Dobozy, A.

Kecskemeti, L.

Magori, A.

Ormos, J.

Sonkodi, S.

Tichy, B.

English

Varna Medical University Press: Journals

I I . Clinical problems STUDY OF T H E L E U K O C Y T E MIGRATION INHIBITORY FACTOR IN HUMAN GLOMERULONEPHRITIS FROM T H E ASPECT OF T H E PROGNOSIS S. Sonkodi, A. Dobozy, B. Tichy, L . Kecskemeti, A. Magori, J . Ormos Key-words: leukocyte migration inhibitory factor — glomerulonephritis — prognosis The leukocyte migration inhibitory factor ( M I F ) is a substance produced by sensitized lymphocytes in response to a specific or aspecific mitogen; this sub-stance decreases the motil i ty of the leukocytes in vi t ro . M I F production is an immune-specific process. I t is induced only by those antigens (in our studies the glomerular basal membrane) towards which the host organism displays hypersen-s i t iv i ty . Migration inhibition detectable in response to a specific antigen can be regarded as a laboratory sign of cellular hypersensitivity (5). The degree of migration inhibition is expressed by the migration index ( M I ) , which is the quotient of the extents of migration of cultures containing and not containing antigen. I n the present work, a study has been made of the prognostic value of the leuko-cyte M I F in human glomerulonephritis. Material and methods The leukocyte migration inhibitory effect of foetal renal antigen was investi-gated in 141 patients demonstrated by renal biopsy to suffer from glomeruloneph-r i t i s (6). I n connection wi th the performance and evaluation of the renal biopsy, reference was made to earlier publications (2, 3) . A c t i v i t y obtained with at least one immune-conjugate by direct immunofluorescence histochemistry (antihuman I g G , IgA, IgM, I g E , polyvalent, C 3 complement) was taken as positive, and its absence as negative. The glomerulonephrites were classified in accordance with the W H O system, on the basis of the evaluation of the renal biopsy sample. The leukocyte migra-tion inhibition was determined wi th the method of Bendixen (1). The migration was regarded as positive when the M I was ^0 ,08 . The question of interest was whether the prognosis for the leukocyte migration test ( L M T ) -positive cases differed from that for the LMT-negative ones. Results and discussion 40 positive and 101 negative cases were available for the comparison. The most acceptable method (4) seemed to be to choose negative cases identical as concerned histological diagnosis and sex, and as similar as possible from the as-pects of age, duration of the disease, degree of proteinuria and renal function, as pairs for the LMT-posit ive cases. Study of the leukocyte migration.. 61 T a b l e 1 No. Age (years) Histology Observation pe­riod (years) Prognostic score Immunosuppression treated ( + ) , not treated (—1) 1. 2. 40 61 focal sclerosis 2 2 0 0 + 3. 4. 32 25 9 5 2 0 + 5. 6. 26 16 2 2 2 0 + + 7. 8. 36 37 mesangio-prolif. g. n. 2 2 0 — 1 + 9. TO. 32 30 2 2 2 1 + IT . 12. 45 24 4 3 1 1 +. : 1 3 . 14. 22 18 5 5 2 0 "+ K i ' 5 . Щ 16. 34 32 2 3 — 1 0 + В 1 7-Щ 18. 47 46 mesangio-prolif. g. n. scler 2 3 0 0 — 19. Л 20. 27 19 l gA nephro­pathy 3 a ; • • • 0 0 _ B ' 2 L H 22. 17 18 5 3 0 0 23. 24. 18 16 membra no-prolif. g. n. Mil 10 6 —2 —2 + • •+ _ f ! 2 5 . ' В ' 26. 22 28 3 4 1 ' 2 + 27. В ь 28; 19 19 6 4 0 1 , -29. SO. 15 25 2 3 1 , 0 ' + 31. 32. 33 35 membranous nephropathy 6 6 0 0 + + 33. 34. 29 33 2 3 0 . —2 R .35. ' ?6. 50 . 3 6 3 4 0 0 + :З7. 38. 45 47 Lupus nephritis 3 4 ". , 1 —1 + З&. 37 6 —1 + 40. 38 4 —1 + 41 . 14 min. inter- 2 0 42. 