J. H. Brown

Dermatologic lesions in a transplant population.

Many authors have reported an increase in the incidence of skin neoplasia in renal transplant patients. Two hundred and twenty-three patients, who received a renal transplants between 1965 and 1984, were examined for the presence of skin lesions. There was a high incidence of simple warts (24%) and hyperkeratoses (21%). Frank malignancy had developed in 9 patients; this is more than 4 times the expected incidence for the population of Northern Ireland.

Outcome of pregnancy following renal transplantation

SummarySuccessful renal transplantation improves fertility with 1 in 50 women of childbearing age becoming pregnant. Pregnancy following renal transplantation is associated with increased maternal and fetal complications. In Belfast 118 women of childbearing age (15–45 yrs) have received a renal allograft and of these 14 (12%) have become pregnant. Twenty-seven pregnancies have resulted in 23 live births (including one set of identical twins), 1 still birth and 4 first trimester abortions. The most frequent complications were hypertension and prematurity. In this group of patients, whose sole immunosuppressive therapy was azathioprine and prednisolone, pregnancy post transplantation was associated with frequent successful outcome and a low incidence of maternal and fetal complications.

Renal replacement therapy in multiple myeloma and systemic amyloidosis

Renal failure frequently complicates both multiple myeloma and systemic amyloidosis. Renal replacement therapy (RRT) may be poorly tolerated and its role in such patients is not clearly defined. Of fifty patients (26 males and 24 females) referred to a single centre because of renal failure associated with multiple myeloma or systemic amyloidosis 37 progressed to end-stage renal failure and 30 of these patients received RRT. Nine patients have been treated by CAPD, 13 by haemodialysis, and 8 patients have required both forms of dialysis.Overall one year and two year survival rates were 66 % and 57 % respectively. The median duration on RRT was 7.5 months (range 1–96 months) with a 51% one year, and a 46% two year survival rate. Of 7 patients with amyloidosis who underwent renal transplantation, 3 died within 6 months of transplantation. Undiagnosed cardiac involvement contributed to this early mortality.We conclude that renal replacement therapy is appropriate for some patients with multiple myeloma and systemic amyloidosis who develop endstage renal failure. Careful asssessment and selection of patients is necessary prior to renal transplantation.

The effect of hypoxia on the erythropoietin response of the uremic rabbit model

Hypoxia induces a number of physiological responses including changes in blood gases, changes in acid-base status, and an increase in circulating erythropoietin (Epo) (1). Epo is a glycoprotein hormone that controls the red cell mass and is produced in the kidney. Chronic renal failure (CRF) is almost invariably accompanied by anemia caused by underproduction of Epo (2). However, the diseased kidney retains the ability to respond to short-term hypoxia; Blumberg et al. (3) have shown that an elevation in erythroid stimulating factor (ESF) occurred in patients with dialysis-dependent CRF who were transferred to altitude for a day. Metabolic acidosis and an increase in red cell 2,3-DPG levels, leading to a shift in the oxygen dissociation curve, are also usually found in CRF. We have investigated the physiological changes and increases in circulating Epo caused by short-term hypobaric hypoxia using a 56-nephrectomized rabbit model of CRF.