Hospitalizations for fractures after renal transplantation in the United States.

PURPOSE: To investigate the incidence, risk factors, and associated mortality of fractures in renal transplant recipients. METHODS: Retrospective registry study of 33,479 patients in the United States Renal Data System (USRDS) who received kidney transplants between 1 July 1994 and 30 June 1997. Associations with hospitalizations for a primary discharge diagnosis of fractures (all causes) were assessed. RESULTS: Renal transplant recipients had an adjusted incidence ratio for fractures of 4.59 (95% confidence interval 3.29 to 6.31). In multivariate analysis, recipients with prevalent fractures, as well as recipients who were Caucasian, women, in the lower quartiles of recipient weight (<95.9 kg), had end stage renal disease caused by diabetes, and had prolonged pretransplant dialysis were at increased risk for hospitalization because of fractures after transplantation. Recipients hospitalized for hip fractures had decreased all-cause survival (hazard ratio for mortality 1.60, 95% CI 1.13 to 2.26) in Cox Regression analysis. CONCLUSIONS: In the early post-transplant course (<3 years), renal transplant recipients had a greater incidence of fractures than the general population, which were associated with decreased patient survival. Preventive efforts should focus on recipients with the risk factors identified in this analysis, most of which can be easily obtained through history and physical examination.

Alveolar hemorrhage and pulmonary hypertension in systemic sclerosis: a continuum of scleroderma renal crisis?

Alveolar hemorrhage occurs as a complication of systemic inflammatory diseases. In addition to alveolar hemorrhage, patients with systemic sclerosis (SSc) may suffer from digital infarction, pulmonary hypertension, and renal crisis. Although a common pathogenesis of this disease that explains the variety of problems during a patient's illness has yet to be identified, the unique characteristics of SSc may alter our approach to alveolar hemorrhage in this patient population. We describe a patient with SSc, who presented with pulmonary hypertension and alveolar hemorrhage complicated by features suggesting re-occurrence of scleroderma renal crisis. Our successful management of this patient, with complications that are usually of high morbidity, may be attributed to our judicious use of glucocorticosteroid therapy and maximization of angiotensin-converting enzyme inhibition. In view of the potential for glucocorticoids to precipitate scleroderma renal crisis, we suggest caution in the use of these medications for manifestations that may be similar in their pathogenesis.

Presence of adipose fat as a criterion of implant compatibility.

An analysis of the tissue sections from previous implant studies was performed define additional criteria which could be considered in determinations of biocompatibility of implant materials. Adult albino rabbits were implanted with biomaterials in the sacrospinalis muscle for periods of 2, 6, 18, and 54 weeks. Fourteen different implant materials were used in this study. The tissues were examined histologically for the appearance of adipose fat cells within the membrane surrounding the implant as an important criterion of tissues implant compatibility. The results were compared with other previously used criteria in judging biocompatibility of implant materials. For the most compatible nonreactive materials, adipose tissue formation within the pseudomembrane began at 6 weeks and was quite extensive at 54 weeks. The reactive materials studied by us did not exhibit this phenomenon.