A renal allograft recipient with late recurrence of focal and segmental glomerulosclerosis after switching from cyclosporine to tacrolimus.

BACKGROUND: Focal and segmental glomerulosclerosis (FSGS) is one of the most frequent and severe primary glomerulonephritis that recurs in transplanted kidneys. Although cyclosporine seems to have no effect on the frequency of FSGS recurrence, there is evidence that cyclosporine reduces proteinuria and prolongs graft survival in patients with recurrent glomerulonephritis after renal transplantation. The effect of tacrolimus on nephrotic syndrome after renal transplantation is controversial. METHODS: We describe the case of a 30-year-old man with steroid-resistant nephrotic syndrome due to FSGS who developed nephrotic syndrome 5 years after renal transplantation due to recurrent disease when he was switched from cyclosporine to tacrolimus. RESULTS: He was given pulses of methylprednisolone and returned to cyclosporine. His proteinuria decreased, but he rapidly developed chronic renal failure. CONCLUSIONS: This observation strongly suggests that tacrolimus should be given with considerable care in renal transplant recipients with FSGS.

Pretransplant hepatitis C virus infection: a predictor of proteinuria after renal transplantation.

BACKGROUND: Reports have suggested that hepatitis C virus (HCV)-infected kidney recipients may develop de novo glomerular lesions caused by the virus. We studied the relationships between pretransplantation anti-HCV antibodies and the occurrence of proteinuria and the link with short- and long-term patient and graft survival. METHODS: A total of 322 consecutive renal recipients treated at a single center from 1989 to 1994 whose sera were routinely assayed for anti-HCV antibodies at the time of transplantation were analyzed. The risks of persistent proteinuria (>1 g/day), graft loss, or death were estimated by Kaplan-Meier analysis. The relationship between clinical variables and each outcome was examined by Cox multivariate regression analysis. RESULTS: Before transplantation, 9.6% of the recipients were anti-HCV antibody positive. Persistent proteinuria developed in 13.6% recipients. The presence of anti-HCV antibodies was strongly associated with proteinuria (relative risk [RR]=5.36, 95% confidence interval [CI]=2.49-11.51). Proteinuria occurred more frequently in second grafts (RR=2.64, 95% CI=1.10-6.29). The number of HLA-A,B mismatches was an independent risk factor (RR=1.55, 95% CI=1.10-2.19). Recipient age (RR=0.80, 95% CI=0.63-1.02) and duration of dialysis (RR=0.86, 95% CI=0.77-0.96) were protective factors. Histology of biopsies from 26/44 recipients with proteinuria showed that de novo glomerular lesions were more frequent in HCV-positive patients, although the difference was not significant. One- and five-year graft survival rates were significantly worse in patients with proteinuria (90.7% and 41.1%) than in patients without it (95.6% and 91.8%) (P<0.00001). Despite the strong association between HCV infection and proteinuria, patient and graft survival rates in anti-HCV-positive and anti-HCV-negative recipients were similar. CONCLUSIONS: The presence of anti-HCV antibodies before renal transplantation seems to be a major risk factor of proteinuria after transplantation. This may be due to glomerular lesions caused by HCV. However, anti-HCV has no impact on 5-year patient and graft survival.

The influence of allopurinol on kidney haemodynamic and excretory responses to renal ischaemia in anaesthetized rats.

1. This study examined the impact of allopurinol on the renal functional responses to a 30 min period of ischaemia in anaesthetized rats. 2. Immediately on reperfusion, blood pressure rose transiently, while renal blood flow remained stable throughout at control values. Glomerular filtration rate was decreased by some 90% over the first and 80% over the sixth hour (P<0.001). 3. Allopurinol, 50 or 100 mg kg-1, had no effect on the blood pressure or renal blood flow responses over the 6 h reperfusion period but glomerular filtration decreased by 60% initially, and to less than 30% of basal at 6 h. 4. Urine flow and absolute sodium excretion increased 2 - 3 fold in the first 2 h but decreased thereafter. Fractional sodium excretion was 30 times higher for the first 2 h but decreased reaching some 10 fold higher at 6 h. In the presence of allopurinol, urine flow and absolute sodium excretion increased by 5 - 6 fold in the first 2 h, and fell by half by 6 h which was greater than in the vehicle group (P<0.01). Fractional sodium excretion increased 20 fold in the allopurinol animals in the first 2 h period, but fell at a faster rate (P<0.01) than in untreated rats. 5. Potassium excretion decreased (P<0.05) by one half for the 6 h reperfusion period but in the allopurinol animals it was minimally altered. 6. Allopurinol largely ameliorated the decrease in kidney haemodynamic and excretory function following an ischeamic period for the initial few hours of reperfusion.

