Belatacept conversion in an HIV-positive kidney transplant recipient following anti-thymocyte globulin induction.

Herein, we describe a case of early belatacept conversion in a human immunodeficiency virus (HIV)-positive kidney transplant recipient in an effort to improve suboptimal graft function and avoid drug interactions following anti-thymocyte globulin (ATG) administration. We observed improvement in renal function without HIV disease progression or opportunistic infections. Donor-specific antibodies appeared shortly after conversion but cleared without intervention. This case highlights belatacept as a means to improve renal function and avoid significant drug interactions even following ATG induction.

A reversible cause of 'end-stage renal disease': discrepant findings in serial duplex ultrasonograms in a suspected occlusion of a renal arterial bypass graft.

Duplex ultrasonography may be inaccurate due to a number of variables in operator and patient characteristics. We describe a 40-year-old woman who presented with acute kidney injury after prior complex abdominal aortic surgery that had left her with an essentially solitary functional kidney. On the basis of normal Doppler findings, she was started on dialysis. Owing to high clinical suspicion and a failure of renal function to return, a second Doppler study was performed 3 weeks after the first, revealing the characteristic tardus-parvus waveform of renal artery stenosis. The patient underwent urgent renal arterial angioplasty and stent placement. She experienced an immediate increase in urinary output, required no further dialysis, and the creatinine improved to 1.7 mg/dL (her prior renal baseline). The case illustrates an important complication of abdominal aortic aneurysm repair, draws attention to a potential source of error in the Doppler measurement, and underscores the limitations of duplex ultrasonography for excluding renal artery stenosis in the presence of high pretest probability.

Bismuth compounds in organic synthesis. A one-pot synthesis of homoallyl ethers and homoallyl acetates from aldehydes catalyzed by bismuth triflate.

[reaction: see text] Three one-pot methods for the conversion of aldehydes to homoallyl ethers catalyzed by Bi(OTf)(3).xH(2)O (1 < x < 4) have been developed. The one-pot synthesis of homoallyl ethers can be achieved either by in situ generation of the acetal followed by its reaction with allyltrialkylsilane or by a three-component synthesis in which the aldehyde, trimethylorthoformate or an alkoxytrimethylsilane and allyltrimethylsilane are mixed together in the presence of bismuth triflate (0.1-1.0 mol %). In addition, a three-component synthesis of homoallyl acetates, which is achieved by reacting the aldehyde, acetic anhydride, and allyltrimethylsilane in the presence of bismuth triflate (3.0-5.0 mol %), has been developed. The use of a relatively nontoxic, easy to handle, and inexpensive catalyst adds to the versatility of these methods.