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This study compared the antihypertensive effect and acceptability of a perindopril-based group with that of an atenolol-based group in Indian hypertensive type 2 (non-insulin-dependent) diabetic patients.100 ambulant patients aged between 35 and 69 years were recruited into this monocentric, randomised, double-blind study in two parallel groups for 1 year after a 1-month washout period on placebo. The setting was a tertiary care institution.All patients had stable, essential hypertension between 95mm Hg and 115mm Hg, type 2 diabetes with glycosylated haemoglobin (HbA(1C))12%, and albuminuria between 300mg and 3.5g/24 hours. There were 50 patients per treatment group and two patient population groups were studied, intention-to-treat (ITT) and per-protocol (PP). The former constituted all patients, whilst the latter included those without major protocol deviation and who completed the 12-month study.The study drugs were perindopril 4 to 8mg once daily or atenolol 50 to 100mg once daily. In each group therapeutic adjustment was planned by doubling the dose and then by the addition of hydrochlorothiazide 25mg daily. Nifedipine 30 to 60mg daily was subsequently added if the desired drop in blood pressure was not obtained. The ITT group was analysed by Student's t-test, and a 2-way analysis of variance was performed for the PP population.A comparison of the control of hypertension, biochemical abnormalities, blood sugar and adverse effects was performed in the atenolol group versus the perindopril group.On single-dose therapy after 1 month 17 patients (60%) had normal blood pressure [diastolic blood pressure (DBP)/=90mm Hg] on atenolol 50mg daily, while 13% (30.23%) had normal blood pressure (DBP/=90mm Hg) on perindopril 4mg daily (p = 0.013). In the ITT group the sitting systolic blood pressure (SBP) decreased by 14.4 +/- 22.3mm Hg at the end of the treatment period on atenolol from 174.4 +/- 17.9mm Hg at the initial period, and the sitting SBP decreased by 21.6 +/- 20.3mm Hg at the end of perindopril treatment from an initial value of 172.1 +/- 20.3mm Hg (probability 0.091). The sitting DBP decreased by 18.6 +/- 8.7mm Hg on atenolol from 100.5 +/- 4.8mm Hg at the initial period and by 15.8 +/- 9.1mm Hg on perindopril from 100.6 +/- 5.2mm Hg (probability 0.112). Glycaemic control was similar for HbA(1C) fasting and postprandial glucose in the ITT population, while fasting glucose increased over time from 10.7 +/- 4.1 to 12.0 +/- 3.4 mmol/L; p0.001 in the PP population in the atenolol group.The percentage of normalised patients (sitting DBP/=90mm Hg) was similar in both groups. Patients on perindopril monotherapy required more additional antihypertensive drugs compared with atenolol monotherapy. There was a significant increase in fasting blood sugar in the atenolol-based group (p0.001).

Summary The prognostic importance of hypertension at the onset of clinical lupus nephritis is not well established. We studied retrospectively 44 patients with lupus nephritis in order to ascertain the prevalence of hypertension at presentation and to investigate a possible association between hypertension and renal functional impairment. A correlation was also sought between hypertension and histological class of lupus nephritis. Hypertension was graded as mild (diastolic 95–99 mmHg), moderate (100-114) or severe (> 115). Impaired renal function (creatinine > 120 mumol/l) was graded as mild (120-200 mumol/l), moderate (200-350 mumol/l), or severe (> 350 mumol/l). Histological class and the presence of hypertensive renal vascular lesions was recorded. The prevalence of hypertension was 38%. There were 17 hypertensives and 27 normotensives. The incidence of renal impairment was greater in the hypertensives, 47% vs 18.5% (p = 0.04). Mean serum creatinine was also higher higher in this group (p = 0.02). The presence of hypertensive renal vascular lesions identified a high-risk subgroup who had a higher incidence of renal functional impairment and worse renal function than the hypertensive group as a whole. Even at an early stage, hypertension and hypertensive renal vascular lesions correlated well with renal functional impairment. Aggressive treatment of hypertension is therefore essential in early lupus nephritis in order to prevent further deterioration of renal function as the disease evolves.

