Chronic allograft nephropathy: its diagnosis and treatment

The process of chronic allograft nephropathy (CAN) is primarily concerned with disparity in major histocompatibility. However, changes similar to CAN have been seen in human kidney transplants between identical twins, as well as in rat kidney isografts. Such changes cannot be explained by antigen-dependent factors; antigen-independent factors are likely to be involved in the onset of CAN. A CAN-type picture also was seen in a rat single kidney model subjected to ischemic injury, indicating the importance of ischemia in the process of CAN. In the present study, CAN was accelerated by renal ablation in a rat kidney transplant model with reduced nephron number. Conversely, recipients with increased renal mass bearing two allografts, did not show any signs of CAN. These observations suggested that a non-allogenic factor such as ischemia and insufficient nephron number is critical in the development of CAN, and thus the etiology of CAN is hypothesized as follows. Many factors such as ischemic injury, acute rejection or infection reduce the functioning nephron number, which causes hyperfiltration in remaining nephrons leading to glomerulosclerosis. This in turn, further reduces the functioning nephron number. These progressive events may reinforce further the stimulus of hyperfiltration, thereby establishing a self-sustaining vicious cycle. Any factor preventing the reduction of functioning nephron number, can be a candidate for treatment. Herein, we showed that treatment with hepatocyte growth factor (HGF), a renotropic factor, in the initial disease stage prevented further development of CAN.     

Chronic kidney disease in the VACTERL association: clinical course and outcome

Approximately 60% of VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects/radial limb dysplasia) patients have renal anomalies that can be associated with chronic kidney disease (CKD). With improved medical care, a large proportion of these patients survive into adulthood. Longitudinal follow-up data regarding the management of kidney disease in these children is lacking. Twelve VACTERL patients with CKD stage 2–5 and 12 age-matched controls with similar urologic anomalies and CKD [mean follow-up period 15.0 ± 1.4 (SE) and 11.9 ± 2.1 years, respectively] were identified in a single center. Eight VACTERL patients progressed to end-stage renal disease (ESRD) compared to four controls (66.7 vs. 33.3%, respectively). Six VACTERL patients were dialyzed pre-transplant. Of the four patients on peritoneal dialysis (PD), three had to be switched to hemodialysis due to complications, whereas two of the three controls on PD did not experience significant problems. Seven VACTERL patients underwent renal transplantation compared to four controls. Mean creatinine clearance 2 years post-transplant was 65.8 ± 6.3 in VACTERL patients vs. 87.8 ± 7.1 ml/min per 1.73 m² in controls (p = 0.03). VACTERL patients had a significantly lower mean height standard deviation score than the controls (−2.34 ± 0.41 vs. −1.27 ± 0.24, respectively; p < 0.05). Based on these results, VACTERL patients with CKD develop ESRD more frequently, experience more complications with dialysis, may have a poorer transplant outcome, and have more severe growth failure than controls.     

Hypoplasia renum: A comparative study of diagnosis,clinical course and management

Twenty patients with hypoplastic kidney (12 men and 8 women, left kidney in 13 cases, right kidney in 7 cases) were observed between 1961 and 1971. The age of the patients ranged from 14 to 60 years. The anomaly predominated (65% of the patients) in the third and fourth decades of life; in this age the diagnosis of the true nature of the condition was often due to complications requiring examination. Carefully taken history and complete radiological survey are essential for the recognition. The value and characteristic features yielded by particular investigation are discussed. In 8 patients clincial diganosis was confirmed at operation. Most common complications of hypoplastic kidney included hypertension, lithiasis, hydronephrosis, pyelonephritis and periodic hematuria. In 9 pateints (4 women and 5 men) renal hypoplasia was associated with other anomalies of the genitourinary tract.     

Characteristics of the clinical course, diagnosis and treatment of abscesses of the pancreas

The work presents an analysis of treatment of abscesses of the pancreas in 21 patients. The ultrasonic examination is one of the main methods of complex diagnostics of this complication. All the patients were operated upon. Eight patients died (38%).     

