Mary G. McGeown

CYCLOPHOSPHAMIDE AND REPRODUCTIVE FUNCTION

Abstract Eight male patients who had received cyclophosphamide showed testicular atrophy on histological examination. In two there was evidence of regeneration 28 and 10 months after the end of treatment. Six out of eight female patients (all of whom developed amenorrhœa during cyclophosphamide therapy) had a return of menstruation when the drug was withdrawn.

Erythropoietin production in kidney tubular cells

The erythropoietin gene has been cloned in three mammalian species including man and recombinant erythropoietin is now used to treat the anaemia of chronic renal failure. Despite the isolation of the gene the precise cellular location of erythropoietin synthesis remains controversial. We present studies which demonstrate erythropoietin production by kidney tubular cells. Erythropoietin gene expression (messenger RNA) was detected by in situ hybridization using an oligonucleotide gene probe and the translated protein product by immunohistochemistry employing antibodies raised to pure recombinant DNA derived erythropoietin.

ACUTE RENAL FAILURE IN THE ELDERLY

Abstract Dehydration and electrolyte imbalance were important factors in the development of acute renal failure in 122 elderly patients. These factors were present in 50% of the cases. The mortality was 57·3% and this corresponds with the overall mortality in acute renal failure, irrespective of age.

Advantages of low dose steroid from the day after renal transplantation.

We have used a low dose of steroid (20 mg of prednisolone), commencing the day after transplantation, for 151 consecutive renal transplants in 141 patients. Five patients received grafts from living related donors, 146 received cadaver grafts. All patients received azathioprine for routine immunosuppression and the first 47 received a single dose of actinomycin C i.v. for treatment of rejection. No other immunosuppressive drugs were used. This treatment provided satisfactory immunosuppression as 109 of 151 grafts continue to function for periods of 3 months to 10 years and, of 42 grafts lost, only 17 failed from rejection. The cumulative survival of first cadaver grafts at 1 and 2 years in recipients of all ages (7 to 55 years) was 77.9 and 76.0%, respectively; in recipients 15 to 34 years old, 90.9 and 86.1%, respectively. Twenty-three patients died, no patient died from infection during the admission for transplantation, and infection played a part in the deaths of only four patients. The incidence of other complications was low; seven patients developed gastrointestinal complications, one died, four patients developed diabetes, all survived; only one patient developed avascular necrosis of bone.

ONE HUNDRED KIDNEY TRANSPLANTS IN THE BELFAST CITY HOSPITAL

Abstract 100 kidney transplants have been carried out on 91 patients (7 had 2 transplants and 2 had 3 transplants). 4 transplants were from living related donors and 96 from cadavers. 76 patients survive, all but one with functioning kidneys. The cumulative survival of patients was 82% at 2 years and 80·7% at 5 years. 8 patients died with functioning grafts, and 2 of the other deaths took place more than 3 months after removal of a rejected kidney and resumption of haemodialysis. There were no deaths from sepsis in the first 60 days after transplantation. The cumulative survival of all grafts was 82·1% at 2 and 5 years. The cumulative survival of first grafts was 82·5% at 2 and 5 years.

MAGNESIUM/CALCIUM RATIO IN URINE OF PATIENTS WITH RENAL STONES

Abstract The urinary magnesium/calcium ratio was found to be significantly lower in patients with renal stones than in healthy controls. There are indications that a decrease in this ratio is an important factor in the process of stone formation and it would appear that an attempt to increase it might be worth while, at least in those patients with recurrent renal stones in whom this ratio is low.

Prevalence of advanced renal failure in Northern Ireland.

OBJECTIVE--To determine the prevalence of advanced chronic renal failure in Northern Ireland as part of an assessment by the Renal Association of the level of service provision for treatment of such patients. DESIGN--Prospective notification of patients reaching a defined level of advanced chronic renal failure (serum creatinine concentration greater than or equal to 500 mumol/l or blood urea concentration greater than or equal to 25 mmol/l) within one year and follow up for at least three, and, at most, four years after notification. SETTING--Northern Ireland. PATIENTS--122 Patients with a serum creatinine or blood urea concentration higher than the defined level newly detected from 1 March 1985 to 28 February 1986. MAIN OUTCOME MEASURE--Survival after notification. RESULTS--77 Patients of all ages/million population/year had advanced chronic renal failure compared with 67/million/year between the ages of 5 and 80 found in an earlier study of the same population. 62% Of the patients were older than 50 years. Seventeen (14%) of the patients either required dialysis or died within one month of notification, 51 (42%) survived for at least three months, and 23 (19%) for one year or longer. Three patients, all of whom were attending a renal clinic, survived for periods of 43, 45, and 46 months respectively without renal replacement treatment. CONCLUSIONS--The increased number of new patients disclosed in this survey compared with the earlier survey is mainly owing to an increased number of older patients. Such patients often have disabilities other than renal failure, are less likely to be capable of self treatment, may develop complications more often and require more frequent hospital admissions, and may not be suitable for transplantation and consequently have considerable resource implications for the NHS.

Further details of third recorded case of redwater (Babesiosis) in man

Clinical details and laboratory and postmortem findings of a human case of redwater (piroplasmosis or babesiosis) caused by Babesia divergens. This is the third proved case in man. All three patients had had splenectomies.

TEN-YEAR RESULTS OF RENAL TRANSPLANTATION WITH AZATHIOPRINE AND PREDNISOLONE AS ONLY IMMUNOSUPPRESSION

93 patients received 102 renal transplants between 1968 and 1977. 99 grafts were from cadavers and 3 were from live donors; 93 were first grafts, 7 were second, and 2 were third. At 10 years total actual patient survival was 66.6%. 50 (55.5%) of 90 first cadaver grafts, and 52.2% of all cadaver grafts, survived at 10 years. Cardiovascular disease was the commonest cause of death, being responsible for 18 of 31 deaths (58%).

CHRONIC RENAL FAILURE IN NORTHERN IRELAND, 1968-70: A Prospective Survey

Abstract A prospective survey of patients suffering from renal failure, with a bloodurea permanently above 100 mg. per 100 ml., was carried out over the three-year period 1968-70. The patients notified were followed up until death, acceptance for regular dialysis, or the end of the survey period, and their suitability for treatment was assessed. Over the three-year period there were 176 patients aged 5-60 considered suitable for regular dialysis therapy in a population of 1·5 million (a frequency of 38 per million per annum) and there were 150 patients aged 5-55 (a frequency of 33·3 per million per annum).