21 capil l . g. n. 2 0 62 S. Sonkodi, A. Dobozy, B . T i c h y , L . Kecskemeti,. . . Such pairing could not be performed for the minimal change glomeruloneph­ri t is group, as the L M T was positive in a l l patients here, and every patient un­derwent remission. During the observation period, 15 of the 21 pairs took part in immunosuppres­sive therapy. The course of the disease and the changes resulting from treatment were classified as described by Wiedemann et a l . (7). Thus, the following charac­teristics and numerical values were used: considerable improvement (2) mild improvement (1) no essential improvement (0) mild deterioration (-1) considerable deterioration (-2) In the assessment of the condition, the following data were taken into account: blood pressure, oedema (presence or absence), blood picture (anaemia), u r i ­nary findings (quantitative protein and sediment), renal function parameters (serum creatinine, endogenous creatinine clearance), histological findings, fundus picture. If the point values for the LMT-posit ive and the LMT-negative cases of the pairs are added up separately, a lO-point^difference is found in favour of the L M T -positive cases (table 1). In 8 of the 21 pairs the LMT-posi t ive patients received the higher score, in 3 cases the LMT-negative one did so, and in 10 cases there was no difference. Among the 15 pairs who participated in immunosuppressive therapy, there were 10 pairs the members of which differed with respect to the prognosis: in these 10 pairs, the condition of the LMT-posit ive patient improved in 7 cases, was un­changed in 2 ones, and deteriorated in one case; in the LMT-negative patients, the prognosis was good in 3 cases, unchanged in 4 ones, and poor in 3 ones. The L M T was always positive in the 8 minimal changes glomerulonephritis patients; they could be influenced well with therapy, i . e. the prognosis was clearly good. At present, the characteristic c l in ica l (hypertension, nephrotic syndrome), laboratory (restricted renal function, chronically low complement, or possibly high complement) and histological (considerable half-moon formation i . e. cres­cents in the glomeruli, dense-deposit changes in the basal membrane, linear im-munofluorescence-positivity) signs are better known as concerns a poor prognosis. Our investigations suggest that the presence of cellular hypersensitivity i n glomerulonephritis is a favourable indication from the aspect of the course of the disease. R E F E R E N C E S 1. В е n d i x е n, G . Acta Med. Scand., 184, 1968, 99—103. — 2. M a g о r i , A . , S. S o n k o d i , E . S z a b 6, et a l . Orv. Hetil . , 118, 1977, 2013—2020. — 3. M a g o r i . A . , J . О r m о s, S. S o n k o d i , S. T u r i , J . Z о m b о r i , B . I v a n y i , E . K e m e -n y. Ultrastruct. Pathol., 5, 1984, 185—198. — 4. R a s h i d, H . , P . A. E . B i r d , T . T . V e r n a z z a , et a l . Br i t . Med. J . , 282, 1981, 1196—1197. — 5. S о b о r g, M. , G . В е n d i x е n. Acta Med. Scand., 181, 1967, 247—256. — 6. S о n к о d i , S. , A. D o ­b o z y , В. T i с h y, A . M a g o r i , К. В о d a, J . О r m о s. Internat. Urol. Neptirot.y 16, 1984, 175—180. — 7. W i е d е m a n n, M . , R . L a n d о n, G . B r a n d , et a l . The-rapiewoche, 33, 1983, 4575—4582. Study of the leukocyte migration. 63 ИССЛЕДОВАНИЕ ИНГИВИРУЮЩЕГО ФАКТОРА МИГРАЦИИ ЛЕЙКОЦИТОВ ПРИ ГЛОМЕРУЛОНЕФРИТЕ У ЧЕЛОВЕКА С ТОЧКИ ЗРЕНИЯ ПРОГНОЗА . Шонкоди, А. Добоци, Б. Тихи, Л. Кечкемети, А. Магори, #. Ормош Р Е З Ю М Е По методу Бендиксена исследован ингибирующий фактор лейкоцитной миграции у 41 больных с доказанным биопсией гломерулонефритом. Ингибитор лейкоцитной миграции в ответ на специфический антиген рассматривается как лабораторный признак сверхчув­ствительности клеток. Авторами установлено, что при положительном тесте (миграционный индекс <0.8) прогноз гломерулонефрита лучше . 

STUDY OF THE LEUKOCYTE MIGRATION INHIBITORY FACTOR IN HUMAN GLOMERULONEPHRITIS FROM THE ASPECT OF THE PROGNOSIS

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STUDY OF THE LEUKOCYTE MIGRATION INHIBITORY FACTOR IN HUMAN GLOMERULONEPHRITIS FROM THE ASPECT OF THE PROGNOSIS

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