Beta-trace protein-based equations for calculation of GFR in renal transplant recipients.

Recently, we showed that serum beta-trace protein (BTP) is an alternative marker of glomerular filtration rate (GFR) in renal transplant recipients (RTR). We have now developed three BTP-based GFR formulae derived by multiple regression analyses from the patients who had participated in that study. Currently, we validated the diagnostic performance of these BTP-formulae in 102 consecutive RTR who underwent a technetium diethylenetriamine pentaacetic acid (DTPA) clearance for GFR measurement in comparison to the re-expressed Modification of Diet in Renal Disease (MDRD) equation and a recently proposed BTP-based equation (referred to as 'White equation'). The best-performing BTP formula was found to be: GFR = 89.85 x BTP(-0.5541)x urea(-0.3018). This equation estimated true GFR virtually without bias (+0.43 mL/min/1.73 m(2), not significant [NS]), while a small, but significant, overestimation was seen for the MDRD formula (+3.43 mL/min/1.73 m(2), p = 0.003). Precision and accuracies within 50% of true GFR (93.1% and 88.2%, respectively) tended to be higher for the BTP formula, but the differences did not reach significance. The White equation overestimated the true GFR by 9.43 mL/min/1.73 m(2)(p = 0.001), and was inferior with respect to precision and 50% accuracy (79.4%). BTP-based GFR calculations are reliable, and may serve as an alternative to the re-expressed MDRD equation.

Renal anemia aggravated by long-term parvovirus B19 and cytomegalovirus infection in a renal transplant patient: case report and evaluation of B19 seroprevalence in dialysis patients.

Due to viral replication in erythroid precursor cells, severe anemia represents a major complication of B19 infection. However, cytomegalovirus (CMV) is the leading cause of virus-induced complications with a significant impact on graft outcome of renal transplant patients. Herein, we present a long-term B19 infection in a 45-year-old female renal transplant patient, which aggravated the renal anemia associated with a concomitant CMV infection. Since no data were available on the seroprevalence of this virus in pretransplant patients, we determined the B19 serostatus of 90 dialyzed pretransplant adult subjects.

[Primary oxalosis in childhood. Plain film findings during the course of the disease (author's transl)]. / Primäre Oxalose im Jugendalter. Nativbefunde unter Krankheitsprogression.

The radiological changes in the kidneys and skeleton in primary oxalosis in a patient are described. Crystalline calcium oxalate deposits, which are a secondary phenomenon, are responsible for the findings, which are of great significance both functionally and prognostically. Hyperoxalaemia is due to an enzyme defect, which leads to hyperoxaluria; this causes a reduction in renal function and can lead to rapid progression of the condition.

[Computer tomographic diagnosis of pericardial effusions (author's transl)]. / Computertomographische Diagnostik des Perikardergusses.

Thirty patients with suspected pericardial effusions, or with cardiac enlargement of unknown cause were examined by computer tomography. In 19 cases a diagnosis of pericardial effusion or haematoma was made. All these cases were confirmed by echo cardiography or transthoracic puncture. The accuracy of computer tomography diagnosis did not depend on the aetiology, but could be increased by contrast enhancement. The computer tomographic criteria are enumerated and compared with those of echo cardiography. Examples of the most important differential diagnoses are discussed.

[MR tomography following kidney transplantation]. / MR-Tomographie nach Nierentransplantation.

The results obtained by MR tomography in 30 patients after renal grafting are compared with the clinical and histological data in respect of corticomedullary contrast (CMC). In 22 patients with regular functioning of the transplant the CMC was normal at 19.4%. Eight MR examinations yielded a clearly reduced CMC below 14%. In 7 of these 8 patients it was possible to prove histologically the existence of an acute tubular necrosis or of a transplant rejection. Noninvasive MR tomography yielded an early indication for treating the acute renal transplant rejection without being able to differentiate between such a rejection and acute renal failure.

[Continuous arteriovenous hemofiltration in acute postoperative and post-traumatic kidney failure]. / Kontinuierliche arterio-venöse Hämofiltration beim akuten postoperativen und posttraumatischen Nierenversagen.

Acute renal failure of 40 patients with polytrauma or abdominal surgery was treated by continuous arteriovenous hemofiltration. The excretory function of the kidney could be replaced by the method. Spontaneous urine excretion recurred in five patients after an interval of 11.3 days. The best survival rate was in patients with acute renal failure after bleeding shock. Contrary to the conventional hemodialysis no special personal or apparatus besides the hemofilter is necessary. Thus, continuous hemofiltration is not withheld from patients that can not be moved to dialysis.

Tumour induction as a consequence of immunosuppression after renal transplantation.

Immunosuppressed recipients of organ transplants have a higher incidence of carcinoma than the general population. A retrospective analysis was made at the Department of Urology of Bonn University, investigating 236 renal allograft recipients as to the incidence of neoplasms before and after transplantation. Eleven patients developed malignant tumours after transplantation. In 4 out of these 11 patients, case history showed pre-existing malignancies. Two of the 4 patients developed a second tumour, while the other two had tumour progression (latency period 21-77 months). Three of the 4 patients died of their tumours 21, 42 and 77 months after transplantation, whereas one female patient is still alive and free of neoplasms 32 months after transplantation. In 7 out of these 11 patients de novo tumours were diagnosed (latency period 3-88 months). All of them are still alive (NED between 15 and 85 months), six of them with good transplant function. There was no difference to be seen in the incidence of malignancies between kidneys supplied by Eurotransplant (n = 40) and ABO compatible kidneys from our own donors (n = 196). The higher incidence rate of neoplasms in transplant recipients requires high standards in preventive measures. Any suspicious change that may occur in the course of a thorough follow-up of transplant recipients must be removed and examined histologically. Patients with previous malignant diseases must be payed special attention, since they frequently tend to develop another malignant tumour and progression of existing tumours, respectively. As far as immunosuppression is concerned, therapeutic guidelines for the treatment of transplant recipients do not differ from those set up for patients on haemodialysis. Since immunosuppression with increased rates of tumour incidence can also be observed in dialysis patients, the mere fact of increased incidence of neoplasms cannot be taken as an argument against transplantation. With a more or less equal risk of tumour incidence the crucial factor should be the higher quality of life for transplant recipients.