The clinical course of IgA nephropathy after kidney transplantation and its management

Immunoglobulin (Ig) A nephropathy is one of the most common primary glomerulonephritides worldwide causing end stage renal disease in up to 20–40% of affected patients, nearly two decades post diagnosis. Kidney transplantation is the treatment of choice for patients with renal failure, secondary to glomerular diseases. However, IgA nephropathy has a strong tendency to recur in the graft, and although initially thought to be a benign condition, several reports of graft loss, due to recurrent IgA nephropathy, there have been over the last three decades. Overall graft survival has been significantly improved in kidney transplantation, as a result of reduced incidence of acute rejection, as more potent and more specific immunosuppressive agents are now available in clinical practice. Thus, the rates of IgA nephropathy and other glomerulonephritides recurrence are expected to increase, since graft survival has been improved. However, the reported incidence of IgA nephropathy recurrence in the graft varies substantially across centers, as a consequence of different levels of interest, diverse biopsy policies and differing durations of follow up, of the published studies. Notably, recurrence rates of patients receiving graft biopsies by clinical indication only, ranges from 13% to 50% with graft loss being between 1.3% and 16%. The aim of this review is to underline important pathogenetic insights of IgA nephropathy, describe the clinical course of the disease after kidney transplantation, with emphasis on the incidence of recurrence and the associated risk factors, and finally provide all available options for its management in transplant recipients.     

The influence of the clinical course and diagnosis on the length of surgical stays]

The length of stay (LOS) is one of the major determinants of rising costs in surgical patient care. We studied the timing of the diagnostic procedures performed in 323 surgical patients admitted to 8 surgical departments of a large hospital. Of these: 50 underwent gastrectomy, 28 colectomy, 90 biliary tract (BT) operation, 94 appendectomy and 61 saphenectomy. The average total and preoperative LOS were respectively 27 and 11 days in the gastrectomy group, 26 and 10 in the colectomy group, 10 and 4 in the appendectomy group, 20 and 11 in the BT group, 12 and 6 in the saphenectomy group. The LOS was not affected by the presence of a benign or malignant lesion in gastrectomy and colectomy. In the appendectomy and BT groups, patients admitted from the emergency room had a significantly lower total LOS when compared to elective admissions (8 vs 12 and 9 vs 21 days respectively, p < 0.01). The multiple regression model showed that global and preoperative LOS were influenced by the number of instrumental exams (contrastographic, endoscopic, echographic).     

十二指肠损伤的特点及其诊断和治疗

目的提高十二指肠损伤的外科治疗水平。方法回顾性总结我院１９７３～１９９７年间收治的十二指肠损伤３４例临床经验。结果合并其他腹部脏器损伤７９％（２７／３４）,单纯十二指肠损伤２１％（７／３４）。损伤部位以十二指肠降部为多见占５９％（２０／３４）,水平部次之占２４％（８／３４）。术中漏诊率为１５％（５／３４）;手术后并发症发生率为３５％（１２／３４）;病死率为１５％（５／３４）。结论掌握十二指肠损伤的特点,注重早期诊断、早期手术,加强术中探查,掌握好探查指征,根据伤情选择合理、恰当的术式,加强术后管理,可提高治愈率。     

The prenatal diagnosis of obstructive uropathy and its course in the postnatal period]

The results of ultrasound investigation of 24 pregnant women at pregnancy term of 22-39 weeks, who had a developmental anomaly of the urinary system of a fetus been revealed, and as well the findings of complex postnatal examination of 24 children at the age of from 10 days to 12 months are presented. In 62.5% of fetuses, obstructive uropathy was revealed, in 37.5%--cystic anomaly of the kidneys. At the postnatal period, obstructive uropathy was characterized by progressive development of retentive changes in the upper urinary tract requiring the operative correction, or by their stable dilation subject to conservative treatment.     

Etiology and clinical course of hydrocephalus

This article discusses the incidence, various causes, and different clinical presentations in children and adults with hydrocephalus.