[A mini-invasive approach to renal autotransplantation in the management of loin pain hematuria syndrome]. / Approche mini-invasive de l'autotransplantation rénale dans la prise en charge du loin pain hematuria syndrome.

OBJECTIVE: To review retrospectively our experience with laparoscopic approach to renal autotransplantation in four patients using a single iliac incision in the management of loin pain hematuria (LPH) syndrome. METHODS: Four patients with LPH (all women, mean age 29.5 years, range 23-36 years) underwent four technically successful laparoscopic nephrectomies with renal autotransplantation, using a single iliac incision to both harvest and transplant the kidney. Hand assistance was used in two patients immediately before clamping the renal pedicle. All patients required narcotic analgesics preoperatively. RESULTS: Mean total surgical time was 4.1 hours. For laparoscopic donor nephrectomy phase, mean operative time was 1.9 hours. The warm ischemia time was 5 minutes. The cold ischemia time was 58 minutes. The hospital stay was 6 days. None of the patients had abnormal renal function postoperatively. Three of four patients had episodes of iliac fossa pain with effort at the level of the transplantation incision. Two of four patients became Morphine-free. The other two required a significantly reduced dose of oral narcotics. None of these patients required nephrectomy. (Median follow-up 9 months). CONCLUSION: Laparoscopic approach to renal autotransplantaion using a single extended iliac incision in the management of LPH syndrome can be considered as a less invasive treatment compared to open renal autotransplantation in selected patients. This technique may be extended to patients having other conditions requiring autotransplantation.

Treatment Response and Outcomes in Post-transplantation Lymphoproliferative Disease vs Lymphoma in Immunocompetent Patients.

Posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation may carry a poorer prognosis than lymphoma in immunocompetent individuals, but comparative data are lacking. In a retrospective, single-center, case-control study, 21 cases of PTLD were identified in patients undergoing kidney transplantation since 2000, and compared to 42 nontransplanted controls cared for in the same institution and matched for age, prognostic index, and cerebral localization. Two-year and 5-year overall survival was 57% and 44%, respectively, in PTLD patients and 71% and 58% in controls (log-rank test P = .20). On multivariable analysis, overall survival was similar for PTLD and control patients (hazard ratio 1.71, 95% confidence interval 0.81 to 3.61, P = .16). Response rate to first-line chemotherapy was similar between the 2 groups. Death was due to progression of the disease in 46% vs 94% of PTLD and control patients, respectively (P < .01), or sepsis in 31% vs 0% (P = .03). Treatment-related mortality was significantly higher in PTLD (19%) than in controls (0%, P = .03). In conclusion, response to first-line chemotherapy and overall survival are similar in PTLD and control patients, whereas causes of death were significantly different. Better prevention and management of infectious complications could improve the results in PTLD patients.

[Rapidly progressive ANCA positive glomerulonephritis as the presenting feature of infectious endocarditis]. / Glomérulonéphrite rapidement progressive à ANCA révélant une endocardite infectieuse subaiguë

The association of positive cytoplasmic antineutrophil antibody (ANCA) necrotizing crescentic glomerulonephritis with endocarditis raises diagnostic issues. Indeed, it is often difficult to determine if the kidney injury is either secondary to an infectious disease or caused by an ANCA-associated small vessel vasculitis. We report a 59-year-old man admitted in nephrology for acute glomerular syndrome in whom the renal biopsy showed a crescentic necrotizing glomerulonephritis. A diagnosis of vasculitis was initially considered in the presence of high titer of ANCA (anti-proteinase 3). Because of associated Staphyloccocus aureus endocarditis the patient received both corticosteroids and antibiotics that allowed remission of both kidney injury and endocarditis. The renal presentation and the disappearance of ANCA support the infectious etiology of this glomerulonephritis rather than an ANCA-associated small vessel vasculitis. It is important to be cautious in the presence of ANCA positive extracapillary glomerulonephritis and endocarditis should be ruled out before initiation of corticosteroids that may be nevertheless necessary in severe acute glomerulonephritis.