RESUMO
A 34 year old woman with sickle cell (SS) anemia and chronic renal failure of unknown etiology was maintained on dialysis for 11 months before she received a cadaveric renal transplant. After 24 months, transplant function is excellent although a mild urinary concentrating defect (Umax = 532 mOsm/liter) is present. Renal biopsies five and 11 months after transplant revealed mild focal interstitial infiltrates and mesangial thickening. A major complication has been the reemergence of numerous severe painful crises, inferred to be caused by an increased blood viscosity consequent to a rising hematocrit value, after a hiatus of many years. The succession of crises was stopped with a prophylactic partial exchange transfusion program, reemerged when the program was discontinued, and was stopped again when the transfusion program was reinstituted. We conclude that renal transplantation may be successfully performed in patients with sickle cell disease. Complications of the hemoglobinopathy may develop, but painful crises can be successfully managed with judicious transfusion therapy.
Assuntos
Anemia Falciforme/complicações , Transplante de Rim , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , Cadáver , Feminino , Humanos , Dor/etiologia , Recidiva , Fatores de Tempo , Transplante HomólogoRESUMO
In 61 hemodialysis patients undergoing subtotal parathyroidectomy, there was a good correlation between the preoperative serum immunoreactive parathyroid hormone value (iPTH) and the weight of parathyroid tissue removed surgically (p less than or equal to 0.001). Postoperatively, iPTH decreased rapidly from an initial mean (+/- SD) of 2,928 +/- 1,600 muleq/ml and remained at 365 +/- 296 muleq/ml at last follow-up of patients still undergoing hemodialysis (normal, less than 50 muleq/ml). Of six patients who had recurrent hyperparathyroidism (10 percent of total), three required a second subtotal parathyroidectomy. Aluminum-related osteomalacia eventually developed in six patients with bone biopsy-proven hyperparathyroidism before parathyroidectomy. Nine patients with severe fracturing bone disease and hypercalcemia preoperatively but without clear evidence of hyperparathyroidism did not show a favorable response to subtotal parathyroidectomy (high mortality within 28 months, persistence of hypercalcemia, and symptomatic bone disease). Thus, subtotal parathyroidectomy can benefit patients with clearly established severe progressive hyperparathyroidism not responsive to medical therapy but is contraindicated in patients with low iPTH values and no bone biopsy evidence of severe hyperparathyroidism.
Assuntos
Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/complicações , Glândulas Paratireoides/cirurgia , Diálise Renal , Alumínio/toxicidade , Osso e Ossos/patologia , Feminino , Humanos , Hiperparatireoidismo Secundário/etiologia , Masculino , Osteomalacia/etiologia , Hormônio Paratireóideo/sangue , Recidiva , Fatores de RiscoRESUMO
Significant prolongation of renal allograft survival was demonstrated in a controlled canine model with the host suboptimally immunosuppressed when grafts were perfused for 24 hr with cryoprecipitated plasma (CPP) that had been obtained from plasma of dogs "pretreated" with i.v. cyclophosphamide (80 mg/kg for 5 1/2 hr) and i.v. methylprednisolone (60 mg/kg for 2 1/2 hr). The active metabolites of these drugs within the pretreated plasma may have modified the graft immunogenicity in vitro. However, the use of pretreated kidneys in combination with 24 hr of perfusion with CPP did not result in prolonged graft survival. Furthermore, 24-hr perfusion of pretreated kidneys with their own pretreated CPP did not improve graft survival. This suggests that the pretreated canine kidney does not tolerate pulsatile preservation with CPP; this is in contrast to the human experience and may be attributable to a species difference.
Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Animais , Precipitação Química , Crioglobulinas , Cães , Feminino , Terapia de Imunossupressão , Rim/patologia , Necrose , Perfusão , Plasma , Fatores de Tempo , Transplante HomólogoRESUMO
Simultaneous transplantation of the pancreas is an option for diabetic patients undergoing kidney transplantation to attempt to halt progression of diabetic complications, but the additional risk imposed by the procedure is unclear. Our aim was to determine the morbidity attributable to pancreas transplantation during simultaneous pancreas and kidney transplantation. We compared the first posttransplant year of 18 consecutive recipients of combined pancreas and kidney transplantation to 18 consecutive recipients of kidney transplantation alone. All patients received cadaver donor allografts between 1986 and 1989, and had type I diabetes mellitus with chronic renal failure. There were no differences in patient survival (94% both groups) or satisfactory renal allograft function (89% pancreas/kidney group, 83% kidney group) up to 18 months after transplantation. Eighty-eight percent of pancreas allografts were functioning satisfactorily at 18 months. There was a mean (+/- SD) of 1.5 +/- 1.0 acute rejection episodes per patient for the pancreas/kidney group compared to 0.8 +/- 6 for the kidney-only group (P less than 0.02). Cytomegalovirus infection and wound complications were each encountered more often after pancreas/kidney transplantation than kidney transplantation alone, and together with rejection accounted for a difference in days of hospitalization during the first year (71 +/- 34 vs. 27 +/- 13, P less than 0.001). We conclude that simultaneous pancreas transplantation during cadaver donor kidney transplantation accounted for more frequent rejection episodes, CMV infections, and wound complications. These complications resulted in more hospitalization for patients undergoing simultaneous pancreas/kidney transplantation than kidney transplantation alone.
Assuntos
Diabetes Mellitus/cirurgia , Transplante de Rim , Transplante de Pâncreas , Adulto , Cadáver , Infecções por Citomegalovirus/etiologia , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Hospitalização , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Transplante de Pâncreas/efeitos adversos , Transplante de Pâncreas/mortalidade , Complicações Pós-OperatóriasRESUMO
Twelve liver and 5 kidney transplant recipients with severe cytomegalovirus infection were treated with Ganciclovir (7.5 mg/kg/day, intravenously). Ten were evaluable (compatible clinical picture, organ involvement shown histopathologically or by culture, viremia, and absence of concomitant infection). All 17 patients were studied for adverse drug side effects. A total of 9 evaluable patients survived the infection; 1 died during treatment due to infection or drug toxicity. A death 19 days after completion of treatment was due to unrelated causes. Patients became afebrile after 2-9 days (mean, 5.3 days) of treatment. Liver function improved, pulmonary infiltrates cleared, and hypoxemia reversed during therapy. Viremia ceased during therapy in 9 patients; asymptomatic viruria persisted or recurred in 6 of 7 patients studied. No relapses occurred during follow-up (7-17 months; mean, 13 months). Transient neutropenia and thrombocytopenia occurred in 3 and 1 patients, respectively. Ganciclovir appears promising for treatment of severe CMV infection in patients with kidney or liver transplants.
Assuntos
Aciclovir/análogos & derivados , Infecções por Citomegalovirus/tratamento farmacológico , Transplante de Rim , Transplante de Fígado , Aciclovir/uso terapêutico , Infecções por Citomegalovirus/microbiologia , Ganciclovir , Humanos , Infecções Oportunistas/tratamento farmacológico , Pneumonia/complicações , Fatores de TempoRESUMO
BACKGROUND: Already there is evidence that simultaneous pancreas and kidney (SPK), or pancreas after kidney (PAK) transplantation, in patients with type 1 diabetes mellitus and end-stage kidney disease prevents worsening of diabetic polyneuropathy, but neuropathic improvement is delayed and incomplete. METHODS: In 85 patients with type 1 diabetes mellitus who underwent SPK or PAK transplantations, we performed sequential neuromuscular evaluations before, every 3 months after, and yearly after transplantation, quantitating muscle weakness separately from overall severity of polyneuropathy. RESULTS: We found that, on average, the weakness subscore of the Neuropathy Impairment Score of the lower limbs [NIS(LL)-W] was significantly worse at 3, 6, 9, and 12 months (by about 5 points) than at baseline. By contrast, for these times after transplantation, a composite score of nerve conduction abnormalities, an independent measure of severity of polyneuropathy, was not significantly worse and, in fact, was significantly improved. In multivariate analysis, length of hospital stay correlated with the increased weakness. CONCLUSIONS: We conclude that: (1) increased neuromuscular impairment after transplantation is mainly due to muscle weakness and not to worsening polyneuropathy; (2) in multivariate analysis, duration of hospitalization after transplantation was significantly associated with this increased weakness; (3) increased weakness is probably due to development of myopathy, which may be related to graft rejection, immunosuppression, sepsis, and intercurrent infections; (4) in future transplantation trials, weakness should be evaluated separately from neuropathic status, and the lowest efficacious dosages of immunotherapy should be used; and (5) essentially all diabetic patients reported that SPK or PAK transplantation was worthwhile because it freed them from diabetic lifestyle concerns.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Transplante de Rim/efeitos adversos , Debilidade Muscular/etiologia , Transplante de Pâncreas/efeitos adversos , Adolescente , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Condução Nervosa , Satisfação do Paciente , Estudos ProspectivosRESUMO
BACKGROUND: Solitary pancreas transplants, both pancreas transplant alone (PTA) and pancreas after kidney (PAK), have higher rejection rates and lower graft survivals than simultaneous pancreas-kidney transplants (SPK). The aim of this study is to compare three different antibody induction regimens in solitary pancreas transplant recipients and to assess the role of surveillance pancreas biopsies in the management of these patients. METHODS: Solitary pancreas transplant recipients between 01/98 to 02/00 (n=29) received induction with either daclizumab (1 mg/kg on day 0, 7, 14), OKT 3 (5 mg/day x0-7), or thymoglobulin (1.5 mg/kg/day x0-10). Maintenance immunosuppression was similar for the three groups. All rejections were biopsy-proven either by surveillance/protocol or when clinically indicated. RESULTS: The 1-year graft survival was 89.3% overall and 91.7% in the thymoglobulin group. Thymoglobulin significantly decreased rejection in the first 6 months when compared with OKT3 or daclizumab (7.7 vs. 60 vs. 50%). Acute rejections were seen on surveillance biopsies in the absence of biochemical abnormalities in 40% of patients. CONCLUSIONS: Thymoglobulin induction regimen led to a low incidence of acute rejection and a high rate of graft survival in solitary pancreas transplants. In addition, surveillance biopsies were useful in the detection of early acute rejection in the absence of biochemical abnormalities.
Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Pâncreas/imunologia , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Biópsia , Daclizumabe , Feminino , Sobrevivência de Enxerto , Humanos , Imunoglobulina G/uso terapêutico , Transplante de Rim , Masculino , Muromonab-CD3/uso terapêutico , Pâncreas/patologiaRESUMO
Frank C. Mann, a world-renowned experimental physiologist, played a major role in the early laboratory investigation of organ transplantation procedures. During this centennial of his birth, we acknowledge the important contributions of Dr. Mann.
Assuntos
Transplante/história , Animais , Cães , História do Século XX , Humanos , Minnesota , Fisiologia/históriaRESUMO
During the course of 3 decades, and particularly during the past 5 years, clinical renal transplantation has improved to become a safe mode of therapy for end-stage renal disease. Currently, more than 95% 1-year survival can be expected, both in patients who receive allografts from living-related donors and in those who receive cadaver kidneys. One-year living-related donor graft survival is 98%, and 1-year cadaver graft survival is 87%. Cyclosporine has been an important adjunctive immunosuppressive agent not only because of improved results but also because it has shortened hospitalization time.
