Active enhancement of canine kidney allografts (author's transl)]

In 32 beagles heterotopic renal allotransplantations and bilateral nephrectomies were carried out. Control animals (5 dogs) survived 9.4 +/- 1.6 days. 22 recipients were pretreated with donor-specific semisoluble spleen antigen; 5 recipients pretreated with the antigen alone (780 mg/kg body weight) survived 16.6 +/- 2.3 days. A pretreatment with antigen combined with 5 mg/kg body weight Prednisolone resulted in no significant prolongation of survival time (5 animals), but 5 dogs survived significantly longer after pretreatment with the antigen and 50 mg/kg body weight Prednisolone (27.4 +/- 2,7 days). In 5 recipients after preoperative application of 3 doses Prednisolone alone (50 mg/kg body weight each) no prolongation of survival time could be observed (10.2 +/- 0.7 days). We found no correlation between lymphocytotoxic antibody titre and survival time.     

Mixed infection after renal transplantation (author's transl)]

Severe mixed infection was observed in 9 out of 101 renal transplant recipients over a period of 6 years and was characterized by the simultaneous incidence of bacterial, fungal and viral infections. Severe septicaemia was clinically evident in all cases. The critical clinical situation called for a rapid assessment of the differential diagnosis and relevant bacterial, fungal and viral investigations. Antibacterial and antimycotic therapy must be instituted as soon as possible on account of the high mortality from mixed infection in renal transplant recipients. The reduction or discontinuation of immunosuppressive therapy during infection did not impair renal transplant function.     

Dermatological complications after renal transplantation (author's transl)]

58 renal transplant patients were submitted to dermatological check-up investigations at regular intervals over a mean period of 26.2 months after surgery. 98% of the case material showed dermatological complications. In an analysis of the findings in 55 patients with infectious complications, viral infections occurred in 40, bacterial in 30 and mycotic infections in 20 patients. Dermatological manifestations of non-dermatological complications were mainly due to immunosuppressive therapy. The data stress the necessity of optimum cooperation between dermatologists and the attendant physician in the case of renal transplant patients.     

Immunosuppressive therapy in renal disease (author's transl)]

Since immunological events were found to be pathogenetically involved in various forms of glomerulonephritis, corticosteroids and immunosuppressive drugs were introduced in the treatment of nephritis. However, as opposed to the findings in the paediatric nephrotic syndrome, controlled and multicentric trials with immunosuppressive therapy revealed disappointing results in the management of renal disease in adults. Significantly better results under immunosuppressive therapy, were seen only in the nephrotic syndrome based on the so-called "no changes" or "minimal changes" nephritis. In chronic membranous and proliferative glomerulonephritis the clinical course in the treated group was not statistically different from that of the untreated group. In some disorders of connective tissues, such as systemic lupus erythematosus, polyarteritis nodosa and Wegener's granulomatosis, corticosteroids and immunosuppressive agents seem to exert a favourable effect on the course of renal disease. Encouraging results concerning the combined use of immunosuppressive drugs, anticoagulants and platelet aggregation inhibitors in mesangiocapillary (membrano-proliferative) glomerulonephritis and rapidly progressive nephritis have also been presented. Several factors such as incomplete immunosuppression, druginduced antigen tolerance and increased immune complex formation as a consequence of inhibited antibody production may contribute to the fact that many patients with different forms of nephritis do not benefit from long-term immunosuppressive therapy.     

Hepatitis b infection in renal transplant recipients (author's transl)]

During a period of 4 1/2 years the incidence and clinical course of endemic hepatitis B infection was studied in 43 renal transplant recipients with an observation time of 3 to 47 (average: 26.3) months after surgery. During the investigation period 27 out of 43 patients (62.8 per cent) had hepatitis B infection. In 8 patients HBs antigenaemia persisted after chronic dialysis treatment. After surgery HBs antigenaemia was detected for the first time in 7 patients. Recurrence of HBs antigenaemia was noted in one patient. In 7 further cases with HBs antigenaemia after transplantation regular controls of HBsAg and HBsAb were not available before transplantation. In 2 patients HBs antibodies were detectable at the time of transplantation; 2 further patients developed HBs antibodies postoperatively. Hepatitis B infection showed a mild and persistent clinical course. 6 out of 7 icteric patients simultaneously had other severe mycotic and viral infections. Therefore, the conclusion was drawn that in patients with coexisting multiple infections liver damage is not necessarily attributable to HBs antigenaemia.     

Serum lactate dehydrogenase activity after renal transplantation (author's transl)]

Regular 4-weekly follow-up controls of serum lactate dehydrogenase activity in 23 renal transplant recipients revealed a constant rise in serum LDH activity during the early postoperative months. During the first post-transplant month serum LDH activity increased from 150.0 +/- 48.2 mE/ml to 195.5 +/- 84.8 mE/ml, serum enzyme activity being highest (329.1 +/- 143.2 mE/ml) 6 months after surgery. Since serum creatinine levels remained relatively constant, it seems unlikely that renal rejection played a major pathogenic role in the production of increased LDH activity. Since the pattern of lactate dehydrogenase isoenzymes was ithin normal limits, the pathogenesis of increased LDH serum activity following renal transplantation is not yet clear. Possible causes such as liver damage due to hepatitis B, macrocytosis induced by immunosuppressive therapy and myopathy to steroids are discussed.     

Advances in the surgical treatment of renal calculi (author's transl)]

The most important advances in the surgical management of renal calculi are reviewed and the following current concepts are discussed: operation of the kidney in situ with dorsal muscle-sparing lumbotomy; intrasinusal pyelolithotomy as a modern principle of stone surgery; modern techniques for the localization and removal of stones from the renal pelvis (X-ray, ultrasound, coagulum pyelotomy); methods of hypothermal kidney preservation and operative techniques for staghorn calculi; and modes of surgical stone prophylaxis.     

Hyperacute rejection of an HL-A identical renal allograft (author's transl)]

Hyperacute renal allograft rejection is described in a patient suffering from mesangio-proliferative glomerulonephritis. The transplanted kidney was HL-A identical and the direct cytotoxic cross-match between the recipient's serum and donor lymphocytes was negative. Intrarenal consumption of C 3, but not of C 1 q, C 4, total haemolytic complement, IgG or Igm was demonstrated. Immunofluorescence studies exhibited dense granular deposits of C 3, but not of IgG, IgM C 1q or C 4. These findings together with the observation of beta 1 C-beta 1A converting activity in the patient's serum, raised the possibility that the alternative pathway of complement activation induced by nephritic factor could have operated in this case. Further studies will be necessary to clarify the question whether hyperacute rejection of renal allografts is only antibody mediated or not.     

The diagnostic scope of ultrasonography in renal pathology (author's transl)]

The accuracy of ultrasonography in the diagnosis of different pathological renal conditions is evaluated. Correlations were established to the findings on intravenous urography and selective angiography. Ultrasonography is suitable for the determination of the exact size and site of the kidney and, therefore, should be used routinely in the follow-up of renal transplant recipients. The ability to differentiate between solid and cystic lesions is of partcular value. Moreover, perirenal changes are easily recognizable. The limits of B-mode sonography lie in the interpretation of central expanding lesions with a diameter of under 3 cm. This non-invasive method should be used selectively in the diagnosis of renal disease, whereas angiography should be limited to the classification of equivocal ultrasound findings and in the case of solid tumours.