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Previous reports indicate that maternal and fetal outcome in pregnancies complicated by systemic lupus erythematosus (SLE) may be strongly influenced by the presence of renal disease. As the relationship between renal histology and clinical function in SLE is not consistent, prospective data on the outcones of such pregnancies would aid patient counselling. Fifteen women with SLE had 18 pregnancies subsequent to renal biopsies, performed from 3 months to 8 years prior to conception. Their renal function was evaluated before, during and after pregnancy. Fourteen of 15 patients had evidence of renal involvement, based on by light and electron microscopic sections: 7 had mesangial involvement (WHO Class II); 5 had active focal or diffues glomerulonephritis (Classes III and IV); two had membranous involvement (Class V); 1, no evident disease. Perinatal outcome was similar whether lesions were milder (8 continuing pregnancies, 4 term deliveries) or more severe (6 continuing pregnancies, 3 term deliveries). Clinical renal function was normal in all but 3 cases at the beginning of pregnancy; 2 additional patients experienced moderate deteriorations in renal function during pregnancy but recovered normal function in the puerperium. Fetal outcome was abnormal (3 premature deliveries, 1 neonatal death, 1 spontaneous abortion) in all cases where renal function was decreased, while 10 of 13 pregnancies in patients with normal renal function ended in term deliveries. The data suggest that currently preconceptual rena histology provides a less accurate basis for perinatal counselling than does the assessment of clinica renal function.

• We report the case of a 5-year-old girl who died two years after onset of the idiopathic nephrotic syndrome, which failed to respond to treatment with corticosteroid and cyclophosphamide. Severe atherosclerotic changes were noted in both coronary arteries. Prolonged hyperlipidemia in patients with long-standing nephrotic syndrome may represent a major risk factor predisposing to premature coronary atherosclerosis in children who are also destined to develop chronic renal failure.(Am J Dis Child 131:976-980, 1977)

During a retrospective study of 100 patients who underwent renal biopsy because of pregnancy complicated by hypertension, we found 19 patients in whom proteinuria exceeded 5.0 Gm. per 24 hours and an adoitional eight patients in whom excretion ranged between 3.5 and 5 Gm. per day. Of these 27 patients, 23 had the kidney lesion of pre-eclampsia, and three of them had superimposed hypertensive changes in the vasculature. The remaining four had other renal diseases. We located and re-examined 10 of the 23 pre-eclamptic women, 12 to 104 (mean, 36) months after delivery. Serum creatinine levels were normal in all but one, who was discovered to have polycystic kidney disease. During the same time period, we located the records of six women who had heavy proteinuria during gestation but were normotensive. Thus, at our institution, pre-eclampsia is the most common cause of the nephrotic syndrome in pregnancy. The frequency of nephrotic proteinuria in pre-eclampsia appears higher than previously suspected, but, despite this fact, recovery was complete in most instances.

The mean concentrations of total protein and the electrophoretic fractions of the serum proteins, as well as the mean levels of haptoglobin and ceruloplasmin were determined among gravidas with acute hypertension classified by renal morphology. Among these subjects, elevated mean values for alpha-1 globulin and haptoglobin were statistically significant. When comparisons were made with normal gravidas at corresponding periods of gestation, an elevated mean concentration of alpha-1 globulin identified the group of patients with the toxemic glomerular lesion. When comparisons were made between the groups of patients with abnormal renal morphology, an elevated mean level of haptoglobin characterized the group of patients with the lesions of chronic latent glomerulonephritis.

THE PURPOSE of this report is to record serial clinical and electron microscopic studies in 2 adults who have had the nephrotic syndrome. The clinical course of the 2 patients has been marked by a subsidence of the nephrotic syndrome and a persistence of evidence of renal disease. Renal biopsy studies were carried out before and after the nephrotic syndrome subsided. In each instance, light microscopy revealed diffuse thickening of the walls of the glomerular capillary loops. Electron microscopic studies performed during the nephrotic syndrome revealed that in both cases the glomerular capillary loop thickening was caused primarily by the aggregation of material, here termed extrinsic membranous deposits, on the outer surface of the basement membrane. Studies performed following subsidence of the nephrotic syndrome revealed that in both cases the extrinsic membranous deposits were no longer evident, but that marked structural changes were present within the glomerular basement membrane.

The kidney of a 9-year-old child was transplanted extracorporeally to the forearm of a 35-year-old anephric man. The kidney was perfused in a sealed chamber by blood from chronically cannulated forearm vessels. Immunosuppressive drugs and heparin sodium were administered during the transplantation period. Renal function was maintained satisfactorily until acute vascular rejection occurred on the 25th day. There were no untoward signs or symptoms attributable to the procedure, and the patient improved markedly. It is suggested that extracorporeal renal transplantation may be useful as a test for viability and functional competence of cadaver kidneys. It also may be helpful in study of immune rejection mechanisms.