Three-year longitudinal clinical trial of arterial function assessed by a oscillometric non-invasive method in comparison with carotid sclerosis and transferrin kidney-transplanted patients.

Chronic kidney disease remains one of the main risk factors of cardiovascular disease. However, patients with kidney transplantation have better life expectancy and better quality of life compared with patients on dialysis. In patients with a well-functioning graft, the main cause of death is cardiovascular in origin. Metabolic pathways have complex effects on arterial function that can be monitored by conventional ultrasonography and with the assessment of arterial stiffness by oscillometric non-invasive technique. Forty-one primer cadaver kidney-transplanted patient were involved in a 3-year longitudinal clinical trial (21 female, 20 male; average age, 40.16 ± 12.56 years). Arterial stiffness parameters referring to rigidity of the arterial wall (pulse wave velocity [PWV], augmentation index, and pulse pressure) were investigated. Correlation between stiffness, and laboratory parameters (serum creatinine, urea, hemoglobin, albumin, cholesterine, triglycerides, transferrin, uric acid, glomerular filtration rate, and C-reactive protein) were analyzed. A non-invasive oscillometric method--Tensiomed Arteriograph--was applied to assess the arterial stiffness parameters. Statistical analysis was performed with the use of Statistica for Windows, version 8.0. A value of P < .05 was considered statistically significant for all statistical tests. We found a positive correlation between PWV and left ventricular wall thickness and a negative correlation between PWV and ejection fraction. We also found a positive significant correlation between serum level of transferrin and PWV. There was simultaneous significant progression concerning PWV and carotid artery sclerosis in a 3-year follow-up. There was no fatal cardiovascular event during the study period among our patients. All of our patients involved in this study are still alive. Our findings suggest that arterial stiffness monitoring is a reliable method to assess global cardiovascular risk among kidney-transplanted patients. The oscillometric method is convenient, fast, painless technique to monitor arterial function, which, in the case of pathological findings, proposes more frequent cardiovascular control.

Noninvasive perioperative monitoring of arterial function in patients with kidney transplantation.

Development of atherosclerosis is accelerated in kidney transplant recipients. Impaired metabolic pathways have a complex effect on the arterial wall, which can be measured by noninvasive techniques. Few data are available on the change of stiffness parameters in the postoperative course, so in this study we analyzed the stiffness parameters of kidney transplant recipients during the perioperative period. Seventeen successful primary kidney transplant patients with uneventful postoperative period (7 woman, 10 men; 46.16 ± 12.19 years) were involved in our short-term prospective longitudinal study. We analyzed the correlation between noninvasively assessed stiffness parameters (pulse wave velocity [PWV], augmentation index [AIx], pulse pressure [PP], systolic area index, diastolic area index, diastolic reflection area), ankle-brachial index (ABI), and laboratory parameters (creatinine, glomerular filtration rate, urea, haemoglobin, C-reactive protein). Stiffness parameters were measured with a Tensiomed Arteriograph. These parameters were assessed before the transplantation, and 24 hours, and 1 and 2 weeks after surgery under standard conditions. We found that creatinine (P = .0008) and C-reactive protein (P = .006) serum levels decreased, and glomerular filtration rate increased significantly (P = .0005). We revealed that PWV (P = .0075) and AIx (P = .013) improved significantly. There was no significant change in ABI, PP, and the other monitored parameters. Along with the available data in the literature, our findings suggest that kidney transplantation has a positive effect on the arterial function.

Relationship between serum paraoxonase and homocysteine thiolactonase activity, adipokines, and asymmetric dimethyl arginine concentrations in renal transplant patients.

