Beldon A. Idelson

Renal autotransplantation for recurrent renal colic.

Renal autotransplantation as an alternative to ileal interposition has been done successfully in patients with repetitive episodes of renal colic. Urinary tract continuity has been re-established by anastomosis of a Boari tube directly to the renal pelvis. This has resulted in easy egress of recurrent calculi without pain. Furthermore, the musculature of the Boari tube seems to be adequate for prevention of vesicorenal reflux. The procedure has been devoid of electrolyte and mucous urinary retention problems associated with ileal interpositionand it is advocated as an alternative in the management of such patients when medical therapy fails.

Clinical Use of Rabbit Antihuman Lymphocyte Globulin in Cadaver-Kidney Transplantation

Abstract Twenty-six consecutive recipients of cadaver-kidney transplants were treated with rabbit antihuman lymphocyte globulin (ALG) in addition to conventional immunosuppressive therapy. Each of the first 10 of these recipients has been followed for more than 12 months. The one-year transplant survival in this group was 90 per cent. Rabbit ALG administration was well tolerated. Most patients had no symptoms related to ALG injections. There were four acute transplant rejection episodes in the first 10 patients and four episodes in 16 subsequent patients followed for more than four months. All acute rejection episodes occurred six weeks or more after transplantation, and all were easily and promptly reversed by a temporary increase in the dose of steroid therapy. Immediate, hyperacute rejection by preformed antibodies was the only cause of kidney transplant loss in the entire series.

Nephrostomy in renal transplantation.

Abstract Complications leading to urinary extravasation developed in four of thirty-three renal transplant recipients. The management of these patients was facilitated by the use of temporary nephrostomy drainage, resulting in a functioning kidney and survival in all cases. The advantages of nephrostomy in transplantation, as described, are as follows: fistulas and extravasations, dangerous in the immunosuppressed patient, can be converted to situations of controlled urinary drainage; the success of reoperative surgery of the urinary tract can be secured by total urinary diversion accomplished by nephrostomy; and excellent postoperative radiologic studies of urinary tract disease can easily be performed by nephrostogram. We believe that these cases demonstrate the value of the much maligned nephrostomy in the transplanted patient, converting the potentially fatal complications of urinary leakage and obstruction to more easily manageable problems.

Profound persistent eosinophilia in a patient with spontaneous renal atheroembolic disease

We describe an elderly women who died of renal failure secondary to spontaneous renal atheroembolic disease. The sole clinical clue to this diagnosis was a profound eosinophilia up to 19,100/mm3 and a relative eosinophil count of 80%. Renal atheroembolic disease should be a prominent consideration in any patient with both renal insufficiency and peripheral eosinophilia.

A Continuous Ambulatory Peritoneal Dialysis Patient With Fungal Peritonitis

A 42-year-old black man with end-stage renal disease (ESRD) was admitted to the hospital because of cloudy peritoneal dialysate, nausea, anorexia, and abdominal pain. Eight years previously he had had advanced chronic renal failure, malignant hypertension, and bilaterally small kidneys. Aggressive management of his hypertension led to no improvement of his renal function and he started on chronic hemodialysis. A cadaver donor kidney transplant performed in 1985 was lost to chronic rejection in 1987. He subsequently began chronic ambulatory peritoneal dialysis (CAPD), using four daily exchanges of 2 liters of dialysate. He did well until 6 weeks before the present admission when an episode of bacterial peritonitis was successfully treated with appropriate antibiotics. One week later he was admitted with right lower lobe pneumonia and received intravenous antibiotics for 10 days. The respiratory infection resolved, but no etiologic agent was demonstrated. Three weeks later, he returned because of cloudy peritoneal effluent, mild abdominal pain, nausea and vomiting, and low-grade fever. His temperature was 37.0C and he had diffuse abdominal tenderness with guarding. Laboratory abnormalities included blood urea nitrogen of 73 mg/dl, serum creatinine of 17.1 mg/dl, and a peripheral white blood cell (WBC) count of 1 l,200/mm3. The peritoneal fluid contained 110 red blood cells and 2,200 WBC/mm3, with 82% neutrophils and 18% mononuclear cells. A Grams stain demonstrated budding yeast forms and pseudohyphae, later identified as Candida albicans.