A. Khedher

Incidence and Risk Factors for Post–Renal Transplant Diabetes Mellitus

INTRODUCTION Posttransplant diabetes mellitus (PTDM) is a common, serious complication of renal transplantation. The aim of this retrospective study was to estimate the incidence and to identify potential factors predisposing to PTDM. PATIENTS AND METHODS We evaluated 296 adult nondiabetic patients who underwent kidney transplantation at our center. PTDM was defined according to 2003 international consensus guidelines. Potential factors predisposing to PTDM were analyzed individually and simultaneously using a logistic regression model. RESULTS Over 2054.5 years of cumulative follow-up, 51 patients (17.2%) developed diabetes corresponding to an annual incidence of 2.5%. PTDM was diagnosed after a median of 2.9 months (range: 0.2-168). The mean age of affect individuals was 33.3±7.4 years. Patients with PTDM were significantly older (P<.0005) and showed an higher body mass index (BMI; P<.004). Univariate analysis revealed that age, BMI, family history of diabetes, vascular nephropathy, and hepatitis C infection were associated with PTDM. Multivariate analysis rescaled the roles of age (relative risk [RR]=1.046/y; P<.04), BMI (RR=1.107/kg/m2, P<.05), vascular nephropathy (RR=7.06, P<.03), and hepatitis C infection (RR=2.72, P<.03) as independent factors predisposing to PTDM. CONCLUSION Among our relatively young kidney transplant recipients, in whom only 8% received tacrolimus, PTDM was a frequent complication. We suggest that the use of oral glucose tolerance tests to screen patients identifies those predisposed to develop this complication.

La fibrose rétropéritonéale

Resume Objectif Nous avons etudie les caracteristiques cliniques, therapeutiques et evolutives de la fibrose retroperitoneale. Methodes Nous avons analyse les observations de fibrose retroperitoneale diagnostiquees entre 1980 et 2002 dans notre hopital, a partir des resumes de 15 patients ayant une fibrose retroperitoneale (FRP). La surveillance therapeutique a ete fondee sur la biologie et la radiologie. Resultats Il s’agissait de 11 hommes et de 4 femmes dont l’âge moyen etait de 44,5 ans avec des extremes de 28 a 64 ans. Tous les malades avaient des douleurs essentiellement lombaires et abdominales. Un syndrome inflammatoire existait dans tous les cas et une insuffisance renale dans 11 cas. Les explorations radiologiques ont montre une hydronephrose uni ou bilaterale dans 14 cas et la plaque de fibrose dans 13 cas. Le traitement a ete constitue de corticoides seuls dans 9 cas, de chirurgie seule dans 3 cas et de chirurgie associee a la corticotherapie dans 3 cas. Dix rechutes a raison de 1 a 5 ont ete observees chez 4 malades apres arret des corticoides. Apres un delai moyen de suivi de 36 mois (18 j a 11 ans) 1 deces a ete observe, 12 patients avaient une fonction renale normale et 2 malades ont garde une insuffisance renale moderee. Conclusion Nous avons confirme la rarete de la fibrose retroperitoneale, la difficulte de son diagnostic, la frequence de la douleur, du syndrome inflammatoire et de l’insuffisance renale. Les corticoides sont efficaces et un suivi regulier est necessaire.

Multiple myeloma of the liver presenting as non-obstructive jaundice

Dear Editor, Multiple myeloma (MM) involves, mainly but not exclusively, the bone marrow. It is occasionally associated with jaundice. The underlying process may be a myeloma infiltration of the head of the pancreas or hepatic amyloid deposition or extra-hepatic biliary obstruction due to an abdominal plasmacytoma. A rare case of myeloma manifested by jaundice after hepatic myeloma infiltration is reported. A 55-year-old man was referred to our hospital because of weakness, weight loss and jaundice. Physical examination showed somnolence, jaundice and hepatomegaly 10 cm below the costal margin. Cardiovascular and respiratory examinations were normal. Results of the blood test performed on admission were as follows: calcium 3.62 mmol/l, bilirubin 203 μmol/l, alkaline phosphatase 373 IU/l (normal 100–280 UI/l), γ-glutamyltransferase 888 IU/l, lactate dehydrogenase (LDH) 727 IU/l (normal 5–270 IU/l), aspartate aminotransferase (SGOT) 145 IU/l, alanine aminotransferase (SGOT) 136 IU/l, creatinine 1395 μmol/l, haemoglobin 7.6 g/dl, white cell count 8.9× 10/l, platelets 82×10/l, prothrombin index 46% and Creactive protein 40 mg/l. Serum and urine protein studies revealed an M-component Lambda. Serological tests were negative for hepatitis B and C viruses. Blood, stool and urine cultures did not reveal any growth. A bone marrow aspirate was performed, showing 46% of atypical plasma cells with prominent nucleoli (Fig. 1). Residual normal haemopoeitic cells were markedly reduced in number. There was no evidence of lytic lesions on X-ray films. However, abdominal ultrasound scan showed hepatomegaly and ascitis. Neither biliary dilatation nor tumor nodules were seen by abdominal computerized axial tomography (Fig. 2). A liver biopsy was performed and showed dilated sinuses containing plasma cells, plasmablasts and extramedullary haemopoeitic cells. Myeloma cells also infiltrated portal tracts (Fig. 3). There was no evidence of amyloid deposition in the liver biopsy. A diagnosis of MM with liver involvement was made. The patient was treated with Dexamethasone. But unfortunately, his condition deteriorated with the onset of renal failure. He died a few days later. Extraosseous manifestations are found in less than 5% of patients with MM. Elevation of the LDH level suggest the presence of occult extraosseous disease and predict a poor prognosis [1, 2]. In our patient, the serum LDH level was very high. Myeloma causing jaundice has occasionally been reported in literature. However, all cases reported to date have been due to hepatic amyloid deposition or extrahepatic biliary tract obstruction. As far as we know, only two cases of liver dysfunction due to plasma-cell infiltration have been confirmed by biopsy [3, 4]. Liver involvement in MM is uncommon. It is frequently found at autopsy, but it is clinically manifest in a few patients. Signs of liver dysfunction are not part of the Ann Hematol (2007) 86:529–530 DOI 10.1007/s00277-007-0267-9