[ comparison between the effect of oral and intravenous prednisolone in prevention of acute rejection during the first two weeks of renal transplantation]

Induction of anti rejection therapy in renal transplanted patients is performed in various forms and there is a great difference in steroid administration. The aim of this study was to compare the effect of oral and intravenous prednisolone [Methyl prednisolone] in prevention of rejection during first two weeks of hospitalization. In this clinical trial study during one year in a randomized trial, 60 patients in two groups [31 for parenteral route and 29 for oral route] were studied for rate of rejection. Also, according to gender, age [less or more than 35 years old], clinical manifestations, time of rejection [first or second week] and the results of isotope scan [DTPA], the findings were assessed. It was found eight cases of rejection in oral group and six cases in parenteral, one without any significant difference. Also, there was no significant difference between two groups for other parameters. The only meaningful difference was for isotope scan that was true for all rejections of the parenteral group but in only 25% of rejections of the oral group, it showed the problem [p=0.049]. In short term, there is no significant difference between two methods. But because sample size was small, this study should be repeated with larger one

[Colonic perforation in a kidney recipient with cytomegalovirus [CMV] colitis]

Gastrointestinal [GI] involvement is a cause of morbidity and mortality in kidney transplant recipients. Patients are at risk of GI infections during 1-6 months after transplantation. The major viral pathogen involving GI tract in transplanted patients is CMV. The incidence of active disease in seropositive patients is about 25%. There is a significant increase in mortality of kidney recipients suffering GI disease with CMV. A 58-year-old man hospitalized with weakness and confusion three weeks after kidney transplantation. Gradually LLQ [Left Lower Quadrants] tenderness appeared. Abdominal X-ray showed subdiaphragmatic air. Sigmoidal perforation was revealed after abdominal laparotomy. CMV-PCR [Polymerase Chain Reaction] from blood was positive and CMV colitis was confirmed by colonic biopsy. Ganciclovir and broad spectrum antibiotics were started but he died 5 days later because of sepsis. CMV disease may be fatal in kidney recipients. Despite severe disease, there may be just a few signs and symptoms. So, there must be a high index of suspicion in kidney recipients during first 6 months after transplantation

[Report of a case of medical treatment of emphysematous pyelonephritis]

Background and Objective: Emphysematous pyelonephritis is an acute and necrotizing parenchymal and perinephric infection. It is a rare and life threatening condition. To reach a successful outcome, early diagnosis and treatment is most important. Nowadays, the use of CT scan and antibiotics has enabled us to replace surgery with medical treatment in some cases

Cases: A 74-year-old man referred with bad general condition, decrease in level of consciousness, fever, flank pain and dysuria from a few days ago. Lab tests were compatible with a urinary tract infection and acute renal failure. Abdominal sonography and CT scan showed gas in both renal parenchymas. The diagnosis of emphysematous pyelonephritis was made. Hemodynamic support, control of blood sugar and IV antibiotics were applied. Uremic syndrome led to hemodialysis. Ultimately signs and symptoms improved and the infection was treated and the patient was discharge. Gradually renal function improved and hemodialysis was deceased

Conclusion: Early medical treatment can replace surgery in this life threatening condition