ABSTRACT
We describe a case of anti-glomerular basement membrane (GBM) antibody-mediated disease in association with concomitant Burkholderia pseudomallei (melioidosis) bacteraemia. The temporal profile of the illness and initial absence of circulating anti-GBM antibodies, in light of the subsequent definitive histological diagnosis of anti-GBM disease, makes this case interesting and unusual. Additionally, there have been no prior case reports suggesting melioidosis as a cause of biopsy-proven glomerulonephritis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Glomerular Basement Membrane Disease/diagnosis , Anti-Inflammatory Agents/therapeutic use , Autoantibodies/metabolism , Hemofiltration/methods , Kidney Failure, Chronic/diagnosis , Melioidosis/complications , Abdominal Pain , Anti-Glomerular Basement Membrane Disease/drug therapy , Anti-Glomerular Basement Membrane Disease/immunology , Chills , Fever , Fluorescent Antibody Technique , Humans , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/physiopathology , Male , Melioidosis/immunology , Melioidosis/physiopathology , Methylprednisolone/therapeutic use , Middle Aged , Myalgia , Plasma Exchange/methods , Treatment OutcomeSubject(s)
Arteriovenous Shunt, Surgical/adverse effects , Hand/blood supply , Hand/pathology , Ischemia/etiology , Adult , Atrophy/etiology , Humans , MaleABSTRACT
AIM: To determine the outcome of renal transplants from living related donors. METHODS: Retrospective analysis of 33 living related donor renal transplants done between March 1976 and 31 December 1994 at Christchurch Hospital. RESULTS: One of the 33 renal transplants patients received an ABO incompatible kidney and was excluded from the statistical analysis. Twenty-one (66%) of 32 grafts continue to function. The 1, 5 and 10 year graft survival rates were 82%, 73% and 48%, respectively. The estimated 1 and 10 year patient survival rates were 96% and 94%, respectively. With the introduction of cyclosporin the 1 and 5 year graft survival rates increased to 90% and 80%, respectively. Three patients received donor specific transfusion preconditioning and one patient a skin graft from the prospective donor. Four patients (12.5%) had current and/or peak panel reactive antibody titres of more than 25%. Three of these grafts failed after 2, 95 and 463 days. Two grafts were lost due to catastrophic vascular complications. CONCLUSION: The overall outcome for patients who were not highly sensitised was excellent. The degree of sensitisation of the recipient, and the extent of atherosclerotic vascular disease in the recipient, were major predisposing factors for the graft loss due to rejection and vascular complications during the early post transplant period.