Advantages of short-time ureteric stenting for prevention of urological complications in kidney transplantation: an 18-year experience.

We retrospectively studied the incidence of urological complications in a consecutive series of 590 patients (group B) who received a kidney transplant (KT) with a ureteral stent from January 1994 to December 2002. The ureteral stent was sewn to the bladder catheter during the surgical procedure and left in situ for a mean time of 10 days (range 8 to 12 days). The results were compared to a consecutive series of 414 patients who received a KT from March 1986 to December 1993 without a ureteral stent (group A). The two groups were comparable in terms of donor and recipient gender, ischemia time, delayed graft function, and chronic rejection incidence, but differed in mean donor age (44.1 vs 36.0 years), mean recipient age (45.4 vs 39.1 years), living/cadaveric donor rate (19.8% vs 11.9%), arterial lesions and bench reconstruction rate (11.1 vs 3.5%), as well as acute rejection episodes (11.7% vs 29.2%). Complications were seen in nine patients in group B (1.5%) and 17 patients in group A (4.1%) (P < .0001). Urinary leaks presented in two patients in group B (0.3%) and 11 patients in Group A (2.6%; P < .0001), while stenosis was present in six patients in group B (1.5%) and 7 in group A (1.2%) (P = NS). Urological complications such as urinary tract infection and macroscopic hematuria were similar in both groups. Time to presentation of a leak was within 2 weeks from KT in 10 patients (92.3%), while stenosis presented early in four patients (one in group B and four in group A). Of the stenoses, 69.3% presented late (beyond 12 weeks) in five patients in group B and three in Group A. In conclusion, our data suggest that routine use of double pigtail ureteral stent significantly decreased the incidence of leaks and early stenoses, but it did not modify late stenosis incidence. In the last decade, risk factors for urological complications have been increasing over time, namely, older donors and older recipients, living donation, length of dialysis, and the use of grafts with arterial lesions. Therefore we believe that a ureteral stent should be routinely considered to afford the advantage to protect the urinary anastomosis in the early postoperative period when the incidence of complications is highest, without the need of cystoscopy for its removal.

End-stage renal failure from renal amyloidosis of the AA type associated with giant lymph node hyperplasia (Castleman's disease).

A case of end-stage renal failure caused by renal amyloidosis of the AA type is reported. No chronic disease responsible for the deposition of reactive amyloid was detected until giant lymph node hyperplasia of the angiofollicular type was identified in a mediastinal mass. Amyloid was found within the tumour mass and was characterized by immunochemistry with monoclonal antibodies to be of the AA type. Castleman's disease should be added to the list of chronic diseases endangering renal function by inducing the production and tissue deposition of secondary (AA) amyloid.

[Evolution of pregnancy in 14 patients with lupus nephropathy]. / Evoluzione della gravidanza in 14 pazienti con nefropatia lupica.

Authors have examined 14 pregnant patients with renal involvement by systemic lupus erythematosus. Variations in blood creatinine, proteinuria and blood pressure were considered in the prepregnancy, pregnancy and postpartum periods in relation to the histologic results of renal biopsy and obstetric outcome.

Steroid-sensitive nephrotic syndrome with mesangial IgA deposits: a separate entity? Observation of two cases.

In minimal-change steroid-sensitive nephrotic syndrome with selective proteinuria, mesangial IgA deposition at immunofluorescence is a very rare finding which has been previously considered a pure coincidence. Two patients, aged 6 and 14 years, respectively, with a steroid-sensitive but frequently relapsing nephrotic syndrome and highly selective proteinuria, exhibited minor glomerular alterations at light microscopy and an immunofluorescence deposition of predominant and diffuse mesangial IgA, confirmed by electron microscopy as dense deposits. The observed syndrome, that is surprisingly identical to sporadic literature reports, can be considered a separate entity or subgroup belonging either to IgA nephropathy or to lipoid nephrosis. In the latter case mesangial IgA could be the marker of an easy relapsing course.

Diabetic nephropathy: clinical and histological study in 22 patients.

Twenty-two patients with insulin-dependent diabetes mellitus and renal involvement were submitted to renal biopsy. Mean age was 42 years; 10 were males, 12 females. The mean interval between clinical manifestation of nephropathy and biopsy was about 2 years. At the time of biopsy, 4 groups were distinguished according to clinical conditions, depending on the presence or absence of nephrotic syndrome and renal failure. Renal lesions were semiquantitatively evaluated, a separate score being considered for glomerular and vascular lesions. Immunofluorescence most frequently showed a pattern of faint linear IgG deposits along glomerular basement membranes. Severity of histological lesions and pattern of urinary abnormalities were not correlated with the duration of diabetes or the patients' age. Both glomerular and vascular lesions were correlated with the presence of renal failure, while no relationship with the pattern of urinary abnormalities was found. Fourteen patients were followed for more than one year after biopsy: 5 had normal renal function, 4 were in chronic renal insufficiency and 5 in end-stage renal failure (3 were in dialysis, 2 died). There was no correlation between the 3 above-mentioned types of evolution and glomerular histological findings. Nevertheless a higher score of vascular impairment at biopsy was observed among patients who subsequently were found to have a more unfavorable prognosis. Therefore renal biopsy, by providing information on the degree of renal vascular damage, may have some value in predicting the clinical course of diabetic nephropathy.

Acute renal failure in 11 children with non-Hodgkin lymphoma.

Twelve episodes of acute renal failure (ARF) in 11 children hospitalised for non-Hodgkin lymphoma (NHL) are reported. Six of 11 were classified as abdominal Burkitt type lymphoma, three as lymphoblastic convoluted cell lymphoma, and two as lymphoblastic lymphoma. Oliguria was present in six cases. Duration of ARF ranged from 3 to 23 days. Only one child required peritoneal dialysis. According to possible mechanisms of renal injury patients were divided into three groups: neoplastic renal infiltration (5 cases), uric acid intratubular precipitation (5 cases), treatment-related ARF (2 patients). ARF was always reversible, regardless of aetiology.