Paraoxonase lactonase activity protects against homocysteinylation; therefore, it can be a potential contributing factor to prevent atherosclerosis. We aimed to determine paraoxonase and HTLase activities and to clarify the relationship between HTLase activity and some cardiovascular risk factors, such as homocysteine, cystatin C asymmetric dimethylarginine (ADMA), and adipokines both in hemo dialyzed and transplanted patients. Among 114 hemodialyzed, 80 transplanted and 64 healthy control subjects, we investigated body mass index (BMI) as well as fasting serum contents of urea, uric acid, creatinine, cystatin C, homocysteine, glucose, lipids, total protein and albumin. Serum paraoxonase (PON 1) and HTLase activities were measured spectrophotometrically. ADMA, ADPN adiponectin, leptin (LEP) levels was determined with a sandwich enzyme-linked immunosorbent assay method. Dyslipidemic patients showed hypercholesterolemia, and high low-density lipoprotein (LDL); parallel with improved renal function, they displayed decreased cystatin C and homocysteine levels (P < .001). There was a significant negative correlation between PON 1 activity and cystatin C and homocysteine concentrations (P < .05). Obese patients revealed significantly higher LDL (P < .05) and leptin concentrations (P < .01). There was a significant positive correlation between PON 1 activity and adiponectin levels (P = .0276). Both dialyzed and transplanted patients displayed significantly lower HTLase activities compared to the control group (P < .001), particularly lower HTLase and PON 1 activities in dialyzed subjects compared with the transplanted group (P < .05). HTLase activity showed significant negative correlations with ADMA levels among the whole study population (P < .001), whereas positive associations were noted between PON 1 and HTLase activities (P < .001). HTLase activity may be a new predictor of cardiovascular risk in renal failure although it is modulated by other risk factors.

Prospective study of changes in arterial stiffness among kidney-transplanted patients.

BACKGROUND: Chronic kidney disease is one of the main risk factors for cardiovascular disease. Changes in stiffness parameters can predict the higher risk of the development of cardiovascular disease. METHODS: Cadaveric donor kidney transplant patients (n=184) were followed in a cross-sectional single-center study. Arterial stiffness parameters were measured by arteriography. We analyzed the correlation between stiffness parameters and immunosuppressive therapy, the main operation parameters, patient age, elapsed time since transplantation, carotid artery stenosis, and septual wall thickness. We enrolled 24 patients in a 3-year longitudinal study to analyze changes in stiffness parameters. RESULTS: Our cross-sectional study showed pulse wave velocity (PWV) to be significantly related to the age of the patient (P=.0001; r=0.41). There was no significant correlation between the stiffness parameters and type or dosage of immunosuppressive drugs and number of transplantations. We noted significant correlations between pulse pressure (PP) and pulse wave velocity (PWV), and augmentation index (AI) (P=.01). Patients with abnormal PWV (>12 m/s) showed significantly higher systolic blood pressures, body mass indexes, PP, and AI (P<.01). Our 3-year longitudinal study revealed a significant elevation in PWV. CONCLUSIONS: Improving endothelial function and prevention of atherosclerosis may help to reduce cardiovascular complications. Among chronic kidney disease patients, early transplantation is a possible way to prevent cardiovascular events. It is better to perform the transplantation at as early an age as possible.

Insertion/deletion polymorphism of the angiotensin-converting enzyme predicts left ventricular hypertrophy after renal transplantation.

BACKGROUND: Kidney transplant recipients show a higher risk for cardiovascular complications, such as left ventricular hypertrophy and heart failure, leading to the premature death in many cases. METHODS: We investigated the contribution of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism to the development of left ventricular hypertrophy (LVH), an indicator of heart disease progression among kidney transplant recipients. RESULTS: We observed a significant correlation between graft function and left ventricular mass index. The occurrence of LVH or severe LVH was significantly greater among patients with at least one D-allele (ID or DD). CONCLUSION: The use of ACE inhibitors or angiotensin receptor blockers seemed to be advantageous for patients with the ID and especially, the DD genotype.

Arterial stiffness in chronic renal failure and after renal transplantation.

