Recovery of allograft function after complete withdrawal of immunosuppression.

We describe an interesting case of a patient who recovered function of a previously failed kidney allograft after immunosuppressive medications were discontinued for 4 months, requiring maintenance hemodialysis. He had a split-thickness skin graft to his abdomen because of previous surgical complications. His postoperative course was complicated by sepsis and refractory hypotension. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone. At the same time, hemodialysis was stopped for possible catheter-related infection. The patient recovered function of the previously failed allograft and has not required hemodialysis.

Glomerulomegaly and proteinuria in a patient with idiopathic pulmonary hypertension.

Glomerulomegaly is a histologic finding present in idiopathic pulmonary hypertension, congenital cyanotic heart disease, morbid obesity associated with sleep apnea syndrome, sickle cell disease, and polycythemic states. This study examines the case of a 34-yr-old woman with idiopathic pulmonary artery hypertension who presented with nephrotic-range proteinuria. Kidney biopsy revealed enlarged glomeruli with mesangial-proliferative glomerulonephritis. A review of the pertinent literature and a discussion of the proposed pathophysiologic mechanisms leading to glomerulomegaly are presented.

Scintigraphic assessment of pericardio-peritoneal window patency. Relevance to peritoneal dialysis.

To alleviate recurrent pericardial effusion secondary to systemic lupus erythematosus, pericardio-peritoneal window was performed. Subsequently, end stage renal disease developed and the patient required peritoneal dialysis. Patency of the pericardio-peritoneal window was demonstrated by intraperitoneal injection of Tc-99m SC through a Tenckhoff catheter, which prompted special counsel to the patient in order to prevent infectious pericarditis potentially complicating peritoneal dialysis induced-peritonitis.