research projects include the transcriptional regulation of the human. Na/H exchanger; the cellular and molecular biology of polycystic kidney disease; the ...
EDITORIAL
Tomas
Berl, Editor
Denver,
Co
COMMITIEE
William
Henrich
Mark
Toledo,
OH
Minneapolis,
Paller
Fred MN
Silva
Oklahoma
City,
OK
THE NEPHROLOGY TRAINING PROGRAM AT NEW ENGLAND MEDICAL CENTER/TUFTS UNIVERSITY SCHOOL OF MEDICINE The Nephrology
Training
Program
at New
England
Medical
Center/Tufts
University
School
of Medicine
was
founded
by Dr. William B. Schwartz in 1950. Between 1971 and 1982, the training program was headed by Dr. Jordan J. Cohen, who was succeeded by Dr. Nicolaos E. Madias, the current director. Over this period of time, the program has prepared approximately
program
130 physicians
includes
Several
training
tracks
intensive clinical training or at least 2 yr of basic Clinical
renal
training
range
in clinical
nephrology
and
in basic
are offered
to accommodate on career
rigorous
of pregnancy.
variable
emphasis.
exposure
career
Additional
to all aspects
transplantation.
and
aspirations.
training
programs
are
available
can
of inpatient
the
research.
Currently.
reflecting
the
diverse
can
pursue
training
1 or 2 yr of
1 or 2 yr of clinical
including
of hemodialysis.
practice, dialysis
the
Trainees include
practice,
techniques
major emphasis is given to outpatient management of patients receiving chronic
of research
or clinical
9 trainees.
depending research.
In addition, and primary
A broad
and
encompasses
complications
hemofiltration. hypertension.
for careers
15 faculty
general
nephrology.
peritoneal
dialysis,
including consultative or after transplantation. interests
of the
research
and
nephrology.
faculty.
Ongoing
basic
research projects include the transcriptional regulation of the human Na/H exchanger; the cellular and molecular biology of polycystic kidney disease; the regulation of Nat. K ATPase in uremia; the role of cytokines in vascular pathophysiology; and the molecular genetics of murine lupus. The Nephrology Clinical Pesearch Center, a facility that has centralized the clinical-research resources of the division, provides support for all clinical research. Ongoing projects include participation in national collaborative trials on the progression of renal disease and the morbidity and mortality in hemodialysis; the role of cytokines in the biocompatibility interventional trials in acute renal failure; hepatitis C infection status, comorbidity. and outcomes in hemodialysis. A number journal club,
of teaching conferences research conference,
of dialysis
in organ
support the educational biopsy conference, and
the
membranes
transplantation;
mission of the Nephrology
program Forum,
and
dialysis-related
symptoms;
and the assessment including a conference
of health
a clinical conference. designed to relate
the principles of basic science to clinical problems in nephrology, the proceedings of which are published monthly in Kidneylnternational. Trainees have considerable opportunities to exercise their teaching skills. In addition to sharing with the faculty the responsibility of teaching fourth-year medical students during their renal elective, trainees participate in teaching
the
Renal
Pathophysiology
Course
to the
second-year
medical
class.
Rapidly Progressive Glomerulonephritis Immunotherapy for Cancer Mark
G. Parker,
Michael
B. Atkins,
Angelo
A. Ucci,
and
After
Andrew
icine,
Tufts
S. Levey University
School
of Medicine,
MG. Parker, AS. Levey, Division of Nephrology, New England Medical Center and the Department of Medicine, Tufts University School of Medicine, Boston, MA
A.A. Ucci, Department Medical Center and cine, Boston, MA
of Pathology, Tufts University
MB. Atkins, Division of England Medical Center
(J. Am.
1995;
1 Received
February
2Coffespondence Mall
Road,
Burlington,
1, 1994. Accepted to Dr. M.G.
Parker,
Hematology-Oncology, and the Department
July
21, 1994.
Lahey
clinic,
Section
MA 01805.
1046-6673/0510-1 740$03.00/0 Journal of the American Society of Nephroiogy copyright © 1995 by the American Society of Nephroiogy
1740
New of Med-
of Nephroiogy,
41
Soc.
Nephrol.
Boston, New School
MA
England of Medi-
5:1740-1744)
ABSTRACT Cytokines have been used in experimental and standard protocols for immune enhancement for cancer. The combination of interleukin-2 and interferon-alpha 213 has been used in experimental protocols for metVolume
5
‘
Number
10
‘
1995
Parker
astatic renal cell carcinoma. A man who developed rapidly progressive renal failure after receiving this combination therapy is reported. A renal biopsy revealed a pauci-immune crescentic glomerulonephritis. Antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibodies were absent. The spectrum of renal disease and potentially related extrarenal manifestations associated with interleukin-2 and interferon-alpha are reviewed. A pathogenesis of altered cell-mediated immunity, consistent with abnormalities in extrarenal organs after immune enhancement, is proposed. Key Words:
Pauci-immune
interferon-alpha.
glomerulonephritis.
ce/lu/or
I
often.
particular systems
immunity
adverse
IFN-y) activating phocyte populations jury.
In the
diminished ety
of these
specific and with resultant
,
kidney,
IL-2
perfusion
of other
forms
prerenal
of renal
after
treatment
static
renal
CASE
REPORT
A
with
cell
pathology
IL-2
have
and
a state of A vanalso
been
therapies. In this ofa patient who gbomerulonephriIFN-a
213 for
meta-
carcinoma.
66-yr-old
man
was
evaluated
for
weight
loss,
of 7. 1 mmol/L
a specific gravity for albumin, and cells or casts.
(20
mg/dL),
of 1 .019
(pH
a sediment
A serum
a urinalysis
5.5),
albumin
of 22
at 5 X 106 IU/m2 Sc every doses, then each day, 5 days each week, tion with IFN-a 2(3 (Schering, Kenilworth, 106 IU/m2, 3 days each week, was used
Journal
CA)
of the
American
Society
of Nephrology
after
the
triazolam.
pulmonary immunotherapy
nod-
admitted to the hospital included acetaminophen
A physical
examination
with
revealed
hy-
and fluid overload. There were no signs or of extrarenal vasculitis. A chest radiograph pulmonary vascular congestion, but no focal process.
The
BUN
was
protein, merous
and red
a sediment blood cells,
examination red blood
occasional granular casts. no growth. A 24-h urine protein, and the creatinine A renal
ultrasound
16 mmol/L
(45
mg/dL),
(4.5 mg/dL), and albushowed a specific gravity with 3+ blood and 3+ cell
The urine collection clearance
showed
a
revealing casts,
nuand
culture showed had 1 .42 g of was 10 mL/mln.
12.6-cm,
solitary
left
kidney with no hydronephrosis. The following serologies were obtained: C3, 1.35 g/L (0.87 to 2.20); C4, 0.50 g/L (0. 15 to 0.54), total hemobytic complement (CH50), 299 U ( 150 to 250), antinuclear antibody titer, < 1 :40; perinuclear and cytoplasmic antineutrophil cytoplasmic antibody (ANCA) titers by indirect immunofluorescence, < 1 :8; antlstreptolysin 0.