Arterial stiffness is an independent cardiovascular risk factor, along with aging, hypertension, and cardiovascular disease. The augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes. Arteriography was used to determine systolic and diastolic blood pressure, pulse pressure (PP), AIx, and PWV in 82 male and 64 female renal transplant recipients (mean [SD] age, 45.3 [11.2] years). Cardiovascular risk was assessed using echocardiography and ultrasonography of the carotid arteries. The left ventricular wall thickness, ejection fraction, and stenosis of the carotid arteries were also measured. Fasting serum creatinine, cystatin C, homocysteine, C-reactive protein, immunoreactive parathyroid hormone, lipid, and calcium-phosphorus concentrations were determined. The serum cystatin concentration was 2.1 (0.2) mg/L, and the homocysteine concentration, 15.2 (2.6) micromol/L. After transplantation, body mass index, fat mass, and visceral fat area increased significantly (P < .01). The AIx was increased (AIx > or =10%) in 20% of men and 37% of women, PWV was increased (>10 m/s) in 43% of men and 34% of women, and PP was pathologically high (>12 m/s) in 10% of men and 12% of women. The PWV was significantly related to age (r = 0.52) and ventricular wall thickness (r = 0.46). Pulse pressure, BMI, and systolic and diastolic blood pressure correlated positively but modestly with PWV. There was a significant relationship between AIx80 and systolic (r = 0.42) and diastolic (r = 0.39) blood pressure and PP (r = 0.33). The ejection fraction correlated negatively with PWV and AIx. There was a strong association between carotid artery stenosis, PWV, and AIx80. All patients with PWV greater than 10 m/s demonstrated carotid artery stenosis. In conclusion, arteriography is an objective, noninvasive, and convenient method for early diagnosis and follow-up of atherosclerosis.

Insertion/Deletion polymorphism of Angiotensin-converting enzyme as a risk factor for chronic allograft nephropathy.

Angiotensin-converting enzyme (ACE) inhibitor therapy is widely used to treat chronic allograft nephropathy (CAN), which suggests a possible role of the renin-angiotensin system in the pathologic mechanism of the disease. The objective of this study was to investigate the possible link between CAN and ACE. The ACE insertion/deletion polymorphism and the amount and activity of ACE were determined in cadaver kidney recipients with CAN (n = 38) or normal renal function (n = 34). The DD genotype was observed significantly more frequently in the CAN group compared with the group with normal renal function. Moreover, the DD genotype was associated with a higher serum ACE concentration and greater serum ACE activity, compared with II genotype homozygotes. The insertion/deletion polymorphism of ACE affects ACE expression and activity in serum, and, therefore, may have an important role in the pathogenesis of CAN. These findings suggest that determination of the ACE genotype may be useful in identifying patients at high risk. In particular, the DD genotype may be considered an indication for ACE inhibitor therapy.

Comparison of calcium and alfacalcidol supplement in the prevention of osteopenia after kidney transplantation.

