Myeloma cast nephropathy: a rare cause of primary renal allograft dysfunction.

We describe a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no prior history of multiple myeloma preceding her transplantation. A 72-year-old woman on hemodialysis for 4 years prior to transplantation due to presumed hypertensive nephrosclerosis developed immediate graft dysfunction posttransplantation. The graft biopsy specimens were consistent with myeloma cast nephropathy for which she was treated with plasmapheresis and chemotherapy using bortezomib and dexamethasone. She achieved partial hematologic remission and recovered excellent graft function by 3 months posttransplantation. This is the first report of successful recovery of renal allograft function after development of cast nephropathy.

Arterial anastomosis disrupton in two kidney recipients of contaminated grafts from a donor with Gorham's syndrome.

Transmission of donor infections to immunosuppressed recipients may produce serious complications. Here, we report two cases of ruptured renal artery pseudoaneurysm within a few months after renal transplantation from a donor with Gorham's syndrome, a rare disease characterized by proliferation of vascular and lymphatic channels associated with extensive bony destruction. The donor had died of respiratory failure, sepsis, and anoxic brain death due to difficult airway control secondary to a maxillofacial deformity.

Effect of biocompatibility of hemodialysis membranes on serum albumin levels.

Hypoalbuminemia in end-stage renal disease is a marker of high morbidity and mortality. In some patients, the cause of low serum albumin levels is easily identified and therefore treatable, but in many patients, the cause is not clear. We studied the effect of changing the dialysis membrane from a bioincompatible to a biocompatible membrane on serum albumin level. Stable hemodialysis patients dialyzed with cuprammonium membranes who had serum albumin levels less than 3.5 g/dL were switched to the more biocompatible membrane, polysulfone. Serum albumin levels increased from 3.22 +/- 0.037 to 3.35 +/- 0.038 g/dL (mean +/- SE; P < 0.002). The increase was seen in patients both with and without diabetes. Thus, dialyzer membrane may affect serum albumin levels and should be considered in the differential diagnosis of hypoalbuminemia in patients undergoing hemodialysis with bioincompatible membranes. Membrane choice may have an important effect on the outcome of morbidity and mortality of hemodialysis patients.

Multifocal musculoskeletal cystic tuberculosis without systemic manifestations.

A case of multifocal cystic tuberculosis is presented, affecting the clavicle and the iliac bones with considerable soft tissue involvement. It was found in a 34-year-old male, an immigrant from Yemen. The extensive cystic nature of both lesions and the lack of systemic manifestations despite multifocal disease are unusual.