Posterior reversible encephalopathy syndrome (PRES) as a complication of immunosuppressive therapy in renal transplantation in children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Posterior Reversible Encephalopathy Syndrome (PRES) as a Complication of Immunosuppressive Therapy in Renal Transplantation in Children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Pregnancy in renal transplantation.

UNLABELLED: Pregnancy in kidney transplantation is, considering its numerous complications, listed in category of high-risk pregnancies. Complications occur as consequence of action of immunosuppressant drugs and mutual interactions of graft on pregnancy and pregnancy on graft. To asses conception it is necessary for female patient to fulfill conditions after which planning and management of pregnancy are carried out. Planning means a list of actions which altogether have as a goal to decrease risk factors for future mothers and for babies as much as possible. Pregnancy management is also procedural, including numerous hospitalizations, in which pregnancy, fetus and renal function are controlled, on-time identifying potentially dangerous complications and solving ones that might have already occurred. With all given precautions there is still no guarantee for successful pregnancy termination, although given measurements significantly improve possibilities of normal childbirth, like those in general population. KEYWORDS: renal transplantation, pregnancy.

One hundred kidney transplantations in Tuzla.

INTRODUCTION: Kidney transplantation assures considerably better quality of life than the treatment of end-stage renal disease patients with dialysis. GOAL: Authors intended to present results of kidney transplantations that were performed for over 13 years in UCC Tuzla. EXAMINEES AND METHODS: Total of 100 transplantations have been done over 13 years. The gender and age structure have been presented, as well as number of transplantations per year, type of transplantation (living related donor, living unrelated donor, deceased donor), number and percentage of donors and results of transplantations expressed as survival of both the patient and transplanted kidney/ renal graft. We also wanted to presented other important events such as dates of introduction of certain drugs, dates of first cadaver transplantation, transplantation with desensitization protocols and dates of first living unrelated (spousal/emotional) transplantation. RESULTS: The survival of patients and renal grafts were demonstrated by Kaplan-Meier curve, and obtained results were fully in range of results recommended in other literature and by other authors. One-year survival of graft is 94%, with five-year survival being 75%. One-year survival of patients is 95%, and five-year survival of patients was 84%. DISCUSSION: Our results have been compared to those from other studies, gaining suggestions for transplantation improvement. CONCLUSION: Among all modifications of renal replacement therapy transplantation is by far the method of choice because, its well known advantages aside, it also has an economical advantage over chronic treatment with dialysis and it should therefore become interesting to healthcare systems.

[Acute rejection in kidney transplantation]. / Akutno odbacivanje u transplantaciji bubrega.

INTRODUCTION: Transplantation of kidneys (TK) is the best way of curing patients with terminal kidney disease. Unfortunately, right after the operation, different kinds of complications are possible and might happen to transplant. The worst and the most often complication is acute rejection (AR). PURPOSE: The aim of work is to find the most often clinical signs and symptoms of AR. The aim of research is to value the influence of AO on function of graft and to find the influence of AR on surviving patients and graft. METHODS: This study has been done on 91 patients, 62 male and 29 female patients in the age of 38.58 +/- 11.4. Patient are divide in two groups: experimental group which includes 29 patients that have had one or more episodes of acute rejection. We used serum concentration of creatinine defined by Cocroft-Gault curve to measure function of transplant. Time of patients and graft survival is estimated by Caplan-Meier curve. RESULTS: In a group of patients with acute rejection we registered 42 episodes of dysfunction of graft which are treated as AR. The average creatinine in a group of patients with acute rejection was 183.42 +/- 65.39 micromol/L. Clearance of creatinine of group patient without AR is much bigger (p < 0.0001) than average clearance of creatinine of patients with acute rejection. Average serum creatinine in this group of patients is 147.59 +/- 62.57 and it is quite smaller (p < 0.002) than average creatinine at patients with acute rejection. Survival of all patients after five years is 91%, survival of patients without acute rejection is 96%, and with acute rejection is 80% (p < 0.014). Five year survival of graft is 78%, at the patients without acute rejection is 96% and at the patients with acute rejection is 64% (p < 0.0001), which is quite shorter. DISCUSSION: Clinical image of acute rejection is unspecific. There is not arranged values of serum creatinine although in some research those values are 130-170 micromol/L. This values includes patients which did not have an acute rejection. Five year survival patients and graft in our patients that did not have an acute rejection is same as in the results of relevant centers. But survival of patients and grafts in patients that had an acute rejection is little bit lower than it is in the results in relevant centers. CONCLUSION: There is no clinical picture than can help you to recognize an acute rejection because many other dysfuncion look the same. Acute rejection reduces function of transplant. Survival of patients and graft is mutch longer in the patients without acute rejection.