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Background: A reduction in salivary and lachrymal secretion has been described in many pathologies; however, such alterations have not been described in patients with renal failure. This study was designed to estimate the frequency of alterations in salivary and lachrymal secretion in haemodialysed patients. PATIENTS ABD METHODS: We studied 63 haemodialysed patients and 23 healthy control subjects. In all of them we tested salivary secretion (Saxon test), lachrymal secretion (Shirmer test) as well as the presence of symptoms of xerostomia and xerophthalmia. In a subgroup of patients We investigated any evidence of ocular lesions and tissue damage of salivary glands (histopathology). We also tested the correlation between salivary and lachrymal secretion and autonomic nervous system function. Furthermore, we also studied the association between xerostomia and xerophthalmia and serum auto antibodies (anti nuclear, anti-Ro (SS-A), anti-La (SS-B)) and anti HCV antibodies., Results: On average salivary and the lachrymal secretion was markedly reduced in uraemic patients compared with healthy controls. We found the alterations in salivary glands function to be strongly related to salivary glands fibrosis and atrophy and independent of amyloid accumulation. On the other hand, we observed that xerostomia and xerophthalmia were unrelated to autonomic dysfunction as well as to HCV infection and circulating auto antibodies. Moreover, xerophthalmia was frequently associated with evidence of corneal damage., Conclusions: Reduced salivary and lachrymal secretion is frequent in uraemic patients. Such alterations are often asymptomatic and could be an expression of the accelerated age-dependent decline in glandular function and the attendant fibrosis and atrophy.

Skin biopsy specimens from 2 patients with dermatitis herpetiformis were examined by means of direct immunofluorescence with fluoresceinated aggregated human IgG (FAIgG) for the presence of tissue antiglobulin activity. Positive FAIgG staining was seen in both skin biopsy specimens yielding a fluorescence pattern similar to that of immunoglobulin and complement deposits. Tissue antiglobulin activity was no more detectable in a second skin biopsy obtained from one patient whose rash was controlled by Dapsone. These findings suggest an involvement of tissue antiglobulin activity in the pathogenesis of dermatitis herpetiformis. In fact, tissue antiglobulin activity is capable of acting as an immunoabsorbent and binding immunocomplexes from the circulation.