G. D. Chisholm

POSSIBLE AIRBORNE SPREAD OF SERUM-HEPATITIS VIRUS WITHIN A HÆMODIALYSIS UNIT

Abstract An outbreak of Australia (Au) antigen-positive hepatitis in a haemodialysis unit seems to have been due to a specific incident, when a considerable amount of Au-antigen-positive blood was spilled. If the reasoning presented is correct, then haemodialysis units will have to take precautions against the airborne spread of the serum-hepatitis virus.

LATE URINARY-TRACT INFECTION AFTER RENAL TRANSPLANTATION

Abstract Urinary-tract infection occurring three months after renal transplantation was studied in 52 patients. The incidence of infection was 83% in females and 43% in males. When the primary diagnosis was chronic pyelonephritis the infection-rates were significantly greater than with other end-stage renal diseases. Since there was no evidence that these infections affected the function of the transplanted kidney, a conservative approach in the management of such patients is recommended.

Urea distribution in the body after haemodialysis.

With increasing use of the artificial kidney as a definitive method of treatment in some cases of renal failure, opportunities have arisen to study the effects of haemo dialysis on urea distribution in the body. Although it has been generally accepted that urea is freely and rapidly diffusible in the body fluids of normal subjects (McCance and Widdowson, 1951), the validity of this concept in uraemic patients undergoing haemodialysis on an artificial kidney has recently been questioned, and evidence has been adduced to support a contention that a relatively non-freely diffusible intracellular urea exists in such circumstances (Blackmore and Elder, 1961). In individual uncomplicated cases of acute oliguric renal failure the pre-dialysis daily increment of plasma

HYPERTENSION IN PATIENTS ON REGULAR HÆMODIALYSIS AND AFTER RENAL ALLOTRANSPLANTATION

Abstract The blood-pressure in a group of forty patients on a renal replacement programme for at least 5 months (mean period 17 months) has been investigated. Sixteen had been on regular intermittent haemodialysis and twenty-four had been treated by renal allotransplantation. Transplantation provided better results in respect of the blood-pressure. Bilateral nephrectomy in patients on dialysis and after transplantation is recommended for patients with persistent hypertension. In cases where hypertension persists in patients after transplantation and nephrectomy, chronic rejection or stenosis of the arterial anastomosis are usually responsible.

The diagnosis of rejection of renal allotransplants in man.

Abstract The changes in eight simple laboratory determinations on blood and urine in 20 rejection episodes after renal allotransplantation have been analysed. The most significant changes were a fall in the 24-hour urinary urea and osmolar excretion; these were also the earliest and most reliable evidence of a rejection episode. Changes in 24-hour urine volume and platelet-count were also significant but were harder to evaluate. In all rejection episodes there was a significant decrease in creatinine clearance which returned to previous levels after treatment. The changes in blood-urea, 24-hour urinary protein, and sodium excretion were neither early nor significant.

MEASUREMENT OF GLOMERULAR FILTRATION-RATE USING 131I-DIATRIZOATE

Abstract Glomerular filtration-rate was measured after a single injection of sodium 131 I-diatrizoate and external counting over the heart. The results obtained show a highly significant correlation with standard diatrizoate clearances, and are more accurate than endogenous creatinine clearances. The method is simple and clinically useful and has the advantages that it does not require intravenous infusion, urine collection, or difficult chemical estimation.

MEASUREMENT OF EFFECTIVE RENAL PLASMA-FLOW BY THE CLEARANCE OF 125I-HIPPURAN

Abstract In a comparison of the clearance of p -aminohippurate and 125 I- o -iodohippurate in 30 patients, this radioisotope was found to provide a simple and accurate method for measuring the effective renal plasma-flow.

Investigations into the use of 77Br labelled 5α-dihydrotestosterone for scanning the prostate

The potential use of a potent androgen labelled with a gamma emitting radionuclide for scanning the prostate was investigated. 2αbromo 5α-dihydrotestosterone was synthesized and subsequently labelled with 77Br. The distribution of this compound was studied in rat and human tissues. The maximum concentration of radioactivity in the rat prostate at 1–4 h following the injection was found to be between 0.5–0.8% of the injected dose per gram of the tissue. In the human however, that value was 0.002–0.003%. Considering the overall results it was concluded that this compound is not appropriate for scanning the prostate.

FACTORS INFLUENCING EARLY FUNCTION OF CADAVER RENAL TRANSPLANTS

Abstract 33 cadaveric renal transplantations have been analysed with respect to the influence of donor ventilation, donor hypotension, and ischaemic times on the onset of function. Provided antemortem donor hypotension does not exceed 1 hour, the transplanted kidney functions within 4 days even when the warm ischaemia has been 2 hours. However, if donor hypotension exceeds 6 hours, the onset of function is likely to be delayed and dialysis will be required.

HYPERCALCÆMIA FROM CALCIUM ION-EXCHANGE RESIN IN PATIENTS ON REGULAR HÆMODIALYSIS

Abstract Significant hypercalcaemia due directly to therapy with calcium ion-exchange resin (120 g. weekly) to control hyperkalaemia is reported in five of eight patients with chronic renal failure undergoing regular intermittent haemodialysis. This was not always associated with an abnormal calcium x inorganic-phosphate product, because of concurrent aluminium-hydroxide therapy. The need for calcium ion-exchange resin to control hyperkalaemia in these patients has been avoided by lowering the potassium concentration in the dialysate.