Magnetic resonance imaging may be an asset to diagnose and classify fluoroquinolone-associated Achilles tendinitis.

The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone-associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2*-weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture.

Factors predisposing to post-renal transplant erythrocytosis. A prospective matched-pair control study.

We conducted a prospective study on 81 consecutive patients who had a kidney transplant with graft function for over 3 months to evaluate the prevalence of erythrocytosis following renal transplantation (PTE) and its potential risk factors. True PTE was defined as a RBC mass > 120% of the theoretical value allowing for sex, weight and height. 18 patients (22.2%) developed PTE (RBC mass = 157 +/- 21%) with no evidence of polycythemia vera (PV), or secondary polycythemia due to reduced arterial oxygen, kidney or hepatic tumors. PTE was more common in males (p = 0.041) and less common in patients treated with recombinant erythropoietin (rHEPO) prior to transplantation. 18 non-polycythemic patients (Hb 12.6 +/- 1.3 g/dl) matched for sex, age and renal function were used as case controls. Fewer PTE patients were transfused post-transplantation (p = 0.026). At the time of diagnosis, mean serum EPO was normal and similar to that of controls. PTE patients had lower serum ferritin (p = 0.005) and more commonly received iron supplementation when PTE occurred (p = 0.003). Other clinical factors did not differ significantly between the two groups. Two patients had a thrombotic event, 6 recovered spontaneously and 11 were successfully treated with angiotensin-converting enzyme inhibitors (ACEI). The normalization of Hb, hematocrit and RBC mass in ACEI treated patients was accompanied by a decline in serum EPO (p = 0.008). We conclude that true erythrocytosis is prevalent in cyclosporine-treated renal transplant patients. PTE seems to be an idiopathic erythrocytosis. Pretransplant rHEPO treatment may limit PTE by blunting the increased sensitivity of erythroid precursors to EPO and iron supplementation, which stimulates the development of PTE. ACEI treatment is effective and safe.

Renal transplantation in patients over sixty years of age.

The aim of this study was to analyze whether old age affects the outcome of renal transplantation. Data were presented on all 337 renal allografts performed from January 1, 1987 to November 30, 1992 in the department of Nephrology and Urology, University Hospital of Nancy. Of these, 32 (9.5%) were performed in patients over 60 years old at the time of transplantation (mean duration of follow-up 22.3 +/- 17.1 months). No significant difference was noted in patient and graft survivals between the two groups at 36 months (respectively 83.8% and 76.1% in elderly patients; 96% and 82.8% in younger recipients). In the older group, all grafts were lost due to death (2/5) or nephrectomy (3/5) with a functional transplant (3/5) whereas chronic rejection accounted for the majority of graft loss in the younger group (23/43, p < 0.05). Episodes of acute rejection occurred with a very low incidence in elderly patients (15.6%). Infections were infrequent in this group and did not represent serious complications. Functional rehabilitation and quality of life were as good in elderly as in younger recipients. These results suggest that renal transplantation is an acceptable form of treatment for patients older than 60 years with end-stage renal disease in the absence of obvious contraindication.

Relationship between blood pressure and renin, angiotensin II and atrial natriuretic factor after renal transplantation.

