ABSTRACT
A longitudinal study was carried out on 19 recipients of cadaveric renal allografts, monitoring their anti-donor and anti-third party responses in the mixed lymphocyte reaction (MLR) at the time of transplantation and at 3, 6, and 12 months post-transplant. Two patterns of responses were identified: in the first (n = 11), patients showed, or later developed, donor-specific hyporesponsiveness, and in the second (n = 8), patients had persistent antidonor and anti-third party responses. After 1 year, the serum creatinine, number of episodes of acute rejection and biopsy findings were compared in both groups. In the first group, the mean serum creatinine was 136.4 mmol/l, the total number of acute rejection episodes was three and in nine of the ten available biopsies, there were minimal cellular infiltrates and normal appearance of the glomeruli, tubules and blood vessels. In the second group, the mean serum creatinine was 163 mmol/l, the total number of acute rejection episodes was 12 and in five of the seven biopsies available, evidence of ongoing rejection was obtained. The difference in mean serum creatinine was not statistically significant (P > 0.05), but the difference in the numbers of acute rejection episodes was (P < 0.05). It is concluded that in some renal allograft recipients, a state of donor-specific hyporesponsiveness develops, and this state may be associated with better graft outcome at 1 year. These data may be useful in selecting patients for reduced immunosuppressive therapy.
Subject(s)
Kidney Transplantation/immunology , Lymphocytes/immunology , Acute Disease , Adult , CD8-Positive T-Lymphocytes/immunology , Creatinine/blood , Female , Graft Rejection/blood , Graft Rejection/immunology , Humans , Immunoglobulin G/immunology , Immunoglobulin G/isolation & purification , Longitudinal Studies , Lymphocyte Culture Test, Mixed , Lymphocyte Depletion , Male , Middle Aged , Spleen/immunology , T-Lymphocytes, Regulatory/immunology , Tissue Donors , Transplantation, HomologousABSTRACT
This study examines the relationship between developmental outcomes of high-risk infants and parental perceptions and expectations. Parents of 209 consecutive high-risk infants were asked to provide their development interpretations and expectations before their infants received standard developmental assessments between April and October 1989. Moderate correlations between parents and professional assessments of motor and language skills were noted (p less than .05 to p less than .01). Most agreements occurred when infants were assessed as normal by professionals. Disagreements were common and occurred in all areas of development. These mismatches were not associated with gestational age at birth, neonatal complications, poverty, or estimates of parental experience. Professionals should take seriously any expressed developmental concerns by parents of high-risk infants. Expressed developmental concerns, however, cannot be relied on for developmental screening of high-risk infants.
Subject(s)
Attitude , Brain Damage, Chronic/psychology , Developmental Disabilities/psychology , Infant, Premature, Diseases/psychology , Parents/psychology , Brain Damage, Chronic/diagnosis , Child, Preschool , Developmental Disabilities/diagnosis , Female , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Intensive Care, Neonatal , Language Development Disorders/diagnosis , Language Development Disorders/psychology , Male , Neurologic Examination , Neuropsychological Tests , Psychomotor Disorders/diagnosis , Psychomotor Disorders/psychologyABSTRACT
Clinical features have been correlated with renal function, histology and selective renal angiography in 19 patients with recurrent painless haematuria, recurrent loin pain, or both haematuria and loin pain in whom urinary infection, calculi and anatomical abnormalities of the urinary tract had been excluded. No deterioration in renal function was observed in any patient over periods of up to nine years. Although all patients showed similar glomerular changes histologically, consisting of focal and segmental mesangial thickening and proliferation and periglomerular fibrosis, mild tubular damage was more common in those with loin pain. All patients with loin pain whether or not they had haematuria, had abnormal renal angiograms consisting of focal or generalized vascular lesions sometimes associated with cortical infarcts. The possible aetiological factors are discussed with particular reference to oestrogen-containing compounds.
Subject(s)
Hematuria/etiology , Kidney/blood supply , Pain/etiology , Adolescent , Adult , Biopsy , Blood Vessels/pathology , Estrogens/adverse effects , Female , Hematuria/drug therapy , Humans , Infarction/complications , Kidney/pathology , Kidney Cortex/blood supply , Kidney Diseases/chemically induced , Male , Radiography , Recurrence , Renal Artery/abnormalities , Renal Artery/diagnostic imaging , Warfarin/therapeutic useABSTRACT
Two cases of acute renal failure complicating multiple myeloma are reported. In both, the renal failure preceded the diagnosis of multiple myeloma. In one case oliguria occurred after performance of a venogram; renal function returned to normal after two weeks of intermittent peritoneal dialysis, emphasizing the reversibility of the renal failure in some cases.
