Winnipeg, Canada
Health Sciences Centre,
Department of Clinical Physiology, Bispebjerg Hospital, Copenhagen
H. C. LOU
oids
can
Division of Nephrology Ospedale Policlinico, 20122 Milan, Italy
and
Dialysis,
C. PONTICELLI A. TARANTINO P. PIOLTELLI F. INVERNIZZI
Medical Clinic IV, University of Milan
W. A. TWEED G. JOHNSON
AUTOLYMPHOCYTOTOXIC ANTIBODIES AND KIDNEY TRANSPLANTATION
M. JONES
on chronic hxmodialysis may have in their lymphocytotoxic antibodies which react with their own lymphocytes. Kidneys have been transplanted successfully in patients with autolymphocytotoxins despite a positive crossmatch with the lymphocytes of the kidney donor.’Among 132 patients we found autolymphocytotoxic antibodies in 9.
SIR,-Patients
N. A. LASSEN
HIGH-DOSE METHYLPREDNISOLONE PULSES IN ACTIVE LUPUS NEPHRITIS
SIR,-Dr Levinsky and his colleagues (March 12, p. 564) reported a rapid reduction of immune-complex levels and clinical improvement in two patients with active lupus nephritis after administration of high-dose methylprednisolone. We can confirm the efficacy of intravenous steroid pulses in exacerbations of this disease. Six women with diffuse proliferative lupus nephritis and severe clinical symptoms and immunological signs of activity were
and his colleagues that intravenous high-dose sterhave an immunosuppressive action as well as an antiinflammatory effect seems confirmed. Active lupus nephritis is a serious disease which often requires a dangerous protracted course of large doses of oral steroids. A very short course of high-dose intravenous methylprednisolone could be a promising alternative, both improving the results and reducing the side-effects.
Levinsky
given methylprednisolone pulse therapy (1000 mg/day
for 3 days) followed by oral prednisone (0-5-1 mg/kg/day). Double-stranded D.N.A. binding and serum C3, C4, and Clq levels were assessed before treatment and serially for 4-8 weeks. In all the patients clinical symptoms (fever, joint pains, malaise, and rash) soon improved. Serum-creatinine levels returned to normal in patient A and fell in another patient (E) who had chronic renal failure. In two patients with stable renal failure before the treatment (C and F) and in the two with normal renal function the serum-creatinine did not alter. Moreover, the percentage of d.S.-D.N.A. binding fell, and serum levels of C3, C4, and Clq rose. In some cases this effect was rapid, in others it was less dramatic, and, particularly for the complement components, normal values were reached slowly. These results show that methylprednisolone pulse therapy can have a useful role in reversing clinical signs of activity in lupus nephritis. Since this improvement is accompanied by an important lowering of d.S.-D.N.A. binding and by a later increase of serum complement components, the suggestion by Dr 7. Häggendal, E., Johansson, B. Acta neurol scand. 1972, 48, 265.
serum
Because these antibodies interfere with the selection of cadaver
kidneys, giving a positive cross-match with all donors, we tried to remove the autolymphocytotoxins without eliminating the antibodies reactive with lymphocytes of unrelated individuals. We found that, at 4°C, autolymphocytotoxic antibodies could be adsorbed onto autologous erythrocytes. Eluates from these erythrocytes were then prepared at 37°C in saline, and the autolymphocytotoxic activity was recovered in the eluate. In 7 of the 9 patients, the autolymphocytotoxins reacted only with the patient’s B lymphocytes at 22°, 30°, and 37°C. In 2 patients, autolymphocytotoxins were additionally reactive with an enriched T-lymphocyte population at 15° and 22°C. We do not know why adsorption onto autologous erythrocytes removed the autoantibodies and we are now investigating this problem. In one patient ’Sephadex G-100’ chromatography of the serum demonstrated that the autoantibody was of the IgG class. In most of the patients the titre of the lymphocytotoxic antibodies was stable for more than a year. No correlation has been found between presence of the autolymphocytotoxins and the cause of renal failure, neither were there signs of autoimmune disease in the patients. Kourilsky et aJ.3 have reported that patients with glomerular diseases may have a positive direct antiglobulin test with anti-complement serum. All our patients had positive direct 1. 2.
Cross, D. E., Greiner, R. R., Whittier, F. C. Transplantation, 1976, 21, 307. Stastny, P., Austin, C. L. ibid. p. 399. 3. Kourilsky, O., Poyau-Lemaux, C., Lucas, J. P., Neuilly, G., Richet, G. Lancet, 1974, ii, 683.
EFFECT OF METHYLPREDNISOLONE PULSE THERAPY ON D.N.A. BINDING, SERUM COMPH.M) NJ SERUM-CREATININE IN SIX PATIENTS WITH ACTIVE LUPUS NEPHRITIC
COMPONENTS,
AND
