Kidney transplantation in Brazil and its geographic disparity.

The Brazilian National Transplantation System coordinates and regulates perhaps the largest public transplantation program worldwide. Since its implementation in 1997, the number of kidney transplantations increased from 920 (5.8 pmp) in 1998, to 4,630 (24.

Hemorrhagic cystitis secondary to adenovirus or herpes simplex virus infection following renal transplantation: four case reports.

Viral infections are common complications following renal transplantation. However, there have been few reported cases of viral cystitis secondary to herpes simplex virus or adenovirus infection. Herein, we have reported four cases of hemorrhagic cystitis secondary to infections with herpes simplex virus and adenovirus following renal transplantation.

Renal cell carcinoma in renal transplant patients.

Objectives: To report our experience with renal cell carcinoma in patients with end-stage renal failure receiving dialysis at two institutions that perform a large number of transplantations. Renal cell carcinoma is more frequent in patients with end-stage renal failure treated with dialysis and in renal transplant patients than in the population at large.

Methods: We reviewed the case histories of 1375 consecutive patients who had transplanted kidneys functioning for more than 1 year.

Bilateral nephrectomy of huge polycystic kidneys associated with a rectus abdominis diastasis and umbilical hernia.

Background: Patients with end-stage renal failure due to huge autosomal dominant polycystic kidney disease usually have an umbilical hernia and rectus abdominis diastasis, which are very troublesome. Pretransplant bilateral nephrectomy techniques does not manage the umbilical hernia and rectus abdominis diastasis. We report our experience in performing bilateral nephrectomy and repairing the rectus abdominis diastasis and umbilical hernia through the one, small incision.

Coronary angiography is the best predictor of events in renal transplant candidates compared with noninvasive testing.

Guidelines for the detection of coronary artery disease (CAD) and assess of risk in renal transplant candidates are based on the results of noninvasive testing, according to data originated in the nonuremic population. We evaluated prospectively the accuracy of 2 noninvasive tests and risk stratification in detecting CAD (>or=70% obstruction) and assessing cardiac risk by using coronary angiography (CA). One hundred twenty-six renal transplant candidates who were classified as at moderate (>or=50 years) or high (diabetes, extracardiac atherosclerosis, or clinical coronary artery disease) coronary risk underwent myocardial scintigraphy (SPECT), dobutamine stress echocardiography, and CA and were followed for 6 to 48 months.

The relationship between ultrafiltrate volume with icodextrin and peritoneal transport pattern according to the peritoneal equilibration test.

Objective: To establish a relationship between peritoneal transport membrane pattern, analyzed by the peritoneal equilibration test (PET), and drained volume using icodextrin (7.5% Ico) and glucose (3.86% Glu) solutions.

Reciprocal influences between ambulatorial peritoneal dialysis and pulmonary function.

The aim of this study was to verify if dialysis solution volumes used in patients on continuous ambulatory peritoneal dialysis (CAPD) interfere with pulmonary function and if the pulmonary volumes interfere with the lymphatic absorption of the peritoneal cavity. We submitted 10 CAPD patients with a mean age of 48 +/- 18 years and on CAPD for 35 +/- 27 months to the following evaluations: first, measurement of the lymphatic absorption from the peritoneal cavity; second, measurement of the hydrostatic intraperitoneal pressure; and third, expirometry with the peritoneal cavity full of dialysis solution and empty. There were no differences between the expirometry results obtained with the peritoneal cavity full and empty of dialysis solution, and the results were in accordance with the prediction for this population.

Hyperhomocyst(e)inemia in chronic stable renal transplant patients.

Purpose: Hyperhomocyst(e)inaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(e)inemia in renal transplant recipients.

Methods: Total serum homocysteine (by high performance liquid chromatography), creatinine, lipid profile, folic acid (by radioimmunoassay-RIA) and vitamin B12 (by RIA) concentrations were measured in 3 groups.

Intraperitoneal pressure and hernias in children on peritoneal dialysis.

Abdominal wall hernias have been increasingly recognized in patients on continuous ambulatory peritoneal dialysis (CAPD). They are also more frequent in children than in adults. The aim of this study was to determine the influence of intraperitoneal pressure (IPP) on the development of hernias in children on CAPD, and if there was a difference between IPP in children and adults.

The impact of azathioprine on chronic viral hepatitis in renal transplantation: a long-term, single-center, prospective study on azathioprine withdrawal.

