Proton pump inhibitors do not increase the risk of acute rejection.

BACKGROUND: Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA). Proton pump inhibitors impair exposure to MPA due to incomplete conversion from MMF. Lower exposure to MPA could result in an increased risk of acute rejection. We investigated whether MMF-treated renal transplant patients who concomitantly used pantoprazole as ulcer prophylaxis had a higher risk of acute rejection within the first three months after transplantation than those who used ranitidine. METHODS: We performed a retrospective study in adult patients who underwent kidney transplantation between January 2007 and December 2011. Their immunosuppressive therapy consisted of steroids, tacrolimus and MMF and they used either pantoprazole or ranitidine as ulcer prophylaxis. RESULTS: 202 patients were included: 125 using pantoprazole and 77 using ranitidine. There was no difference in the number of patients with biopsy-proven acute rejection (BPAR): 13 (10.4%) in the pantoprazole group versus 7 (9.1%) in the ranitidine group (NS). Also after correction for inequalities between the two groups, there was no significant relationship between the risk of BPAR and the type of anti-ulcer agent. CONCLUSION: There was no evidence for an increased incidence of BPAR in renal transplant patients who use pantoprazole in combination with MMF.

[Vomiting: not a benign symptom in children with diabetes]. / Braken: bij kinderen met diabetes mellitus geen onschuldig verschijnsel.

Two girls, 14 and 15 years old and known for several years with diabetes, came to the paediatric outpatients' clinic because they had been vomiting for 1-2 days. Laboratory tests revealed diabetic ketoacidosis. After administration of fluids and short-acting insulin, and sodium bicarbonate in one of the girls, the patients recovered, although one of them continued to have fluctuating glucose values. In most children, vomiting indicates benign gastro-enteritis and is therefore self-limiting. But in children with diabetes mellitus, vomiting can be more sinister because it could lead to, or be a symptom of, diabetic ketoacidosis. Even with normal blood glucose levels, severe metabolic disturbances are possible, and tests diagnosing diabetic ketoacidosis are recommended.

Chorioretinal dysplasia-microcephaly-mental retardation syndrome: another family with autosomal dominant inheritance.

We describe a boy and his father with the chorioretinal dysplasia-microcephaly-mental retardation syndrome (CDMMS). Our report extends the phenotypic spectrum of autosomal dominant CDMMS by describing microphthalmia for the first time in an autosomal dominant family. The boy was also severely mentally retarded in contrast to the usual mild mental retardation in AD-CDMMS. Furthermore he had hypertonia, dysmorphic features and low body weight, which are uncommon in AD-CDMMS. CDMMS is a rare disorder. We traced 18 reports on CDMMS including 10 families, 6 with horizontal transmission and 4 with vertical transmission. There are 8 reports and observations on isolated cases with CDMMS. This might imply genetic heterogeneity with autosomal recessive and autosomal dominant inheritance, with a more severe clinical picture in the former but with quite variable inter- and intrafamilial expression. A review of the literature is given. The existence of autosomal recessive inheritance in families with so-called horizontal transmission is discussed as variable expression, reduced penetrance and germline mosaicism may also explain this condition. Careful (particularly ophthalmologic) examination of first degree relatives is necessary before genetic counseling is given.