The aim of this observational study was to compare the effect of calcium and alfacalcidol supplementation on the regression of hyperparathyroidism and on prevention of osteopenia in patients up to 3 years after renal transplantation. Two historical cohorts were compared for that purpose. One hundred and fifty-nine patients received calcium carbonate supplement (group 1), while 81 patients were treated with alfacalcidol (group 2). Serum Ca, phosphate (P), Mg, creatinine, alkaline phosphatase (AP) and parathyroid hormone (PTH) levels were determined before and after transplantation in the two groups, for 3 years. Femoral neck and lumbar spine bone mineral density (BMD) was measured only at 3 and 6 months and 1, 2 and 3 years after transplantation. At baseline there was no difference in age or sex ratio, but prevalence in post-menopausal women was higher in group 1 (6.9% versus 1.2%). Duration on dialysis was comparable but prevalence of interstitial and undetermined nephropathies was higher in group 1. Baseline serum concentrations of PTH, Ca and P were comparable in both groups. After transplantation, plasma creatinine decreased to comparable levels in both groups. Immunosuppression by triple therapy was more prevalent in group 2, so that cumulative dose of steroid was higher in group 1, especially at 1 month because of higher incidence of acute rejections (51% versus 13%). Mean intact PTH levels decreased in both groups, from 18 pmol/l to 8.4 and 7.9 at 3 years, but the decrease was significantly greater with alfacalcidol at 6 and 12 months. At 3 months, BMD were comparable at both sites. From 3 months to 3 years after kidney transplantation, mean lumbar spine BMD significantly increased from 0.963 to 1.054 g/cm(2) in group 1, whereas there was no significant decrease (1.048 to 1.006 g/cm(2)) in group 2, the difference in changes being significant ( P<0.05). Femoral neck BMD was not significantly increased in either group (0.932 to 0.993 g/cm(2) in group 1, and 0.850 to 0.907 g/cm(2) in group 2). Expressed as percentages, these changes were +9.4% and -4% for lumbar BMD and +6.5% and +6.7% for femoral neck, for groups 1 and 2, respectively. Prevalence of osteopenia was not significantly lower at 3 years in group 1 (45% and 51%) than in group 2. During the follow-up period, osteonecrosis was diagnosed in six patients (3.8%) in group 1 and in nine (11%) in group 2. In conclusion, alfacalcidol compared to CaCO3 supplement suppressed hyperparathyroidism more rapidly and strongly. In spite of higher osteopenia risk in the CaCO3 group, lumbar BMD increase was greater and incidence of osteonecrosis higher in this group, suggesting better bone protection with CaCO3 than with alfacalcidol.

[Analgesics-induced chronic renal failure in patients on dialysis therapy in Hungary]. / Analgetikum-nephropathia elófordulása krónikus veseelégtelenség miatt dializált betegekben Magyarországon.

In recent years elaboration of the diagnosis of analgesic-nephropathy (ANP) with the help of imaging techniques significantly increased the possibility of diagnosing the disease. Therefore, evaluating the prevalence of ANP has become more accurate in our country as well. The prevalence of ANP has been investigated in patients who have newly been taken into the dialysis program due to renal disease of unknown aetiology in 22 dialysis centers between December 1994-December 1997. The diagnosis of ANP has been based on revealing chronic drug abuse in the history and positive results of renal imaging (decrease in length of both kidneys combined with either bumpy contours and/or papillary calcification). Among 284 patients dialysed with unknown diagnosis 42 (14.8% of all cases) proved to have ANP. All patients except 2 took analgesic mixtures containing phenacetin/paracetamol, phenason derivatives, acetilsalysilic acid, caffeine and/or codeine. According to their investigations, ANP is a common disease resulting in end-stage renal failure in Hungary as well.

[Changes in cardiovascular risk factors after renal transplantation]. / A cardiovascularis rizikófaktorok alakulása vesetranszplantáció után.

Authors examined the serum concentration of creatinine, uric acid, homocysteine, cystatine C, total cholesterol and triglyceride in 115 male and 77 female patients six months after the transplantation. The change of the BMI (Body Mass Index) was studied, fat and water body weight was determined by bioelectrical impedance analysis, and the ratio of intra- and extracellular volume was calculated. Both creatinine and cystatine C levels decreased significantly compared to the levels before the transplantation (p < 0.001) because of the good renal function, and there was a good correlation between creatinine, cystatine C and homocysteine levels (r = 0.5315 in females, r = 0.3189 in males). Elevated BMI (36.49%) and hypercholesterolaemia along with moderate hyperhomocysteinaemia was found in a considerable part of the patients. Increase in body weight was confirmed by the increase in fat body weight and volume determined by bioelectrical impedance analysis. In patients with adequate compliance the ratio of intra- and extracellular volume was between 1.67 and 1.79. Blood pressure values showed frequently the non-dipper phenomenon despite appropriate antihypertensive therapy, and negative diurnal index was found with high nocturnal blood pressure levels. The mean blood pressure was 148/81 +/- 13.2/4.8 mmHg in males and 133/84 +/- 15.3/9.8 mmHg in females. Authors enhance the importance of regular monitoring of cardiovascular risk factors in the prevention of cardiovascular complications.

