research projects include the transcriptional regulation of the human. Na/H exchanger; the cellular and molecular biology of polycystic kidney disease; the ...
THE NEPHROLOGY TRAINING PROGRAM AT NEW ENGLAND MEDICAL CENTER/TUFTS UNIVERSITY SCHOOL OF MEDICINE The Nephrology
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
intensive clinical training or at least 2 yr of basic Clinical
to accommodate on career
to all aspects
1 or 2 yr of
1 or 2 yr of clinical
major emphasis is given to outpatient management of patients receiving chronic
In addition, and primary
including consultative or after transplantation. interests
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,
support the educational biopsy conference, and
mission of the Nephrology
and the assessment including a conference
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
Rapidly Progressive Glomerulonephritis Immunotherapy for Cancer Mark
S. Levey University
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
1, 1994. Accepted to Dr. M.G.
Hematology-Oncology, and the Department
1046-6673/0510-1 740$03.00/0 Journal of the American Society of Nephroiogy copyright © 1995 by the American Society of Nephroiogy
New of Med-
Boston, New School
England of Medi-
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
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:
IFN-y) activating phocyte populations jury.
specific and with resultant
a state of A vanalso
therapies. In this ofa patient who gbomerulonephriIFN-a
of 7. 1 mmol/L
a specific gravity for albumin, and cells or casts.
of 1 .019
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
admitted to the hospital included acetaminophen
and fluid overload. There were no signs or of extrarenal vasculitis. A chest radiograph pulmonary vascular congestion, but no focal process.
a sediment blood cells,
examination red blood
occasional granular casts. no growth. A 24-h urine protein, and the creatinine A renal
(4.5 mg/dL), and albushowed a specific gravity with 3+ blood and 3+ cell
The urine collection clearance
culture showed had 1 .42 g of was 10 mL/mln.
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.