[Urolithiasis as a cause of terminal failure of kidney function and its significance after kidney transplantation].
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Biomedical subjects
Publications and source records attributed to V Kocandrle.
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13 patients treated daily for an extended time with Imuran and prednisone and 4 patients treated in the same way with Imuran only were cytogenetically analysed for the induction of structural chromosomal aberrations and SCEs. There was an increase in the number of aberrations and SCEs in nearly all patients analysed. However, we did not find any dose-dependent cumulative effect on chromosomal damage, with the exception of 1 patient tested in a small group of 4 patients involved in a prospective cytogenetic study, who showed a significant time-dependent increase in the number of aberrations.
We examined the renal function in 18 brain dead patients 2-0 h before removing the kidneys and 72 h after their transplantation to the recipient. The kidneys were preserved by simple hypothermia. In brain dead patients we found no demonstrable relationships between PCr and CCr or between Purea and CCr. At this time the Purea and PCr values are not a sufficiently accurate indicator of renal function. We also examined the plasma and urinary concentrations of Na, K, urea and osmotically active substances and calculated their excretion fractions. We found that, prior to removal, the kidneys were in a state of combined osmotic and water diuresis. The osmotic diuresis was chiefly of a non-sodium type and was produced by a mannitol load. Water diuresis was evidently caused by inhibition of ADH output consequent to brain hypoxia. We also investigated the relationship between the CCr values before nephrectomy and in the early posttransplantation phase. We found that there was a relationship between the recipient's CCr values in the early posttransplantation period and donor's CCr/total ischaemic time index. Calculation of this index can be valuable, especially in high risk transplantations.
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Peripheral PRA was examined in 11 patients with graft artery stenosis after the onset and throughout the course of hypertension. In the acute stage PRA was elevated in 9 patients and decreased to normal in the later stage of hypertension in all but 1 patient with malignant hypertension. The findings suggest that the determination of peripheral PRA is helpful in diagnosing graft artery stenosis only in the acute stage of hypertension, but it has no unequivocal value to the prognosis of hypertension or indication for operation.
Using the radioisotope method, we examined the residual bladder volume in 30 persons without kidney and urinary tract disease, 71 patients with recurrent urinary tract infections and 56 renal transplant patients. The results showed significantly higher bladder volumes in patients with urinary tract infection than in transplant patients without urinary tract infection, non-transplant patients with urinary tract infections and subjects without urinary tract disease. Increased residual bladder volume, which is a manifestation of disturbed bladder evacuating capacity, is not related to age, the length of the postoperative period, the presence of vesicoureteral reflux, or the pretransplantation level of diuresis. The results suggest that the major factor responsible for the disturbed evacuating capacity is the degree of bladder wall injury sustained on neo-ureteral implantation. Functional disturbances render the bladder prone to bacterial invasion of the lower urinary tract and recurrent urinary tract infection.
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On the basis of 15-years' experience with the allogeneic transplantation of the kidney, the authors present recommendations, concerning the dosage of azathioprine and prednisone (methylprednisolone) during the schematic immunosuppression. There are favourable first experiences with the immunosuppression controlled according to continuous following of the count of lymphocytes able to form rosettes E (degree of immunosuppression) and that of functional granulocytes (toxicity).