Evaluation and selection of living related kidney donors--our experience in a government hospital.

In a state-funded, live related-donor kidney transplantation programme, 616 eligible end stage renal failure (ESRF) patients were seen over a four-year period. 73% of them had potential related donors, 64% of whom were willing to donate. Fear of surgery, non-congenial pre-morbid relationships and discouragement by family members were the most common reasons for unwillingness to donate. After investigations, 76% of the willing donors were found to be fit. ABO incompatibility, lymphocyte cross-match positivity and anatomic abnormalities were the most common grounds for non-acceptance. Sixty eight percent of the willing, fit donors finally donated their kidneys, patient-death and donor-recipient withdrawal before surgery accounting for the remaining. One hundred and forty eight patients underwent renal transplantation. Two-thirds of the donors were females, mothers (37%) forming the single largest group. Eight five percent of the recipients were males. Overall, only 35% of the eligible ESRF patients had related, willing and fit donors attesting to the need for an active, cadaver-donor transplantation programme.

Leptospirosis in Madras--a clinical and serological study.

Leptospirosis was confirmed by Microscopic Agglutination Test (MAT) and/or ELISA in 57 patients admitted to the Government General Hospital, Madras, India, during November and December of 1990 and 1991 with symptomatology suggestive of the disease. Fifty (88%) of the 57 cases were males; the mean age of all the cases was 39.6 years (range 17-72). The main clinical features were: fever 100% jaundice 84%, Myalgia 82%, acute renal failure 72% and conjunctival suffusion 58%. Non-azotemic jaundice occurred in 19% of cases. Renal failure was non-oliguric in 24% of cases. 3.5% of patients died. 23 patients underwent peritoneal and/or hemodialysis. ELISA IgM titres ranged from 1:80 to 1:10240 (geometric mean tire 911). MAT titres > or = 1:1600 and > or = 1:800 occurred in 39 of 54 and 51 of 54 cases respectively. Autumnalis was the serogroup most commonly recorded serologically, and Leptospira interrogans serovar autumnalis was isolated from one patient. This study shows that leptospirosis is a significant health problem in Madras, though normally grossly underestimated due to the absence of routine laboratory diagnostic facilities for the disease. Gross under-reporting is also likely in other high rainfall third world areas.

Acute renal failure due to acute diarrhoeal diseases.

Fifty four patients with acute renal failure (ARF) due to acute diarrhoeal diseases (ADD) were treated between August 1987 and May 1988. There were 39 males and 15 females. The mean age was 46.25 years. These patients were referred by general practitioners (GP's) and private nursing homes during an epidemic of ADD in Madras city in 1987-'88. Investigations revealed plasma urea (mean +/- SD) 129 +/- 52.8 mg/dl. and plasma creatinine (mean +/- SD) 7.51 +/- 4.3 mg/dl. 42 patients underwent peritoneal dialysis. 3 had haemodialysis. 29 patients died (mortality, 53.7%). The most significant factor for high mortality was the time interval from onset of ADD to diagnosis of ARF which was 5.2 +/- 2.17 days in the patients who survived compared to 8.5 +/- 3.1 days in the patients who died (P less than 0.01). It is concluded that (a) GP's had given inadequate fluid therapy before admission and (b) were initially not aware of renal failure and so referred them late to hospital.

Assessment of progression of chronic renal failure--using reciprocal of serum creatinine.

Twenty-seven patients with chronic renal failure (CRF) were studied over a period of 6 to 57 months. The mean serum creatinine (Scr.) was 4 mg/dl. All patients were started on conservative therapy. The rate of progression of renal failure was assessed by least square linear regression analysis using reciprocal of Scr. (1/Scr.) versus time plots. Group I (13 patients) showed steady progression to end-stage renal failure (mean slope 0.013328). 7 of 13 patients had chronic glomerulonephritis. 11 had nephrotic proteinuria. In group II (14 patients), the regression line remained static indicating arrest of progression of renal disease (mean slope 0.0087858). 6 of 14 had nephrosclerosis. 3 had nephrotic proteinuria. We conclude that (1) assessment of progression of CRF by linear regression analysis of 1/Scr. vs time is a useful method. (2) persistent nephrotic proteinuria is an adverse longterm risk factor. (3) conservative therapy has a definite role in the management of CRF.