1194 CROSS-REACTION STUDIES
striking male predominance in glomerulonephritis must importance, and we suggest that research should concentrate on environmental and genetic factors rather than immunological mechanisms, which are probably secondary. There has been no significant therapeutic advance in the treatment of glomerulonephritis in the past decade; a new approach is clearly needed, and we suggest that a clue may lie in the disThe
be of
surely
turbed sex incidence of this disease. Renal Unit, Sefton General Hospital, Liverpool L7 8XP
curve. The apparent serumcalculated as the product of the apparent cross-reactivity and the quantity of protein in plasma (see table). The total immunoreactive gastrin concentration in plasma as a result of protein interference (57 pg/ml) is in the middle of the range of basal values. This accords with the results of Rehfeld et al .4 who showed that "big big" gastrin in serum was an artefact due to protein interference. It would be interesting to know if other basal hormone concentrations are real.
not
always parallel
gastrin
to
concentration
the
gastrin
was
Department of Physiology, Medical School,
University of Newcastle upon Tyne, Newcastle upon Tyne NE 1 7RU
D. J. J. SANDERS SANDERS D.
P. K. LUND S. ZAHEDI-ASL
ÆTIOLOGICAL IMPLICATIONS OF SEX RATIO IN GLOMERULONEPHRITIS
SIR,-Of our 35 patients with the nephrotic syndrome, 23 (65%) are male, and 65 (66%) of the 98 patients on maintenance hsemodialysis in the Liverpool region are male; 51 of the haemodialysis cases had glomerulonephritis and 43 (84%) were male. Hereditary nephritis and Allport’s syndrome have a male predominance, and in polycystic disease the sex incidence is’equal; in contrast, chronic pyelonephritis and analgesic’nephropathy are more common in females. This predominance of males in series of patients with glomerulonephritis is not usually mentioned in current nephrological literature, even
though such a striking sex difference is likely to have some xtiological significance, suggesting a genetic or, more probably, an environmental factor. The current view is that glomerulonephritis is primarily an immunological disorder, and this has been the basis for a masof research. However, most well-authenticated immunological conditions, such as thyroid disorders, rheumatoid arthritis, disseminated lupus, and myasthenia, are more common in females. The marked predominance of males in glomerulonephritis argues against it being a primary immunological disorder. Furthermore, immunosuppressive therapy should be effective in an immune disorder, yet, despite many trials, its value in glomerulonephritis remains uncertain. The only lesion in which steroids and immunosuppressive therapy have a proven effect is the minimal-change lesion, in which antibody or immune-complex deposits have not been convincingly demonstrated in the glomeruli. "Two recent reviews of Goodpasture’s syndrome’ have also shown a marked predominance of males (73%), and a high proportion of these cases were involved in manual or industrial employment, so re-affirming the possibility that certain industrial solvents may be implicated in the causation of glomeru-
sive
amount
lonephritis.2 4. 1.
Kidney Int. 1978, 13, 492. 2. Zimmerman, S. W., Groehler, K., Beirne, G. J. Lancet, 1975, ii,
IMPROVEMENT OF GLOMERULONEPHRITIS AFTER DISCONTINUATION OF SOLVENT EXPOSURE
SIR,-Patients with glomerulonephritis are more often exposed to organic solvents and fuels than are controls,I-4 sugthat certain hydrocarbons can induce or worsen this disease. This idea is supported by our finding that discontinuation of such exposure in patients with acute and chronic glomerulonephritis can lead to improvement.5 Of patients with chronic glomerulonephritis we had (by Feb. 1, 1979) followed-up 32 who had never been exposed (group 0), 18 patients who were exposed during follow-up (group E), and 32 patients who had been exposed before, but not during, follow-up (group EO). The follow-up periods varied from 6 months to 6 years (mean 33 months). The mean glomerular filtration-rate (G.F.R.) was lower, and proteinuria was more pronounced, in group EO than in groups 0 and E. Yet the mean "Cr-E.D.T.A. clearance increased by 6-4 ml/min, but decreased in group 0 by 10 ml/min and in group E by 19.4 ml/min. The differences between the mean change in G.F.R. in group EO and in the other two groups were highly significant (EO vs 0, p
striking male predominance in glomerulonephritis must importance, and we suggest that research should concentrate on environmental and genetic factors rather than immunological mechanisms, which are probably secondary. There has been no significant therapeutic advance in the treatment of glomerulonephritis in the past decade; a new approach is clearly needed, and we suggest that a clue may lie in the disThe
be of
surely
turbed sex incidence of this disease. Renal Unit, Sefton General Hospital, Liverpool L7 8XP
curve. The apparent serumcalculated as the product of the apparent cross-reactivity and the quantity of protein in plasma (see table). The total immunoreactive gastrin concentration in plasma as a result of protein interference (57 pg/ml) is in the middle of the range of basal values. This accords with the results of Rehfeld et al .4 who showed that "big big" gastrin in serum was an artefact due to protein interference. It would be interesting to know if other basal hormone concentrations are real.
