Living kidney donors developing end-stage renal disease.

The incidence of end-stage kidney failure (ESRF) was analyzed among the cohort of 1112 living kidney donors who underwent nephrectomy from 1965 through 2005. It was found that at least six persons had developed ESRF at 14 to 27 years (median = 20 years), following donation. Five of six were men. Five were parents and one, a sibling. The diagnoses were nephrosclerosis (n = 4), postrenal failure (n = 1), and renal carcinoma (n = 1). One donor, aged 45 years, underwent kidney transplantation.

Steroid-free immunosuppression in kidney transplant recipients and prograf monotherapy: an interim analysis of a prospective multicenter trial.

This report described an interim analysis of a investigator-driven multicenter trial in renal transplant recipients: the Prospective Quality of life Renal Transplantation Switch Study; Tacrolimus-based immunosuppression ("PQRST study"). Patients included in the trial initially treated with cyclosporine-based immunosuppression after renal transplantation who experienced side effects, such as hypertension, hyperlipidemia, hypertrichosis, or other adverse reactions, were converted to a tacrolimus-based immunosuppressive regimen (n = 31). Steroids were subsequently discontinued between 3 and 6 months after the conversion. As of today 19/31 (50%) patients have been successfully weaned off steroids with the remaining patients in this process. In this interim analysis, with a follow-up ranging from 1 to 18 months both patient and graft survivals were 100%. No patient experienced an acute rejection episode; none of the grafts were lost. Blood pressure decreased in 22/31 (71%) of the patients. No patient developed de novo diabetes or other serious side effect related to the conversion. Three patients were withdrawn from the trial because of side effects: bleeding, depression, and proteinuria. However, none of these adverse events were felt to be directly related to the change of the immunosuppressive regimen to tacrolimus monotherapy. In conclusion, conversion from cyclosporine to tacrolimus-based therapy was safe and well tolerated; it may improve the cardiovascular risk profile after kidney transplantation.

What causes the failures in surgically constructed arteriovenous fistulas?

A retrospective analysis was made of 191 uraemic patients whose first arteriovenous fistula was constructed in the period 1972-1978. Only direct-type lower forearm fistulas were considered. The aim was to identify and evaluate factors influencing fistula patency rate. Evaluation was done by simple and multiple regression analyses and by actuarial life table computation. Early failure of fistula occurred most frequently in patients with diabetes, peroperative blood pressure less than 110 mmHg, small-calibre veins and/or less than maximal uraemia. The early failure rate among patients with low peroperative blood pressure was 53%, and in the other patients 24%. Among patients with serum creatinine higher than 1 140 mumol/l the corresponding figure was 11%, while in those with lower values it was 35%. Long-term fistula patency was influenced by sex (with advantage to males), by diabetes or diabetic vasculopathy, and seemingly be a tendency to hypotension in some patients. Direct-type forearm fistula may well be utilized in patients with narrow veins. The operation should not be performed long before induction of haemodialysis. This is because some of the fistula's lifespan will be wasted if it is created too soon, and because the early failure rate is lower in patients with advanced uraemia. The analysis also reflects problems that can be anticipated, as diabetics constitute an increasing proportion of patients requiring vascular access.

Total and subtotal colonoscopy with short instrument and without fluoroscopy.

The technique and results of 111 consecutive colonoscopies with a short colonoscope without the use of X-ray screening are reviewed. The caecum could be reached in 44 percent of the cases. No complications occurred. The great clinical value of the procedure is shown by the following findings:X-ray-negative lesions--including 2 cases of carcinoma--were found in 35 percent of the cases, radiologically demonstrated lesions could be defined more precisely in 18 percent, and the presence of colonic lesions could be ruled out in 11 percent in spite of equivocal X-ray findings. It is concluded that many more centres ought to take up the procedure, which offers the prospect of significantly reducing suffering and death from colonic disease.