Results of renal transplantations performed at the Clinic of Urology in Bratislava.

From June 1972 to the end of 1983, 145 transplantations of cadaveric kidneys were performed at the Clinic of Urology in Bratislava. A clinical analysis of the first 110 renal transplantations is presented with regard to patients and allograft survivals and occurrence of surgical and urological complications.

Dynamics of serum minerals changes after renal transplantation.

In 27 patients surviving with transplanted cadaver kidneys for 12-107 months, calcium, phosphorus, magnesium and creatinine serum levels, glomerular filtration rate and incidence of serum mineral levels pathological deviations following renal transplantation were evaluated. In early posttransplantation period hypercalcemia and hypomagnesemia developed in one fourth of the observed group of patients and hypophosphatemia in two thirds of patients. Expressive hypermagnesemia developed in one patient. Calcium and phosphorus levels gradually normalized, excluding rare exceptions; magnesium serum level exceeded an upper limit of normal values in majority of patients, nor to medicamentous treatment was stated.

Preparedness of patients to renal transplantation.

The outcome of renal transplantations depends to a considerable degree on the general condition of patients before the transplantation. The patients in the dialysis programme are regularly watched and any complications which might contraindicate the transplantation are recorded. Despite this, verging complications were repeatedly found which, by themselves, do not contraindicate the operation but may increase the risk of the operation and thereby the outcome of the transplantation. In the present study the general conditions of 38 patients coming from different dialysis centres in the Slovak Socialist Republic are assessed. These patients underwent renal transplantation at the Clinic of Urology in Bratislava.

Operations in patients treated by regular haemodialysis.

Patients with chronic renal insufficiency treated by regular dialysis tolerate well surgical interventions provided they are appropriately prepared for the operation. It is first of all the management of symptoms of the uraemic syndrome by an effective dialysis, the follow-up during the operation and in the immediate postoperative period. On the basis of experience with 31 regularly dialysed patients, the authors have set their criteria for a total anaesthesia. Also the risks and the most frequent complications occurring during and after the operation are pointed out.

Transient impairment of tubular reabsorption of calcium (TRCa) after renal transplantation.

TRCa calculations (using the values of plasma ultrafiltrable Ca and urinary Ca) revealed impaired renal Ca handling in 14/32 patients with transplanted kidneys. TRCa improved in relationship with the increment in renal transplant function, and was within the normal range in all patients with GFR above 50 ml/min. There was a positive correlation between serum Ca and TRCa; hypocalcaemia was found in 9 patients and hypercalcaemia in 3. In the majority of hypocalcaemic patients TRCa impairment was discovered, however, pathologically decreased serum Ca values were found in only one half of the patients with impaired TRCa. In most hypocalcaemic patients the concomitant renal transplant insufficiency, hyperphosphataemia and/or insufficient dietary Ca intake seemed likely to have contributed to serum Ca depletion.

Impaired tubular reabsorption of magnesium after renal transplantation.

Tubular reabsorption of magnesium ( TRMg ) was calculated from the values of plasma ultrafiltrable Mg and urinary Mg in 36 patients with transplanted kidneys. The study revealed a defect in TRMg in all investigated patients. The lowest TRMg values were found in patients with poor function of the transplanted kidneys. TRMg increased in relationship with the increment in glomerular filtration rate, nevertheless in the majority of the cases the TRMg values did not reach the values of healthy individuals.

Chronic renal insufficiency (CRI) in urolithiasis.

In 80 adult kidney stone formers (52 with reversible and 28 with irreversible renal impairment) laboratory and clinical data were evaluated to estimate the share of abnormalities in the metabolism of stone forming substances in the development of renal impairment, and to search for the causes of the irreversibility of renal impairment. The study confirmed the previous results from this laboratory suggesting a causal relationship between renal impairment and metabolic disorders. No significant differences in the incidence of metabolic disorders or in therapy have been found in patients with irreversible renal impairment as compared to those with progressive deterioration of renal function. Irreversible renal impairment developed in relationship with bilateral kidney stone formation and recurrent urinary infection.