[Acute pancreatitis after kidney transplantation]. / Vesetranszplantált betegek akut hasnyálmirigy-gyulladása.

UNLABELLED: Pancreatitis following kidney transplantation was first described by Starzl in 1964 [19]. The incidence rate of the disease involving severe complications ranges from 1.2 to 6.8%. The number of risk factors, besides those of the normal population, is increased by a number of other factors, i.e. uremia, disorder of lipid metabolism, polycystic kidney, immunosuppressive drugs, cytomegalovirus infection, etc. The mortality of acute pancreatitis in a kidney transplant patient is, in spite of treatment with the most up-to-date methods, is much higher (53-60%) than that for a non-transplant patient. In the period between 27 June 1991 and 31 December 2000 the number of cadaver kidney transplants performed in the Transplantation Division of the 1st Department of Surgery of the Medical and Health-Science Centre of the University of Debrecen was 349. During this period 9 incidences of acute pancreatitis were found in 8 patients. The frequency of incidence was 2.56%. In the present communication we analyse the prognosis of 9 kidney transplant patients, with special respect to immunosuppression. RISK FACTORS: One patient was administered Cyclosporin alone, four were given Cyclosporin and Steroids, a further one Cyclosporin, Steroids and Azathioprine, the remaining three were treated with Cyclosporin, steroids and Mycophenolate Mophetil. In six cases out of nine multiorgan insufficiency (kidney, lung, liver) was encountered on presentation, three cases were accompanied by peritonitis. In spite of early jejunal nutrition, intensive therapy, antibiotic treatment, CT monitoring, if needed, necrectomy and oncotomy, three of our patients died from multiorgan insufficiency induced by septico-toxic state (mortality 33.3%). Other six patients recovered. CONCLUSIONS: The mortality rate of acute pancreatitis is much higher in immunosuppressed patients. The role of the etiological factors is not unequivocal in the development of pancreatitis. Nevertheless, all possible risk factors have to be taken into consideration when starting the immunosuppressive treatment of transplant patients and during their follow-up. By optimally adjusting the immunosuppressants we can decrease the risk of pancreatitis, however, the prognosis of the diseases, in agreement with the data in the literature, cannot be considerably improved even with the most up-to-date methods.

[Changes in calcium metabolism after kidney transplantation]. / Változások a calcium anyagcserében vesetranszplantációt követóen.

Prospective study was performed to measure the changes in calcium metabolism after kidney transplantation. 139 recipients received calcium substitution (1st group) and 81 patients were treated with alfacalcidol (2nd group). Serum Ca, P, Mg, alkaline phosphatase (AP) and intact PTH levels were determined before transplantation and at 1, 3, 6, 12 and 24 months thereafter in the two groups. Femoral and vertebral bone mineral density was measured with bone densitometer at the same period. The serum Ca level elevated and the serum P concentration decreased significantly in both group. The mean serum Mg and AP concentration changed in the normal range after the transplantation. The intact PTH level decreased significantly in both group at 2 years following transplantation. The intact PTH concentration changed from 17.1 pmol/l to 9.3 pmol/l in the 1st group, and it is decreased from 17.7 pmol/l to 7.9 pmol/l in the 2nd group. Bone densitometry showed osteoporosis in both group. At 12 months and at 24 months after kidney transplantation bone mineral density (BMD) of lumbar spine was 90.8% and 86.9% in the 1st group and 85.3% and 81% in the 2nd group. At the same time BMD of the femoral region was 84.4% and 85.5% in the 1st group and 82.0% and 81.3% in the 2nd group. The BMD did not changed significantly in the 1st compared to the 2nd group. During this period osteonecrosis was diagnosed in 6 patients in the 1st group and in 9 cases in the 2nd group. In conclusion, the serum Ca and P levels were in the normal range after kidney transplantation. The alfacalcidol treatment significantly decreased the intact PTH concentration compared to the calcium substitution. Moderate osteopenia was observed in both groups after the transplantation, despite of the administration of alfacalcidol treatment.

