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Chronic renal failure (CRF) in the elderly is a cause of multiple endocrine dysfunctions. The three most common pituitary axes involved are the thyrotrope, lactotrope and gonadotrope axes. Thyroid dysfunction may be the consequence of thyroid or pituitary failure. Hyperprolactinemia results in gonadal failure and is present in 30% of patients. Early presentation of menopause and andropause are common in patients with CRF. Sexual hormonal replacement is controversial and must be individually tailored. We propose a systematic screening in the elderly with CRF: determination of TSH, TPO antibodies and cervical palpation, measures of PRL, LH, FSH and testosterone to explore lactotrope and gonadotrope axis.

We report another case of acute interstitial nephritis with uveitis (TINU syndrome) in a 35-year-old woman. About thirty cases were described since the first ones 20 years ago. We discuss the assessment needed to reach the diagnosis. The evolution is unusually favourable with steroid therapy.

The incidences of clinical and biological markers of atopy were investigated in 16 children with IgA nephropathy (IgAN) (group A) and in 22 with Henoch-Schönlein purpura nephritis (HSPN) (group B). The incidence of increased plasma IgE levels according to age-matched normal values was significantly higher in group B (17/22, 77%) than in group A (7/16, 44%) (P

The adhesion of normal rat peritoneal macrophages to normal rat glomerular epithelial or mesangial cells has been studied in vitro after a 60 min incubation at 37 degree C. After washing, the cell preparations were examined by phase contrast or scanning electron microscopy. Quantitative studies were also performed using macrophages labelled with 99mTc tin colloids. Peritoneal macrophages predominantly adhered to the cultured mesangial cells. The percent-age of labelled macrophages adhering to these cells was about 10 times higher than that of labelled macrophages adhering to the cultured epithelial cells. This percentage increased proportionally to the number of labelled macrophages added, and was strongly reduced by the prior incubation of macrophagic cells with aggregated IgG, with anti-fibronectin IgG, or with F(ab')2 fragments of anti-fibronectin IgG. Furthermore, the macrophage-mesangial cell interaction was significantly reduced by the prior incubation of mesangial cells with anti-fibronectin IgG or with F(ab')2 fragments of anti-fibronectin IgG. The data demonstrate that normal rat peritoneal macrophages preferentially adhere in vitro to normal rat glomerular mesangial cells, and that this binding may be modulated, at least, by: (a) the Fc receptor binding activity of macrophages; (b) the fibronectin molecules available at the surface of macrophages and of mesangial cells.

A proliferative glomerulonephritis was induced in rats preimmunised with rabbit IgG by injecting a sub-nephrotoxic dose of rabbit anti-rat GBM IgG. All the rats developed a severe proteinuria within 2-5 days after the injection of anti-GBM IgG. At the same time, many mononuclear phagocytes infiltrated the glomeruli, the colloidal iron staining of the glomerular filtration barrier was altered, and the urinary excretion of laminin and of neutral proteinase strongly increased. However, the pattern and intensity of staining of different collagenous and non-collagenous BM glycoproteins were not modified, as shown by indirect immunofluorescence microscopy. The existence of a direct significant correlation between the proteinuria and the laminin urinary excretion, and between the latter and the urinary neutral proteinase activity suggests that lysosomal proteinase of mononuclear phagocytes may be involved in the damage of the GBM during the course of this experimental glomerulonephritis.

The perfusion of polymeric or secretory IgA-Concanavalin A complexes into the aorta of rats led to a mannose-dependent binding of both IgA and lectin to the glomerular capillary wall, as shown by double immunolocalization experiments, by quantitative analysis of the amount of radiolabelled complexes bound per g of kidney, and by blocking experiments with the corresponding carbohydrate. Rats injected with amounts of those complexes as low as 500 micrograms developed, one hour later, a focal and segmental proliferative glomerulonephritis characterized by the deposition of injected complexes and of rat C3 and rat fibrin/fibrinogen in most glomeruli; focal thrombosis and small areas of necrosis in 10 to 15% of glomeruli, confined to the periphery of a single lobule of the tuft and segmental infiltration of these glomeruli by polymorphonuclear leucocytes and platelets. At the same time, many mesangial cells exhibited a hyperactive appearance, and red blood cells were noted in tubular lumens. In contrast, rats similarly injected with either monomeric IgA-ConA complexes, multimeric or secretory IgA-peanut agglutinin complexes or polymeric or monomeric IgA aggregates of comparable apparent molecular weight did not develop obvious glomerular lesions within one hour. The data indicate that performed polymeric IgA-ConA complexes can specifically bind to glomerular structures in vivo and trigger acute glomerular lesions locally, analogous to those observed in some glomerular diseases associated with a cryoglobulinaemia.

The perfusion of polymeric IgA (pIgA)--or secretory IgA (sIgA)--Concanavalin A (ConA) non-immune complexes (apparent Mol.Wt greater than 10(3) Kd) into the aorta of rats led to a dose-dependent and a mannose-dependent deposition of both IgA and lectin into the glomeruli. Rats injected with amounts of those complexes as low as 500 micrograms developed, one hour later, a focal and segmental proliferative glomerulonephritis characterized by: a) the deposition in the mesangial area of most glomeruli of injected complexes and of rat C3; b) small areas of fibrinoïd necrosis in 10 to 15% of glomeruli, confined to the periphery of a single lobule of the tuft; c) a segmental infiltration of those glomeruli by polymorphonuclear leucocytes, mononuclear phagocytes and platelets; d) a hyperactive aspect of mesangial cells; e) the presence of red blood cells in tubular lumens. By contrast, no glomerular lesions were obvious in rats similarly injected either with monomeric IgA (mIgA)-ConA, pIgA-peanut agglutinin (PNA) or sIgA-PNA complexes or with heat-aggregated pIgA or mIgA. The data indicate that preformed polymeric IgA-ConA complexes can specifically bind to glomerular structures in vivo and locally trigger, as antigen-antibody complexes, an acute inflammatory reaction resulting in glomerular lesions similar to those observed in Henoch-Schönlein purpura nephritis.