Aims: Caries is a multifactor disease, and impaired stimulated salivary flow rate and buffering capacity are the best-known risk factors. The salivary flow rate, pH, buffering capacity and DMFT (decayed, missing and filled teeth) index of adult hemodialysis patients were compared with those of healthy controls. Material and methods: Seventy-two (34 F, 38 M, mean age: 45.05 +/- 14.15 years) hemodialysis patients and 50 (26 F, 24 M mean age: 43.92 +/- 18.80 years) control saliva were collected after prestimulation and expressed as ml/min. Salivary pH and buffering capacity were measured (Ericsson method). The dental examinations were performed according to WHO criteria and DMFT index was calculated. Statistical analysis was performed with Student t-test and Pearson correlation test. Results: The patients' mean salivary flow rate was 0.69 +/- 0.31 ml/min, pH, 8.15 +/- 0.72, buffering capacity, 6.83 +/- 0.71 and DMFT index was 11.91 +/- 8.73. The salivary flow rate was less than the controls (p < 0.001), but salivary pH and buffering capacity were higher (both p < 0.001). There was no difference in DMFT index between groups (p > 0.05). There was no significantly negative correlation between DMFT index and stimulated salivary flow rate, pH but there was a positive correlation with buffering capacity (r = 0.286, p < 0.05) in the patients. Moreover, there was no significantly positive correlation between stimulated salivary flow rate and pH buffering capacity in these patients. Conclusions: Salivary flow rate of hemodialysis patients was less than the hyposalivary limit. Salivary pH and buffering capacity were both above the reference values, but DMFT index of hemodialysis patients did not differ from that of controls. However, caries and related dental infections may lead to serious problems in infection-prone hemodialysis patients, so these patients should have regular dental examinations and careful treatments.

Background. Coronary artery calcification scores (CACS) calculated by electron beam computed tomography (EBCT) have been correlated with atherosclerotic burden in the non-uraemic population. However, the validity of this test in. chronic haemodialysis patients (HD) is currently uncertain. In the present cross-sectional study, associations between carotid atherosclerosis and coronary calcification in HD patients are investigated.Methods. We studied 79 chronic HD patients (39 male, 40 female; mean age, 45 +/- 12 years). The mean time on HD was 68 +/- 54 months (range, 6-187 months). In these patients, we measured serum calcium, phosphorus, total cholesterol, cholesterol subgroups and iPTH levels. EBCT, echocardiography, and high-resolution B-mode carotid Doppler ultrasonography were also performed.Results. Plaque-positive HD patients had significantly higher CACS than plaque-negative patients (851 +/- 199 vs 428 +/- 185, mean +/- SE, P = 0.006). Coronary calcification scores were correlated with serum phosphorus (r = 0.37; P = 0.001). Only 8 of the 24 HD patients without coronary calcification had carotid plaques (33%), whereas 34 of the 53 patients with coronary calcification had carotid plaques (64%) (P = 0.015). Carotid plaque scores were correlated with CACS (r = 0.40; P = 0.001). A stepwise linear regression (model r = 0.72; P < 0.001) revealed that CACS (log-transformed data of CACS) was associated with age (P < 0.001), time on dialysis (P = 0.004), serum phosphorus level (P = 0.016) and carotid plaque scores (P = 0.037).Conclusions. Atherosclerosis is independently associated with coronary artery calcification and with hyperphosphataemia in chronic HD patients. CACS appeared to be predictive of both coronary atherosclerosis and carotid atherosclerosis.

