We have demonstrated in this study the neoexpression of cytoskeletal proteins within diabetic kidneys. This has allowed the identification of new predicting histological markers for the progression of diabetic nephropathy.

These results suggest that an increase in cell proliferation is an early event preceding cyst formation and can result from haploinsufficiency at Pkd2. The possible pathogenic link between tubular cell proliferation, interstitial fibrosis and cyst formation is discussed.

Background/Aims: Focal segmental glomerulosclerosis (FSGS) is a common type of glomerular disease that can lead to chronic renal failure. Various therapeutic regimens have been used in nephrotic FSGS patients. The effect of treatment with prednisolone alone or its combination with azathioprine and cyclosporin and parameters related to a poor outcome are studied. Methods: Fifty-one patients with idiopathic FSGS and a follow-up period of 5 years were included. Twenty-five were treated with prednisolone alone (1 mg/kg BW/day) or combination of prednisolone (0.5 mg/kg BW/day) with azathioprine (2 mg/kg BW/day) or cyclosporine (3 mg/kg BW/day) in gradually reduced doses whereas 26 patients received no immunosuppressive drugs. Lower prednisolone dose regimens were used as initial treatment in obese, borderline diabetics or patients with bone disease. The clinical course was estimated using the end-points of 50% or doubling of baseline serum creatinine and/or end-stage renal failure. The contribution of clinical and histological parameters in the clinical outcome was estimated by univariate and multivariate analyses. Results: Increase of baseline serum creatinine by 50% during the follow-up period was observed in 2 treated and 9 untreated patients (8% vs. 35%, p = 0.03) whereas doubling of serum creatinine in 2 and 5 patients respectively (8% vs. 19%, p = NS). End-stage renal failure developed in 4 of 51 patients (8%), 2 treated and 2 untreated (p = NS). Parameters related to a poor outcome were baseline serum creatinine and severity of glomerulosclerosis (multivariate analysis OR = 1.08, p = 0.01). Most of patients (68%) who reached end-points had persistent nephrotic syndrome during the follow-up. Remission of nephrotic syndrome was observed more frequently among treated (75 vs. 30.7%, p = 0.05). Prednisolone alone was followed by remission of nephrotic syndrome in 62.5% whereas combination of lower prednisolone dose with azathioprine and cyclosporin in 80 and 85.7% of patients. No serious side-effects were observed. Conclusion: This and previous studies suggest that steroid and/or immunosuppressive therapy have a role in amelioration of the clinical course and remission of nephrotic syndrome in patients with FSGS A combination of low predisolone dose with cyclosporine could be used as initial treatment in patients with higher risk for side-effects from the usual prednisolone dose.

No abstract

SheffieldSUMMARY A case of antibiotic associated pseudomembranous colitis following total cystectomy is reported, in which there was involvement of the ileal conduit. The small bowel remaining in situ was uninvolved. Bacteriological studies revealed Clostridium difficile and the toxin in both colon and ileal conduit. Relevant publications concerning pathogenesis are discussed, in relation to the unusual site described in this case. Epidemiological evidence is reviewed which suggests that isolation of patients with pseudomembranous colitis is a logical course of action.Pseudomembranous colitis is now firmly associated with Clostridium difficile and toxin production. Reported cases often complicate antibiotic therapy particularly ampicillin, and involvement of the colon is the predominant effect, with uncommon and atypical changes in the ileum. We describe a case in which pseudomembranous colitis occurred in a patient following total cystectomy for carcinoma of the bladder. The typical colonic lesions are described along with identical lesions within the isolated ileal loop. The ileum in situ proximal to the ileocaecal valve was uninvolved. Case reportA 70-year-old man underwent a total cystectomy in November 1982 for a transitional cell carcinoma of the bladder. He also had ischaemic heart disease and chronic obstructive airways disease. Prior to this the tumour which had been diagnosed in 1979 had been irradiated in 1980. Initially the lesion appeared to have been controlled but by early 1982 recurrence was detected. Recurrent infections, pain on micturition and intractable bleeding necessitated a cystectomy. During the months prior to cystectomy several courses of antibiotics including cephradine metronidazole and ampicillin, were given for repeated urinary tract infections. Five days after the cystectomy in addition to postoperative metronidazole and neomycin, a course of ampicillin (500 mg sixhourly for 11 days) was given because of patchy consolidation of the right middle lobe. Twenty-one days after the cystectomy he complained of nausea Accepted for publication 31 May 1983 and abdominal pain together with vomiting. On examination his abdomen was distended and tense with hyperactive bowel sounds.Intravenous feeding was instituted until bowel movements which were loose commenced seven days later. He was allowed home but had to be admitted after eight days because of recurrent diarrhoea, abdominal pain and weight loss. His wife commented that the ileal loop had been offensive for a few days prior to his readmission. He was treated symptomatically for five days with no improvement. Sigmoidoscopy at this stage revealed the classical plaques of pseudomembranous colitis. Despite treatment by vancomycin the patient died the next day, 44 days after his cystectomy and 16 days after the onset of his diarrhoea. NECROPSYThe body was that of an elderly man with evidence of considerable recent weight loss. There was severe chronic bronchitis and emphysema. The large bowel revealed the irregular raised yellowish-white p...