Renal transplantation with aged donors

Research indicates that aged heart-beating cadaveric donors cause greater risk factors in kidney transplantation. The influence of age on the outcome of non-heart-beating (NHB) cadaveric renal transplantations has not yet been clarified. From July 1986 to May 1999, 63 patients who received cadaveric renal transplantation at Osaka City University Hospital and Osaka City General Hospital were divided into two groups according to their age. Renal function and graft-survival rates of the two groups were compared. The mean values of nadir donor serum creatinine were significantly worse (P < 0.05) in the aged donor group. In the aged donor group the percentage of immediately functioning grafts was lower and the percentage of non-functioning grafts was higher. During the first 10 years post-transplant, graft survival in the aged donor group was significantly lower than that in the younger donor group. We conclude that cadaveric renal transplantation from NHB aged donors can be to the detriment of renal function and graft survival rates compared to transplantation from younger donors.     

Renal tuberculosis in the antibiotic era

At the Department of Urology in Belgrade 1424 patients were treated for renal tuberculosis in the period 1950 to 1967 (18 years). The number of patients affected with renal tuberculosis has been declining in the last years although, in relation to the incidence of other diseases, it should have been increased. This can be attributed to correct treatment of pulmonary tuberculosis in the course of which there are undoubtedly some healed cases with initial renal tuberculosis. Besides, the clinical and anatomical character of renal tuberculosis has also changed in recent years. Quiet forms without turbulent symptomatology are predominating. Anatomically medium forms are less frequent, as if a polarization had occurred toward light and very serious (destructive) forms. Conspicuous is the increase in the incidence of destructive forms and exclusion of the kidney, and particularly exclusion (on urography) with obliteration of the ureter. This can be attributed to the influence of the antibiotics, and perhaps also to a change of the pathogenic character of the mycobacterium itself (tendency toward fibrous forms). An outline is given of the observation of the 1424 patients with renal tuberculosis, of whom 405 patients showed exclusive forms.     

老年人脊柱结核的外科治疗

目的探讨老年人脊柱结核外科治疗的围手术期处理方法和手术疗效。方法回顾分析1998年5月至2005年6月行手术治疗的36例老年人脊柱结核患者的临床资料。年龄61～86岁,平均70．2岁。术前有合并症者28例,合并截瘫者20例。3例行CT引导下经皮穿刺置管引流术;12例行前路病灶清除、植骨、前路内固定术;5例选择前路清除病灶、植骨、后路内固定术;7例采用经肋横突病灶清除、椎间植骨,后路椎弓根系统内固定术;9例行后路病灶清除、植骨和内固定术。术后抗结核药物治疗9—24个月。随访时间1．5—6年,平均3年10个月。结果术后33例次发生并发症,1例术后围手术期肺部感染死亡,随访期间因心梗及脑出血各死亡1例,其余患者病灶治愈,未再复发。31例患者X线片显示植骨融合。后凸畸形得到部分矫正。术前截瘫者,完全恢复11例,部分恢复5例。结论通过对伴发疾病及并发症的患者术前认真评估和处理,老年脊柱结核患者一般可耐受手术治疗。手术治疗及内固定的应用有助于病灶愈合,促进恢复。     

Renal tuberculosis simulatingpolycystic kidney disease angiographically

A unique case of advanced bilateral renal tuberculosis is reported in which a false diagnosis of polycystic kidney disease was made by renal arteriography. Silent ureteral obstruction generated by the infectious process had produced a form of hydronephrosis in which the renal arterial branches were stretched around large, avascular cystic areas without obliteration of small vessels. This produced an angiographic appearance similar to that seen in adult polycystic disease. Following left nephrostomy drainage and antituberculous chemotherapy for one year, repeat renal arteriograms revealed marked improvement in size and function of the left kidney while the right kidney had become autonephrectomized.     

Renal tuberculosis: a case report

Tuberculosis or TB (tubercle bacillus) remains a major public health problem in developing countries. Over the last decades extra-pulmonary locations of the disease have become more frequent due to the increased prevalence of acquired immune deficiency syndrome and the increase number of organ transplants. The urogenital localization represents about 27% of all extra-pulmonary localizations of TB and may be due either to a disseminated infection or to a primitive genitourinary localization. The majority of patients, has pyuria, sometimes with hematuria. The diagnosis of urinary tuberculosis is based on the finding of pyuria in the absence of infection by common bacteria. The initial medical treatment includes isoniazide, rifampicin, pyrazinami-de, ethambutol and streptomycin. This disease should be suspected in patients with unexplained urinary tract infections, especially if immunocompromised and/or coming from endemic areas.     

Renal amyloidosis secondary to tuberculosis of cecum

Renal amyloidosis can occur as a primary or secondary, systemic or localized disorder. It is defined as a chronic infiltrative disorder characterized by impaired organ function caused by extracellular insoluble protein fibrils. Although colonic tuberculosis is not uncommon, the occurrence of reactive renal amyloidosis in such patients is not as prevalent. We report a single case of renal amyloidosis in a patient with tuberculosis of the cecum who presented with nephrotic syndrome.     

Renal calcification in genito-urinary tuberculosis A clinical study

1. Calcification in renal tuberculosis is not warranting a healing process, but may be a clinical manifestation of the disease. 2. Calcification presenting at least one year after the start of treatment should be considered differently from calcification first seen on presentation, and s,ould be treated in the same way as renal calculi. In view of the high incidence of associated active renal tuberculosis, calcification present when first seen should be removed, preferably with partial excision if the lesion is amenable to this form of treatment, but if it is not removed, patients should be followed up indefinitely, as complications can occur at any time. 3. Extra-renal calcification is more common in patients suffering from genito-urinary tuberculosis who present with renal calcification. 4. The incidence of renal calcification in patients suffering from renal tuberculosis is increasing. This could either be due to the host, the pathogenic organism, or possibly the treatment. As the host and treatment have not changed, it would suggest some alteration in the character of the organism.