The objective of the study was to assess the evolution of renin, angiotensin II, atrial natriuretic factor (ANF) and blood pressure (BP) in the first trimester following renal transplantation in man Thirty-two recipients were investigated for 3 months post-transplantation. Twenty had a history of hypertension with moderate cardiac hypertrophy. Thirty-one retained their native kidneys. Five kidney donors had a history of mild hypertension. The recipients were perioperatively volume-expanded with 0.9% saline and diuresis was maintained for 48 h with furosemide and dopamine. The sodium intake was 25 mEq/24 hours. Prophylactic immunosuppressive therapy was antilymphocyteglobulins (25 cases), or anti-LFA1 (7 cases) and maintenance therapy was cyclosporine-prednisone (8 cases), or cyclosporine-prednisone-azathioprine (24 cases). Mean BP, serum creatinine, urinary sodium excretion (UNA) and hormonal (renin, angiotensin II and ANF) parameters were collected every other day for the first week after transplantation and then twice monthly. Twenty (62.5%) patients developed hypertension and hypertension was more frequent in patients with a delayed graft function, than in patients with immediate good graft function (10/20 vs. 4/12, p < 0.05%). Both hypertensive (group HBP) and normotensive (group NBP) patients had similar very low renin and angiotensin II plasma levels, after an initial early peak. Analysis of covariance with multiple regression analysis showed that in the HBP patients, BP was negatively correlated with UNA (p = 0.02) and positively with plasma ANF (p < 0.01). The normal BP patients also showed a correlation between BP and UNA, although it was limit of statistical significance (p = 0.05); there was no correlation between ANF and BP. We conclude that the RAS is rapidly depressed after renal transplantation and does not interfere with BP regulation. The hypertension in the early stage of post-transplantation varies inversely with the urinary sodium excretion. The defective sodium excretion, which dominates the effect of the low sodium diet, results in volume overload, increased ANF and volume-dependent hypertension.

Measurement of hydrostatic intraperitoneal pressure: a necessary routine test in peritoneal dialysis.

This paper summarizes our clinical studies on hydrostatic intraperitoneal pressure (IPP), showing the interest of this measurement in routine clinical practice. IPP can easily be measured routinely be a simple and safe method: the measure of the column of dialysate in the peritoneal dialysis (PD) line before drainage, with point 0 located on the midaxillary line. The normal value is 12 +/- 2 cm of water (cm H2O) with an intraperitoneal volume (IPV) of 2 L, with linear increases of 2.2 cm H2O for each additional liter. IPP must be measured to estimate the tolerance of IPV: the maximal permissible IPV is reached for an IPP of 18 cm H2O, squaring with a decrease of 20% in vital capacity and sometimes arising before clinical symptomatology. However, IPP measured at rest could not predict PD mechanical complications (hernias, dialysis leakages, hemorrhoids, etc.), which are more dependent on parietal previous history or predisposition. IPP is significantly higher during the first three days after peritoneal catheter implantation (17 +/- 3 cm H2O) than during the 12 following days (10 +/- 4 cm H2O). It is recommended to postpone the start of PD until after catheter implantation, and patients should remain supine for the first three days. On the other hand, IPP strongly reduces the overall ultrafiltration (UF) volume: an increase of 1 cm H2O in IPP caused a decrease of 70 mL in global UF after two hours. Therefore, IPP should be measured in diagnosis of losses of UF. However, UF loss during peritonitis is not due to an increase of IPP.

Potential interest of anti-ischemic agents for limiting cyclosporin A nephrotoxicity.

Chronic administration of cyclosporin A induces nephrotoxicity in humans. This is related to a cyclosporin A-induced constriction of afferent glomerular arterioles and mesangial cells, which leads to a decrease in filtration pressure and creatinine clearance. Afterwards, cellular lesions are observed involving mainly tubular atrophy and interstitial fibrosis, both of which are nonspecific. The initial mechanism of its toxicity is not clearly explained. The current pharmacological approach is symptomatic in order to counteract or minimize the consequences of a prime cause, which still remains to be defined. However, cyclosporin A has a deletereous effect on mitochondrial functions and mainly on ATP synthesis, which occurs when Ca2+ accumulates in matrix mitochondria. The effects of trimetazidine, an antischemic drug used in the treatment of angina pectoris, have been assessed. This drug is effective in experimental models of hypoxia induced by cyclosporin A: it restores ATP synthesis previously decreased by Ca2+ and cyclosporin A, and releases a part of Ca2+ excess accumulated by mitochondria at concentrations reached in humans at usual dosage regimens. At higher concentrations, it reverses the mitochondrial permeability transition previously generated (opened) by Ca2+ and a pro-oxidant such as terbutylperoxide (t-BH). It was also observed that trimetazidine does not modify the immunosuppressive effects of cyclosporin A in various models. These data suggest that nephrotoxicity of cyclosporin A is not irrevocably linked to its immunosuppressive effect but that it may be possible to counteract at least partly its nephrotoxic effects without altering its effectiveness in preventing graft rejection.

APD: clinical measurement of the maximal acceptable intraperitoneal volume.

