Challenge of tuberculosis in renal transplantation.

There is very high incidence of tuberculosis (TB) in dialysis and renal transplant (RT) recipients in developing countries. Clinical manifestation of TB may be atypical or obscure in initial stages. Common clinical abnormalities include pyrexia, pulmonary infiltrates, exudative pleural effusion, and exudative ascites. Aggressive investigations must be done in patients with pyrexia, pulmonary abnormalities, scanty sputum, and weight loss. BAL and computed tomography (CT) scan of the chest should be done in such cases. Tuberculin skin test is not helpful in the majority of patients. New blood tests to quantitate PPD reactivity in vivo and tests to distinguish between latent M tuberculosis infection from BCG-induced reactivity have been devised recently. Side effects of anti-TB drugs, especially hepatitis, need close observation because of the frequent occurrence of viral hepatitis in such cases. Tests to confirm latent TB are desirable before starting chemoprophylaxis in RT recipients. INH prophylaxis cannot be recommended universally in all RT recipients.

Autosomal dominant polycystic kidney disease: observations from a university hospital in saudi arabia.

Thirty cases of autosomal dominant polycystic kidney disease (ADPKD) seen at King Fahd Hospital of the University, Al-Khobar over a period of eight years, were analysed with respect to clinical features, laboratory investigations, radiological findings, complications and outcome. There were 13 males and 17 females with a mean age of 45 yrs + 10.1 (range 16-65 years). There was positive family history of renal disease in 17 cases. At the time of presentation, 27 cases had abdominal pain. The other features noted were hematuria (20 cases), polyuria (10 cases), urinary tract infection (22 cases), headache (9 cases), uremia (7 cases) and nephrolithiasis (5 cases). Bilaterally palpable kidneys were present in all cases. Hypertension (17 cases) was the next common clinical finding. Other clinical features noted were hepatomegaly (5 cases) and mitral valve prolapse (5 cases). Twenty-one patients had cysts in liver and five had cysts in spleen. Varying degrees of renal failure were seen in 15 cases. Six (20%) patients progressed to end stage renal disease during the period of observation.

Clinicopathologic course of hepatitis B infection in surface antigen carriers following living-related renal transplantation.

We present the clinical course, serology, and histopathology of 17 living-related renal allograft recipients who were hepatitis B surface antigen (HBsAg) positive at the time of transplantation. Although 14 patients were hepatitis B e antigen (HBeAg) positive, none had clinical hepatitis at the time of transplantation. All patients were receiving moderate doses of prednisolone and azathioprine only. At the mean short-term follow-up of 70 months (range, 6 to 132 months), none of the patients had seroconversion to antibody to HBsAg. Four patients died due to extrahepatic complications between 16 and 50 months following transplantation. Of these, three had normal liver function at the time of death and one had portal tract infiltration by chronic inflammatory cells. One patient died due to fulminant hepatitis at 6 months after transplantation. Of the remaining 12 patients, although 11 were HBeAg positive, only two developed chronic active hepatitis. Our short-term follow-up data suggest that chronic liver disease is not a frequent complication following living-related renal transplantation in HBsAg carriers. In addition, the presence of HBeAg at the time of transplantation does not predict a bad prognosis. Thus, in a living-related renal transplant program, asymptomatic carriers of HBsAg with positive HBeAg are not a contraindication for renal transplantation.

Outcome of patients with pre-existing hepatitis B virus infection following renal transplant.

Twenty four patients who were HBsAg positive prior to renal transplantation were studied with respect to their hepatic and renal outcome. The kidneys in all patients were obtained from living related donors. The standard immunosuppressive therapy consisted of azathioprine and prednisolone. Post-renal transplant follow-up varied from 32-86 months (mean 55 +/- 9). Renal functions, liver functions, HBsAg and HBsAb status was closely monitored during follow-up. One patient developed acute hepatitis four months after transplantation; this resolved in 10 weeks. Four patients showed transient elevations of liver enzymes. The results of liver biopsy in 16 cases revealed, normal histology (8), virus in hepatocytes (5), and acute hepatitis (3). None of the patients had evidence of chronic liver disease. Two patients died due to chronic rejection/chronic renal failure and two patients died due to septicaemia. Five living patients have mild to moderate chronic rejection. It was concluded that pre-existing HBsAg carrier state in transplant patients had no deteriorating effect on the liver. The mortality was related to chronic rejection and septicaemia.

