N. Edward

Death during the first 90 days of dialysis: A case control study☆

Comparison of survival data among centers may be used to assess performance, but may be influenced by the number of patients who die during the first 90 days of renal replacement therapy (RRT). Data published by registries in Europe do not detail these deaths, and US data generally exclude them from analysis for financial reasons. To study factors influencing such deaths we compared 42 patients who died within 90 days of first commencing RRT in one Scottish renal unit (group A) between 1971 and 1992 with 42 age- and sex-matched controls who started RRT over the same period and survived longer (group B). Patients who died within 90 days of RRT ranged in age from 25.3 to 83.7 years and had a mean age of 65.2 (SEM, 1.6; 95% confidence interval, 61.9 to 68.4). The proportion of patients who died during the first 90 days of RRT increased from 2% of all patients treated before 1981 to 12% in subsequent years. Thirty-three patients in group A received emergency dialysis via temporary venous access compared with only nine in group B (P < 0.055). There were more patients in group A with a diagnosis of arteriosclerotic renal artery stenosis (14 v 1) and with a history of smoking (15 v 2) than in group B (P < 0.0005). Median renal or nonrenal follow-up before RRT was 1.1 month in group A and 10.6 months in group B (P < 0.0001). Fewer patients in group A had no coexisting disease (1 v 17; P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of N-acetyl-β-d-glucosaminidase excretion after renal transplantation

N-Acetyl-beta-D-glucosaminidase activity (NAG) was assayed in 750 early morning urine samples from 25 renal transplant patients during the post operative period. Eighty four per cent of all acute rejection episodes were preceded or accompanied by a greater than two-fold rise in NAG activity; similar increases were caused by dialysis, gentamicin therapy and ureteric dehiscence. Only 9% of all significant increases in NAG excretion could not be accounted for by any of these four processes. Analysis of the day-to-day pattern of NAG activity as opposed to individual NAG values provided a clue to the occurrence of rejection during immediate post-transplantation oliguria.

IgA Nephropathy Is Not a Rare Disease in the United Kingdom

A retrospective analysis of all renal biopsies performed in the Grampian Region of Scotland during 1977-1980 revealed that IgA nephropathy was the most frequently encountered glomerular lesion. The commonest indications for renal biopsy were the presence of asymptomatic urinary abnormalities (90/184; 48.9%) especially asymptomatic haematuria (42/184; 22.8%). A histological diagnosis was made in 36 of the 42 patients presenting with asymptomatic haematuria (85.7%); 16 of the 26 cases of IgA nephropathy presented in this way. Overall, IgA nephropathy was detected in 14.1% of all biopsies and accounted for 21.8% of primary glomerular diseases. This study indicates that IgA nephropathy is apparently more common in Grampian than elsewhere in the United Kingdom. However, it is suggested that this does not represent a true variation in the prevalence of the condition; IgA nephropathy is probably a common cause of haematuria in the United Kingdom.

Diagnostic value of urinary N-acetyl-β-d-glucosaminidase, its isoenzymes and the fractional excretion of sodium following renal transplantation

Daily total urine N-acetyl-beta-D-glucosaminidase activity, isoenzyme profile and fractional excretion of sodium were measured in 13 consecutive renal transplant patients. Rejection episodes were clinically diagnosed in 12 patients, 11 of whom (92%) showed an increased enzymuria either before or during the onset of clinical signs. The ratio of the two major isoenzymes (A/B) fell during 10 episodes (83%) and in six of these (50%) increased levels of the minor isoenzyme forms were observed. Increased fractional excretion of sodium was associated with nine (75%) of the episodes. Increased fractional excretion of sodium with a raised total enzymuria accompanied by a reduced A/B ratio and an increased proportion of the minor isoenzyme forms occurred in eight (67%) of the rejection episodes. The use of these measurements in the diagnosis of episodes of acute rejection in renal transplantation is discussed.

POSSIBLE MECHANISM OF ACTION OF TRANSFUSION EFFECT IN RENAL TRANSPLANTATION

The mechanism by which blood transfusions given before renal transplantation improves allograft survival was studied in 31 transplant recipients. The presence of non-cytotoxic, Fc receptor blocking antibodies to donor and leukaemic B lymphocytes in pre-transplant sera correlated with both improved graft survival (p less than 0.03 and less than 0.1, respectively) and the number of blood transfusions given (p less than 0.05 and less than 0.03, respectively). Moreover, 6 out of 10 previously untransfused prospective transplant recipients developed these potentially protective antibodies during a course of elective blood transfusions. These results indicate that such non-cytotoxic, Fc receptor blocking antibodies in pretransplant recipient sera (a) are associated with improved allograft survival, (b) correlate with the number of blood transfusions given, and (c) can develop in response to blood transfusion.