Assuntos
Transplante de Rim , Soro Antilinfocitário/uso terapêutico , Cadáver , Diabetes Mellitus Tipo 1/complicações , Quimioterapia Combinada , Rejeição de Enxerto/efeitos dos fármacos , Antígenos HLA/análise , Antígenos HLA-DR , Antígenos de Histocompatibilidade Classe II/análise , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Rim/imunologia , Falência Renal Crônica/cirurgia , Pessoa de Meia-Idade , Reoperação , Doadores de TecidosRESUMO
Two immunosuppressive regimens-cyclosporine plus prednisone and azathioprine plus prednisone-were compared in 78 renal transplantation patients (39 in each treatment group) who were successfully managed for more than 15 months. In patients who received cyclosporine, the dosage was adjusted to achieve trough whole blood concentrations of 100 to 250 ng/ml measured by liquid chromatography. A greater number of haplotypes matched in the azathioprine-treated group than in the cyclosporine-treated group (P less than 0.026). Graft survival was similar in patients who received azathioprine (95%) and those given cyclosporine (94%). The azathioprine group had a higher mortality (7%) than the cyclosporine group (2%). In a comparison of the two treatment groups, no statistically significant difference was found in posttransplant renal function, based on either serum creatinine or iothalamate clearance. We conclude that renal toxicity due to cyclosporine can be minimized to statistical nonsignificance by using cyclosporine dosages that provide trough whole blood concentrations in the range of 150 to 250 ng/ml during the first 4 months of therapy and 80 to 200 ng/ml thereafter.
Assuntos
Ciclosporinas/sangue , Transplante de Rim , Adulto , Azatioprina/uso terapêutico , Cromatografia Líquida , Ciclosporinas/administração & dosagem , Ciclosporinas/efeitos adversos , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/efeitos dos fármacos , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Nefropatias/induzido quimicamente , Testes de Função Renal , Masculino , Prednisona/uso terapêutico , Estudos RetrospectivosRESUMO
OBJECTIVE: The causes and circumstances of intracerebral hematoma after kidney transplantation have been poorly studied. No data are available on its impact on outcome after a successful renal grafting. PATIENTS AND METHODS: We used the Mayo Clinic medical diagnostic index to identify the patients with a diagnosis of intracerebral hematoma among the 1573 patients who received a renal transplant at the Mayo Clinic between 1966 and 1998. RESULTS: Ten intracranial hematomas occurred in 9 patients and were the cause of death in 6 (1%) of the 530 patients known to have died. The interval from renal transplantation to intracranial hematoma ranged from 12 to 114 months (average, 57 months). All patients with intracranial hemorrhage had poorly controlled hypertension. Intracranial hematoma was more frequently and significantly associated with autosomal dominant polycystic kidney disease (4/146 [2.7%]; P<.01) and with diabetes mellitus (3/410 [0.7%]; P<.01) than with other underlying causes of renal failure (2/1017 [0.2%]). CONCLUSION: In this preliminary study, the risk of cerebral hemorrhage may have increased 10-fold in patients with autosomal dominant polycystic kidney disease and 4-fold in patients with diabetes mellitus, when compared with the population of patients having other causes of renal failure. Most cerebral hemorrhages were catastrophic and fatal but appeared to be responsible for only 1% of the deaths after renal transplantation.
Assuntos
Hemorragia Cerebral/etiologia , Aneurisma Intracraniano/complicações , Transplante de Rim/efeitos adversos , Rim Policístico Autossômico Dominante/cirurgia , Idoso , Feminino , Humanos , Falência Renal Crônica/genética , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/complicações , RupturaRESUMO
At the inception of a liver transplantation program at our institution, an organ procurement service was established. Specially trained personnel, availability of a transportation system, and development of communication between distant retrieval sites and the operating room were important elements of this service. For the first 100 liver allografts in our transplantation program, 118 retrievals were necessary. The central location of the Mayo Clinic allowed retrieval from anywhere within continental North America. In this initial phase of the liver transplantation program, the concern that organ availability would be the rate-limiting factor was unfounded.
