Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study.

Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.

Renal paratransplant hernia: an unusual complication of renal transplantation?

Renal paratransplant hernia constitutes an unusual variant of internal hernia caused by entrapment of bowel through a defect in the peritoneum covering the transplanted kidney. Only three cases have been previously reported. We present three new cases of renal paratransplant hernia. Abdominal pain and vomiting were the main symptoms. Clinical diagnosis of bowel obstruction and paratransplant hernia was reached using abdominal CT scan. All patients underwent an emergency surgical procedure, and one patient needed resection of necrotic bowel. The three patients survived owing to early surgical intervention, and they were discharged asymptomatic. Paratransplant hernia represented 1.1% of our series of transplant patients. Early diagnosis and surgical treatment are esential in transplant patients with bowel obstruction to avoid high morbidity and mortality rates.