[Renal cell carcinoma: unusual late metastases 14 and 23 years after kidney transplantation]. / Nierenzellkarzinom: Ungewöhnliche Spätmetastasierung 14 und 23 Jahre nach allogener Nierentransplantation.

HISTORY AND FINDINGS: An asymptomatic 70-year-old man was found to have a tumor in the region of the left adrenal gland, having undergone cadaveric kidney transplantation 23 years ago. Two years before this a right nephrectomy had been performed for a renal cell carcinoma. There was no left kidney because of agenesis. 14 years after the kidney transplantation a metastasis of the renal cell carcinoma was identified in the thyroid gland. After its resection no further metastases had been discovered. INVESTIGATIONS: Laboratory tests were unremarkable. But a tumor was detected in the left adrenal gland by computed tomography. DIAGNOSIS, TREATMENT AND COURSE: The left adrenal gland was successfully resected. Its histology confirmed a second metastasis of the renal cell carcinoma 23 years after renal transplantation, but no other metastases were found. CONCLUSIONS: Kidney transplantation can be successfully performed even in patients with pre-existing carcinoma. A late metastasis of a renal carcinoma may occur. Close long-term follow-up of the patients is therefore essential.

[Water and electrolyte disturbances in critical care]. / Entgleisungen des Wasser- und Elektrolythaushaltes auf der Intensivstation.

Management of critically ill patients regularly involves the treatment of water and electrolyte disturbances. Moreover, critical care itself may contribute to volume overload and electrolyte abnormalities. Initial therapy should be followed by consequent diagnostic evaluation. The shift of volume and potassium in severe pancreatitis, for example, may lead to a life-threatening situation. In brain-dead patients, successful organ donation is facilitated by careful maintenance of water and electrolyte homeostasis.