Assuntos
Transplante de Fígado , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/organização & administração , Humanos , América do NorteRESUMO
Monoclonal antibodies were used to identify helper T cells (TH) and suppressor/cytotoxic T cells (TS/C) in liver allograft biopsy specimens obtained 7,21,90,180, and 365 days postoperatively and then annually or during episodes of graft dysfunction and after treatment of rejection episodes. Biopsy specimens were obtained from 70 hepatic allografts from patients treated with cyclosporine and corticosteroids. Rejection was diagnosed by the presence of appropriate laboratory and light microscopic findings and at least 16 weeks of follow-up to exclude other causes of graft dysfunction. Three immunohistologic patterns were noted: no or only a trace of T lymphocytes, predominantly TH infiltrate with or without a small amount of TS/C cells (portal TH), and a mixture of TH with an equal or greater number of TS/C infiltrate (portal mix). Of 68 biopsy specimens obtained during quiescent periods, only 3 had a portal tract T-lymphocyte infiltrate. Of 30 protocol biopsy specimens, 24 contained such an infiltrate a mean of 12.4 days before biochemical and routine histologic indications of rejection in the allograft. At the time of the rejection episode, 33 biopsy specimens were immunohistologically labeled; portal tract T-lymphocyte infiltrate was predominantly TH in 8 and a mixture of TH and TS/C in 25. All rejection episodes with a predominantly TH pattern responded to methylprednisolone. Of the 25 rejection episodes with a portal mix pattern, only 3 responded to methylprednisolone. Eighty-seven biopsy specimens were obtained more than 10 days after treatment of rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Rejeição de Enxerto , Transplante de Fígado , Sistema Porta/patologia , Linfócitos T/patologia , Anticorpos Monoclonais , Seguimentos , Rejeição de Enxerto/efeitos dos fármacos , Humanos , Técnicas Imunoenzimáticas , Fígado/imunologia , Metilprednisolona/uso terapêutico , Sistema Porta/imunologia , Linfócitos T/imunologiaRESUMO
OBJECTIVE: To characterize a clinical syndrome that occurs in some women who have undergone breast or axillary lymph node biopsy or partial mastectomy. MATERIAL AND METHODS: Six case reports are presented, the clinical and histopathologic findings are described, and the implications for recognition of this entity are discussed. RESULTS: Patients who had undergone partial mastectomy, breast biopsy, or axillary lymph node excision shortly thereafter had clinical signs (most notably, erythema and edema) suggestive of infectious mastitis or inflammatory breast cancer. Representative histologic sections of involved skin revealed dilated dermal vessels without specific evidence of infection or cancer. Although antibiotic therapy was generally ineffective, the clinical findings resolved with time (from 2 months to 1 year). This condition should be considered in the differential diagnosis when this circumscribed patient population has such intervention-related symptoms. CONCLUSION: This clinical syndrome may mimic an infectious or neoplastic process, but we hypothesize that it is due to interruption of lymphatic vessels. Appropriate recognition may alter the use of antibiotic therapy or surgical intervention.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias , Adenocarcinoma/patologia , Idoso , Axila , Biópsia , Neoplasias da Mama/patologia , Feminino , Humanos , Linfonodos/patologia , Mastectomia Radical Modificada , Mastectomia Segmentar , Mastite/diagnóstico , Pessoa de Meia-IdadeRESUMO
The medical records of 293 patients who underwent renal transplantation were analyzed for the occurrence of Streptococcus pneumoniae and Haemophilus influenzae infections in relation to splenectomy. Splenectomy was done in 236 (81%) graft recipients before or concomitant with transplantation. Bacteremia developed in five and fulminant sepsis in two from 3 to 32 months after splenectomy. No serious infections with these organisms occurred in the nonsplenectomy group. These results suggest that asplenia may be an additional factor predisposing transplant patients to serious infection. Prevention of these serious pneumococcal infections may be possible with polyvalent pneumococcal vaccine.
Assuntos
Transplante de Rim , Infecções Pneumocócicas/etiologia , Esplenectomia/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/prevenção & controle , Estudos Retrospectivos , Risco , Transplante Homólogo , VacinaçãoRESUMO
Recurrent corticosteroid-resistant nephrotic syndrome with focal segmental glomerulosclerosis (FSGS) caused the failure of a first renal allograft in a 41-year-old man. Recurrence of the nephrotic syndrome in the second renal allograft was successfully controlled by the administration of meclofenamate, and the renal function has remained stable for 2 1/2 years. No accepted treatment is available for corticosteroid-resistant nephrotic syndrome with FSGS. This report suggests that administration of meclofenamate might be beneficial in some patients with corticosteroid-resistant nephrotic syndrome and FSGS. Because of the potential side effects, however, careful supervision of this therapy is of the utmost importance.
