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Expression of villin, a 95-kd F-actin bundling and severing protein, is restricted in animal tissues to epithelial cells with a brush border. Thus, the enterocytes of the intestine and epithelial cells of proximal but not distal tubules of the kidney are strongly positive. Here we report a similar staining pattern for human intestine and kidney. In four human colon adenocarcinomas villin expression was seen in tubular and glandular structures but not in the undifferentiated parts. Fourteen human renal carcinomas (9-Grade I and 5 Grade II) were villin-positive, and 2 sarcomatous renal carcinomas (Grade III) were villin-negative. The percentage of tumor cells that were villin-positive varied from 10-90% for the Grade I and II types. Our results indicate that villin may be a grading marker that deserves further study in renal carcinoma. They also raise the question whether the majority of renal carcinomas are derived from the proximal tubular epithelium rather than from the distal epithelium.

This paper sets out the arguments for drug treatment of chronic glomerulonephritides (GN). Although the pathogenesis and mechanism of progression of chronic GN remained to be clarified, on the basis of controlled studies performed to date, there is a strong case to be made for an aggressive treatment approach to this disease spectrum. For instance, in patients with idiopathic membranous glomerulonephritis a six months treatment with chlorambucil (0.2 mg/KG/day) or prednisone (0.6 mg/KG/day) each given once a day over a period of three months has recently been shown to improve the outcome of the renal functional parameters after three years follow up. In another controlled trial a daily dose of 225 mg dipyridamole and 975 mg aspirin given over 12 months in patients with membrano-proliferative GN type I has been reported to normalize the increased platelet consumption rate and to stabilize the glomerular filtration rate. A third trial has demonstrated that the combined use of cyclophosphamide (100 mg/day) and prednisone (30 mg/day) over several months was superior to the use of prednisone alone (40 mg/day) in improving the long-term prognosis of diffuse-proliferative lupus nephritis (type IV, WHO). In some entities, however, as in IgA-nephritis there is still no evidence for a specific treatment improving the course of the chronic glomerular disease. Other therapeutic problems have to be solved: thus, in patients with minimal change nephropathy with a steroid dependent nephrotic syndrome the benefit of cyclophosphamide (given over three months) or of cyclosporin A is still being investigated. Furthermore, there is some evidence that progression of chronic GN, particularly that of glomerular sclerosing, can be prevented by a low protein diet. The role of eicosanoides and their inhibitors in this context has not yet been fully investigated. The different drug trials and new therapeutic concepts indicate a rapid development of chronic GN treatment. Therefore, a failure to treat actively is difficult to understand.

Clinical and experimental data indicate that glomerular function and morphology may be influenced by plasma lipids. In familial lecithin-cholesterol-acyltransferase (LCAT) deficiency and in Fabry's disease, lipids accumulate in glomeruli and are assumed to induce sclerosis. The present study was undertaken to examine if dietary lipids could exert effects on the glomeruli of normal, unilaterally nephrectomized rats, and of rats with two-kidney, one clip (2-K,1C) hypertension. In rats with two kidneys on a diet rich in fat and cholesterol, cholesterol concentrations in very low density lipoproteins increased. In these rats the number of glomeruli with sclerotic foci was significantly higher than in rats on a low fat, cholesterol free diet. After 6 months on the diet the percentage of glomeruli with sclerosis (SC) was 13.2 +/- 4.1 (N = 9) in rats with a cholesterol diet and 1.8 +/- 0.6 (N = 11) in control rats (p less than 0.05). The fat and cholesterol diet exacerbated glomerular lesions in the remnant kidney model of uninephrectomized rats. The sclerosis in rats with only one kidney was 38.2 +/- 9.5 (N = 6) on a cholesterol diet compared with 8.7 +/- 3.0 (N = 6) in control rats after 6 months (p less than 0.05). After 3 to 4 months on a fat rich diet cholesterylester was increased in isolated glomeruli. The composition of the dietary lipids influenced the development of glomerular lesions. A linseed oil diet that is rich in unsaturated fatty acids, especially linolenic acid, did not cause major plasma lipid abnormalities and was accompanied by a low sclerosis (1.2 +/- 0.3; N = 9) for rats with two kidneys. In rats with chronic 2-K, 1C hypertension the percentage of glomeruli with partially sclerosed tufts in the unclipped kidney was significantly higher on a fat and cholesterol diet (F) than on a control diet (N) (SC: diet F 31.0 +/- 4.0, N = 13; diet N 12.2 +/- 2.6, N = 12; P less than 0.05). In the clipped kidney, protected against the arterial hypertension, only an increased number of glomeruli with mesangial expansion was noted in rats with the cholesterol diet. Glomerular hemodynamic factors seem to play an important pathogenetic role in the induction of glomerular sclerosis by a lipid rich diet. The fact that dietary lipids can aggravate glomerular lesions in states of arterial hypertension and nephron loss may have implications for the progression of renal disease in humans.

