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Biomedical subjects

G Mourad

Publications and source records attributed to G Mourad.

At least 145 records · Page 8Linked to original sources
PubMed1986

[Hypertension and stenosis of the graft artery: effects of conversion enzyme inhibition].

The use of angiotensin converting enzyme inhibitors may lead to reversible renal insufficiency in transplant patients with transplant renal artery stenosis (TRAS). We assessed acute effects of captopril (50 mg, p. os) in 7 cadaver kidney recipients (mean age: 35.6 +/- 4 yrs) with TRAS, 9 to 46 mo after transplantation. All patients were treated by prednisolone and azathioprine. After captopril administration, mean arterial pressure decreased from 127 +/- 6 to 119 +/- 7 mmHg, effective renal plasma flow from 152 +/- 19 to 118 +/- 19 ml/min/1.73 m2, glomerular filtration rate from 59 +/- 8 to 39 +/- 10 ml/min/1.73 m2 and filtration fraction from 0.39 +/- 0.02 to 0.32 +/- 0.07. Among the 7 patients, 2 developed immediate and transient anuria; 4 presented a net decrease of GFR, only one had stable GFR. This patient was chronically treated by captopril; as BP was not controlled, furosemide (40 mg p. os) was added. Serum creatinine increased from 180 to 250 mumol/l. Percutaneous angioplasty was done without decrease in BP; however, treatment by captopril and furosemide could be reinstitued without deterioration in renal function. We conclude that: acute renal failure in kidney graft recipients with TRAS is frequent, but not mandatory; sodium depletion induced by diuretics enhances the fall in GFR; acute effect of captopril must be assessed in patients with TRAS before the use of this product as long term antihypertensive treatment.

Acute Kidney Injury↗
PubMed1986

[Effect of inhibition of angiotensin converting enzyme on hypertension following kidney transplantation].

The activation of the renin angiotensin system is thought to be an important factor contributing to hypertension following kidney transplantation (TX). We studied 21 hypertensive renal transplant recipients, without evidence of acute graft rejection or transplant artery stenosis, 6 to 60 months post-TX. The acute responses of mean arterial pressure (MAP) and renal hemodynamics (ERPF: effective renal plasma flow, 131I-Hippuran clearance) and function (GFR: glomerular filtration rate, creatinine clearance; UNaV: urinary sodium excretion rate) to converting enzyme inhibition (CEI) by captopril were assessed. CEI induced a decrease in MAP (118 +/- 2 to 110 +/- 2 mmHg), renal resistance (RR: 0.27 +/- 0.02 to 0.21 +/- 0.01) and filtration fraction (FF: 0.31 +/- 0.02 to 0.23 +/- 0.01). ERPF (307 +/- 24 to 333 +/- 18 ml/min/1.73 m2) and GFR (88 +/- 5 to 78 +/- 5 ml/min/1.73 m2) were not significantly changed. UNaV increased by 53 +/- 24 mumol/min. Changes in MAP (r = -0.66), ERPF (r = 0.74) and FF (r = -0.88) were significantly correlated with the log of control plasma renin activity (PRA). In 10 patients with an increase of ERPF (range: + 30 to + 70%) and no change in GFR, the activated renin system could originate from the recipient's own kidneys. In the remaining 11 patients, CEI was associated with no increase in ERPF (change: + 2 to - 27%) and a fall in GFR, a response suggesting a possible intrarenal vascular damage. These results indicate that RAS participates in the regulation of systemic and renal vascular tone, with a possible predominant effect on efferent glomerular arteriole.

Adult↗
PubMed1985

Transmission of Mycobacterium tuberculosis with renal allografts.

Disseminated tuberculosis occurred in 2 allograft recipients of kidneys procured on the same donor. Both recipients were treated by low dose prednisolone and azathioprine, and one of them was on a special protocol including antilymphocyte globulins as rejection prophylaxis. None of them experienced acute rejection. The early posttransplant period was uneventful except for the occurrence of mild viral infections in both cases (herpes simplex virus in case 1 and cytomegalovirus in case 2). 2 and 6 months after transplantation, respectively, patient 1 developed acute fever, asthenia, and disorientation while patient 2 presented with spiking fever and miliary pneumonitis. Mycobacterium tuberculosis grew in the urine of both recipients in the absence of clinical genitourinary symptoms. The two mycobacterial species had the same bacteriologic characteristics and the same antibiotic sensitivity. As the recipients had no evidence of a previous history of active tuberculosis, it is suggested, as for some other infectious agents, that mycobacterium was transmitted along with the transplanted kidneys.

Azathioprine↗
PubMed1985

Recovery of renal function in patients with accelerated malignant nephrosclerosis on maintenance dialysis with management of blood pressure by captopril.

