Long-term course of post-transplant mesangial IgA deposition: clinicopathologic study of nine cases

We conducted the present study to elucidate the fate of post-transplant mesangial IgA deposit under the long-term observation. Out of a total of 45 cases with post-transplant mesangial IgA deposition, nine cases with more than 4 yr of follow-up term were enrolled in this study, and clinicopathologic characteristics were described. The study included three men and six women with a mean age of 34.2 yr. The average observation time from the detection of mesangial IgA deposition was 6.1 yr. Three cases were categorized as recurrent IgA nephropathy, while six cases were classified into latent mesangial IgA deposition. One case with hypertension developed end-stage renal disease. The significant improvement in microscopic hematuria was observed in one recurrent IgA nephropathy case. Microscopic findings included mild mesangial stalk thickening in all but one case. IgA deposition demonstrated a significant decrease in three latent mesangial IgA deposition cases. No apparent reduction in dense deposit quantity was observed on electron microscopy. There was no association between clinicopathologic findings and the regimen of anti-immunosuppressive agents. This study showed the improvement of the disease activity did occur in both recurrent IgA nephropathy and latent mesangial IgA deposition. Further investigation of latent mesangial IgA deposition may present the important clue to the pathogenesis of IgA nephropathy.

Severe ectopic calcification of the intestinal wall in a patient on long-term continuous ambulatory peritoneal dialysis therapy

We report autopsy findings of a 69-year-old man on long-term CAPD therapy for 13 years who showed linear peritoneal calcification. Continuous ambulatory peritoneal dialysis (CAPD) was started in 1982. He has been administered excessive amounts of vitamin D(3) derivatives (VitD) (2.0 to 2.5 microg daily) and calcium carbonate (4 g daily) for secondary hyperparathyroidism since initiation of CAPD. In May 1995, his intact parathyroid hormone (PTH) level increased over 1,000 pg/mL. Immediately after VitD was changed from pill to liquid, the dose was increased to 5 microg daily. Although the serum calcium level remained between 4.5 and 4.9 mEq/L, and serum phosphate level was 5.0 to 7.2 mg/dL, plain abdominal radiography and computed tomography showed continuous calcification along the intestinal wall in October 1995. In spite of the continuation of CAPD therapy, he remained asymptomatic until he died of congestive heart failure in January 1997. He experienced eight episodes of peritonitis during his clinical course. Autopsy showed that numerous calcified plaques were present on the submucosal portion between the thickened serosa and the longitudinal layer of the muscularis externa. The remainder of the subserosa was fibrotic, and the small arteries had markedly thickened intima and severely narrowed lumina.

Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis

We report a patient with autosomal dominant polycystic kidney disease (ADPKD) undergoing long-term hemodialysis who underwent transcatheter arterial embolization (TAE) of the renal arteries to shrink enlarged kidneys. In 1983, the patient started hemodialysis because of chronic renal failure secondary to ADPKD. However, renal size continued to increase. In January 1997, he was admitted to our hospital with abdominal distension and anorexia, in addition to progression of anemia. Upper gastroendoscopy showed an esophageal ulcer and severe external compression of the stomach. Renal angiography using the Seldinger technique showed stretched and deformed segmental renal arteries with massive enlargement of the kidneys. TAE with stainless steel coils was performed on both renal arteries. With a rapid and progressive decrease in kidney size, anorexia and anemia were improved, and the gastrointestinal compression was eliminated. In some patients with ADPKD, renal size continues to increase even after the initiation of dialysis. In about 10 years, patients develop gastrointestinal complications, such as dysphagia, ileus, severe constipation, and intestinal perforation. Surgical procedures such as nephrectomy are not satisfactory. This report shows that TAE is a safe and effective therapy for patients with ADPKD with massively enlarged kidneys.

[A case report of use of horseshoe kidney as renal transplant from live donor]

This is a report on a surgery performed in February, 1995 describing the donation of a living donor's horseshoe kidney used for renal transplantation. The recipient was a 31 years-old male on hemodialysis since 1994. The donor was the healthy 55 years-old father of the recipient who had an uncomplicated horseshoe kidney. The isthmus was perfused by an accessory artery. Via transperitoneal approach, the horseshoe kidney was mobilized for in situ perfusion. A microwave coagulator was used to divide the isthmus, and the cut surfaces were closed by mattress sutures and fibrin glue. The left kidney was transplanted into the recipient's right iliacfossa. While his post-transplant course was complicated by urinary leakage, the graft remained free of rejection until and beyond the 6 months post transplant period when he was discharged at s-Cr 1.7 mg/dl. The donor's convalescence was uneventful. During the 20 months post-transplant period both the donor and recipient are doing well.