not
always parallel
gastrin
to
concentration
the
gastrin
was
Department of Physiology, Medical School,
University of Newcastle upon Tyne, Newcastle upon Tyne NE 1 7RU
D. J. J. SANDERS SANDERS D.
P. K. LUND S. ZAHEDI-ASL
ÆTIOLOGICAL IMPLICATIONS OF SEX RATIO IN GLOMERULONEPHRITIS
SIR,-Of our 35 patients with the nephrotic syndrome, 23 (65%) are male, and 65 (66%) of the 98 patients on maintenance hsemodialysis in the Liverpool region are male; 51 of the haemodialysis cases had glomerulonephritis and 43 (84%) were male. Hereditary nephritis and Allport’s syndrome have a male predominance, and in polycystic disease the sex incidence is’equal; in contrast, chronic pyelonephritis and analgesic’nephropathy are more common in females. This predominance of males in series of patients with glomerulonephritis is not usually mentioned in current nephrological literature, even
though such a striking sex difference is likely to have some xtiological significance, suggesting a genetic or, more probably, an environmental factor. The current view is that glomerulonephritis is primarily an immunological disorder, and this has been the basis for a masof research. However, most well-authenticated immunological conditions, such as thyroid disorders, rheumatoid arthritis, disseminated lupus, and myasthenia, are more common in females. The marked predominance of males in glomerulonephritis argues against it being a primary immunological disorder. Furthermore, immunosuppressive therapy should be effective in an immune disorder, yet, despite many trials, its value in glomerulonephritis remains uncertain. The only lesion in which steroids and immunosuppressive therapy have a proven effect is the minimal-change lesion, in which antibody or immune-complex deposits have not been convincingly demonstrated in the glomeruli. "Two recent reviews of Goodpasture’s syndrome’ have also shown a marked predominance of males (73%), and a high proportion of these cases were involved in manual or industrial employment, so re-affirming the possibility that certain industrial solvents may be implicated in the causation of glomeru-
sive
amount
lonephritis.2 4. 1.
Kidney Int. 1978, 13, 492. 2. Zimmerman, S. W., Groehler, K., Beirne, G. J. Lancet, 1975, ii,
IMPROVEMENT OF GLOMERULONEPHRITIS AFTER DISCONTINUATION OF SOLVENT EXPOSURE
SIR,-Patients with glomerulonephritis are more often exposed to organic solvents and fuels than are controls,I-4 sugthat certain hydrocarbons can induce or worsen this disease. This idea is supported by our finding that discontinuation of such exposure in patients with acute and chronic glomerulonephritis can lead to improvement.5 Of patients with chronic glomerulonephritis we had (by Feb. 1, 1979) followed-up 32 who had never been exposed (group 0), 18 patients who were exposed during follow-up (group E), and 32 patients who had been exposed before, but not during, follow-up (group EO). The follow-up periods varied from 6 months to 6 years (mean 33 months). The mean glomerular filtration-rate (G.F.R.) was lower, and proteinuria was more pronounced, in group EO than in groups 0 and E. Yet the mean "Cr-E.D.T.A. clearance increased by 6-4 ml/min, but decreased in group 0 by 10 ml/min and in group E by 19.4 ml/min. The differences between the mean change in G.F.R. in group EO and in the other two groups were highly significant (EO vs 0, p
