Acute renal failure complicating nonfulminant hepatitis a in HLA-B27 positive patient.

Here we report the case of a previously healthy 32-year-old HLA B27 positive male who developed completely reversible acute oliguric renal failure in the course of nonfulminant hepatitis A infection. This is a rare complication of uncertain etiology. B27 positive individuals are prone to a number of immune system derangements including overreacting in interactions with some microbiologic agents. We made our consideration on the basis of some experimental models and the presumed pathogenesis of reactive arthritis in these individuals. As a result here we postulate a hepatitis A virus-triggered, immune mediated mechanism of renal injury restricted to genetically susceptible (i.e. B27 positive) individuals. In regard to this hypothesis we warrant additional HLA-profiles and future similar cases for further confirms and conclusions.

Organ transplantation at the Rijeka Clinical Medical Center--from kidney to pancreas.

From January 1971 to January 1994 the authors performed 560 kidney, and two simultaneous pancreas and kidney, transplantations at the Rijeka Clinical Medical Center. Three hundred and nine kidneys (55%) were from a related living donor (two from unrelated living donors), while 253 (45%) kidney and two pancreas grafts were from cadaveric donors. Analyzing the mean patients' age at the time of transplantation the authors noticed its steady increase over five-year periods, a decrease of chronic glomerulonephritis from 76% to 60%, and a gradual increase in diabetic nephropathy from 0 to 6%. Cumulative 1- and 5-year patient survival rates after living donor transplants including conventional immunosuppression were 95 and 83%, respectively; with Cs the survival rates were 94% and 90% (N. S.). For living donor kidney grafts the 1- and 5-year survival rates with conventional immunosuppression were 76% and 50%, respectively. With Cs the survival rates were considerably higher: 88% after 1 year and 71% after 5 years (p < 0.01). Cumulative survival rates of patients with cadaveric transplants receiving conventional immunosuppression were 82% and 71%, respectively; with Cs they were 87% and 78% (N.S.). The survival rate of cadaveric transplants was 51% after one year and 38% after five years in the first period, but it improved significantly after introduction of Cs. increasing to 81% and 52%, respectively (p < 0.001). Renal transplantation in diabetics does not preclude the recurrence of diabetic nephropathy in the graft; successful pancreas and kidney transplantation does, however, and thus offers the patient a better quality of life.

[Microscopic hematuria]. / Mikroskopska hematurija.

Isolated microhematuria, without any other systemic and local causes, is frequent phenomenon in clinical practice. It is a diagnostic problem for both general practitioners and nephrologists. By means of standard diagnostic procedures it is usually very hard to define nature and origin of blood in urine. Therefore, in those cases invasive diagnostic methods of examination are usually applied, cystoscopy, invasive radiology etc. Light microscopy and supravital coloring secure high-quality approach to various elements formed in urine's sediment. They also provide better analysis of the morphology of erythrocytes. It is of great importance to define their origins. Using verified methodological principles, this method attains its real place in diagnostic procedures applied to examine the origins of blood in urine.