IgA associated glomerulonephritis.

Immunohistological analysis of 1146 renal biopsies revealed IgA associated glomerulonephritis (IgAGN) in 83 (7.24%) patients (33 children, 50 adults). Clinical features were unusually severe in a high proportion. Nephrotic syndrome (NS) responding poorly to prednisolone was found in 24%, hypertension (HT) in 39%, and azotemia in 34% of patients. NS was slightly more frequent in children than in adults, but HT and azotemia occurred twice as often in adults as in children. Histologically, extensive glomerular crescents and sclerosis were prominent. In addition, moderate arteriolitis and arteriolosclerosis and marked tubulointerstitial nephropathy were notable features. Thus, a low incidence and marked severity characterized IgAGN in this study.

The effect of serum from patients of chronic renal failure on colony forming units (CFU-S) in mice.

Repopulating ability of mouse bone marrow stem cells, treated with pre-dialysis, post-dialysis and control sera was assessed by colony forming units (CFU-S). Significant lower colony counts were observed in pre-dialysis group as compared to control group. There was an improvement in the colony counts when the cells were treated with post-dialysis sera. The study suggests the presence of inhibitor/s of CFU-S in the uraemic sera which is/are partially removed by haemodialysis.

Emergency treatment with ketoconazole in disseminated intravascular coagulation due to metastatic prostatic carcinoma.

We report the use of ketoconazole to control disseminated intravascular coagulation due to prostatic carcinoma. Clinical improvement in the condition of the patient was noted in 48 hours and coagulation profile became normal in 10 days.

Significance of transplant perfusion index in the diagnosis of acute rejection in live related renal allograft recipients.

The study was undertaken to assess the usefulness of transplant perfusion index (TPI) in the differential diagnosis of renal allograft dysfunction with special reference to acute rejection. It was observed that the TPI has a sensitivity of 100 per cent and specificity of 98.1 per cent in the diagnosis of acute rejection. It was also observed that the serial values of TPI provided valuable clues and guide in the management of transplant dysfunction and helped in the immediate and long term follow-up of patients with renal allografts.

Incidence of reflux nephropathy (RN) in ESRD and effect of nephrectomy in RN on blood pressure and haematocrit following renal transplantation.

One hundred and fifty cases of end stage renal disease (ESRD) on pretransplant workup showed vesicoureteric reflux (VUR) in 21 (14%). Of these, 15 were primary reflux nephropathy (PRN) whereas 6 were secondary VUR. All patients in PRN group showed grade III to IV reflux while secondary VUR ranged between grade I to II. In the PRN group 38.5% had severe, 23% moderate and 23% mild hypertension; 53.3% were nonoliguric and 46.7% were oliguric. Mean plasma renin activity (PRA) was 6.6 and 2.85 ng/ml/hr in PRN and secondary VUR groups respectively. All cases of PRN and 2 from secondary VUR underwent nephrectomy and a month later renal transplantation. Following surgery blood pressure normalised without therapy in 50% and another 50% required lesser drugs in comparison to age matched non nephrectomised controls who showed hypertension in 100% cases, 60% requiring 3 to 4 drugs combination (p less than 0.05). Risk of low haematocrit in nephrectomised patients was insignificant.

Vestibular functions in conservatively treated chronic renal failure.

Chronic renal failure can produce malfunction of multiple organs, including auditory and vestibular apparatus. Twelve patients of chronic renal failure of varying etiologies treated conservatively were subjected to vestibular function tests. Only 33% of the patients had normal ENG data. Fifty-eight per cent of the patients had canal paresis and 8% showed hyperactive response. Ototoxic drugs like furosemide may be most important factor in aetiology of vestibular dysfunction in chronic renal failure.

Effects of acute administration of nifedipine on glomerular filtration rate and urinary excretion of sodium and uric acid in patients with mild-moderate essential hypertension.

A prospective study was conducted in 25 patients with essential hypertension to study the effects of sublingual administration of nifedipine on some renal functions. Glomerular filtration rate was estimated by radioisotope clearance techniques using Tc-99m diethylene triamine pentaacetic acid (DTPA). The change in urinary excretion of sodium and uric acid were also monitored. A basal estimation of these parameters was followed by repeat studies after lowering the blood pressure to normotensive levels by sublingual administration of nifedipine. It was observed that acute administration of nifedipine does not produce a significant change in the glomerular filtration rate, but causes marked and significant natriuresis and uricosuria.