Renal papillary necrosis in patients with IDDM.

Although diabetes mellitus is reported in 29% of patients with renal papillary necrosis (RPN), the frequency of RPN among patients with insulin-dependent diabetes mellitus (IDDM) has from autopsy studies been estimated to be only 4.4%. In vivo data on the prevalence of RPN in patients with IDDM have been lacking. We therefore studied the prevalence of RPN in 76 patients with long-standing IDDM and in 34 age-matched control subjects by intravenous urography. None of the control subjects showed radiographic signs of papillary necrosis. RPN was observed in 18 patients (23.7%); 15 were women (83.3%). Age and duration of diabetes was not different between patients with and without papillary necrosis, and there was no significant difference between the two groups regarding the prevalence of microangiopathic complications, i.e., proliferative retinopathy and diabetic nephropathy. Microscopic hematuria was three times more frequent in patients with than without RPN (44 vs. 16%; P less than .02). In addition, pyuria was reported in 40% of patients with papillary necrosis, and 61% of them gave a positive history of urinary tract infection compared to 16% (P less than 05) and 32% (P less than .02), respectively, in patients without papillary necrosis. It is concluded that RPN is a more frequent complication of long-standing IDDM than appreciated from autopsy studies, and being female and having a history of urinary tract infection are associated with an increased risk of RPN.

Cytogenetic in vivo and in vitro effects of low dose radiation and contrast agents.

Chromosome analysis was performed on five persons before and after urographic examination. Despite a small increase in chromosome aberration frequency after the examination, no statistically significant increase was demonstrated. Whole body lymphocytes were analyzed for chromosome aberrations after exposure to low dose radiation, contrast agents and radiation together with a contrast medium. A significant increase in aberration frequencies at the 2.5% level was observed in irradiated blood samples containing the iodized contrast agent metrizoate.

Steroid treatment and aseptic necrosis of the femoral head in renal transplant recipients.

The subject of our study was 546 renal transplant recipients with a graft survival for minimum 12 months. Of these, 29 renal recipients (5.3%) developed aseptic necrosis of the femoral head. The examination revealed that there were no significant differences between the renal recipients with hip necrosis and the control group in the total quantities of administered glucocorticosteroids, whereas there was a highly significant correlation between the two groups in the number of the intravenously administered methylprednisolone pulse doses.

Endovascular treatment of aortic aneurysms in Finland: the first four years' experience.

BACKGROUND AND AIMS: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS: The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Radiation load of kidney transplant recipients caused by radiodiagnostics.

The radiation dose from diagnostic procedures was estimated for 79 kidney transplant recipients. The mean bone marrow does was 4.8 rad, the mean gonad dose for men 16.5 rad, and for women 5.6 rad. A dose of this magnitude has no obvious immunological effect, whereas a canserogenic and a genetic effect must be taken into consideration.

Lupus-like syndrome associated with pulmonary reaction to nitrofurantoin. Report of three cases.

A systemic lupus erythematosus-like syndrome developed simultaneously with pulmonary reactions of the chronic type in three female patients after treatment with nitrofurantoin for 12, 27 and 38 months, respectively. The syndrome was characterized by elevated ESR, polyclonal hypergammaglobulinaemia, the presence of IgG antinuclear antibodies and a positive latex-fixation test. Two patients had severe arthralgia and one of them peripheral lymphadenopathy. Pleural effusion and a chronic active hepatitis were present in the third patient, in whom interstitial cystitis also developed. All signs and symptoms of the lupus-like syndrome disappeared, without corticosteroid or other medication, when nitrofurantoin was omitted. The diminution of pulmonary infiltrates and the reversal of interstitial cystitis also appeared to be directly related to cessation of nitrofurantoin therapy. Our findings indicate that long-term medication with nitrofurantoin may cause, in addition to pulmonary changes, a simultaneous lupus-like syndrome our data also raise the possibility that interstitial cystitis may occur as an adverse reaction to nitrofurantoin therapy.

Doppler ultrasound in the diagnosis of renal transplant artery stenosis--value of resistive index.

Doppler ultrasound (DU) with angiographic correlation was performed in 19 hypertensive renal transplant recipients suspected for transplant artery stenosis. DU included calculation of the intrarenal resistive index (RI) and measurement of the maximum systolic velocity in the transplant artery. All 10 cases having a pathologically low RI (< or = 0.6) had a > or = 50% stenosis; specificity and positive predictive values were thus 100%. There were 5 false-negative diagnoses, sensitivity 67%. The measurement of maximum systolic velocity was feasible in only 15 cases (79%). Using a cut-off point of 2 m/s the sensitivity was 91% and there were 4 false-positive cases and one false-negative case. Balloon percutaneous transluminal angioplasty (PTA) was performed in 13 cases, of which 9 were successful. In all successful cases RI was < 0.6 after PTA. We conclude that low RI (< 0.6) is highly suggestive for transplant artery stenosis. RI may serve as an indicator of the hemodynamic success of PTA.

Pulmonary infections after renal transplantation.

The prevalence of pulmonary infections has been assessed in a series of 93 patients who succumbed after renal transplantation. Pneumonia was considered to be the immediate cause of death in 15 patients; microscopic examination revealed further 10 cases, with pneumonic foci in the lungs. Consequently, the prevalence of pulmonary infections was 27%. Pneumonia was diagnosed on chest X-ray in only 48%, with "uraemic lung" as the most common confounding diagnosis. Clinical microbiology disclosed pathogenic bacteria in the sputum in 40% of the cases. It is concluded that the diagnostic yield would be enhanced by more frequent chest X-rays and presumably with more invasive methods of acquiring specimens for microbiological studies. It is also possible that the application of more stringent criteria for the use of high-dose intravenous steroids for supposed rejection will lead to less pneumonia in patients with renal transplants.

Magnification angiography in the evaluation of transplanted kidneys.

Conventional and magnification angiography were performed on 34 occasions in 31 patients with renal allografts. The differential diagnosis between acute rejection and tubular necrosis was uncertain. In chronic rejection, where vascular abnormalities dominate, the diagnosis was easier. The magnification angiography demonstrated the small intrarenal arteries to better advantage, resulting in a more accurate assessment of the condition.