In automated peritoneal dialysis (APD) patients treated with 3-L dwell, intraperitoneal volumes can easily be increased up to 4 or 4.5 L using hypertonic solutions without objective control of their good tolerance. In 20 adult patients treated with continuous ambulatory peritoneal dialysis (CAPD) in good conditions, hydrostatic intraperitoneal pressure (IPP) and pulmonary vital capacity (VC) were measured in strict supine position, after infusing isotonic dialysate in 0.5-L increments from 2 up to 5 L as tolerated, according to intraperitoneal volumes (IPV). None of the patients had cardiac or pulmonary dysfunction. IPP was measured following a routine method previously described. In all cases, experience was stopped when IPP increased over 20 cm H2O and/or VC decreased over 25%. IPV is linearly and positively correlated with IPP (p < 0.0001), and negatively with VC (p = 0.0012), but the reliability of VC is less than that of IPP, particularly in old patients. Clinical symptomatology of bad IPV tolerance never occurred alone and was always associated with an increase in IPP over 20 cmH2O and/or a decrease in VC over 25%. The maximal acceptable IPV is better defined by an IPP less than 18 cmH2O, according with a decrease in VC of less than 20%. Routine measurement of IPP can be used to determine maximal IPV and for optimal PD prescription.

Diagnosis and treatment of chronic lead poisoning in CAPD patients.

In order to screen for abstruse lead poisoning in continuous ambulatory peritoneal dialysis (CAPD) patients, delta-aminolevulinic acid dehydratase (ALAD) levels were measured in 18 CAPD patients, 156 patients treated with hemodialysis (HD), and 420 control patients with normal renal function (NRF). An EDTA (ethylenediamine tetraacetic acid) mobilization test was performed in patients with low levels of ALAD (< 0.40 mumol of porphobilinogen formed per milliliter of red blood cells): 1 g of EDTA was infused IV followed by 20 L of hemofiltrate in HD patients and four bags of dialysate in CAPD patients. Lead was assayed in the ultrafiltrate liquid, the bags of dialysate, and in the 24-hour urine. ALAD levels were significantly lower in CAPD and HD patients than in the NRF subjects. ALAD was significantly correlated with EDTA mobilized lead in both dialysis and NRF patients. Using the usual criteria (EDTA mobilized lead > 800 micrograms/24 hours), the rate of lead poisoning observed was similar in the two groups. These results suggest that ALAD assay followed by the EDTA mobilization test is as effective in CAPD patients as in NRF subjects to diagnose and to treat chronic abstruse lead poisoning.

Evolution of intraperitoneal hydrostatic pressure following peritoneal catheter implantation.

Intraperitoneal hydrostatic pressure (IPP) was measured in 10 patients for 15 days (until day 15) following peritoneal catheter implantation. Tenckhoff catheters were surgically implanted using a transrectal approach. The patients began peritoneal dialysis (PD) immediately, initially with small intraperitoneal fluid volumes (500 mL), gradually increasing to reach 2000 mL by day 7. In one patient PD was delayed until day 7 because of an initial leakage of dialysate. Inspiratory and expiratory IPP were measured daily, with the zero point fixed at the midaxillary line with the patient in the supine position. Despite the small intraperitoneal fluid volumes used initially (500 mL), IPP was much higher in the first 3 days following implantation than in the next 12 days (17 +/- 3 cm of water vs 11 +/- 1 cm of water). IPP remained high until day 3, then gradually decreased in a linear fashion until day 12, despite the increased intraperitoneal volumes used, and then remained constant. In conclusion, IPP was found to be significantly higher for 3 days following intraperitoneal catheter implantation, whichever intraperitoneal volume was used. This may be due to tense abdominal muscles from pain caused by the surgery or because of reduced intraperitoneal compliance at the beginning of PD.

Intraperitoneal hydrostatic pressure and ultrafiltration volume in CAPD.

The intraperitoneal hydrostatic pressure (IPP) and overall ultrafiltration (UF) volume were measured in 34 patients after a 2-hour exchange with 2 L of dialysate containing 3.86% glucose. These patients had been treated with continuous ambulatory peritoneal dialysis (CAPD) on average for 26 +/- 20 months under stable conditions. The patients were at rest during the 2-hour exchange. The normal IPP measured with the patient lying completely flat was on inspiration (IPPinsp) 14 +/- 4 cm of water (cmH2O) and on expiration (IPPexp) 12 +/- 3 cm H2O, for an intraperitoneal volume of 2820 +/- 319 mL. The mean UF was 744 +/- 323 mL. The mean IPP (IPPmean), defined by (IPPinsp+IPPexp)/2, had a negative linear correlation to the UF volume (r = 0.66; p = 0.0001). The linear regression test showed that an increase of 1 cm H2O in the IPPmean reduced the overall UF volume by 70 mL in 2 hours. In conclusion, even though the UF is produced by the osmotic pressure of the dialysate, it is also influenced to a great extent by the intraperitoneal hydrostatic pressure, which should not be ignored.

Routine measurement of hydrostatic intraperitoneal pressure.

A simple, non-invasive and well-tolerated technique for routine measurement of intraperitoneal hydrostatic pressure (IPP) in patients treated with peritoneal dialysis (PD) is presented. The height of the dialysis fluid in the PD line was measured, under atmospheric pressure, before drainage and during inspiration (IPPinsp) and expiration (IPPexp), taking the axillary line as the reference point of the resting subject in strict supine position. Normal values were established for a population of 18 patients treated with PD for 19.8 +/- 20.9 months under clinical and biological stable conditions. For an intraperitoneal volume of 2,820 +/- 419 ml, IPPinsp = 14 +/- 2 cmH2O; IPPexp = 12 +/- 2 cmH2O; IPP mean (defined as (IPPinsp+IPPexp)/2) = 13 +/- 2 cmH2O; IPP (defined as IPPinsp - IPPexp) = 2 +/- 2 cmH2O. IPP could not predict mechanical complications (hernia, hemorrhoids, dialysis fluid leakage) but the maximal IPPexp clinically tolerated was 20 cmH2O.

Intraperitoneal pressure, peritoneal permeability and volume of ultrafiltration in CAPD.

Peritoneal permeability (PP), hydrostatic intraperitoneal pressure (IPP) and the overall volume of ultrafiltration (UF) were measured in 23 patients treated by CAPD under stable conditions. PP, IPP and UF were measured during the same exchange with a 2-liter bag with 3.86% glucose, dwell time of 2 hours. PP was evaluated with 3 indices: glucose peritoneal desaturation at 2 hours, urea peritoneal saturation at 2 hours, and crossing time of glucose and urea peritoneal equilibration curves. IPP was evaluated at inspiration (IPPinsp) and at expiration (IPPexp)-giving IPPmean-by measuring the height of the dialysis fluid in the PD line under atmospheric pressure, with point zero located on the axillary line of the subject in strict supine position. Net UF volume was inversely correlated with IPPmean. The net UF volume was strongly affected by IPP since a 1 cmH2O increase in IPPmean caused a decrease of 74 ml in global UF in 2 hours, probably by modification of the lymphatic reabsorption and perhaps of the transcapillary UF.

Prevalence and epidemiology of hepatitis C infection in patients on peritoneal dialysis in France. French PD centers.

We performed a cross-sectional study to establish the hepatitis C virus (HCV) serologic status for all French patients undergoing peritoneal dialysis (PD) on January 1, 1995. We listed a total of 1508 patients, and the exhaustiveness rate was about of 75% of the whole French PD population treated at this date. Only 47 of the 1508 patients were anti-HCV positive (HCV+): the global HCV prevalence was 3.12%. HCV+ patients were treated by PD for a longer time than HCV-patients (4 +/- 4 vs 2 +/- 2 years; p < 0.001); 89% of the HCV+ patients received blood transfusions; 60% had been previously treated by hemodialysis, and 26% previously received a kidney transplantation. In 49% of the HCV+ patients, HCV antibodies were discovered before the start of the peritoneal dialysis program, and a seroconversion was observed in only 4 (0.27%) of them during the PD treatment. All these patients received blood transfusion. In patients without past history of hemodialysis or transplantation (exclusively treated by PD), HCV prevalence was 1.5%, not far off that of the general population. Peritoneal dialysis seems not to be an additional risk factor for hepatitis C infection in France.

[Mesangial IgA deposits nephropathy]. / La néphropathie à dépôts mésangiaux d'IgA.