BACKGROUNDAn increased activation of the renin-angiotensin system probably plays a major role in the development of post-transplant erythrocytosis (PTE). It is known that deletion type polymorphism (DD) in the angiotensin converting enzyme (ACE) gene is associated with higher circulating angiotensin II (AII) levels. The aim of this study was to investigate the effect of ACE gene polymorphism on development of PTE.METHODS86 PTE patients (male/female: 68/18, mean age: 32 +/- 10 years) and 68 consecutively transplanted non- PTE patients (male/female: 38/30, mean age: 31 +/- 10 years) were included; 140 patients (91%) had been transplanted from living donors; 92 patients (60%) had hypertension. ACE gene polymorphism was determined by polymerase chain reaction (PCR).RESULTSThe mean time to appearance of PTE was 8.8 +/- 7.9 (range of 1-53) months. DD genotype was detected in 65 patients. PTE patients had a higher prevalence of hypertension (70% vs. 46%, p=0.003) and a lower frequency of DD genotype (34% vs. 54%, p=0.014) as compared to non-PTE patients [OR: 2.2 (1.14-4.25, 95% CI)]. PTE developed more frequently in male patients (68/106: 64%) than females (18/48: 38%) (p=0.002). Patients with DD genotype had a significantly longer leading time to PTE in Kaplan-Meier survival analysis with log-rank (136 +/- 15 vs. 92 +/- 13 months, p=0.015). In Cox regression analysis, hypertension (p=0.002) and recipient ACE genotype (p=0.013) were retained as independent variables for predicting PTE development.CONCLUSIONSPTE develops more frequently in male, hypertensive renal transplant recipients with good allograft function. DD-type ACE gene polymorphism seems to protect against PTE development.

Background: In this prospective-controlled study, we aimed to investigate the effect of changes in insulin resistance and anthropometrical parameters on serum leptin levels (SLL) after renal transplantation (Tx).Patients and methods: Thirty-four patients (M/F: 19/15, mean age: 29 +/- 9 yr) and 30 age and sex-matched healthy controls (C) were included. Body weight, subscapular, suprailiac, periumbilical, biceps and triceps skinfold thicknesses, neck, wrist, hip and waist circumferences, as well as body mass index and body fat mass were measured as anthropometrical parameters. In order to measure the serum glucose, insulin and SLL, blood samples were obtained before and 1 wk, 1 and 6 months after Tx. Homeostasis Model Assessment (HOMA) values were calculated as an index of insulin resistance.Results: Serum leptin levels (SLL) of the patients at pre-Tx were significantly higher than C (21.5 +/- 3.5 vs. 7.8 +/- 0.9 ng/mL, p = 0.002) and decreased at first week after Tx (from 21.5 +/- 3.5 to 8.4 +/- 1.5 ng/mL, p < 0.001). Thereafter, it gradually increased to 12.8 +/- 2.1 ng/mL in the first month and to 14.4 +/- 2.1 ng/mL in the sixth month after Tx. Serum leptin levels at sixth month were significantly higher than C (p = 0.005). Serum insulin and HOMA values changed similar to SLL after Tx. Correlations between SLL and HOMA persisted during the study period [pre-Tx (r : 0.40) and at first (r : 0.38) and sixth (r : 0.47) months]. In linear regression analysis, HOMA and fat mass were found as independent variables for predicting SLL at the sixth month after Tx.Conclusion: Serum leptin levels dramatically decreased immediately after Tx and significantly correlated with serum insulin levels and HOMA during the entire study. Increase in SLL at sixth months was probably because of increase in fat mass, insulin resistance and steroid use in renal transplant recipients.

Background: Reduced salivary flow has been reported in patients undergoing hemodialysis (HD) treatment. Our aim was to investigate the most important factors associated with stimulated salivary flow rate (ssfr) in chronic HD patients. Methods: Fifty HD patients (27 F, 23 M, mean age 46. 7 ± 13.2 years) were divided into two groups according to the duration of HD treatment as those receiving HD therapy less than or equal to (group I) or those more than (group II) 24 months. Fasting blood samples were obtained to determine hepatitis B and C serology, and biochemical and hematological parameters before a HD session. After prestimulation with a standard weight paraffin wax, stimulated saliva was collected in the HD patients and control group (23 F, 25 M, mean age 45.7 ± 19.1 years) and the flow rate was expressed as ml/min. Results: Both HD groups consisted of 25 patients. There was no significant difference between the two HD groups other than serum alkaline phosphatase (ALP) levels and presence of HCV. The ssfr was decreased than controls in both groups (0.8 ± 0.6 and 0.7 ± 0.4, respectively, vs. 1.5 ± 0.5 ml/min) and it did not correlate with any parameter. Smoking had a positive effect on ssfr in all groups. Conclusion: Although the salivary flow rate decreased significantly in chronic HD patients, the duration of therapy displayed no effect on the salivary changes in HD patients, but smoking increased ssfr.