Homocysteine and cystatin C level changes in haemodialysed patients and connection with cerebro- and cardiovascular complications.

Plasma homocysteine and Cystatin C levels of 360 chronic haemodialysed patients were measured in fasting (191 men, mean age: 55.5 years; and 169 women, mean: 62.9 years). The patients were divided into subgroups: diabetes mellitus (34 men and 38 women 7 vs 8 IDDM). obliterative arteriosclerosis (68 men and 61 women), cardiovascular complications (75 men and 84 women) and stroke (16 men and 12 women), and after renal transplantation in chronic rejection (15 men and 5 female). Homocysteine was determined by IMx analyser from Abbott by FPIA method. Immunoturbidimetric method was used for quantification of Cystatin C (PETIA). The lowest Cystatin C concentration was found in diabetic patients (4.35 +/- 0.15 mg/l in men and 3.18 +/- 1.77 mg/l in women) and the highest one occurred in anuric and bilateral nephrectomised and transplanted chronic rejected patients (6.075 mg/l in men and 6.35 mg/l in women: p<0.001). The homocysteine levels (24.98 +/- 2.94 micromol/l in men and 23.88 +/- 1.76 micromol/l in women) exceeded the upper limit of reference range (<15.0 micromol/l). There was a significant difference in favour of subgroup of cardiovascular (27.25 micromol/l in men and 26.87 micromol/l in women) and stroke patients (27.16 micromol/l in men and 30.76 micromol/l in women p<0.001). Elevated levels were found in chronic rejected patients with accelerated arteriosclerotic events (25.94 micromol/l in men and 27.43 micromol/l in women). Good positive linear correlation was found between serum homocysteine and Cystatin C levels (r=0.2393 and 0.2252). The authors demonstrated hyperhomocysteinaemia associated with high Cystatin C concentration in four subgroups of haemodialysed patients (obliterative and accelerated arteriosclerosis, cardiovascular disease, and cerebrovascular complications and stroke).

Serum paraoxonase activity changes in uremic and kidney-transplanted patients.

Serum paraoxonase (PON) is a high-density lipoprotein (HDL)-associated hydrolase, which inhibits low-density lipoprotein oxidation. Uremic and kidney-transplanted patients have an increased risk of atherosclerosis, to which an increased lipoprotein oxidation may contribute. The aim of our study was to determine whether the PON activity or phenotype is altered in uremic and kidney-transplanted patients, and to compare the values with those of healthy controls. 117 uremic patients on long-term hemodialysis treatment, 115 renal-transplanted patients, and 110 healthy controls were involved in the study. The PON activity was significantly reduced in the uremic patients compared to controls (PON 101.36+/-30. 12 vs. control 188.05+/-58.96 U/ml; p < 0.001), while in kidney-transplanted patients the values were almost identical to those of controls (PON 161.5+/-35.39 U/ml). The different immunosuppressive drug combinations did not influence PON activity. To assess whether the altered PON activity was due to a decrease HDL level, we standardized the enzyme activity for the HDL concentration (PON/HDL ratio). We found that the standardized enzyme activity was lower in the uremic (102.7+/-54.8) and kidney-transplanted patients (144.5+/-32.7) when compared to controls (194.5+/-94.5; p < 0.001). The phenotypic distribution of PON in uremic, renal transplant and control patients are as follows: AA 66.67, 56.48 and 66.67%; AB 31. 62, 33.3 and 26.67%; BB 1.71, 10.19 and 6.67%. We conclude that the decreased PON/HDL and PON/apoA-1 ratios may lead to a reduction in the antioxidant capacity of HDL, which might contribute to the accelerated development of atherosclerosis in uremic and kidney-transplanted patients.

