Faculty Bibliography

A 34-year old male renal transplant recipient developed thrombotic microangiopathy (Hemolytic Uremic Syndrome) in the early post-transplant period following combined immuno-suppressive therapy with tacrolimus and everolimus. The management consisted of discontinuation of tacrolimus and substitution with mycophenolate mofetil. His renal functions improved, the hematological abnormalities reversed and he continues to have good graft function one year later.

We performed this study to observe the nutritional status in our renal transplant recipients using serum parameters, body mass index (BMI), and dual energy x-ray absorptiometry (DEXA) that measured the fat distribution. We studied 109 patients who had chronic kidney disease due to different etiologies, and received mean hemodialysis before they underwent successful renal transplantation. The body mass index and the prevalence of type 2 diabetes mellitus revealed a significantly positive correlation with older age (p< 0.05). The mean values of serum sodium, chloride, potassium, calcium, and phosphorous were found to be within the normal range. There were no significant differences in these parameters according to age distribution. However, the mean serum creatinine was elevated, 154 +/- 18 micromol/L, which was compatible with a significant but stable renal dysfunction. iPTH levels in most of our patients were within two times the normal values (101+/- 81 pg/ml). The mean hemoglobin levels were low in all our patients (91.6 +/- 19.4 g/L). The mean bicarbonate levels were within normal limits (23 +/- 3.5 mmol/L), however there were some patients below normal. The plasma proteins and albumin were lower than normal; 62.2 +/- 8.6 g/L, and 36.1 +/- 5.1 g/L, respectively. We conclude that the BMI, fat distribution and percentage as measured by DEXA scan, as well as the prevalence of type 2 diabetes mellitus in our transplant population revealed a significantly positive correlation with older age. The elevated mean plasma iPTH levels, decreased mean serum bicarbonate, albumin, and hemoglobin levels are most likely related to renal allograft dysfunction which is usually inherent with the grafts and may eventually affect the nutritional status of the patients. Subsequently, the initial weight gain may be hampered by the graft dysfunction. Prospective long-term studies are required to confirm our findings on larger transplant populations.

A 21- year-old lady presented with chyluria, severe malnutrition, secondary amenorrhea, profound hypoalbuminemia, heavy proteinuria and renal tubular abnormalities suggestive of Type IV renal tubular acidosis. No particular cause for chyluria could be ascertained. She was successfully treated with an injection of 2% silver nitrate into the left ureter and urinary bladder. She continues to be well after 15 years of follow-up.

A 68-year-old male patient with end-stage renal failure on maintenance hemodialysis using a right internal jugular dual-lumen catheter developed thrombosis of the internal jugular vein with extension into the superior vena cava after removal of the catheter. As he developed a lower backache with MRI finding of disease of the D11 and D12 vertebrae, a bone biopsy performed showed multiple myeloma. Anticoagulant therapy led to recanalization of the thrombosed veins.

A 48-year-old man with diabetes mellitus and hypertension was found to have a thoracic right-sided ectopic kidney with a sensorineuronal hearing loss and tubular abnormalities such as hyponatremia, hypokalemia, metabolic alkalosis with microalbuminuria. He was treated with ACEI and sodium and potassium supplements. However, this only partially corrected his metabolic abnormalities.