The success rate of different treatment protocols for primary glomerulonephritis (PGN) is 60-70%. Recently, it has been suggested that in somel patients who are unresponsive to standard treatments, \ mycophenolate mofetil (MMF)- the pro-drug of mycophenolic acid- can be used. In our study, the \ results of 20 patients suffering from PGN (7 membranous nephropathy, 6 membranoproliferative GN, 3 focal segmentary glomerulosclerosis, 2 Ig A nephropathy, 1 proliferative GN and 1 mesangioproliferative GN) are investigated. The patients that were given MMF for 2-13 months (mean 7.35 months) were followed up for 8.95 month on the j average and given MMF l-2g/day. In the patients that \ had proliferative lesion (membranoproliferative GN, \ Ig A nephropathy, proliferative and\ mesangioproliferative GN) in histopathological"\ examination the complete response rate was found\ 70% whereas in the patients that did not have proliferative lesion, it was found 30%. Apart from this, in 3 patients the steroid sparing effect of MMF was observed while no serious side effect was noted. In conclusion, MMF is a well tolerable new \ immunosuppressive drug that enables steroid dose: reduction and can be effective in the treatment of PGNs in which proliferative lesion is prominent. The \ prospective, controlled and large studies about this subject would be exciting.

In this study, we evaluated the clinical and laboratory data of the patients presenting after the Marmara earthquake. Crush syndrome was diagnosed in 60 patients (30 M, 30 F, mean age: 31.3±13.8 years). They were buried under the rubble for a mean period of 12.3±15.1 hours. On admission, 27 patients were oligoanuric and the mean serum creatinine, creatinine phosphokinase and potassium levels were 4.4±3.2 mg/dl, 18453.1±24527.2 IU/L, and 4.9±1.7 mEq/L, respectively. The most frequent site of trauma was the lower extremity. Dialysis treatment was initiated in 40 patients (19 M, 21 F, mean age: 32.7±13.0 years). Mean number of hemodialysis sessions/patient was 8.9±6.8. Nine (23%) patients among the dialyzed and 4 (20%) among the non-dialyzed died leading to an overall mortality of 21.6%. This low mortality rate suggests that the death rate from acute renal failure due to crush syndrome could be decreased by extensive follow-up.

Background. Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to Third World countries for commercial transplantation, although the high risk of complications is well established and ethical arguments debate this practice.Methods. The midterm outcome of 115 patients who had been commercially transplanted in various countries and admitted to our center for post-transplant care and follow-up between 1992 and 1999 was retrospectively analyzed. Data considering the transplantation practice and post-transplant course were collected from the patient files. Outcome of these patients was compared with those with a living related transplant performed at our center.Results, The patients (91 male and 24 female; mean age of 42 +/- 12 years) were transplanted in India (N = 106), Iraq (N = 7), and Iran (N = 2). The mean follow-up period was 64.5 +/- 23.9 months. Post-transplant course was complicated by numerous surgical and/or medical complications, and many of the latter were unconventional infections caused by malaria, invasive fungal infections, and pneumonia due to various opportunistic pathogens. Overall, 52 patients still have functioning allografts, while 22 lost their grafts, 20 died, and 21 were lost to follow-up. Graft survival rates at two, five, and seven years were 84, 66, and 53%, respectively, for the study group, while it was 86. 78, and 73% for living related transplantations performed at our center (P = 0.036). Patient survival rates for the same periods were 90, 80, and 74% for the study group and 90.85, and 80% for the living related transplantations (P = 0.53).Conclusions. Besides the ongoing ethical debate, commercial transplantation carries a high risk of unconventional complications, and despite that the patient survival rate is comparable. graft survival is worse than conventional living related transplantations at the midterm.

Increased QT dispersion seems to be related to an increased risk of arrhythmia and sudden death, a common cause of mortality in hemodialysis (HD) patients. Increase in sympathetic tone has been documented in HD patients. In this study, we aimed to investigate the effect of changes in the autonomic tone on QT dispersion (QTd) in HD patients. Twenty HD patients (M/F 13/7; age, mean ±SD, 28 ± 10 years) and 22 age- and sex-matched healthy controls (M/F 12/10; age, 30 ± 10 years) were included. The patients were dialyzed three-times weekly; time on dialysis was 17 ± 8 months. The QT durations were measured from 12 lead surface EKGs and were corrected for RR intervals. Corrected maximum (QTc max) and minimum (QTc min) QT intervals and their difference (QT c d) were recorded. The effect of the Valsalva maneuver in the release phase on QT c intervals and dispersion was assessed. The HD patients had prolonged values compared to controls: QT c d, 59 ± 17 ms versus 35 ± 7 ms, p < 0.001; QT c max, 458 ± 41 ms versus 397 ± 21 ms, p < 0.001; and QT c min, 398 ± 36 ms versus 362 ± 25 ms, p < 0.001. After the Valsalva maneuver no changes were observed in controls: QT c max, 397 ± 21 ms versus 396 ± 22 ms, p = 0.9; QT c min, 362 ± 24 ms versus 358 ± 19 ms, p = 0.5; and QT c d, 35 ± 7 ms versus 38 ± 10 ms, p = 0.15. Whereas, in HD patients all values were significantly shortened: QTc max, 458 ± 41 ms versus 427 ± 35 ms, p = 0.003; QTc min, 398 ± 36 ms versus 379 ± 34 ms, p = 0.04; and QTc d, 59 ± 17 ms versus 48 ± 15 ms, p = 0.01. The decrease in QTmax was more prominent than the decrease in QTmin, hence QT dispersion was significantly decreased after the Valsalva maneuver, but differences from controls were still significant. In conclusion, increased sympathetic activity may have a role in the prolonged QT duration and increased QT dispersion in HD patients.

In this cross-sectional, controlled study, Helicobacter pylori (H. pylori) infection, a probable factor in the development of gastrointestinal problems, was investigated in dialysis patients and renal transplant recipients. Forty-seven dialysis patients (22 male, 25 female, mean age of 36.6 +/- 15 yr (range 18-83 yr)), 57 renal transplant recipients (39 male, 18 female, mean age of 36.8 +/- 10 yr (range 19-60 yr)) and 55 healthy individuals (34 male, 21 female, mean age of 33.4 +/- 9.6 yr (range 21-58 yr)) were included and no significant difference was found in the study groups. The mean time spent on dialysis in the hemodialysis group was 32.5 +/- 27.7 months (range 1-100 months). H. pylori antibodies were detected in 22 of 57 (38.6%) patients in the transplantation group, 31 of 47 (65.9%) patients in the dialysis group and 39 of 55 (72.5%) in the control group. No correlation was found between H. pylori infection and age, sex, primary disease, frequency of dialysis, duration and type of transplantation and the immunosuppressive therapy. However, patients with H. pylori antibodies spent a shorter time on dialysis compared to patients without the antibodies (26.6 +/- 23.5 vs 44.1 +/- 32.1 months, p = 0.038). The frequency of H. pylori infection in the transplantation group was significantly lower than the control and dialysis groups (p < 0.01). This finding may be explained on the basis of decreased humoral antibody response to H. pylori infection, secondary to immunosuppressive therapy rather than decreased incidence of infection in the transplantation group. Finally, we concluded that the value of the serological test for diagnosis of H. pylori infection should be interpreted cautiously in these patient groups.

Cholesterol crystal embolization is an increasingly recognized disease, presenting with a wide clinical spectrum, usually occurring in elderly men who undergo an angiographic procedure or vascular surgery. We report three patients who developed systemic cholesterol embolic disease and varying degrees of renal failure after angiographic interventions of the coronaries.

Proteinuria, developing after renal transplantation may influence allograft and patient outcomes. This study aimed to investigate the effect of proteinuria on patient and allograft survival. Among 514 patients, 56 (11%) patients with good allograft function and proteinuria were evaluated retrospectively. Patients with proteinuria were classified as group P (20 patients with permanent proteinuria, Male/Female: 16/4) and group T (36 patients with temporary proteinuria, M/F: 29/7) according to the type of proteinuria. Also, considering the amount of proteinuria, patients were classified as group M (32 patients with massive proteinuria, M/F: 29/3) and group NM (24 patients with non‐massive proteinuria, M/F: 16/8). The mean time interval between transplantation and appearance of proteinuria was 23.7 months (range 0–121 months) and no difference was found between groups. Two‐ and 5‐yr allograft survival rates were found to be 85 and 80% in group M, and 95 and 82% in group NM, respectively (p=0.24). In terms of type of proteinuria, 2‐ and 5‐yr allograft survival rates were found to be 70 and 58% in group P and 92 and 87% in group T, respectively. The difference between groups P and T was found to be statistically significant (p=0.02). Most (85%) of the patients with permanent proteinuria also had massive proteinuria. In conclusion, we found a significant relation between type and severity of proteinuria. The type of post‐transplant proteinuria had a stronger effect on allograft outcome than the severity of proteinuria.

Decreased cellular immunity and tuberculin reactivity have been previously documented in hemodialysis patients. Recently, Smirnoff and colleagues (January 1998)1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar reported increased rate of anergy and tuberculin nonreactivity in this group of patients. We also evaluated tuberculin response and its relation with demographic features, nutritional parameters, and peripheral blood lymphocytes subsets distribution in cross-sectional-controlled study.2Yildiz A Sever MS Yildiz P et al.Tuberculin reactivity in hemodialysis patients [abstract]..Nephrol Dial Transplant. 1997; 12: A148Google Scholar In our study, response to intradermal 5 IU PPD (InterVax Biologicals Limited; Toronto, Canada) was assessed and a second tuberculin test was performed to all tuberculin nonreactor patients for booster effect 1 week later. Twenty-nine hemodialysis patients (17 male, 12 female; mean age 30.9±9.5 years) and 13 healthy control subjects (8 male, 5 female; mean age 29.2±6.4 yrs) were included. The mean time spent on dialysis was 20.5±17.4 mos. Patients who had history of tuberculosis, were HIV-positive, or had history of recent infection were excluded. It was previously reported that nutrition had effect on tuberculin response.3Pesanti EL The negative tuberculin test: tuberculin, HIV, and anergy panels..Am J Respir Crit Care Med. 1994; 149: 1699-1709Crossref PubMed Scopus (66) Google Scholar Body mass index, serum albumin, and cholesterol levels were measured as nutritional parameters. Fourteen of the patients (48%) were tuberculin negative (8 male, 6 female; mean age 34.1 ±11.1 yrs), and 15 (52%) were tuberculin positive (≥5 mm) (9 male, 6 female; mean age 26.8±3.4 yr). Tuberculin reactivity was not related with patients' age, gender, time spent on dialysis, and nutritional parameters. Smirnoff and colleagues1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar also reported no correlation with any demographic factors regarding anergy and tuberculin reactivity. Peripheral blood lymphocytes immunophenotypic analysis was performed using monoclonal antibodies against to CD3, CD4, CD8, HLADR, CD56, CD16, and CD19 by FACScan flow cytometer (Becton Dickinson; Sparks Glencoe, MD). On comparing tuberculin positive and negative hemodialysis groups in terms of peripheral blood lymphocytes subsets, no significant difference was found. As a result, tuberculin nonreactivity was detected in nearly half of the hemodialysis patients which was similar to recent data.1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Age, gender, and time spent on dialysis had no correlation with this reactivity. The tuberculin nonreactive group was not different from the positive group when compared for the percentage of lymphocytes subtypes. We concluded that tuberculin responsiveness in hemodialysis patients cannot be predicted by the distribution of lymphocytes subtypes, and this reactivity is likely to be regulated in situ immune response.

Serum Digoxin Levels in Chronic Renal Failure The interpretation of serum digoxin level in chronic renal failure could be difficult due to endogeneous digoxin like substances. The aim of this study was to determine the effect of different stages of renal failure on serum digoxin levels. Sixty-one patients with chronic renal failure were included in the study and were separated into two groups (Group I: patients on digoxin therapy, Group II: patients without digoxin therapy). Each group was further divided into three subgroups depending on the patients' creatinine clearances (a: >50, b: 10-50, c: 50, 10-50, 10 cm3/dk olan Grup la ve Ib'deki hastalarin serum digoksin duzeyleri Grup Ila ve Ilb'deki hastalara gore anlamli olarak fazla (p 10 cm3/dk olan grupta <10 cm3/dk olan gruba gore anlamli (p<0.001) olarak yuksek bulunmustur. Sonuc olarak, serum digoksin duzeylerinin degerlendirildigi kronik bobrek yetersizlikli hastalarda endojen digoksin benzeri maddelerin var olabileceginin unutulmamasi gerektigi ve ozellikle diyaliz oncesi donemde bu endojen maddelerin hatali sonuclara yol acabilecegi kanisina varilmistir.

In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpatient clinic, between 1983 and 1997, were included in the study. The etiology of amyloidosis was familial Mediterranean fever in all patients. The mean follow‐up period was 38.3 ±31.8 (range 7‐65) months. Twelve of the patients were male and 3 female with the mean age 34.13 ±10.87 (range 21‐60) years. Seven patients had living related, 4 living‐unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operation. sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure. acute rejection developed in 2 patients. Renal functions of these patients improved by anti‐rejection therapies. Chronic rejection developed in 3 patients. In the control group, acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodialysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5‐yr graft and patient survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantation is not a contraindication for the treatment of end stage renal failure in patients with renal amyloidosis, it carries high risk of cardiac complications in the postoperative period. Detailed preoperative cardiovascular evaluations are mandatory in these patients and this intervention should improve the prognosis by excluding the patients who have already been complicated with this problem.

In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpatient clinic, between 1983 and 1997, were included in the study. The etiology of amyloidosis was familial Mediterranean fever in all patients. The mean follow-up period was 38.3 +/- 31.8 (range 7-65) months. Twelve of the patients were male and 3 female with the mean age 34.13 +/- 10.87 (range 21-60) years. Seven patients had living related, 4 living-unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operation. Sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure. Acute rejection developed in 2 patients. Renal functions of these patients improved by anti-rejection therapies. Chronic rejection developed in 3 patients. In the control group, acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodialysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5-yr graft and patient survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantation is not a contraindication for the treatment of end stage renal failure in patients with renal amyloidosis, it carries high risk of cardiac complications in the postoperative period. Detailed preoperative cardiovascular evaluations are mandatory in these patients and this intervention should improve the prognosis by excluding the patients who have already been complicated with this problem.

BACKGROUNDIn this study, renal transplant recipients with tuberculosis of different organs, were retrospectively analysed with respect to prevalence, outcome and drug toxicity.PATIENTS AND METHODSIn 520 patients, 22 (4.2%) tuberculosis of various organs was diagnosed. The time interval between transplantation and diagnosis of tuberculosis was 44.4 +/- 33.5 (range 3-111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), and other localizations included jejunum, liver, bone, and urogenital tract.RESULTSSixteen of the 22 patients responded favourably to the treatment and maintain excellent allograft function, whereas six patients (27.2%) died. Toxic hepatitis was seen in four (18%) patients, and one case was complicated with acute hepatocellular failure due to isoniazide (INH). However, of the 23 patients at risk of tuberculosis who had had INH prophylaxis for 1 year, neither tuberculosis, nor hepatotoxicity was observed.CONCLUSIONTuberculosis is a common infection of renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs.

Autonomic dysfunction in hemodialysis patients is one of the components of uremic neuropathy. In this prospective study, we investigated the effect of renal transplantation on uremic autonomic dysfunction with long-term time-domain and frequency-domain heart rate variability. Fourteen hemodialysis patients (10 male, 4 female; mean age 33 ± 11 (range 16–50) years) were examined before and at the early after transplantation period (mean 4.6 ± 1.5 (range 3–7.5) months). The mean time spent on hemodialysis was 16.7 ± 15.6 (range 6–65) months. In time-domain analysis, significant increases in all parameters except pNN50 (SD, SDANN, SDNN, rMSSD) were observed after renal transplantation (p < 0.01). In frequency-domain analysis, low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.40 Hz) spectral power were found to be significantly increased after renal transplantation (4.54 ± 1.04 vs. 12.58 ± 8.69 for LF (p = 0.005), 2.80 ± 1.0 vs. 6.50 ± 3.55 for HF (p = 0.005)), but the LF/HF ratio was not different from a pretransplant period (1.71 ± 0.349 vs. 1.85 ± 0.49, p = 0.26). It was concluded that autonomic dysfunction in hemodialysis patients is reversible and renal transplantation reverses the sympathetic and parasympathetic autonomic dysfunction simultaneously and at a relatively early stage.