The association between retinal ischaemia and end-stage renal damage in thrombotic microangiopathy.

Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are conditions in which thrombocytopenia and microangiopathic haemolytic anaemia are associated with organ damage due to thrombotic microangiopathy (TMA). The prognosis for adults with HUS is variable, with some patients presenting with an acute illness from which a full recovery is made, whilst others develop irreversible renal failure. Evidence of retinal ischaemia was noted on presentation in a normotensive patient with irreversible renal failure due to HUS. This study examined prospectively the optic fundi of all patients who subsequently presented to a single adult renal unit (catchment population approximately 700,000) with HUS. Eleven patients presented with HUS over 12 years (1985-1997). Six patients with irreversible renal failure had retinal abnormalities either at the time or within a few days of initial presentation. The other five patients whose renal function recovered did not develop retinal changes during the course of their illness. Retinal ischaemia associated with TMA is a poor prognostic sign in adults with HUS.

Referral of elderly patients with end-stage renal failure for renal replacement therapy.

An increasing number of patients with end-stage renal failure is being treated in the United Kingdom and in 1987 approximately 50 new patients per million started renal replacement therapy. Nevertheless comparatively fewer patients are treated in this country than in some other European countries and in North America. During the 3 years 1985 to 1988, 95 patients from West Glamorgan started chronic renal replacement therapy (87 patients/million population/year). Of these, 16 were aged 75 years or over on starting treatment. In addition two others attained the age of 75 years during the study period. The proportion of elderly new patients is increasing and in the year 1987 to 1988, 59 per cent were older than 65 years and 32 per cent were older than 75 years. Throughout the United Kingdom many elderly patients are being denied treatment, due partly to under-referral.

Imported epidemic non-A, non-B hepatitis in Qatar.

During one year, 198 patients were admitted to the Hamad General Hospital, Qatar, with acute viral hepatitis. Sera from 126 of these were tested for HBsAg, IgM anti-HBc, IgG anti-HAV, IgM anti-HAV, and delta antibody in those positive for HBsAg. Only 6% of the patients were Qatari nationals and the remainder were immigrants. Of the 126 patients tested, 7 had acute hepatitis A, 29 had acute hepatitis B (none were positive for delta antibody), and the remaining 91 were regarded as having had acute non-A, non-B hepatitis. Of this latter group, 75% were Indian immigrants of whom 59% presented within six weeks of arrival in Qatar and only 2 patients presented later than eight weeks. These patients were thought to have contracted the infection in transit camps in India before immigration to Qatar.