Idiopathic IgA nephropathy of Berger's disease is characterized by prominent and diffuse IgA deposits in the mesangium. In many countries, it is the most common type of primary chronic glomerulonephritis. Typically, it is revealed by recurrent episodes of gross hematuria in association with ENT infection, but it can progress insidiously with microscopic hematuria and proteinuria. Serum IgA levels are increased in about 50% of cases. IgA nephropathy is not a minor condition: 20% of patients develop end-stage chronic renal failure 10 years after diagnosis and 50% after 20 years. IgA nephropathy can recur in a transplanted kidney suggesting that this disease is a systemic disorder although it has a remarkable tropism for the kidney. Even though many points remain to be elucidated, its pathogenesis appears to be linked to a genetic factor responsible for a lymphocyte dysfunction and an acquired environmental factor such as penetration of an antigen via the mucosa which may give rise to an excessive and inappropriate IgA immune response with the deposition of IgA in the mesangium and the development of progressive renal alterations. No treatment has been shown to be effective but tonsillectomy advised in case of a recurrent tonsillar focal infection is most often accompanied by a decrease in the incidence of gross hematuria. Corticosteroid therapy can be of benefit in cases involving a nephrotic syndrome associated with minimal glomerular lesions. In all cases, control of possible hypertension is of value in slowing the progression of this disease.

[Acute postoperative renal insufficiency in renal transplantation. Incidence and risk factors]. / Insuffisance rénale aiguë post-opératoire en transplantation rénale. Fréquence et facteurs de risque.

Delayed renal function (DFG) is known to influence both the short and long-term outcome of transplanted kidneys. Data collected retrospectively on all 129 cadaveric renal transplants performed between January 1991 and January 1993 within a single center were analyzed. 42 (32.55%) cases of acute renal failure (ARF) occurred during the immediate postoperative period and 28 patients required dialysis. When compared with immediate good allograft function, DGF was associated with previous failed transplant (7/15 vs 35/114, p = 0.01), donor age (39.2 +/- 13 vs 30.1 +/- 12 years, p = 0.01), and episodes of collapsus of the donor (11/25 vs 31/104, p < 0.01). The graft function of the recipient was not correlated with the serum creatinine of the donor. There was no apparent relationship between the cold ischemia or the anastomosis time and the occurrence of DGF. One-year patient and graft survival were similar in the two groups (respectively for the group ARF and without ARF: 96.4% and 96.5%; 88.8% and 89%), but patients with DGF had higher serum creatinine values at 12 months post DGF (185.6 +/- 44.8 mumol/l vs 157.5 +/- 30.8 mumol/l, p = 0.06). This study suggests that DGF is related to the characteristics of the donor graft and is more frequently encountered in previously transplanted recipients.

[Diagnosis and percutaneous treatment of urinary collections and obstructions]. / Diagnostic et traitement percutané des collections et obstructions urinaires.

The collections encountered around the renal transplant are mainly lymphoceles, more rarely hematomas, abscesses and urinomas, the frequency of which constituting 12% of cases. Their diagnosis is usually made by sonography; the percutaneous puncture is guided by US or CT in order to define its nature and drain the cavity. Urinary obstruction (6% of the cases) may be detected by sonography or scintigraphy, but percutaneous pyelography is often required to confirm the obstruction, to precise its level and nature, and to guide the percutaneous procedure. In the case of urinoma (3% of the cases), ultrasound may be unclear and the urinary extravasation must be then confirmed by scintigraphy, postinjection delayed plain or CT scan films.

[Polycythemia after kidney transplantation]. / Polyglobulie après transplantation rénale.

Between 1971 and 1990, 251 kidney transplanted patients with a well functioning graft were evaluated to determine the frequency of post-transplant erythrocytosis (PTE). Thirty-one patients (13 percent) developed polycythaemia 10.6 +/- 10 months after transplantation. Thromboembolic complications occurred in 22 percent of the cases. The frequency of PTE was higher in males than in females (sex ratio: 7.2 vs 2.1; P < 0.05). Patients with renal dysplasia had a lower incidence of PTE (3 vs 22 percent; P < 0.05) as did those who had been treated with azathioprine (9.4 vs 19 percent; P < 0.05). None of the patients treated with recombinant erythropoietin before transplantation developed PTE during a mean follow-up of 15.1 +/- 4.5 months. The majority of polycythaemic patients had normal erythropoietin levels. These results show that there is an erythropoietin-independent proliferation due to an increased sensitivity of erythroid progenitors or to an erythroid stem cell stimulation by cytokines.