[Predisposing factors for the development of acute severe tubular necrosis in the immediate post-transplantation period]. / Factores predisponentes al desarrollo de necrosis tubular aguda severa en el postrasplante inmediato.

Retrospective study on the incidence of severe acute tubular necrosis (ATN), defined as the need for dialysis on the first week post-transplantation ruling out acute rejection or technical complication, in our series of 81 renal transplantations from corpse donor. It includes an evaluation of the influence on severe ATN presentation of parameters such as recipient and donor's age, level of plasma creatinine prior to extraction, whether the corpse had hypotension, duration of both vascular anastomosis and procedure, type of removal (single or multiorgan) and cold ischaemia. We conclude that in our experience, cold ischaemia of the graft is the only determining factor among the cases studied for ATN presentation conditioning a reduced long-term survival of the graft (0.758 vs 0.971 at 18 months: p.05). Peripheral blood typing of corpse donor would allow us to shorten cold ischaemia duration, and thus achieve a low rate of severe ATN (13.6%).

Evolution of lipid profiles in long-term peritoneal dialysis.

Serial lipid profiles of 102 patients starting chronic ambulatory peritoneal dialysis (CAPD) in our renal unit from January 1985 to December 1990 were collected retrospectively. Transient triglyceride elevation was noted during the first two years of CAPD but declined to normal levels even lower than those at baseline by 60 months. Total cholesterol, HDL and LDL cholesterol levels did not change significantly. Lipid-lowering agents were begun in 17 patients before initiating CAPD, 5 of whom achieved lipid profiles warranting cessation of therapy. Five other patients started treatment while on CAPD. No statistical difference in patient mortality was found when patients hyperlipidemic at the initiation of CAPD were compared to their normolipemic counterparts. We conclude that the return to normal plasma triglyceride levels after transient triglyceride elevation during long-term CAPD implies that adaptative mechanisms of triglyceride production in response to chronic glucose overload may ensue.