To determine the pathogenesis of interstitial nephtitis, immunopathological studies were performed with kidney and serum from a six-year-old boy. The kidney revealed linear staining of tubular basement membranes with antiserums specific for human IgG and C3; the membranes also showed fixation of heterologous complement. After incubation of the patient's serum on frozen sections from normal human kidneys, linear staining with IgG was detected by indirect fluorescence. This staining was eliminated by absorption of the serum with purified tubular basement membranes, but was unaltered by absorption with purified glomerular basement membrane. The antibody reacted with mouse, rabbit, dog, sheep, monkey, Sprague-Dawley and Lewis/Brown Norway rat tubular basement membranes, but not with that of Lewis rat or guinea pig, or with human skin, thyroid, parotid, lung, liver or pancreas. Anit-tubular-basement-membrane antibody may be involved in the pathogenesis of the patient's disease.
Percutaneous renal biopsy has been widely used as a diagnostic procedure. Over 2,000 instances of its use in clinical investigation have been reported, most of these in adults.1-5 The greatest number in children have been reported by Vernier, Good, Worthen, Brunson, and Farquhar,6-17 at the University of Minnesota. Although renal biopsy has offered advantages in research, its practical usefulness is not well established. In order to evaluate the practical value of renal biopsy, we have reviewed our experience gained from light and electron microscopy of renal biopsies performed on 50 children. In this report we have correlated the clinical diagnosis with the pathologic diagnosis and present our assessment of the clinical value of the procedure.
Materials and MethodAs a precaution, the first 15 biopsies were performed in the operating room. After being convinced of the safety of the procedure, we used the treatment room of the pediatric floor for the remaining cases. The site of the biopsy was lo¬ cated according to the method of Muehrcke et al.,18 with the exception that intravenous pyelograms were made in those cases in which the kidneys were not clearly seen in the plain x-ray film of the abdomen.Prebiopsy sedation consisted of oral secobarbital (100 mg.) in children over 8 years and rectal thiamylal sodium (30 mg. per kg. body weight) in
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