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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The outcome of 502 cadaver kidney transplants has been followed for up to six years; these grafts were arranged through the Tissue Immunology Unit of the London Hospital Medical College, the coordinating centre of the London Transplant Group. An analysis of HLA (A and B) recepient-donor matching revealed, as in previous analyses, clear differences (now highly significant) between the best as compared with the lesser matched recipients. A quarter of the patients (group 4 and 3a) had a superior outcome 20-30% greater than poorly matched (2 or less group) which constituted 53% of individuals. The results in the 3b group (28% of patients) were intermediate 10-15% better than the "2 or less antigens in common" group. A small number of recipients mostly 4 or 3 matched who were retrospectively HLA-D matched showed an even better graft survival. The effect of blood-transfusion before transplantation was studied and found to improve the outlook especially in the best-matched groups. No difference was apparent between those receiving less or more than ten units except in a group of patients with cytotoxic antibodies and/or retransplants. This "immunocompetent-presensitised" group had the best outcome provided these recipients had few transfusions and were subsequently well matched. These findings emphasise the continued need for successful collaborative associations, so that improved matching can be achieved which if universally applied would ensure better graft survival for a large number of patients in renal failure.
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PMID:Influence of HLA matching and blood-transfusion on outcome of 502 London Transplant Group renal-graft recipients. 5 79

Both dialysis and kidney transplantation are effective techniques for prolonging life in ESRD. Because dialysis therapy does not effect replacement of the metabolic functions of the kidney, it is less tha perfect. Successful transplantation that replaces all of the aspects of renal function is the treatment of choice. Successful transplantation is highly dependent upon the availability of a suitable donor and the appropriate tissue match, which remains a problem. Present immunosuppressive therapy required to prevent the immunoresponse causing rejection of the renal allograft is a tool too dull for the job. Since all immunoresponse is suppressed, infections are common, as are the multiple complications of cortical steroid therapy. For the dialysis patient, development of more compact effective dialysis apparatus and particularly the availability of replacement therapy hold promise. New approaches to diminishing the immune response to the graft without impairing that to microorganisms may well effect improvement in graft survival as will increasing knowledge of factors other than HLA antigens in the immunologic reaction. Development of an effective method for arresting the progress of glomerulonephritis before it reaches end-stage renal failure would obviate the necessity for dialysis or transplant therapy in appoximately two thirds of ESRD patients.
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PMID:Dialysis versus transplantation in the treatment of end-stage renal disease. 20 86

Comparison of 105 patients suffering of chronical renal failure with 108 normal persons showed that, in the former group, a relation could be established between HLA A2, A3, and B12 histocompatibility antigens as well as haplotype association A2-B12, and chronic infection by herpes virus. The high number of herpes virus observed in patient group bearing the BW 35 antigen was discussed.
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PMID:[Relations of HLA A2, A3, B12 antigens, and A2-B12 supposed haplotype association, with latent herpes virus infection in patients with chronic renal disease (author's transl)]. 22 27

Nuclear material, presumably from damaged leukocytes, adheres to hemodialysis membranes. Previous studies have shown an increased prevalence of antibodies to nuclear antigens in chronic dialysis patients. Present studies verify the increased prevalence of antibodies to nuclear antigens in 52 of 243 chronic dialysis patients (21.4%). Because antibodies are present only intermittently, prevalence increases with repetitive blood sampling. In patients tested every 3 months over several years on chronic dialysis, the prevalence of antinuclear antibodies approaches 100%. The present studies also demonstrate, however, that the prevalence of antibodies is increased in patients with renal failure who have never undergone hemodialysis (10 of 86, 11.6%). Thus the tendency to form antibodies to nuclear antigens may be associated with renal failure rather than dialysis per se. Higher prevalences with increased time on dialysis and transplantation failure may accordingly reflect the greater duration of renal failure. The prevalence of antibodies to nuclear antigens was not significantly influenced by age, sex, type of kidney disease, major blood group, HLA tissue type, or coil reuse. Significantly lower hematocrits and white blood counts were noted when antibodies were present.
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PMID:Antibodies to nuclear antigens in patients with renal failure. 30 44

