A low-carbohydrate diet may prevent end-stage renal failure in type 2 diabetes. A case report

An obese patient with type 2 diabetes whose diet was changed from the recommended high-carbohydrate, low-fat type to a low-carbohydrate diet showed a significant reduction in bodyweight, improved glycemic control and a reversal of a six year long decline of renal function. The reversal of the renal function was likely caused by both improved glycemic control and elimination of the patient's obesity. Insulin treatment in type 2 diabetes patients usually leads to weight increase which may cause further injury to the kidney. Although other unknown metabolic mechanisms cannot be excluded, it is likely that the obesity caused by the combination of high-carbohydrate diet and insulin in this case contributed to the patient's deteriorating kidney function. In such patients, where control of bodyweight and hyperglycemia is vital, a trial with a low-carbohydrate diet may be appropriate to avoid the risk of adding obesity-associated renal failure to already failing kidneys

Antiglomerular basement membrane antibody: Antibody specificity in different forms of glomerulonephritis

Antiglomerular basement membrane antibody: Antibody specificity in different forms of glomerulonephritis. Components were solubilized from human glomerular basement membrane by digestion with collage-nase and pepsin or by extraction with guanidine-HCl either directly or after previous digestion with the enzyme. The diverse preparations were used as antigens in the enzyme-linked immunosorbent assay (ELISA) of antibody titers in sera from patients with Goodpasture syndrome and patients with other forms of glomerulonephritis, that is, systemic lupus erythematosus, periarteritis nodosa, and IgA-related nephropathy. Patients with Goodpasture syndrome had high titers of IgG antibodies reacting most strongly with collagenase digests. The antigen(s) was only partly solubilized by guanidine-HCl extraction, was destroyed by pepsin digestion as well as reduction, and partly destroyed by trypsin digestion. The antigen(s) is most likely noncollagneous protein. Antibodies from patients with other forms of nephritis were directed primarily against antigens in guanidine-HCl extracts, while the antigen(s) was not solubilized by collagenase digestion. Pepsin digestion destroyed the antigen(s). The antibodies were of a different class, that is, the patients with systemic lupus erythematosus had IgG and IgA as well as IgM antibodies; the patients with periarteritis nodosa had IgM or IgG and IgA antibodies, while the patients with IgA-related nephritis had the highest recorded titers of IgA but also had IgG as well as IgM antibodies. None of the patients had antibodies directed against triple helical collagen. The antibody response in anti-GBM antibody-related nephritis, then, is different both with respect to antigen and antibody class and depends on the underlying disease syndrome.Anticorps anti-membrane basale glomérulaire: Spécificité des anticorps dans différentes formes de glomérulonéphrites. Les constituants de membranes basales glomérulaires humaines ont été solubilisés par digestion avec de la collagénase et de la pepsine ou par extraction avec de la guanidine-HCl directement ou après digestion préalable par l'enzyme. Ces diverses préparations ont été utilisées comme antigène dans la titration d'anticorps par essai immunosorbant reliés par enzyme (ELISA) dans des sérums de malades ayant un syndrome de Goodpasture, et de malades avec d'autres formes de glomérulonéphrites, notamment lupus érythémateux disséminé, périartérite noueuse, et néphropathie à IgA. Les malades ayant un syndrome de Goodpasture avaient des titres élevés d'anticorps IgG réagissant très fortement avec des produits de digestion de collagénase. L'antigène(s) était seulement partiellement solubilisé par extraction à la guanidine-HCl, était détruit par la digestion par la pepsine et par réduction, et était partiellement détruit par digestion à la trypsine. L'antigène(s) est probablement une protéine noncollagène. Les anticorps provenant de malades ayant d'autres formes de néphrites étaient essentiellement dirigés contre des antigènes provenant d'extraits guanidine-HCl, tandis que l'antigène(s) n'était pas solubilisé par digestion à la collagénase. La digestion par la pepsine a détruit l'antigène(s). Les anticorps étaient de différentes classes, les malades ayant un lupus érythémateux disséminé avaient des IgG, des IgA, et des IgM comme anticorps; les malades ayant une périartérite noueuse avaient des anticorps IgM, IgG, IgA, alors que les malades ayant une néphrite à IgA avaient les titres les plus élevés d'anticorps IgA, mais avaient également des IgG et des IgM. Aucun des malades n'avait d'anticorps dirigés contre du collagène à triple hélice. La réponse anticorps dans la néphrite liée à un anticorps anti-GBM est donc différente par la classe d'antigènes ou d'anticorps en fonction du syndrome sous-jacent

Glomerulonephritis induced in sheep by immunization with human glomerular basement membrane

Glomerulonephritis induced in sheep by immunization with human glomerular basement membrane. The specificity of the anti-glomerular basement membrane (GBM) antibodies in experimental nephritis in sheep (Steblay's nephritis) was studied and compared with the specifity of antibodies in human anti-GBM nephritis (Goodpasture's syndrome). Sheep were injected monthly with isolated human GBM and antibody reactivities with isolated human and sheep GBM proteins were quantified with ELISA. Expectedly, the sheep had high titers of antibodies against several human GBM antigens. These antibodies remained for the most part in the circulation. In contrast, circulating antibody levels against sheep GBM antigens remained low for a long period of time, but a significant and progressive increase coincided with the development of acute nephritis. These antibodies accumulated in the kidneys of the nephritic sheep and could be eluted from diseased kidneys. They represent auto-antibodies immunologically cross-reacting with antigens of both sheep and human GBM. The specificity of auto-antibodies eluted from the kidneys was analyzed by immunoblotting and ELISA. The major populations reacted with one subunit, termed M2, of the globular domain of collagen IV. The same subunit contains the major antigen in Goodpasture's syndrome. It is concluded that the M2 subunit of the globular domain of collagen IV is recognized by IgG antibodies that primarily bind to the glomerular basement membrane in both Steblay's nephritis and Goodpasture's syndrome, indicating that it is a main nephritogen in both diseases