Objective: To establish the correlation between clinical and biochemical parameters and the urinary patterns of proteinuria detected by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) in preeclampsia.Methods: 34 severe preeclamptics (BP ± 110 mm Hg diastolic and s= + + proteinuria) who were < 34 weeks gestational age were included in the study. Blood and urinary samples were obtained and the following tests performed: full blood count, serum urea, electrolytes and urates, 24-h proteinuria and creatinine clearance, and SDS PAGE.Results: The patients were divided into two groups depending on whether they excreted only albumin or both tubular and glomerular proteins as detected by SDS PAGE. There were no significant differences in maternal age, parity, gravidity, and gestational age between the groups. Systolic and diastolic blood pressures were significantly higher in those who excreted both glomerular and tubular proteins than in those who excreted albumin only: 173/116 versus 156/106 ...

Objective: An ultrastructural evaluation of heparan sulfate proteoglycan macromolecules in the glomerular basement membrane of African women with early-onset preeclampsia and assessment of the relationship of these anionic sites to the degree of proteinuria in these patients.Design: Prospective, descriptive study.Setting: Obstetric wards. King Edward VIII Hospital (KEH), Durban, South Africa, a tertiary referral center serving an underprivileged community.Subjects: Ten patients with early-onset preeclampsia (i.e., between 24 and 34 weeks of gestation) and five controls from adult trauma patients undergoing partial nephrectomy.Main Outcome Measure: Quantitative analysis of polyethyleneimine-labeled anionic sites within the glomerular basement membrane (GBM).Results: There was a significant reduction in labeling within the lamina rara externa of the early-onset preeclampsia (EOPE) group compared to control specimens (P ± 0.02). There was a strong correlation (r = –0.79) between the severity of proteinuria a...

Objectives: To compare Alcian-Blue (AB) binding of erythrocytes in African women with preeclampsia and normotensive controls matched for age, race, and gestational age, and to correlate it with serum creatinine, serum albumin, and 24-h urinary protein excretion.Design: Prospective descriptive study.Setting: Obstetric wards, King Edward VIII Hospital (KEH), Durban, South Africa. Tertiary referral center serving an underprivileged community.Subjects: Eleven patients with early onset preeclampsia–i.e., between 24 and 34 weeks of gestation–and 11 pregnancy-matched controls.Main Outcome Measures: Alteration in AB binding in preeclampsia compared to matched controlsResults: AB binding was significantly decreased in the preeclamptic group [31.05 ng/106 cells compared to controls 65.12 ng/106 cells (P 0.7) between AB binding and serum creatinine but not with serum albumin and level of proteinuria.Conclusion: As altered erythrocyte charge may infer alterations in glome...

We studied alcian blue (AB) binding to red blood cells (RBC) [ABRBC] in 89 children and adults with a variety of glomerular diseases. ABRBC was significantly reduced in the group as a whole when compared with healthy controls (P < 0.001). A moderate correlation between the degree of proteinuria and ABRBC was detected in the children with renal disease (r = 0.43, P < 0.001), but not in adult patients. A significant reduction in ABRBC was detected in 30 of the above children who had Steroid Responsive Nephrotic Syndrome (MCNS) compared to their controls (40.57 +/- 16.6 v. 75.09 +/- 7.81, P = 0.001). A similar decrease from normal values was observed in other childhood glomerular diseases: focal glomerulosclerosis, post-streptococcal glomerulonephritis, membranous nephropathy (52.31 +/- 26.07 v. 79.44 +/- 5.88, P = 0.001). Mean ABRBC was lower in MCNS than other histological groups (P = 0.0518). ABRBC was age-dependent (r = -0.399, P < 0.02). These findings provide further indirect evidence of the relative roles of charge and size selective filters in glomerular basement membrane (GBM) in renal diseases, and suggest that depletion of anionic charge may be a major cause of proteinuria in MCNS.

