Spinal compression by brown tumor in two patients with chronic kidney allograft failure on maintenance hemodialysis

Brown tumors with non-neoplastic process are noticed in patients with end-stage renal disease suffering from a severe form of secondary hyperparathyroidism. Herein, we report a patient with chronic kidney allograft failure returned back to hemodialysis who experienced manifestations of cauda equina compression secondary to a lumbar brown tumor. Also, we had another patient on hemodialysis with a demineralized lesion affecting the cervical vertebrae. Although brown tumor is a rare complication, these two cases highlighted the importance of neurological symptoms in uremic patients. Spinal decompression surgery, in order to alleviate pressure on neurological structures, together with subtotal parathyroidectomy, were highly indicated

Basiliximab reduces the incudence of acute cellular rejection in live related donor kidney transplatation; a single centre experience

The aim of this work is to determine the therapeutic benefit [s] of basiliximab induction therapy in the living related donor kidney transplantation One hundred adult recipients of their first kidney allograft were randomized to two treatment groups, one group received basiliximab and the second served as a control. All patients received a maintenance triple immunosuppressive therapy [steroids, cyclosporine, microemulsion and azathioprine]. The patients were followed up for a minimum of one year. The end points of evaluations included the incidence of acute rejection episodes, severity of rejection, cumulative steroid dose received, patients and graft survival. Basiliximab significantly reduced the proportion of patients who experienced of patients who experienced an acute rejection [18/50] when compared to the control group [31/50]. The cumulative steroid dose at 3 months as well as at 12 months was significantly lower in the basiliximab group. The overall incidence of post-transplant complications was comparable among the two treatment groups. Prophylactic basiliximab is well tolerated and significantly reduces the incidence of acute refection episodes in living related donor kidney transplantation

Growth in children with chronic renal faliure and after transplantation

This study aimed at studying the relation between height, glomerular filtration rate [GFR] and hormonal alteration in children with chronic renal failure [CRF] on regular hemodialysis [HD] and the possible role of normal graft function, after kidney transplantation, in this respect. The study population comprised 18 children with CRF on HD with mean age of 10.56 +/- 3.08 years and 16 children with normal graft function [mean age 11.06 +/- 3.19]. Mean duration on HD was 14.72 +/- 7.73 months for CRF group. Mean interval after transplantation was 1.97 +/- 0.9 years for the group of functioning grafts. Ten normal healthy children of matched age and sex served as controls. All patients were subjected to assessment of growth parameters including height, expressed as standard deviation scores [HtSDS] for chronological age, measurement of serum growth hormone [hGH] and serum parathormone [PTH] by radioimmunoassay. Growth performance was evaluated twice: at the start of the study and after a period of one year. The overall growth retardation in children with CRF on HD corresponded to -3.16 +/- 0.43 [mean SDS for height]. Children with normal graft function had a mean HtSDS of -2.54 +/- 0.29. Growth retardation remained a critical complication after kidney transplantation despite the statistically significant improvement observed compared to the group of children with CRF [P< 0.001]. Our results confirmed that impaired HtSDS with children with CRF correlates with the duration on hemodialysis [r = -0.728, P< 0.001]. There was a significant correlation between GFR and PTH level [r = -0.750, P< 0.001] in children with CRF. Our series of children with CRF had a positive correlation between their SDS for height and GFR [r =0.760 with P<0.001]. Both categories with CRF and with normal graft function had significantly higher levels of both serum hGH and PTH compared to controls [P<0.001], while CRF children had significantly higher serum levels of both hGH and PTH compared to those with normal graft function [P<0.008 and P<0.001 respectively]. Our results support the possibility that growth retardation in children with CRF despite the normal or elevated hGH level may be explained by the presence of peripheral insensitivity to the action of hGH