A large, comprehensive renal transplant program has a major impact not only on patient care, but also on the medical center itself and the larger community. The program at this center has advanced from 15 transplants in 1964 to 141 transplants in 1976. Fifty-nine per cent of patients transplanted have functioning kidneys at this time, including 76 children. Rehabilitation was equal to prerenal disease level in 91% of 169 recipients who lived five years with a functioning graft. Basic research in such diverse areas as renal preservation and immunology, as well as clinical research in optimum immunosuppressive therapy, resulted in significant contributions. Refinement of the mixed lymphocyte culture improved living-related graft survival at two years: 100% for HLA-identical and 91% for non-HLA-identical grafts, compared to 66% reported by the Transplant Registry for the combined group. Modification of immunosuppression improved patient survival at two years: 100% and 86% for recipients of living-related and cadaver grafts, respectively, compared to 83% and 65% reported by the Transplant Registry. The complexity of care of the patient with end-stage renal failure has required active interaction between transplant surgeons and almost every major specialty. The vast clinical material has been a great asset for training transplant surgeons, nephrologists, fellows and residents of multiple specialties, and medical students. The medical center's relationship with communities within a 250 mile radius has been strengthened, as reflected in patient referrals and the development of a multi-community-supported organ procurement system, which has allowed us to perform over 100 cadaver transplants per year for the past three years. Thus the performance of 1,000 renal transplants at this center has resulted not only in rehabilitation of many renal failure patients, but also in expanded and improved research and teaching capabilities, bringing support from multiple medical disciplines and the general community.
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PMID:The impact of 1,000 renal transplants at one center. 33 95

Twenty-four patients with end stage renal failure due to polycystic renal disease have been treated with hemodialysis and transplantation. While on dialysis, the incidence of complications did not differ from a similar group of patients with other causes of renal failure. Bilateral pretransplant nephrectomy is not mandatory except in cases of persistent infection or hemorrhage. A much higher incidence of HLA A3 and HLA B7 was noted in patients with polycystic disease when compared with the general population. Following cadaver renal transplantation, kidney function was significantly better in patients with polycystic disease when compared with those with other forms of renal failure. Patient survival was the same in both groups. We conclude that hemodialysis and transplantation are acceptable forms of treatment for a patient with end stage polycystic renal disease.
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PMID:Transplantation for polycystic kidney disease. 36 86

Between 1968 and 1978, 305 juvenile onset diabetic patients with uremia and 462 nondiabetic uremic patients of similar age received primary renal allografts at the University of Minnesota. Two hundred eight of the diabetic patients are alive and 190 have functioning renal grafts three months to ten years after transplantation. Cumulative patient survival rates at two years for diabetic recipients of kidneys from HLA identical siblings, other related and cadaver donors are 90, 73 and 68%, respectively, the corresponding graft functional survival rates are 90, 67 and 55%. For nondiabetic patients receiving kidneys from the same donor categories the corresponding patient survival rates are 97, 86 and 75%, while the graft functional survival rates are 94, 77 and 64%. The differences in patient and graft survival between diabetic and nondiabetic recipients are statistically significant only for the patients receiving grafts from HLA-nonidentical related donors. For all recipients under the age of 30, there are no statistically significant differences in patient and graft survival. Regardless of the age of the patient or the source of the kidney, the survival of diabetic patients treated with transplantation at our institution is better than the use of chronic hemodialysis, alone. Technical complications do not occur more frequently in diabetic transplant recipients. Cardiovascular disease is responsible for most of the late deaths in these diabetic patients. Amputations of digits or extremities have been required in 15% of the diabetic patients. On the positive side, the vision of 88% of these recipients remained stable or had improved visual acuity, and 82% of the diabetic patients were actively rehabilitated after transplantation. Kidney transplantation is the treatment of choice for end-stage renal failure in diabetic patients, just as it is for most uremic patients.
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PMID:Ten year experience with renal transplantation in juvenile onset diabetics. 38 44

