ABSTRACT
Four patients are presented with pneumatosis intestinalis following kidney transplantation, all with severe cytomegalovirus (CMV) infection. Two patients had a primary infection and two patients had CMV reactivation. One patient died because of disseminated CMV infection. Two patients had concomitantly an active, non-obstructive duodenal ulcer. In a control population of 17 patients who suffered from a duodenal ulcer post-transplant without any evidence of CMV infection, we could not demonstrate pneumatosis intestinalis. We suggest a possible relationship between pneumatosis intestinalis and active CMV infection. The possible mechanisms responsible for this relationship are discussed.
Subject(s)
Cytomegalovirus Infections/complications , Kidney Transplantation , Pneumatosis Cystoides Intestinalis/etiology , Adult , Duodenal Ulcer/complications , Female , Humans , Male , Middle AgedABSTRACT
We evaluated 9 patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function. Moreover, only in patients (n = 2) with a stenosis in one out of more renal arteries a satisfying fall in blood pressure was achieved. Surgical reconstruction of the stenosis was successful in 4 out of 5 patients. Angiotensin I-converting enzyme inhibition in transplant renal artery stenosis often leads to loss of graft function, probably due to efferent vasodilation.
Subject(s)
Acute Kidney Injury/chemically induced , Captopril/adverse effects , Hypertension, Renovascular/drug therapy , Kidney Transplantation , Proline/analogs & derivatives , Renal Artery Obstruction/complications , Adult , Angiotensin-Converting Enzyme Inhibitors , Blood Pressure/drug effects , Captopril/therapeutic use , Humans , Hypertension, Renovascular/etiology , Kidney/drug effects , Kidney/physiopathology , Male , Renal Artery Obstruction/surgeryABSTRACT
After conversion from cyclosporine (Cys) only to prednisolone and azathioprine four months after cadaveric renal transplantation, effective renal plasma flow (ERPF), glomerular filtration rate (GFR) and filtration fraction (FF) all improve. However, this improvement is not uniform. GFR and FF improve in all patients after one week of combined Cys and prednisolone treatment. ERPF improves under the same circumstances only in recipients without previous rejection episodes. After discontinuation of Cys and addition of azathioprine ERPF improves further in all patients. These findings suggest the presence of a low grade rejection, together with Cys nephrotoxicity. The conversion procedure seems to be safe at least during a follow-up period of 9-14 months.
Subject(s)
Cyclosporins/administration & dosage , Kidney Transplantation , Azathioprine/administration & dosage , Drug Administration Schedule , Glomerular Filtration Rate , Humans , Prednisolone/administration & dosage , Renal CirculationABSTRACT
Four patients are described with pneumatosis intestinalis following cadaveric kidney transplantation, all with severe cytomegalovirus (CMV) infection. Two patients had a primary infection and 2 patients had a reactivation of CMV. One patient died because of disseminated CMV infection. Multiple inclusion bodies were found at postmortem examination in lungs and liver, and at the site of the ulcers in the gastrointestinal tract. Two patients had, concomitantly, an active, nonobstructive duodenal ulcer. In a control population of 17 patients who suffered from a duodenal ulcer post-transplant without any evidence of CMV-infection, we could not demonstrate pneumatosis intestinalis. We suggest a possible causal relationship between pneumatosis intestinalis and active CMV infection. The mechanisms that could be responsible for this relationship are discussed.
Subject(s)
Kidney Transplantation , Pneumatosis Cystoides Intestinalis/complications , Adult , Cadaver , Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/complications , Duodenal Ulcer/complications , Female , Humans , Male , Middle Aged , Pneumatosis Cystoides Intestinalis/pathology , Transplantation, Homologous/adverse effectsSubject(s)
Angiotensin-Converting Enzyme Inhibitors , Captopril/adverse effects , Diuretics/adverse effects , Hypertension, Renovascular/drug therapy , Kidney/physiopathology , Proline/analogs & derivatives , Adult , Female , Glomerular Filtration Rate/drug effects , Humans , Hypertension, Renovascular/etiology , Kidney Transplantation , Postoperative ComplicationsABSTRACT
We evaluated nine captopril-treated patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function; in two patients complete anuria developed. Only in two patients with a stenosis in one out of two renal arteries was a satisfactory fall in blood pressure achieved. The mechanisms which may lead to these remarkable results will be discussed.
