ABSTRACT
Granulocyte/macrophage (GM), mixed colony and erythroid burst forming unit assays were performed in 9 post-transplant erythrocytosis (PTE) patients, 18 non-PTE kidney transplant recipients and 12 healthy volunteers. The number of GM precursors was lower in PTE patients than in normal subjects. This indicates that hematopoietic stem cell potential is not altered in PTE.
Subject(s)
Hematopoietic Stem Cells/cytology , Kidney Transplantation , Polycythemia/blood , Adult , Aged , Hematopoietic Stem Cells/physiology , Humans , Kidney Transplantation/adverse effects , Middle Aged , Polycythemia/pathology , Polycythemia/physiopathologyABSTRACT
Therapeutic plasma exchange (PE) or plasma-pheresis has been used in recent years in the treatment of severe hemolytic uremic syndrome (HUS) in children. We analyzed the benefit of PE and peritoneal dialysis (PD) in 9 children, 6 boys and 3 girls, aged 1-10 years, from 1983-1993. All children came from different geographical regions, and all had the sporadic form of the illness. Three patients had the gastrointestinal form, 5 had respiratory prodromes while 1 child developed HUS during the course of varicella. Seven children were hypertensive, but only in 3 was hypertension persistent. The child with varicella had a transient complement decrease. Five children were treated with PE. In 4 children, fresh frozen plasma (FFP) was used as replacement fluid, and human albumin was used in 1 child. Four children were treated with PD and infusions of FFP. Rapid recovery of renal function was observed in 5 patients whereas in 2 oliguric children the recovery of renal function ensued within 1 and 2 months, respectively. Two children developed terminal renal failure (TRF) (in 1 child the treatment was very delayed, and in other child HUS developed following varicella). Only 1 boy had relapses of the disease followed by impairment of renal function from which he gradually recovered. During the 3-10 year follow-up period, only the child with relapses was hypertensive while the others had normal clinical and laboratory parameters. We suggest that PE plays an important role in the early treatment of severe forms of HUS in children.
Subject(s)
Hemolytic-Uremic Syndrome/therapy , Plasmapheresis , Case-Control Studies , Child , Child, Preschool , Diuresis/physiology , Female , Humans , Hypertension/physiopathology , Hypertension/therapy , Infant , Longitudinal Studies , Male , Peritoneal Dialysis , Plasma , Renal Insufficiency/therapy , Retrospective Studies , Serum Albumin/metabolism , Treatment OutcomeABSTRACT
From 1973 to July 1990, 183 kidney transplantations were performed at the Transplantation Unit of the Department of Urology--Faculty of Medicine--University of Zagreb. Out of these, 57 were from the living related donors. The research included 50 (88%) living related donors (28 mothers, 12 fathers, 5 brothers and 5 sisters) followed up from 1 to 15 years after donor nephrectomy. The donors' health conditions were evaluated by clinical-laboratory examinations (biochemical tests, renal function tests, urinoculture, ultrasound, isotopic renal studies, arterial blood pressure). In 48 (96%) neither morphological nor functional changes of the urinary system were found. A certain number of donors requested a transfer to less physically strenuous jobs. Except for the grafts functioning well in the recipients, the results also showed that the quality of donors' lives remained unchanged.
Subject(s)
Kidney Transplantation , Nephrectomy , Tissue Donors , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nephrectomy/adverse effectsABSTRACT
In the evaluation of the immunological state of a kidney transplant there is no reliable diagnostic test. Therefore, several various tests should always be applied. The aim of this study was to define the type of immunological reaction (cellular or humoral) that causes the rejection of transplanted kidney. A group of 45 patients with a kidney transplant were tested 175 times, in various phases of the kidney transplant, starting on the day of transplantation up to several months posttransplant. Specific antibodies (SA) and specific cytotoxic lymphocytes (SCL) directed against donor cells in lymphocyte-mediated cytolysis tests in the presence of antibodies (ADLMC) or without them (LMC) were determined. LMC was significantly correlated with acute rejection (85%). In the phase of clinical quiscence of the kidney transplant LMC was positive in 4% of the cases. During the period of chronic rejection it was positive in 75% of the cases. ADLMC test is significantly correlated with chronic rejection (88%). In the period of acute rejection it was positive in 27% while in clinical quiscence in 11% of the cases. Twenty-two patients with non-immunological disorders of the kidney transplant were tested 62 times. LMC test was always negative, while ADLMC test was positive in 6.4% of the cases. These tests prove to be good parameters for defining immunological reaction. Thus, they can be of great importance in determining adequate immunosuppressive therapy. Negative results of tests in non-immunological disorders of graft function are highly significant.
Subject(s)
Graft Rejection/immunology , Kidney Transplantation/immunology , Adolescent , Adult , Antibody Formation , Child , Cytotoxicity, Immunologic , Female , Humans , Lymphocytes/immunology , Male , Middle AgedABSTRACT
The authors' experience with surgical complications following kidney transplantation is presented. From 1973 till May 1990, 136 transplantations were performed, out of which 21 before and 117 after 1983. Surgical complications occurred in 20 patients, thus reaching the incidence of 14.5% which corresponds with the incidence reported by other institutions. The incidence of vascular complications was 5.0%, of urological 4.3%, of lymphatic 1.4%, of wound infections 2.2%, and of graft ruptures 1.4%. Urological and vascular complications made for 65% of all the surgical complications which in 40% resulted in the loss of the graft. Out of the total number of the lost grafts, surgical complications were responsible in 28.1%.
Subject(s)
Kidney Transplantation , Postoperative Complications , Adolescent , Adult , Female , Humans , Male , Middle AgedSubject(s)
Catheterization, Central Venous , Plasmapheresis/methods , Renal Dialysis/methods , Female , Humans , Jugular Veins , Male , Subclavian VeinSubject(s)
Plasma Exchange/methods , Plasmapheresis/methods , Adolescent , Adult , Child , Child, Preschool , Female , Filtration/methods , Humans , Male , Middle AgedSubject(s)
Filtration/instrumentation , Plasmapheresis/methods , Adult , Female , Humans , Plasmapheresis/instrumentationABSTRACT
A double-blind crossover trial in 50 patients with rheumatoid arthritis was carried out to compare the clinical effectiveness of 800 mg. azapropazone per day with 100 mg. indomethacin per day. Blood plasma concentrations of azapropazone were also studied in 10 patients. Patients received both drugs for a 3-week period, the order of treatment being determined at random. Although there were no marked differences in any of the objective measurements, patients assessments of response to and preference for each drug treatment period suggested that azapropazone produced significant improvement compared to that with indomethacin. Plasma levels of azapropazone remained remarkably constant for each patient. Side-effects with both drugs were mild and transient, and there were no marked variations from normal in any of the laboratory parameters measured.
