Renal failure in a patient with primary antiphospholipid syndrome.

Antiphospholipid antibody syndrome (APLA) is a syndrome complex characterized by recurrent arterial or venous thrombosis, recurrent fetal wastage, thrombocytopenia and presence in serum of antibodies against negatively charged phospholipids like lupus anticoagulant (LA), anticardiolipin antibody (ACLA) and subgroups. These are classified further as primary (wherein this occurs in isolation) and secondary (associated with infection, drugs and malignancies). It is uncommon to find both LA and ACLA in primary APLA syndrome (unlike as in the secondary form). Renal manifestations which include renal arterial and venous occlusion and infarction and thrombotic microangiopathy have also been infrequently described. We hereby present a case of primary APLA syndrome with unusual features of LA and ACLA occurring together and also the presence of renal failure due to left renal artery thrombosis and right renal artery occlusion.

Valvular dysfunction in uraemia.

Regurgitation of the pulmonary, mitral, tricuspid and aortic valves have been observed frequently in chronic renal failure (CRF) and dialysis patients. Two dimensional, M mode and doppler echocardiography were performed on 35 CRF patients and 37 end stage renal failure (ESRD) patients on maintenance haemodialysis. Though structurally normal, valvular dysfunction was noted in 50 per cent of the patients with renal failure. Mitral regurgitation was the commonest abnormality, occurring in 36.1 per cent of the patients. Calcification of the valve was observed in only 5.6 and 16.7 per cent of CRF and dialysis patients respectively. Multiple regression analysis underscored the large contribution of diabetic status in the development of valvular dysfunction. Though end systolic volume was higher in patients with valvular abnormalities, the ejection fraction was well preserved. However, follow up studies are required to assess the significance of the functional valvular regurgitation on the cardiac function of the patients.

Optimal cyclosporine therapy--an Indian experience.

Thirty consecutive adult patients who underwent renal transplantation were prospectively studied. The immunosuppression consisted of cyclosporine, azathioprine and prednisolone. Oral Cyclosporine CyA was initiated at a dose of 7 mg/kg/Day and reduced by 1 mg/kg/month. Blood level of CyA was monitored by monoclonal RIA (Cyclo-Trac-NS) method on 3rd, 10th, 30th, 60th, 90th and 180th days. The dose was titrated according to the blood level and the renal function. In spite of progressive reduction in the dose of CyA, the blood level did not show any significant change, probably because of increased absorption or decreased metabolism. Though the percentage change in CyA dose was significant, the CyA level and serum creatinine remained relatively stable during the follow up period. Our patients required relatively lesser dose to achieve optimum blood level. Though the blood level of CyA ranged between 387 and 2120 ng/dL. There was no evidence of rejection or irreversible nephrotoxicity.