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Biomedical subjects

A P Pandey

Publications and source records attributed to A P Pandey.

At least 19 recordsLinked to original sources

A comparative study of methods of estimating renal size in normal adults.

One hundred live related voluntary kidney donors were studied prospectively. During donor nephrectomy the actual kidney bipolar length was measured and compared to the renal bipolar length estimated from abdominal sonogram, abdominal plain X-ray, intravenous pyelogram, and renal angiogram. Ultrasound was found to measure the kidney more accurately (mean difference between estimated size and actual = -3.4 mm +/- SD 6.96), than plain X-ray (mean difference from actual 13mm +/- SD 5.24), IVP (mean difference from actual 16.9 mm +/- SD 5.74), and renal angiogram (mean difference from actual 15.2 mm +/- SD 5.77).

Adult

Allograft nephrectomy--a 16-year experience.

A review has been made of the indications, technical problems, complications and results of 31 allograft nephrectomies in 29 patients; 12 patients died between 15 days and 1 month after graft nephrectomy, which was undertaken within 6 months of transplantation. Gross local and general complications occurred in 7 patients who survived graft nephrectomy. The procedure is recommended when graft failure occurs within 6 months of transplantation provided it is associated with systemic signs of severe rejection or sepsis, or if it occurs in cases where continuation of immunosuppressants is life-threatening.

Adolescent

Evaluation of extravesical and Leadbetter-Politano ureteroneocystostomy in renal transplantation.

In a series of 650 renal transplantations performed over a 4- year period, the results were evaluated of 125 Leadbetter-Politano and 125 extravesical ureteroneocystostomies. The Leadbetter-Politano technique had a complication rate of 4%, with 3.2% of these patients having a vesical leak. Extravesical ureteroneocystostomy also had a 4% complication rate but only 1.6% of these patients had a vesical leak. Although there was no statistical difference between the two groups with regard to complications, we feel that extravesical ureteroneocystostomy is a quick and simple procedure and well suited to the special challenge presented by renal transplant recipients.

Adolescent

Urinary protein/creatinine ratio as an indicator of allograft function following live related donor renal transplantation.

In a study of 656 urine specimens from 53 consecutive recipients of live related donor renal allografts we found an excellent correlation between the protein content of 24-h urines and protein/creatinine ratio (Up/Ucr) in overnight urine samples. Using this ratio, we evaluated proteinuria up to 180 days after renal transplantation (overnight urine samples analysed, n = 2745). Heavy proteinuria in the immediate post-operative period had no prognostic significance. Eighty-nine percent of all clinically observed acute rejection episodes were accompanied by an increase over baseline of Up/Ucr; in 56.5% of these episodes elevation of Up/Ucr preceded that of serum creatinine. However, as a marker of rejection the usefulness of this parameter was limited owing to large number of false positive elevations. In 50 recipients whose grafts survived for more than 3 mth, proteinuria was graded into minimal, moderate and heavy. Renal function at the end of six months was good in all patients who exhibited proteinuria with Up/Ucr less than 100 mg/mmol creatinine. Persistent proteinuria with Up/Ucr above 100 mg/mmol preceded significant deterioration of graft function. Therefore, a protein-creatinine ratio of 100 mg/mmol can be considered as an apparent cut-off to differentiate stable from deteriorating graft function in long term evaluation of transplant recipients.

Adolescent

Urinary N-acetyl-beta-D-glucosaminidase and aminopeptidase N in the diagnosis of graft rejection after live donor renal transplantation.

An evaluation of the usefulness of urinary N-acetyl-beta-D-glucosaminidase (NAG) and aminopeptidase N (AAP) measurements in the diagnosis and prediction of acute and chronic renal allograft rejection was made. Enzyme activities were measured in 2,745 morning spot urine samples from 53 consecutive live donor renal allograft recipients up to 180 days after transplantation. Reference ranges of urinary enzyme activities in 14 recipients with normal graft function were higher than those established in a carefully selected group of healthy controls. 89 and 91% of 76 clinically diagnosed acute rejection episodes (ARE) in the remaining 39 graft recipients were accompanied by sharp increase over baseline of NAG and AAP respectively. All rejection episodes occurring in the early period after transplantation were characterised by high enzymuria. AAP was more sensitive than NAG as the magnitude of its increase over baseline was more, while NAG was more specific with less number of false positive elevations. Both enzymes were found to be equally good prognostic indices of graft loss and chronic graft deterioration. Regular monitoring of urinary NAG and AAP activities throughout the post transplant period would thus be valuable in (a) diagnosis and prediction of ARE in the early as well as late post operative period and (b) prediction of eventual graft outcome.

Acetylglucosaminidase

Terminal infections in renal transplant patients in a tropical environment.

Infections were a major cause of death in 84% of 38 autopsied renal allograft recipients in a south Indian hospital. Pyogenic bacteria and fungi were the most common etiological agents encountered, being present in 50 and 47% of cases, respectively. Tuberculosis and hepatitis B virus infection were more prevalent and Pneumocystis carinii and cytomegalovirus disease rarer than in comparable series from non-tropical countries. 1 case each of amoebiasis, strongyloidiasis and filariasis were the parasitic infections encountered.

Adult

Renal transplantation in leprosy.

A patient with tuberculoid leprosy and chronic renal failure was given a renal allograft after 5 months of dapsone (DDS) treatment. The leprosy showed continued healing in spite of immunosuppression and was not a significant cause of morbidity. Tuberculoid leprosy does not appear to be a contraindication for renal transplantation.

Adult

Abnormalities of the immune system in patients with chyluria.

A study of the immune system in 11 patients with chyluria showed lymphocytopenia, decrease in T cells, a low serum IgA concentration and suppression of delayed hypersensitivity responses to intradermally injected antigens. The similarity of chyluria to intestinal lymphangiectasia and thoracic duct fistula suggests that the immune deficiency may be due to loss of lymph in the urine.

Adult