Experimental hydronephrosis in mice has been studied with histological, ultrastructural, immunohistochemical, biochemical, and electrophysiological techniques to establish its value as a preparation for the investigation of glomerular microcirculation as well as the electrophysiological and biochemical properties of the renin-containing juxtaglomerular (JG) and vascular smooth muscle (VSM) cells of the afferent glomerular arteriole. During developing hydronephrosis the kidney parenchyma becomes progressively thinner as a result of tubular atrophy, being, after 12 weeks, a tissue sheet of about 200 micron in thickness. In this preparation, the renal arterial tree, in particular the glomerular arterioles, and also the glomeruli can be easily visualized. This permits intravital microscopic studies or direct visual identification of JG and VSM cells for microelectrode impalement. In spite of complete tubular atrophy, the vascular system is well preserved. Ultrastructurally, JG and VSM cells as well as the axon terminals innervating the vessels are intact. The same holds for the glomeruli except for a certain confluence of the podocyte foot processes and a thickening of the basal lamina. Renin immunostaining and kidney renin content in the hydronephrotic organ correspond to those in control kidneys. In addition, renin release from this preparation can be stimulated in a typical manner by isoproterenol and inhibited by angiotensin II, indicating that the receptors controling renin release and the secretory mechanism itself are still intact. Electrophysiological recordings from JG and VSM cells show a high membrane potential (-75 mv), and spontaneous depolarizing junction potentials, owing to transmitter release from the nerve terminals. Inhibitors of renin secretion, e.g. angiotensin II, depolarize both cell types, whereas stimulators such as isoproterenol do not change the membrane potential. We conclude that the hydronephrotic mouse kidney is a suitable model for in vitro studies of the electrophysiology and biochemistry of the media cells of the afferent arteriole, as well as for in vivo studies of glomerular microcirculation.

We report on a 17 year old female patient with amenorrhea, hirsutism and slight acne. Hormonal blood analyses showed markedly increased levels for dehydroepiandrosteronesulfate, testosterone and androstenedione. Ultrasound investigation revealed a large tumor above the left kidney and a small area above the right kidney, suspicious for a tumor on the contralateral side. This was confirmed by angiography. During surgery, bilateral tumors were removed. Pathological diagnosis was made as bilateral adenomas of the adrenal cortex. Postoperatively, an impressive normalization was observed, accompanied by a rapid decrease of the elevated hormone concentrations. This case is the first report of a bilateral occurrence of a virilizing tumor of the adrenal cortex.

We report light- and electron microscopic findings in glomerular amyloidosis (secondary amyloidosis), which occurred after recurrent empyema of the pleura. After healing of the empyema, the clinical symptoms disappeared, over a period of eight years. During the acute stage of the disease (grade II-III amyloidosis) when the nephrotic syndrome was present, amyloid deposits were seen in the mesangium and on both sides of the basement membrane of the glomerular capillaries. Furthermore, denuded basement membrane areas showing the passage of amyloid into the urinary space, and invaginations of the podocyte by straightened amyloid fibrils were found. After clinical recovery (except for a trace of proteinuria), the renal amyloidosis had electronmicroscopically transformed from an active into an inactive or resting form, while the amount of amyloid present was almost the same. In the areas of amyloid deposits, reparative changes were observed, espcially in the area of the mesangial cells and of the podocytes. The podocytes were separated from the persisting amyloid deposits by newly formed basement membrane material.