Entactin: A possible auto-antigen in the pathogenesis of non-Goodpasture anti-GBM nephritis

Entactin: A possible auto-antigen in the pathogenesis of non-Goodpasture anti-GBM nephritis. It has recently been demonstrated that many patients with various types of glomerulonephritis have antibodies to the 6M guanidine-HCl extract of glomerular basement membrane (Bygren et al, Nephrol Dial Transplant 4:254–261, 1989). In the present study a 150K protein was isolated from the guanidine extract of bovine glomerular basement membrane utilizing ion exchange and gel filtration chromatographic procedures. Amino acid analysis and size of the isolated protein revealed similarity to that of entactin/nidogen. The identity of this protein as entactin/nidogen was further suggested by its precipitation with two different antibodies in a radioimmunoassay and by its reaction with four different antibodies in a sandwich ELISA. Inhibition of the antibodies to 150K by bovine entactin, which was isolated separately and sequenced for amino acids, confirmed the identity of the 150K protein as entactin/nidogen. Furthermore, it was shown that about one third of those patients who show antibodies to the crude guanidine extract have circulating antibodies directed against entactin. This was further confirmed by the competitive inhibition of antibodies to the crude guanidine extract in one of the positive serum by entactin in an ELISA inhibition and by immunoblotting experiments. These observations propose entactin as a possible non-Goodpasture glomerular basement membrane antigen that could be involved in the pathogenesis of certain forms of autoimmune glomerulonephritis (non-Goodpasture anti-GBM glomerulonephritis) in man. Most of these patients have a granular pattern of the immunoglobulin deposition along the glomerular basement membrane. This suggests the possibility that anti-GBM glomerulonephritis in human beings can have non-linear immunoglobulin deposits along the GBM

Clinical evaluation of a capture ELISA for detection of proteinase-3 antineutrophil cytoplasmic antibody: Technical Note

Clinical evaluation of a capture ELISA for detection of proteinase-3 antineutrophil cytoplasmic antibody. Technical Note. Detection of antineutrophil cytoplasmic antibodies (ANCA) has become a useful tool in the diagnosis of Wegener's granulomatosis and microscopic polyangiitis. However, the results obtained with indirect immunofluorescence (IIF) and by ELISA for ANCA demonstration do not always correlate. A possible explanation for this finding could be that proteins are denatured during the process of antigen purification or during coating onto the solid phase. To avoid this possibility, a monoclonal antibody to PR3 that is precoated on the plate can be used. In the present study we have used the monoclonal antibody (MoAb) 4A3 for the capture of PR3 in an ELISA, and a clinical evaluation of the diagnostic properties of the new capture ELISA has been made. The sensitivity of the capture PR3-ANCA ELISA was 85% in a material of c-ANCA positive sera. A specificity of 90% was obtained in analyses from patients having various forms of glomerulonephritis. There was a significantly higher diagnostic sensitivity of the capture PR3-ANCA ELISA (85%) compared to c-ANCA by IIF (58%) in patients with Wegener's granulomatosis with renal involvement. Capture PR3-ANCA and direct ELISA for MPO-ANCA together gave a diagnostic sensitivity of 98%, versus 75% using IIF. In conclusion, the capture PR3-ANCA ELISA seems to be a valuable tool in the diagnosis of Wegener's granulomatosis with renal involvement. Preliminary data suggest that the technique may have an advantage over direct ELISA for PR3-ANCA, as well as in the follow-up of c-/PR3-ANCA associated vasculitides. However, further prospective studies are needed to clarify this premise

Sound of well-being – choir singing as an intervention to improve well-being among employees in two Norwegian county hospitals

Objective: Interventions promoting a healthy psychosocial work environment are common, yet little is known about participation and effectiveness of such measures. The aim of this study was to describe differences between participants and nonparticipants in the Sound of Wellbeing (SOW) initiative, including a variety of demographic characteristics, perceived work environment, psychological factors and self-perceived health. The study also compared the participants' and non-participants' retrospective perception of change in the psychosocial work environment and their health during the project period.Methods: In this cultural organizational-level intervention, employees in two county hospitals participated as singers with different hospital departments forming their own choir. The majority of employees (1431 employees; 57.4%) completed a survey questionnaire after the intervention, of which 426 (29.8%) had participated.Results: We analysed the differences between participants and non-participants on several descriptive characteristics, personality, engagement, commitment, general health and demand-control-support, as well as their self-perceived change in some of these variables. Lower participation was found among men, employees above 62 and below 38 years of age, part-time employees, university-educated workers and health care workers. Furthermore, we found more engagement, organizational commitment and self-reported positive change with regard to psychosocial work environment and global health in participants compared to non-participants.Conclusions: The intervention showed promising results for incorporating cultural activities in the work environment, but further investigation of the effectiveness of organizational-level interventions using a pre-post design is needed.</p