Recovery of renal function to a self-sustaining level was observed in 4 patients with accelerated malignant hypertension who required chronic hemodialysis therapy. Excellent blood pressure control was achieved in all the patients on captopril therapy. Hemodialysis could be discontinued after 2-9 months of captopril therapy; on recovery of renal function levels of creatinine clearance became stable ranging from 28 to 56 ml/min within 5-15 months of captopril treatment, and remained at this level during 21-64 months of observation. The management of hypertension and the inhibition of the renin-angiotensin system afforded by chronic angiotensin-converting enzyme inhibition is very promising as a means of reversing the process of malignant nephrosclerosis.

Adolescent↗
PubMed1985

Mycobacterium haemophilum and mycobacterium xenopi associated infection in a renal transplant patient.

The case is presented of a renal-transplant patient in Europe with a Mycobacterium haemophilum infection in association with M. xenopi infection. Clinical signs suggested the diagnosis of mycobacteriosis, which was confirmed by a skin biopsy. Despite antitubercular treatment which rapidly eliminated M. xenopi, the patient's condition did not improve until M. haemophilum was identified. Minimal inhibitory concentrations of various antimicrobial compounds showed a lack of efficacy of isoniazid, and rifampin had no clinical effect. The patient recovered only after careful surgical drainage of the lesions and the administration of minocycline. The pathogenesis of such mycobacterioses is discussed, with focus on the immunodepressive status which in our patient may have been partially induced by a cytomegalovirus reinfection.

Anti-Bacterial Agents↗
PubMed1985

[Re-establishment of urinary continuity by uretero-ureterostomy in renal transplantation. Apropos of 135 cases].

Uretero-ureteral anastomosis was performed in 135 patients (40 women and 95 men) during kidney transplantation using either cadaver (120 cases) or living donor (15 cases) organs. The ureter of the retained kidney was linked proximal to the transplantation, whether or not there had been previous contemporary nephrectomy. Results were highly interesting: no mortality, no need to remove graft for urinary complications and no ureteral anastomotic stenosis. Urological complications were absent in 108 cases (80%) while 17 cases (12.6%) developed a urinary fistula, only 5 of which required surgical intervention Hematoma related to the nephrostomy occurred in 6 cases (4.4%) but operation was necessary in only 2 of these cases. Overall need for repeat surgery involved only 7 patients (5.2%) during the month following transplantation. One of 2 cases of hematoma operated upon required partial excision of the transplantation kidney due to the presence of an intraparenchymatous arteriovenous fistula. A curious finding was that of the 17 cases developing fistulae most of them had received live donor kidneys (5/15) whereas only 12 occurred in the 120 cadaver kidney transplants. Prevention of fistulae appears to be assisted by spatulation of the ureter rather than by its bevelled section, and the maintenance of a long ureteral loop to avoid traction. It is suggested that certain postoperative urine losses may be the result of a hyper-diuresis, without actual dehiscence of the anastomosis. In 4 patients with a urine output of more than 1.5 litres at the time of transplantation, the kidney proximal to the ureteral ligature became infected, and a second nephrectomy was necessary in 4 cases.

Adolescent↗
PubMed1984

[Immunological selection of donors and recipients in renal grafts: antibodies].

It appears that a wide range of antibodies must be taken into account among future recipients of renal allografts. On one hand, the hazard of hyperacute rejection induced by warm allo-antibodies directed against donor's HLA-A, B antigens is well known. It is probable that warm allo-antibodies directed against donor's Ia (HLA-DR) antigens are also harmful. On the other hand, anti-T or B lymphocytes cold auto-antibodies appear neutral, whereas some studies suggest the possibility of enhancing antibodies which may be anti-idiotypic antibodies.

Antibodies↗
PubMed1984

[Immunologic selection of renal transplant donors and recipients: blood transfusions].

Blood transfusions clearly improve the prognosis of cadaver kidney transplantation. The percentage of graft survival at one year is increased, about + 25%. Preoperative transfusions are effective, whereas peroperative transfusions are ineffective. The following technique seems to be good. Each patient should first receive 5 blood transfusions over a short time lapse, and then one unit of blood from time to time, two times per year for example. The blood must be less than three days old and must contain leucocytes. Transfusions induce, in a few hemodialysed patients, an anti-HLA immunisation. It is thus necessary to choose a donor with a negative cross-match. Transfusions induce in many patients a better tolerance for kidney transplant. This tolerance is perhaps immunologically specific. Blood transfusions are also useful for the selection of related donors HLA semi identical with recipients. The recipient is transfused several times with donor's blood. Transplantation is only performed when the cross-match remains negative and then leads to a high percentage of success.

Antibody Formation↗