The importance of bioimpedance (BIA) analysis and Cardio Tens (24-h ABPM and ECG) monitoring in the dialysis programme.

The authors performed bioimpedance analysis and Cardio Tens (24-h ABPM and ECG) monitoring in 66 patients (28 males, 38 females) treated in the chronic haemodialysis programme. They investigated the correlations between the body weights before, during and after dialysis, the changes of the water compartments and fat body weight, and the recorded values of blood pressure and ECG alterations. On the basis of the measurements by this non-invasive method it is concluded that, as a result of dialysis and ultrafiltration, the total body weight and total body water are decreasing in a greater extent in men than in women. By gradually decreasing the body weight, the optimal dry weight could be attained, which resulted in the reduction of blood pressure or even normotension. In the course of dialysis the values of bioimpedance and bioreactance increase. The intradialytic hypotensive indispositions were accompanied by a significant reduction of bioreactance (n = 16). The BMI, total body weight and total body water hyperlipidaemic, hypalbuminic patients with treatment-resistant hypertension are considerably larger than those of the patients with normal blood pressure (p<0.01). During Cardio Tens monitoring 53% of the patients proved to be dippers, 47% of whom had ST depression, while in 73% of the non-dippers ischaemic alterations were encountered together with high hyperbaric impact values. The total body weights and total water compartments of patients returning to dialysis with an excess body weight of more than 3.5 kg were significantly larger than of patients who were cooperative and had no oedemas. In the last hour of dialysis and during the following few hours, arrhythmias and ST depressions of the cardiovascularly instable patients appeared more frequently. The total water compartments of these patients are significantly larger than normotensive, normolipaemic patients with appropriate serum albumin concentrations. The importance of the BIA and Cardio Tens monitoring in determining the optimal dry body weight and improving the cardiovascular condition of the patients is emphasized.

The importance of obesity and hyperlipidaemia in patients with renal transplants.

The authors studied dyslipidaemia and "obesity" in 137 patients (87 males and 50 females) following cadaver renal transplantation with regard to the applied immunosuppressive treatment and the patients' hypertension. The most extreme dyslipidaemic values, the highest levels of total cholesterol, LDL and Apo were found 6 to 18 months after successful transplantation; these values were significantly higher in women than in men. While in the dialysis programme only 21.89% of the patients had BMI values higher than 25.1 kg/m2, after transplantation their proportion was 36.49%. In addition to hyperlipidaemia, hyperuricaemia was encountered in 39.42%, erythrocytosis in 8.76% and diabetes mellitus in 9.48%, respectively. In the group of patients treated only with Cyclosporine-A the incidence of hyperlipidaemia and hypertension was significantly lower than in those receiving a combination of either corticosteroids and Cyclosporine-A or corticosteroids, Cyclosporine-A and azathioprine. There was a close relationship between the unfavourable tendency of obesity and the measured hyperlipidaemia. On the other hand, the extent of proteinuria did not always have a positive correlation with the increase of BMI and body weight, the severity of hypertension and hyperlipidaemia. The authors emphasize the importance of a systematic control of the lipid levels, the significance of a diet with an adequate carbohydrate and lipid content, and the necessity of avoiding obesity by selecting the optimal immunosuppressive treatment.

Fluvastatin (Lescol) treatment of hyperlipidaemia in patients with renal transplants.