Assuntos
Glomerulonefrite/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Transplante de Rim , Ácido Meclofenâmico/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , ortoaminobenzoatos/uso terapêutico , Adulto , Creatinina/sangue , Glomerulosclerose Segmentar e Focal/etiologia , Humanos , Masculino , Síndrome Nefrótica/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Proteinúria/tratamento farmacológico , Proteinúria/etiologia , RecidivaRESUMO
Abdominal pain, oligoarthritis, macular skin rash, and urine sediment with more than 100 erythrocytes per high-power field and proteinuria developed in a renal transplant recipient who had no prior history of an underlying connective tissue disease. A polyarteritis-type necrotizing vasculitis was detected in the small bowel mesentery. A search for other etiologic factors revealed none. This case demonstrates that de novo vasculitis can develop in renal transplant recipients despite adequate immunosuppressive regimens and may respond to increased dosages of corticosteroids.
Assuntos
Transplante de Rim/efeitos adversos , Poliarterite Nodosa/etiologia , Terapia Combinada , Humanos , Terapia de Imunossupressão , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/patologia , Prednisona/uso terapêuticoRESUMO
Better perioperative and operative management techniques have contributed to an improvement in the success rate of pancreas transplantation. Because of a shortage of donor organs, the criteria for acceptability of the allograft have been liberalized, and the development of techniques such as combined liver and pancreas procurement has increased allograft availability. Major advances have been made in organ preservation. Currently, pancreas allografts can routinely be stored for 18 to 24 hours. The technique of pancreaticoduodenal transplantation with a duodenocystostomy for the exocrine drainage is widely used. Experience with anesthetic and intensive-care unit management of these patients is accumulating. With the evolution of pancreas transplantation and with the help of the excellent transplant centers in our area, we developed a pancreas transplantation protocol and performed transplantation based on this protocol in 16 recipients at the Mayo Clinic from October 1987 through December 1988.
Assuntos
Transplante de Pâncreas/métodos , Adulto , Cuidados Críticos , Complicações do Diabetes , Diabetes Mellitus/patologia , Diabetes Mellitus/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pâncreas/patologia , Pacientes , Complicações Pós-Operatórias , Doadores de Tecidos , Transplante Homólogo/métodosRESUMO
Aerobic exercise training has been used as part of the treatment for a variety of chronic disorders, most notably cardiovascular disease. In order to determine the feasibility and utility of regular exercise after renal transplantation, the responses of 10 patients to graded exercise testing were compared before training (T1), immediately after a program of supervised exercise training (T2), and a mean of 2.2 years after completion of the supervised program (T3). Supervised exercise sessions began a mean of 17 days postoperatively and continued for a mean of 5.5 weeks. Patients were encouraged to continue regular unsupervised exercise thereafter. All patients easily tolerated the supervised exercise sessions, which consisted of treadmill walking and cycle ergometry. Exercise capacity improved 90% between T1 and T2 and an additional 12% between T2 and T3. On the average, patients achieved a normal exercise capacity by 8 weeks after transplantation. Of the 10 patients, 7 had continued regular exercise training at T3. The observed increase in aerobic exercise capacity was probably related to improved renal function, an increased hemoglobin concentration, and the surgical healing process as well as the exercise training. We conclude that supervised exercise training for selected patients after renal transplantation is feasible and worthwhile.
Assuntos
Terapia por Exercício , Transplante de Rim , Adolescente , Adulto , Estudos de Avaliação como Assunto , Teste de Esforço/métodos , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/reabilitação , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Malignant nonchromaffin paraganglioma (chemodectoma) is an unusual tumor arising from chemoreceptor cells derived from the neural crest. Although these tumors generally occur in the head and neck, where the term "carotid body tumor" applies, more than 20 cases of retroperitoneal origin have been described. This case report presents the clinical, radiographic, and pathologic features of a chemodectoma arising in the retroperitoneal area that produced severe hypertension by unilateral real vascular compression. The patient underwent exploratory laparotomy, and a left nephrectomy was done. Follow-up examination 1 year after surgery disclosed no clinical evidence of disease, and he had normal blood pressures without medication.