Living Kidney Donation: the Outcomes for Donors

During the past decade, the number of transplantation from living kidney donors has substantially increased worldwide. The rate of increase varies from one country to another. The risk of unilateral nephrectomy to the donor includes perioperative mortality and morbidity plus the long-term risk of living with a single kidney. The rate of perioperative mortality and morbidity is about 0.03% and 10%, respectively. More at- tention is required to prevent serious complications of laparoscopic donor nephrectomy. A grading system in recording perioperative complications is necessary for making it available to each potential donor. The number of studies on long-term outcome of living donors is very limited. The overall evidence suggests that the risk of end-stage kidney disease is not increased in donors, however, mild renal failure, hypertension and proteinuria are not uncommon in living donors. There is also concern that the incidence of cardiovas- cular disease may be higher in kidney donors. Establishing living donor registry and follow-up is extremely important. Only through these registries the long-term risk of kidney donation will become more apparent. Because of severe shortage of transplantable kidneys, some transplant centers are now using donors with comorbidities and few centers are involved in transplant tourism with inadequate donor screening and follow-up. Prevention of these unacceptable practices in living kidney donors was emphasized in Amster- dam Forum in 2004 and Istanbul Summit in 2008

Comparison of dobutamine stress echocardiography and ECG for screening of coronary artery disease in high- risk hemodialysis patients

To compare the results of dobutamine stress echocardiography [DSE] as a sensitive and specific, non-invasive test for screening of coronary artery disease [CAD] in end-stage renal disease hemodialysis patients with the results of ECG. Thirty nine patients at high-risk for CAD by definition were studied. Coronary artery risk factors including age, sex, hypertension, hyperlipidemia and hyperglycemia were reviewed. ECG, chest x-ray [CXR], Echocardiography [Echo] and DSE were done in all. The results showed that 10 out of 11 patients with a normal ECG had negative DSE [npv = 91%] and 9 out of 26 patients with any abnormal ECG had positive DSE [ppv = 35%]. On the other hand 19 out of 26 patients without symptoms of CAD had negative DSE [npv = 73%] and 3 out of 11 patients with symptoms of CAD had positive DSE [ppv = 27%]. Even in high-risk HD patients a normal ECG can reliably predict a normal DSE. Also any abnormal ECG would emphasize on the need for further CAD screening by DSE

effect of fluvastatin on hypercholesterolemia in patients with nephrotic syndrome

The efficacy and safety of fluvastatin, a new 3-hydroxy 3-methyl-glutaryl coenzyme -A reductase inhibitor, was studied in ten nephrotic patients with hypercholesterolemia [fasting total cholesterol over 240 mg/dl and LDL-cholesterol over 160 mg/dl]. Forty mg of fluvastatin daily, for twelve weeks, decreased total cholesterol from 386 +/- 123 mg/dl to 294 +/- 78 mg/dl [p<0.01] and LDL-cholesterol from 233 +/- 88 mg/dl to 171 +/- 64 mg/dl [p<0.01]. HDL-cholesterol was slightly increased. Triglyceride level decreased 33%, from 517 +/- 413 mg/dl to 393 +/- 190 mg/dl. VLDL-cholesterol also decreased significantly from 102 +/- 64 mg/dl to 65 +/- 30 mg/dl [p<0.05]. No adverse effect was seen. We conclude that fluvastatin has a favorable effect on serum lipoproteins in nephrotic patients

Serum erythropoietin titers in various degrees of chronic renal failure

Serum Erythropoietin [EPO] titers were measured by an enzyme immunoassay technique in 89 patients with various degrees of chronic renal insufficiency excluding patients with polycystic kidney disease, cardiopulmonary problems and those who had a recent blood transfusion. According to the degree of renal failure the patients were divided into 3 groups of mild, moderate and severe renal failure. It was seen that the hematocrit decreased significantly by progressive deterioration of renal function [P<0.001 and P<0.01], In all 3 groups, the physiologic inverse relationship between hematocrit and serum EPO levels was also lost due to renal parenchymal damage. In group III with severe renal parenchymal disease, renal EPO synthesis decreased significantly as compared to group I with mild renal failure, [P<0.05] indicating a parallel reduction of renal function and depression in EPO production

Carpal tunnel syndrome among long-term hemodialysis patients

Among 123 patients on chronic hemodialysis, 13 patients with carpal tunnel syndrome [11 bilateral] were detectd. They tended to be 12 years older and had been on hemodialysis two years longer than patients without C.T.S. Duration on hemodialysis appeared to have a causative effect for the development of C.T.S. among females, while impaired calcium-phosphorous metabolism appeared to be implicated among males. The presence of shoulder pain and cystic radiolucencies correlated with C.T.S. Of six hands which were explored surgically, amyloid deposition was found in three. The site of vascular access, sex, underlying renal disease, efficacy of dialysis and predialytic beta 2-microglobulin level had no relation to the development of C.T.S