Richter's hernia: an unrecognised complication of chronic ambulatory peritoneal dialysis.

returning to work after a holiday in England he was repatriated severely ill. He had had a progressive dry cough, drowsiness, anorexia, weight loss, and recurring fevers. Examination showed drowsiness and confusion, tachypnoea, tachycardia, and fever of 40°C. Apart from mild oral candidiasis examination showed no abnormality and there was no lymphadenopathy or splenomegaly. He underwent full investigations with negative results apart from a mild leucopenia (white cell count 3-8 x 109/1 with 93 % neutrophils, 7 %/o lymphocytes). Chest radiography showed slight diffuse upper-zone infiltration. Immunoglobulin and immune complex concentrations, T-cell assays, and repeated marrow biopsy specimens were all normal. Appearances at fibreoptic bronchoscopy were normal, but transbronchial biopsy disclosed cysts of P carinii. He was treated with co-trimoxazole without therapeutic response and on the 12th day developed profound pancytopenia necessitating a change to pentamidine. Again there was no response and he gradually deteriorated and died a week later. At necropsy there was confluent consolidation of the left lung and patchy consolidation in all the lobes of the right. The reticuloendothelial system was normal macroscopically, with no enlargement of glands or the spleen. Microscopy confirmed P carinii to be the infective agent in the lungs, and examination of the spleen and lymph nodes showed a histiocytic medullary reticulosis.

Methods for improving the sensitivity and specificity of the fibrin plate

Fibrinogen prepared by the method of Blombäck and Blombäck is most suitable with respect to sensitivity and stability for the estimation of urokinase by the fibrin plate technique. Adding plasminogen to a concentration of around 0·5 casein units/ml 0·2 g% clottable fibrinogen provides substrate conditions of optimal sensitivity and reproducibility.

Social deprivation indices of patients on renal replacement therapy (RRT) in Grampian.

The social deprivation scores of 169 patients who resided in Grampian region and commenced renal replacement therapy (RRT) in Aberdeen during the period 1 January 1985–30 June 1991 were measured when their serum creatinine concentrations were first >=300 μmol/l, using the Jarman Underprivileged Area (UPA) and Carstairs indices. The numbers in the population of Grampian for each score were obtained from the Information Services team of Grampian Health Board based on the 1981 census. Comparison of the numbers of patients in each category of both Jarman and Carstairs indices showed no differences between the observed numbers of patients and the numbers in the general population. Thus in this study social deprivation occurred no more frequently in those commencing RRT than in the general population.

EVIDENCE THAT PROTECTIVE Fc-RECEPTOR-BLOCKING ANTIBODIES IN RENAL TRANSPLANTATION ARE ALLOANTIBODIES NOT AUTOANTIBODIES

We have previously shown that the presence in pretransplant recipient sera of Fc receptor blocking anti-bodies detected by the EA inhibition assay is correlated with improved allograft survival. Twenty-four such sera were assessed for the presence of autoantibodies by the EA inhibition and lymphocytotoxicity assays. No autolymphocytotoxic antibodies were found, and autologous EA inhibition was noted in only one case. EAinhibiting alloantibodies did occur, and their presence was correlated with improved allograft survival. Sera from 37 dialysis patients were also studied, and neither autologous EA inhibiting nor autologous lymphocytotoxic antibodies were present. Thus Fc receptor blocking alloantibodies that were correlated with improved renal transplant survival were not autoantibodies.

Fiona Melville Bennett

Former consultant ophthalmologist Grampian Hospitals, formerly North East of Scotland Regional Hospital Board, 1961-83 (b 1923; q Edinburgh 1946; FRCS Ed), died from the complications of diabetes mellitus on 4 December 2001. In the early 1950s she studied corneal grafting techniques in Lyon and for some years was the only surgeon in Scotland performing these procedures. Her surgical skills were further enhanced by visits to the university eye clinics in Moscow and Leningrad, and the famous clinic of Professor Vladimir Filatov at Odessa in the Ukraine. Fiona was a talented pianist and musician, and had considered a career in that field.