Background: In transplanted patients, viral hepatitis progresses to chronic liver disease and patient's death after many years of transplantation. Also, it is well known that azathioprine (AZA) is harmful to the liver of these patients. However, it is unclear whether a low dose of AZA still represents a threat to the viral liver disease.

Dynamic tests of parathyroid hormone secretion using hemodialysis and calcium infusion cannot be compared.

Background: Extracellular Ca++ concentration [Ca++] and parathormone (PTH) are related by a sigmoidal function. The set point of the control system is the [Ca++] that produces a half-maximal inhibition of PTH secretion. Whether or not this set point is abnormal in patients with chronic renal failure (CRF) and secondary hyperparathyroidism (SHP) is controversial.

Effect of dialyser biocompatibility on recovery from acute renal failure after cadaver renal transplantation.

Background: It has been reported that patients with acute renal failure (ARF) requiring haemodialysis show an improved recovery of renal function when the dialysis treatment is performed using a biocompatible membrane rather than a bioincompatible membrane. However, most recent published human trials have not been able to confirm these findings.

Method: Over a 2-year period, we prospectively studied 53 patients with ARF after cadaver renal transplantation who required haemodialysis and randomized them into two treatment groups.

Recurrence of focal segmental glomerulosclerosis associated with Kimura's disease after kidney transplantation.

A 13-year-old Brazilian boy with Kimura's disease (eosinophylic lymphoid granuloma) and nephrotic syndrome is reported. Native kidney biopsy showed focal segmental glomerulosclerosis (FSGS). Treatment with prednisolone resulted in partial remission of proteinuria, and he had a progressive loss in renal function, requiring initiation of chronic dialysis, which he underwent for 46 months.

Histological outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone.

Background: Several studies comparing the response of acute cellular rejection (ACR) episodes to different corticosteroid regimens have been conducted. However, in most of them, the histological evaluation of the infiltrate and its correlation with clinical response was not studied. The clinical and histological outcomes of 37 episodes of ACR treated with methylprednisolone (MP) were studied, with the aim to determine how long the infiltrate takes to be cleared after therapy.

Seasonal variation of blood pressure in maintenance hemodialysis.

Context: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported.

Objective: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis.

Mechanism of the diabetogenic action of cyclosporin A.

To investigate the mechanism of diabetogenic action of cyclosporin A (CsA), 7 male Wistar albino rats received 10 mg/kg/day of the drug for 4 weeks (CsA). The results were compared with controls (C); blood CsA levels measured weekly remained stable throughout the experiment (mean +/- SEM) (X = 2657.9+/-155.

Endolymphatic irradiation in preparation for renal transplantation: a 26-year's follow-up.

Objective: The aim of the present study was to analyze the long-term evolution of patients submitted to endolymphatic irradiation as a pre-transplant preparation.

Setting: Referral center of university hospital.

Design: Case-control study.

Renal transplantation in systemic lupus erythematosus. A case control study of 45 patients.

Background: Outcome and the issue of recurrence of disease in systemic lupus erythematosus (SLE) renal transplant recipients is still a matter of controversy. There is a lack of comparative studies with non-SLE patients. The aim of this paper is to compare renal transplantation in lupus patients with a similar matched non-SLE group.

[Comparison of clinical and histological diagnosis in kidney post-transplantation period].

Purpose: To assess the agreement between clinical and histopathological diagnosis in a renal transplantation center, 40 episodes of acute renal failure were studied.

Methods: Kidney biopsies were performed at the moment that a clinical diagnosis was made by the staff.

Results: Nineteen episodes of acute tubular necrosis (ATN), eighteen episodes of acute cellular rejection (ACR), 2 humoral rejections and 1 acute cyclosporin nephrotoxicity episodes were diagnosed.

Glycosuria in glomerular diseases: histopathology and clinical correlations.

There are doubts about the presence of glycosuria and the progress of glomerular disease. Some reports suggest that glycosuria could be an index of a more severe tubulointerstitial lesion. We investigated the presence of glycosuria in 60 patients with primary glomerular diseases: 17 patients (28%) had glycosuria and 43 patients (72%) were glycosuria free.

Post-transplant neutrophilic interstitial nephritis--an important cause of graft dysfunction.

Post-transplant neutrophilic interstitial nephritis (NIN) is characterized by an interstitial infiltrate consisting of polymorphonuclear cells that leads frequently to acute graft dysfunction. In 220 graft biopsies performed because of renal dysfunction over 2 years in our unit, 11 (5%) diagnoses of NIN were made. Only two patients had chronic pyelonephritis as original disease.

Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology.

Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection.