Donating a kidney to a family member. How primary care physicians can help prepare potential donors.

When a relative needs a kidney to survive, family members often impulsively offer to donate one without stopping to consider the physical, emotional, and financial ramifications, which can be considerable. The family's primary care physician can be very helpful in guiding and educating potential donors and, by arranging for screening to be done in the community, can ease the financial strain. The authors discuss the things a potential kidney donor should consider.

Elective conversion from cyclosporine to azathioprine in sensitized patients following cadaveric renal transplantation.

The safety of conversion from cyclosporine to azathioprine following renal transplantation in patients generally considered to be at immunologic risk for allograft loss has not been established. We examined a group of 59 patients who underwent cadaveric renal transplantation and elective conversion from cyclosporine to azathioprine 8.3 +/- 3.8 months following transplantation. Forty-three of these patients received a first transplant and had panel-reactive antibodies (PRA) less than 40% (unsensitized). Sixteen patients received at least their second allograft or had PRA of 40% or more (sensitized). Average follow-up was 17.9 +/- 8.2 months. Nine patients (15%) failed conversion as manifested by the need to restart cyclosporine 1 to 10 months following conversion. All were in the unsensitized group. Of those successfully converted, there were six allograft failures, two from patient death, one from acute rejection, one from recurrent diabetic nephropathy, and two from patient noncompliance. All were in the unsensitized group, although the difference from the sensitized group was not statistically significant (P = 0.051). There were three rejection episodes, all successfully reversed, in the sensitized group and six rejection episodes in the unsensitized group, five of which were reversed. Overall renal function improved in both groups as shown by a significant decrease in serum creatinine. Neither group required increased doses of steroid to compensate for lack of cyclosporine. From these data we can recommend conversion from cyclosporine to azathioprine in patients with cytotoxic antibodies or those undergoing retransplantation.

Cryptococcal cellulitis with multiple sites of involvement.

Cryptococcal cellulitis is an uncommon cutaneous manifestation of generalized cryptococcal disease. We describe the only reported incidence with multiple sites of cutaneous involvement. In an immunosuppressed patient an apparent cellulitis, even with multiple sites of involvement, that does not respond to appropriate antibiotics should alert one to the possible diagnosis of cryptococcal cellulitis.

Surgical treatment of renovascular hypertension.

The evaluation of patients with inadequate control of diastolic blood pressure for surgically correctable forms of hypertension led to the detection and surgical treatment of 56 patients. Detection was facilitated by the use of hypertensive intravenous pyelography and Hippuran renal Scanning. Aortography proved the presence of renal artery disease and renal vein renin assay established its significance in the etiology of the patients' hypertension. Renal artery reconstruction was performed in 50 patients, including 5 who also had reconstruction of major aortoiliac lesions. The extent of renal artery disease precluded arterial reconstruction in six patients, who required nephrectomy. Two postoperative deaths occurred, for a mortality rate of 3.6 per cent. Improvement in mean diastolic blood pressure for the total group of patients from 118 mm Hg preoperatively to 86 mm Hg postoperatively was achieved. Forty-six patients (85 per cent) have a diastolic blood pressure of 90 mm Hg or less; in 5 patients the diastolic blood pressure is 91 to 100 mm Hg but is at least 20 mm Hg lower than the preorative level.

Acute renal failure in McArdle's disease.

A case of reversible acute renal failure in an adult with myophosphorylase deficiency (McArdle's disease) is described. Myoglobinuria, possibly abetted by intravenous urography, was incriminated as the cause of impairment of renal function.A muscle biopsy specimen contained necrotic fibers and no histochemically demonstrable phosphorylase activity. Ultrastructurally, nonspecific degenerative changes were observed.

Gallium citrate Ga 67 imaging in noninfectious interstitial nephritis.

Gallium citrate Ga 67 has been reported to be of value in the diagnosis of both malignant and infectious intra-abdominal diseases. The drug may also be taken up by mononuclear phagocytes in noninfectious tubulo-interstitial disease of the kidney. Positive renal scans from patients with these diseases either become negative or show decreased uptake following treatment. With further support of these findings, gallium citrate Ga 67 may become a valuable tool in both diagnosis and follow-up of noninfectious interstitial nephritis.

Adult polycystic kidney disease and lattice corneal dystrophy: occurrence in a single family.

Most ophthalmologic disorders reported with renal cystic disease have been associated with either medullary cystic disease or juvenile nephrophthisis. A family we investigated demonstrated two previously unreported autosomal dominant disorders: adult polycystic kidney disease and lattice corneal dystrophy.