Evaluation of laser Doppler flowmetry in renal transplantation

Renal grafts are presently evaluated based on the surgeon's observation of the organ microcirculation. Effectiveness of organ microcirculation has traditionally been accomplished through evaluation of the appearance of the graft. Laser doppler flowmetry (LDF) has been suggested as a possible means to determine graft effectiveness. Renal grafts in 46 transplants were studied using LDF and the technique was evaluated. It was found to be a useful technique for monitoring effectiveness of grafts.

[The clinical significance of albuminuria in renal transplantation]

Urinary excretion of albumin was measured after renal transplantation in 37 patients who received cyclosporine quadrotherapy (cyclosporine A, azathioprine, prednisolone and antilymphocytoglobulin). In 26 patients with a favorable clinical course, daily urinary albumin level increased significantly on the first operative day. Subsequently, it decreased gradually, and remained at about 40mg/day after 3 weeks. In these patients, the urinary albumin level did not correlate with blood pressure, whole blood cyclosporine level, serum creatinine level nor urinary enzyme level, i.e. beta 2-microglobulin, NAG, gamma-GTP. As for correlation between the urinary albumin level and biopsy findings in 21 patients who underwent renal graft biopsy, the urinary albumin level was significantly increased in 5 patients with high degree of lymphocyte infiltration in the renal graft as compared with 16 patients with low degree of infiltration. However, there was no significant correlation between the urinary albumin level and the degree of tubular damage. In 4 patients of allograft rejection, a clinical course was reflected better in the albumin level than in the urinary enzyme level, these results show that the measurement of urinary albumin is a useful clinical examination to evaluate the allograft rejection of renal transplantation in cyclosporine era.

In vivo examination of the dynamic properties of the human heel pad

The shock-absorbing characteristics of the heel pad in vivo were examined in adults (N = 16) and 7-year-old children (N = 5) using a drop-impact tester (wt = 5 kg). Impact velocities were 0.72 m/s and 0.93 m/s. It was found that in adults the average peak deceleration was 11.6 G at an impact velocity of 0.93 m/s. The maximum deformation of the heel pad was 11.3 mm, and the computed energy absorption during impact amounted to 79% (range = 75%-89%). These mechanical characteristics remained nearly the same even after 6 min of repeated impacts by the impact tester and even after a 10 km run. The children had larger values of peak deceleration and maximum deformation and smaller energy loss than the adults. It was concluded that the heel pad was a fairly effective shock attenuator and high energy absorber, and that these characteristics remain nearly unchanged even after a relatively long period of repeated impacts. It was also concluded that the mechanical properties of the children's heel pads were different from those of the adults.

Unilateral renal agenesis associated with various metabolic disorders in three siblings

Unilateral renal agenesis with impaired renal function was found in all 3 siblings of a single family, in association with various metabolic disorders such as diabetes mellitus, hyperuricemia and hyperbilirubinemia with gallstones. The present report suggests that unilateral renal agenesis could occur as a manifestation of a genetic disorder.

Acute changes in C3a and C5a in an anaphylactoid reaction in hemodialysis patients

Blood sample were collected from both the arterial and venous lines of the patients undergoing hemodialysis using cuprophan membrane at several time intervals. Radioimmunoassay was then applied to measure the C3a and C5a levels. C3a levels from the arterial lines of patients undergoing uneventful hemodialysis were 463.2 +/- 51.3 ng/ml (mean +/- S.D.), 1112.9 +/- 109.9, 956.0 +/- 72.1, and 721.2 +/- 49.6 at 0, 15, 120 and 360 min, respectively. C5a levels did not change significantly during uneventful hemodialysis. C3a and C5a levels were significantly higher in the blood from the venous lines than those from the arterial lines, a finding indicating that complement activation via alternative pathway takes place in the dialyzer. C3a and C5a levels were markedly elevated in patients with anaphylactoid reaction. Reuses of dialyzers on the patients having a history of an anaphylactoid reaction during hemodialysis suppressed not only the rise of C3a levels, but also the recurrence of the reaction. From these findings, it is concluded that rises of C3a and C5a in the arterial lines of patients are causally related to the induction of anaphylactoid reaction during hemodialysis.