The risk factors for and effects of visceral leishmaniasis in graft and renal transplant recipients.

BACKGROUND: The aim of this study was to identify the risk factors for visceral leishmaniasis (VL) in renal transplant recipients and to analyze the impacts of this disease on graft success and patient health. METHODS: This retrospective, case-control study examined 120 renal transplant patients in a VL endemic area. The treatment group included patients (n=20) who developed VL after transplantation, and the control group (n=100) was composed of renal transplant recipients without VL. This study evaluated socioeconomic, demographic, clinical, and laboratory variables. Bivariate analysis and multiple logistic regressions were performed to identify potential risk factors. RESULTS: The average time between transplantation and Leishmania infection in the treatment group was 29.4 months. Seventeen (85%) patients were cured and 3 (15%) died. In 95% of the cases, a myelogram was used for initial identification of Leishmania forms. The significant risk factors for VL in renal transplant recipients were cytomegalovirus infection after transplantation (odds ratio [OR], 5.29; 95% confidence interval [CI], 1.27-21.97) and living with cats (OR, 5.74; 95% CI, 1.15-28.76). Bacterial infection after transplantation (OR, 3.00; 95% CI, 0.96-9.37) and unpaved streets in the neighborhood (OR, 2.14; 95% CI, 0.71-6.43) tended to increase the risk of VL, whereas a negative Rh factor tended to protect against VL (OR, 0.26; 95% CI, 0.06-1.02). CONCLUSION: Cytomegalovirus infection after transplantation and living with cats increased the risk of VL in renal transplant recipients living in VL endemic areas.

Insuficiência renal aguda pelo uso do esquema multidroga na hanseníase / Acute kidney failure between use of the multiple drug teraphy in leprosy

Sete pacientes consecutivos, de um grupo de 283 portadores de Hanseníase em tratamento com esquema terapêutico multidroga (MDT), foram referidos ao Hospital Evangélico de Londrina e ao Hospital Universitário Regional Norte do Paraná, no período de 1989 a Novembro de 1991, devido a insuficiência renal aguda (I.R.A.). Nestes sete pacientes ocorreram oito episódios de IRA, acompanhados de epigastralgia (8/8), febre (6/8), vômitos (5/8), anúria (4/8), urina escura (4/8), dores ósseas acompanhadas de mialgias (5/8) e icterícia (3/8). Quatro pacientes necessitaram tratamento dialítico, e três foram submetidos à biópsia renal que demonstrou Nefrite Rúbulo Intersticial Aguda. Os autores atribuem estas manifestaçöes ao uso intermitente da rifampicina e sugerem cuidados a serem observados quando se usa esquema multidroga (MDT)