Behaviour of urinary excretion of lysozyme in renal diseases and in urinary tract infections (author's transl)]

Urinary excretion of lysozyme was investigated in a group of 66 patients with various renal diseases, nephrolitiasis and urinary tract infections. The results obtained demonstrate that the amount of the enzyme excreted is related to the entity of tubular damage whereas is not with glomerular damage. No correlation was found between lysozyme excretion neither to the degree of proteinuria neither to the amount of leukocytes and bacteria in the urine. In patients with urinary infections urinary lysozyme increases only when there is a tubular injury of some entity. In 90 pediatric patients with urinary infection and pyelonephritis lysozyme in the urine was found only in two cases. Therefore urinary lysozyme determination cannot be considered for the detection of early tubular injury and is not a helpful diagnostic tool in urinary tract infections.     

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.     

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.     

Morbidity during regular dialysis treatment and after renal transplantation (author's transl)]

Renal transplantation was associated with a lesser degree of morbidity than chronic dialysis treatment in a group of 48 patients with end-stage renal failure. Morbidity was defined as total days of in-patient hospitalization divided by total days of risk. The morbidity during chronic intermittent dialysis, with a mean observation time of 296.1 (20 to 2255) days, was 11.8%, whereas after renal transplantation, with a mean observation time of 1004.0 (131 to 2400) days, only 7.6% of all days at risk were spent in hospital. Morbidity rises to 38.1% during chronic dialysis if all dialysis days on an out-patient basis are considered as hospitalization days. Morbidity was lowest (3.8%) in patients sent home for the first time with a functioning graft. Cardiac complications and fluid lung were the most common causes for morbidity during haemodialysis treatment; morbidity after renal transplantation was mainly due to renal rejection and infections under non-specific immunosuppression. Social and occupational rehabilitation was better after renal transplantation than during haemodialysis treatment. It can be concluded from these data that with regard to the quality of life renal transplantation is the preferable alternative in the management of end-stage renal failure.     

Recurrence of pseudotumour cerebri (intracranial hypertension) after renal transplantation (author's transl)]

The case report is presented of a 24-year-old male who developed the clinical signs and syptoms of pseudotumour cerebri (intracranial hypertension) twice during the course of protracted rejection 1 and 4 months after renal transplantation. Clinically, headache, nausea, hypertensive crisis and, finally, severe coma with an acute mid-brain syndrome was observed. Neurologically a mild left-sided hemiparesis was found on the second occasion. Examination of the fundi revealed bilateral papilloedema. Electroencephalograms showed pathological changes of a diffuse nature, later followed by abnormal delta range activity in the right frontotemporal projection. The withdrawal of corticosteroid therapy may have been responsible for the pseudotumour cerebri in this case.     

Prolonged renal graft survival after repeated blood transfusions (author's transl)]

In order to investigate the influence of pretransplant blood transfusions on renal graft survival, the results in 43 recipients with 10 or more transfusion (group A) were compared with those in 48 recipients with less than 10 or no transfusions (group B). In both groups cadaveric kidneys with mainly 3 or more mismatched histocompatibility antigens were transplanted. The incidence of preformed cytotoxic antibodies was similar in both groups (25.6% and 22.9%, respectively). The cumulative renal graft survival rate was significantly higher in the poly-transfused group: 85.6% +/- 6.1% and 73.4 +/- 7.9% after 1 and 2 years, respectively, in group A in comparison with 73.9 +/- 6.6% and 63.3 +/- 8.1% after 1 and 2 years respectively, in group B (Wilcoxon rank sum test: p less than 0.05). Severe renal rejection with a serum creatinine above 3 mg/100 ml was more frequently observed in group B than in group A. Enhancement due to blocking antibodies must be assumed as a possible explanation for the favourable effect of repeated pretransplant transfusions on graft survival rates.     

Spontaneous rupture of renal allografts (author's transl)]

Spontaneous rupture of an allografted kidney is not such a rare complication of kidney transplantation. In our series 5.2% of the transplanted kidneys ruptured spontaneously. The condition is an acute emergency characterized by the triad, acute abdomen, swelling in the region of the transplant and haemorrhagic shock. The aetiology of transplant rupture seems to be multifactorial, but the superimposition of an acute rejection episode on ischaemic tubular damage with acute renal failure was found to be the most important combination of events leading to transplant rupture in our patients. Exceptionally precise immunological monitoring in the early phases following transplantation and early aggressive therapy of an acute rejection crisis associated with acute renal failure should prevent allograft rupture.     

Inhibition of PZ-peptidases by serum (author's transl)]

The inhibition of two PZ-peptidases by several sera was studied with the aid of methods based on the PZ-peptidase assay of Wünsch and Heidrich Clostridiopeptidase A is inhibited by all sera, whilst the PZ-peptidase from the rabbit serum is inhibited only by heterologous sera. The inhibition is weak and cannot be compared with the strong serum inhibition shown by collagenases.     

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.     

Pz peptidase activity in serum (author's transl)]

Synthetic PZ peptide, synthesized by Wünsch and Heidrich, was used as substrate to determine PZ peptidase activities in the sera of man, rabbit, guinea pig and mouse. The PZ peptidase from rabbit serum was purified 200 fold and characterized. The enzyme has an isoelectric point of 5.0 and pH optima at pH 7.2 and pH 7.9. Its behaviour on gel filtration points to a molecular weight of 60.000 dalton. The peptidase is inhibited by heavy metal ions, SH reagents and serum. Ca ions are EDTA are without any effect. In contrast to collagen peptidases from micro-organisms, the enzyme from rabbit serum does not attack native, but only denatured collagen. The results suggest that PZ peptidases participate in collagen breakdown by cleaving the collagen fragments which are released by the collagenases.     

Amino acid-p-nitroanilide-splitting activities in human serum (author's transl)]

Proteolytic, arylamidase-like activities of human serum are determined by using a sensitive micromethod, based upon the Bratton-Marshall-reaction, and amino acid-p-nitroanilides as substrates. Besides the alanine-aminopeptidase and the oxytocinase, the dipeptide-aminopeptidase II, a neutral peptidase, and 6 other peptidases, not yet identified by us, are differentiated with the aid of 19 substrates, by adding 8 effectors, and by incubating the enzyme tests within the pH range 6.0 to 8.4.     

Bacteriological, virological, and mycological check-up in patients on regular dialysis treatment and after renal transplantation (author's transl)]

Regular bacteriological control examinations of the dialysate may contribue to the elimination of pyrogenic and even septic reactions. Regular checks of HBS-Ag and HBS-Ab are an effective measure in the early diagnosis of hepatitis B, which is characteristically anicteric and follows a prolonged course in patients on regular dialysis treatment (RDT). Virological examinations can be helpful in the diagnosis of cytomegalovirus (CMV) disease in certain cases of unexplained fever. Regular bacteriological examination of the urine is important in the detection of a urinary tract infection possibly necessitating binephrectomy prior to transplantation. After renal transplantation bacteriological control examinations of the urine, determinations of HBS-Ag and HBS-Ab, complement-binding reactions to CMV and mycotic cultures from the throat, sputum and urine should be regularly performed. Urinary tract infections may be found in up to 88% of the transplanted patients. Hepatits-B infection was noted in 62.8% of this case material. Positive Candida albicans cultures from samples of the uurine usually indicate systemic Candida albicans infection. The described diagnostic measures contribute to an effective prophylaxis and therapy of infective complications in patients on RDT and after renal transplantation.