Cellular immune mechanisms may be involved in the pathogenesis of tubulointerstitial nephritis associated with several forms of primary glomerulonephritis. This study aims to characterize the mononuclear leukocytes infiltrating the interstitium in patients with primary membranoproliferative glomerulonephritis (MPGN) and correlates the degree and nature of the infiltrate with renal function. Cellular identification using monoclonal antibodies to leukocyte cell-surface antigens was conducted on renal biopsy specimens from 17 patients with type I primary MPGN (group 1) and 10 controls with various forms of nonproliferative glomerulonephritis (group 2). The majority (14) of the 17 patients in group 1 were black South Africans. Renal function was assessed at the time of renal biopsy. Patients with MPGN had a significant increase in the number of interstitial total leukocytes (LCA), T lymphocytes (T), and B lymphocytes (B) compared with controls. Although the interstitial monocyte (KP(1)) count was also increased in MPGN patients, the difference was not significant. Recorded numbers of cells per square millimeter in group 1 versus group 2 are as follows: LCA, 1306 +/- 1254 versus 138 +/- 91 (P0.001); T, 638 +/- 547 versus 42 +/- 60 (P.0.01); B, 161 +/- 165 versus 57 +/- 50 (P=0.02); and KP(1), 125 +/- 153 versus 54 +/- 59 (P=0.17). As noted in previous studies, the T lymphocyte was the dominant cell, comprising 48.8% of the total count. However, the combined number of T lymphocytes, B lymphocytes, and monocytes accounted for only 70.6% of the total leukocytic interstitial count, implying that the majority of the remaining 29.4% of the cells were mononuclear leukocytes that did not express the antigens we stained for. There was a moderate correlation between the number of interstitial total leukocytes, and impairment of renal function as measured by both the serum creatinine (r = 0.43) and creatinine clearance (r = -0.41). This correlation also existed for the individual cells comprising the infiltrate and was strongest for T lymphocytes (r = 0.63) followed by monocytes (r =0.46) and B lymphocytes (r = 0.41). In conclusion, we have demonstrated a significant mononuclear leukocytic interstitial infiltrate in our patients with type I MPGN and a correlation between all cells of this infiltrate with impaired renal function. This correlation was strongest for the most frequently observed cell, the T lymphocyte.

This study compares our experiences of the incidence and etiology of acute renal failure in pregnancy (ARF-P) in patients requiring hemodialysis, a decade after a previous publication from our institution. A retrospective analysis of the hospital records of 42 patients with a diagnosis of ARF-P during a 3-year period from 1990 to 1992 was undertaken [16% of the total number of acute renal failure (ARF) patients needing hemodialysis]. The incidence of ARF-P (expressed relative to all cases of acute renal failure requiring hemodialysis) decreased from 24.6% (1978) to 16% (1992: p = 0.03). Preeclampsia-eclampsia (PE:E) replaced septic abortion as the principal cause of ARF-P. In those patients with PE:E, thrombocytopenia (platelet count < 150 x 10(9)/L) occurred in all, while 33% developed the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Ingestion of herbal toxins was noted mostly in patients with septic abortion. Maternal mortality was 5% and was due to multiorgan failure complicating septic abortion. The perinatal mortality of 55% occurred in women with early gestation, thrombocytopenia, and high serum creatinine levels. Acute renal failure in pregnancy continues to present a challenge in South Africa, a developing country. There were significantly more obstetric than gynecological causes in 1992 (p = 0.0003). This could be attributed to the steady decline in septic abortion since 1978. The main contributor to obstetric-related causes was PE:E. Greater emphasis should therefore be placed on detecting hypertension at antenatal visits.(ABSTRACT TRUNCATED AT 250 WORDS)