Remarkable differences were observed when 1,465 healthy Caucasian individuals and 128 healthy Negro individuals were compared for the genetic distribution of 25 different HLA antigens. Caucasians had a significantly higher frequency of A1, A3, B8, and Bw16, and Negroes of A28 and Aw30. The haplotype which had the highest incidence as well as the greatest positive linkage disequilibrium was A1-B8 among Caucasians and A2-B12 among Negroes. Genetic distance between the two races was 0.0592. The 89 Caucasian patients with renal failure did not demonstrate any significant deviations in phenotype frequencies (PF) of various antigens, when compared with healthy Caucasians; however, 48 similar Negro patients had twice as high an incidence of Bw17 as the healthy Negroes. No significant deviation in PF was observed in 77 Caucasian patients who had leukemia; however, 32 Caucasian patients who had back pain (24 also had back stiffness) due to spondylitic, arthritic or disc syndrome, had a significant increase of Bw16 and of B27, and a decrease of B12, when compared to Caucasian controls.
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PMID:The HLA polymorphism and susceptibility to disease. 96 89

Significant changes in glomeruli on light microscopy has been observed in 27 of 109 cadaveric renal allografts which functioned beyond 6 months. Tissue was available for study from all but two allografts. The histologic lesions were classified as follows: recurrent glomeruloneophritis, 9 cases (3 focal scierosis, 2 mesangial immunoglobulin A[IgA] disease, 2 mesangiocapillary glomerulonephritis, 1 dense deposit disease, 1 familial nephritis); de novo glomerulonephritis, 1 case (diffuse proliferative glomerulonephritis with crescents); and glomerular change of uncertain etiology, 17 cases (10 mesangiocapillary, 5 focal scierosis, 1 focal proliferative and 1 mesangial proliferative). These lesions were not distinguishable on light, fluorescent and electron microscopy from those in patients with spontaneous renal disease. All patients with glomerular lesions had proteinuria, and all but 3 had microscopic hematuria. Glomerular lesions were not significantly associated with early clinical rejection episodes or HLA compatibility. Presensitization of HLA antigens was significantly related to the occurence of a nonrecurrent glomerular lesion. Vescoureteral reflux was significantly more frequent in those with glomerular change (14 of 24) than in those without (13 of 48). Glomerular lesions were associated with a higher rate of graft loss due to renal transplant failure; renal function in survivors was significantly worse than in those without glomerular lesions.
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PMID:Glomerular lesions after renal transplantation. 109 56

We report three patients, from two unrelated families, with anti-tubular basement membrane (TBM) antibody nephritis associated with membranous nephropathy. This rare disorder is characterized by nephrotic syndrome, tubular dysfunction, and progression to renal failure. Direct immunofluorescent studies in these patients revealed linear IgG deposition along the proximal TBM, while circulating antibodies reacting with proximal TBM but not with glomerular basement membrane were identified by indirect immunofluorescence. Sera from all three patients reacted by enzyme-linked immunosorbent assay and Western immunoblotting with purified 58-kd tubulointerstitial nephritis (TIN) antigen isolated from TBM. Additional reactivity with a 175-kd component, which may be a higher-molecular-weight form of TIN antigen, was observed by immunoblotting. Since recurrent Fanconi syndrome was seen after transplantation in one patient, anti-TBM antibodies were removed by plasmapheresis prior to kidney transplantation in the other two patients. Neither patient has clinical evidence of recurrent anti-TBM nephritis in the allograft despite the posttransplantation reappearance of anti-TBM antibodies in the serum of one patient. Serologic and molecular HLA class I and class II polymorphism analysis has identified the presence of both HLA-B7 and -DRw8 antigens in two unrelated affected individuals (0.3% expected frequency in the white population). We conclude that sera from patients with anti-TBM nephritis associated with membranous nephropathy react with 58-kd TIN antigen previously implicated in the pathogenesis of primary anti-TBM nephritis. This rare autoimmune disorder may be HLA associated with B7 and/or DRw8, providing susceptibility to the disease. Further investigation is needed to understand the pathogenesis of recurrent anti-TBM nephritis in the renal allograft.
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PMID:Role of antibodies to tubulointerstitial nephritis antigen in human anti-tubular basement membrane nephritis associated with membranous nephropathy. 146 68


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