Renal allograft rupture: surgical treatment by renal corsetage with lyophilized human dura

We report 5 cases of renal allograft rupture in which diagnosis was established early through clinical data, laboratory tests and echography. Immediate surgery confirmed the suspicion in all cases. Acute rejection was present in 4 patients and in 1 the previous surgical puncture from the perirenal collection demonstrated serohematic fluid with a biological character similar to that of lymph. This latter case seemed to confirm the suspicion that any process associated with edema in a kidney with obstructed lymphatic tracts (meticulous lymphatic ligatures during donor extraction) is capable of causing a rupture. Conventional surgical treatment is dangerous and insecure on an edematous and friable kidney, resulting in a nephrectomy rate of 55.7 per cent and a postoperative death rate of 8 per cent. Hematoma evacuation, hemostasis by local compression and tridimensional containment of the ruptured areas should be the principles of this operation. By means of renal corsetage with lyophilized human dura these principles can be achieved. This surgical technique, which is simple and secure, its variations and future possibilities are described. In 3 of our 5 patients corsetage with lyophilized human dura was applied. All 5 grafts have taken. Renal function is good in 3 cases and acceptable in 2 at followup between 2 and 15 months.

The significance of the absence of 131I-Hippuran uptake by a kidney graft

Anuria is a frequent complication during the immediate post-transplantation period in kidney transplant recipients. Radioisotopic studies with 131I-Hippuran and 99mTc-pertechnetate allow correct differentiation between viable and non-viable grafts.

Apoprotein A and apoprotein B in patients with chronic renal failure undergoing hemodialysis and in renal graft recipients

Serum concentrations of high density lipoproteins (HDL)-cholesterol, apoprotein A and apoprotein B has been studied in 13 patients with chronic renal failure treated with hemodialysis and in 12 patients with functioning renal graft. 5 patients on hemodialysis and 6 with a renal graft had hypertriglyceridemia. In the hemodialyzed patients, the increase in triglycerides was associated to a decreased concentration of serum apoprotein B. HDL-cholesterol was substantially reduced in the hemodialyzed patients without this being associated with a drop in serum apoprotein A concentration, thus suggesting that there are changes in the qualitative composition of the HDL. In renal graft recipients, the HDL-cholesterol and the apoprotein A concentration were increased. It is suggested that the risk of developing accelerated atheromatosis in patients carrying a renal graft cannot be related to changes in HDL. In patients undergoing hemodialysis, the development of atheromatosis would be related to decreased concentration and also qualitative changes in the HDL together with the increase in the VLDL and LDL.