Hyperlipidaemia of 18 male and 20 female patients following successful renal transplantation was treated with daily 20 mg fluvastatin (Lescol) for 12 weeks. The patients were several months after transplantation, and their total cholesterol levels exceeded 6.5 mmol/l following an 8-week diet. The effect of fluvastatin on the levels of total cholesterol, HDL, LDL, triglyceride, Apo A1 and Apo B, as well as of lipoprotein(a) was examined. Furthermore, changes of the renal function (GFR-urea, creatinine, uric acid) and hepatic function (bilirubin, GOT, GPT, CPK, ALP) were followed up, together with the body weight and blood pressure. The results of the examinations are summarized as follows: Fluvastatin may be administered effectively and without side effects in a daily dose of 20 mg in appropriately selected renal transplant patients. The average total cholesterol values, which were 7.91 mmol/l in men and 7.78 mmol/l in women following the diet, were reduced by 22-25% (p < 0.001) after 6 and 12 weeks, respectively, of fluvastatin treatment. The levels of LDL also decreased significantly (p < 0.001): in response to a 20 mg evening dosage, reduction of more than 25% was observed in 78% of men and 65% of women. Reductions of the Apo B levels were more pronounced in the females (18.3% men vs. 21.2% women). The ratio C/HDL-C decreased both in men (from 5.49 to 4.19) and in women (from 4.83 to 4.02). The ratio Apo B/Apo A1 also decreased (men: from 0.86 to 0.73, women: from 0.73 to 0.66). The concentrations of HDL and Apo A1 did not increase significantly, the reductions in the levels of triglyceride and lipoprotein(a) were not considerable either. An increase in the levels of hepatic enzymes and CPK was not encountered during the administration of fluvastatin. In two patients the levels of serum bilirubin increased by 2-4 micromol/l. Three patients complained about temporary myalgias of the sacroiliac or lumbar region which, however, were not accompanied by elevated CPK levels. The monitored levels of cyclosporine, urea and creatinine did not increase significantly during the 12 weeks of treatment. Two patients had temporary gastric complaints.

Dyslipidaemia and hyperlipidaemia following renal transplantation.

The lipid metabolism of 93 patients with renal transplantation was prospectively studied. It was characterized by the serum levels of cholesterol, HDL, LDL, triglyceride, apolipoprotein Al, Apo B and lipoprotein (a) as well as by lipid electrophoresis. In addition to the examination of lipid concentrations, the authors looked for correlations with other metabolic changes, immunosuppressive treatment and the changes of body weight and hypertension following transplantation. Their conclusion is that hyperlipidaemic and dyslipidaemic changes, as reflected by the levels of total cholesterol, LDL and Apo B, are more considerable in women than in men. The levels of pre-beta and beta lipoprotein were not significantly lower in men than in women. With the passing of time after transplantation and with the reduction of the doses of cyclosporine and corticosteroids, the values of hypertension, hyperlipidaemia and dyslipidaemia decreased. According to the follow-up results, the lipid values measured in the winter and autumn months are higher than those found in the summer. The importance of early and follow-up examinations and of the reduction of pathological metabolic alterations is emphasized.

[Late urinary tract complications of schistosomiasis]. / A schistosomiasis késöi húgyúti szövödményei.

Significant portion of the urologic and nephrologic patients in Yemen are treated because of the early and late complications of schistosomiasis (bilharsiasis). During two years 79 patients with renal insufficiency and complications have been examined and treated by the authors. In combination with moderate restricted renal functions hepatosplenomegaly and signs of portal hypertension were observed in female patients. Granulomatous infiltration, calcification and malignous tumour of the urinary bladder was found in men. Stricture of the ureter, uni- or bilateral consecutive hydronephrosis was detected frequently. In addition to inflammatory components bladder, ureteral and renal stones were verified. In the course of treatment 45 percutaneous nephrostomies were performed and an anterograde pyelography was carried out in 60 patients. Ureteral recanalisation was accomplished by means of an ureter stent in 8 cases. Because of serious uremia maintenance haemodialysis was performed in 52 patients. The aim of this work is to contribute to recognise the disease in early stage and emphasize the importance of establishing diagnosis as early as possible and stress the role of the appropriate causal and symptomatic treatment.