Outcome of patients with pre-existing hepatitis B virus infection following renal transplant.

Twenty four patients who were HBsAg positive prior to renal transplantation were studied with respect to their hepatic and renal outcome. The kidneys in all patients were obtained from living related donors. The standard immunosuppressive therapy consisted of azathioprine and prednisolone. Post-renal transplant follow-up varied from 32-86 months (mean 55 +/- 9). Renal functions, liver functions, HBsAg and HBsAb status was closely monitored during follow-up. One patient developed acute hepatitis four months after transplantation; this resolved in 10 weeks. Four patients showed transient elevations of liver enzymes. The results of liver biopsy in 16 cases revealed, normal histology (8), virus in hepatocytes (5), and acute hepatitis (3). None of the patients had evidence of chronic liver disease. Two patients died due to chronic rejection/chronic renal failure and two patients died due to septicaemia. Five living patients have mild to moderate chronic rejection. It was concluded that pre-existing HBsAg carrier state in transplant patients had no deteriorating effect on the liver. The mortality was related to chronic rejection and septicaemia.

IgA associated glomerulonephritis.

Immunohistological analysis of 1146 renal biopsies revealed IgA associated glomerulonephritis (IgAGN) in 83 (7.24%) patients (33 children, 50 adults). Clinical features were unusually severe in a high proportion. Nephrotic syndrome (NS) responding poorly to prednisolone was found in 24%, hypertension (HT) in 39%, and azotemia in 34% of patients. NS was slightly more frequent in children than in adults, but HT and azotemia occurred twice as often in adults as in children. Histologically, extensive glomerular crescents and sclerosis were prominent. In addition, moderate arteriolitis and arteriolosclerosis and marked tubulointerstitial nephropathy were notable features. Thus, a low incidence and marked severity characterized IgAGN in this study.

The effect of serum from patients of chronic renal failure on colony forming units (CFU-S) in mice.

Repopulating ability of mouse bone marrow stem cells, treated with pre-dialysis, post-dialysis and control sera was assessed by colony forming units (CFU-S). Significant lower colony counts were observed in pre-dialysis group as compared to control group. There was an improvement in the colony counts when the cells were treated with post-dialysis sera. The study suggests the presence of inhibitor/s of CFU-S in the uraemic sera which is/are partially removed by haemodialysis.

Emergency treatment with ketoconazole in disseminated intravascular coagulation due to metastatic prostatic carcinoma.

We report the use of ketoconazole to control disseminated intravascular coagulation due to prostatic carcinoma. Clinical improvement in the condition of the patient was noted in 48 hours and coagulation profile became normal in 10 days.

Significance of transplant perfusion index in the diagnosis of acute rejection in live related renal allograft recipients.

The study was undertaken to assess the usefulness of transplant perfusion index (TPI) in the differential diagnosis of renal allograft dysfunction with special reference to acute rejection. It was observed that the TPI has a sensitivity of 100 per cent and specificity of 98.1 per cent in the diagnosis of acute rejection. It was also observed that the serial values of TPI provided valuable clues and guide in the management of transplant dysfunction and helped in the immediate and long term follow-up of patients with renal allografts.

Incidence of reflux nephropathy (RN) in ESRD and effect of nephrectomy in RN on blood pressure and haematocrit following renal transplantation.

One hundred and fifty cases of end stage renal disease (ESRD) on pretransplant workup showed vesicoureteric reflux (VUR) in 21 (14%). Of these, 15 were primary reflux nephropathy (PRN) whereas 6 were secondary VUR. All patients in PRN group showed grade III to IV reflux while secondary VUR ranged between grade I to II. In the PRN group 38.5% had severe, 23% moderate and 23% mild hypertension; 53.3% were nonoliguric and 46.7% were oliguric. Mean plasma renin activity (PRA) was 6.6 and 2.85 ng/ml/hr in PRN and secondary VUR groups respectively. All cases of PRN and 2 from secondary VUR underwent nephrectomy and a month later renal transplantation. Following surgery blood pressure normalised without therapy in 50% and another 50% required lesser drugs in comparison to age matched non nephrectomised controls who showed hypertension in 100% cases, 60% requiring 3 to 4 drugs combination (p less than 0.05). Risk of low haematocrit in nephrectomised patients was insignificant.