An unusual consequence of deep vein thrombosis.

We report here an unusual case in which deep vein thrombosis, limited to the infrapopliteal region, led to an anterior tibial compartment syndrome as a major complication in a patient who had undergone heart surgery shortly before.

High incidence of nephrogenic adenoma of the bladder after renal transplantation.

BACKGROUND: Tumors of the bladder termed nephrogenic adenomas in kidney allograft recipients are believed to develop as urothelial metaplastic proliferations in response to mechanical trauma, chemical noxae, irradiation, and bacterial or viral pathogens. We report on the incidence of nephrogenic adenoma of the bladder in patients who received renal transplants during a period of 7 years and 3 months at the University Hospital of Vienna. METHODS: Diagnosis was obtained by cystoscopy and histological analysis. Nephrogenic adenoma was treated by transurethral electroresection and administration of antibiotics in case of urinary tract infections. Follow-up consisted of cytological controls of urine and bladder irrigation fluid as well as of cystoscopy every 3 months. RESULTS: In 7 of 1328 renal allograft recipients, nephrogenic adenoma could be detected after 7 to 60 months following renal transplantation. In five patients, recurrence was detected 9 to 23 months after diagnosis of the initial lesion. No evidence of malignant degeneration was observed in any patient. Nephrogenic adenoma was not related to immunosuppressive therapy, cytomegalovirus disease, or gancyclovir therapy. CONCLUSIONS: We suggest that after successful transurethral electroresection of nephrogenic adenomas, cytological controls are adequate every 3 months. Only in renal transplant patients with recurrence of voiding disturbances, macrohematuria, or urinary tract infection are cystoscopy and biopsy indicated in the routine follow-up regimen.

Lipoprotein pattern in end-stage renal disease and following successful renal transplantation.

Lipoprotein abnormalities are common in uremia and frequently persist after successful renal transplantation (RT). Based on the influence of immunosuppression on lipoprotein metabolism, this prospective study in 76 patients has been focused on lipoprotein pattern in end-stage renal disease and after successful RT during a follow-up period of 18 months. Additionally, the influence of different immunosuppressive regimes has been evaluated. Hyperlipidemia was present in 32% of the patients before and in 59% after grafting. Total cholesterol was 5.42 +/- 1.57 mmol/l (mean S D) before RT and continuously and significantly increased during the entire observation period, being highest 18 months after RT (6.8 +/- 1.63 mmol/l; p < 0.01). This was mainly due to an increase in LDL-cholesterol (before RT: 3.68 (1.41 mmol/l; 18 months after RT: 4.69 +/- 1.88 mmol/l; p < 0.05) while HDL-cholesterol values only slightly increased (before RT: 0.99 +/- 0.36 mmol/l; 18 months after RT: 1.13 +/- 0.3 mmol/l; p < 0.05). Changes in total HDL-cholesterol were mainly due to an increase in HDL 3, while HDL 2 moderately increasing remained at low concentrations. As corticosteroid dosage was substantially reduced during the entire observation period, other factors such as cyclosporin A have to be considered for hyperlipidemia in renal transplant recipients. The observation on LDL-cholesterol being highest 18 months after transplantation suggests lipid lowering interventions to be indicated and might improve long-term outcome in renal transplant recipients.

Late ureteral obstruction after kidney transplantation. Fibrotic answer to previous rejection?

Today, the incidence of urological complications following renal transplantation is 2%-10%. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.

Renal cell carcinoma in acquired renal cystic disease 3 years after successful kidney transplantation. Two case reports and review of the literature.

Acquired renal cystic disease (ARCD) has a prevalence of up to 90% in patients with endstage renal failure and an uncommonly high potential of developing into renal cell carcinoma. After renal transplantation, regression of an established ARCD is possible, suggesting a protective effect of transplantation against tumors in the native kidneys. Two case reports describing hypernephromas in kidneys with ARCD 3 years after successful renal transplantation are presented. One patient died 6 weeks after nephrectomy due to metastatic disease, although there were no metastases at the time of operation. The other patient lives with no evidence of disease since 10 months. This report confirms the need of annual sonography of the native kidneys also in renal transplant patients with consecutive computed tomography scanning of suspicious lesions.