The future of nephrologic research: significance and urgent problems

The problems in the diagnosis and especially the pathogenetic mechanism of IgA nephropathy are discussed and suggestions are made that this entity may not be a renal disease of primary renal immunogenetic origin but may be a disease of disturbed mesangial transport mechanism for IgA. Suggestions are made for intensive studies on the pathogenesis and differential diagnosis of focal glomerulosclerosis vs. minimal change disease (lipoid nephrosis) especially by immunohistology and T Cell sub-set abnormalities. It is suggested to study minimal change disease from the viewpoint of a T Cell immunodeficiency with lymphokines as a permeability changing factor. Depressed antibody formation in such partially immunodeficient patients may be important for differential diagnosis from other nephrotic stages. The immunology of acute glomerulonephritis as caused by cytoplasmic streptococcal antigens requires further study together with resultant chronic glomerulonephritis on an auto-antibody basis. The disputed merits of plasmapheresis require further detailed studies. The investigation of the suggested importance of nephrectomies on the renal function of kidney donors is of utmost importance in view of its relation to the future of live donor transplantations.