Successful kidney transplantations essentially depend on the vitality of the organs donated. Warm and cold ischemic times (WIT/CIT) during harvesting, storage, and transplantation damage the transplant, so that in 20%–60% of cases acute kidney failure must be anticipated.

The influence of the stable prostacyclin-analogue Iloprost (Fa. Schering, Berlin) in the enzyme release from extracorporalic perfused kidneys was tested in an experimental investigation. The mechanic hypothermic perfusion was carried out on four different conditions. The estimation of specially cytosolic, lysosomal, and membrane-associated enzymes in the perfusat of the kidneys showed less activities in the Iloprost-protected kidneys. The results after the replantation of the kidneys support the interpretation of the enzyme determinations.

Operative trauma, ischemia, release of catecholamines and thermal stimuli in consequence of harvesting, preservation and transplantation deteriorate the renal capillary circulation. By crossing of tolerance limits arises an irreversible transplant damage. The conditions of our examinations were placed in this field. By pre- and postischemic application of Iloprost was demonstrable an improvement of the ischemic tolerance of the kidney. Correction of renal hemodynamics, antiplatelet action and cytoprotection are the reasons of the protective influence of Iloprost in our opinion.

Evaluar el posible efecto pre-condicionador de sildenafilo en riñones sometidos a isquemia normotérmica, perfusión hipotérmica y posterior autotrasplante.Estudiamos 6 grupos de órganos autotrasplantados: control sin isquemia y autotrasplante inmediato (grupo A); control con 45 min de isquemia y autotrasplante inmediato (grupo B); isquemia + perfusión del órgano en bomba y autotrasplante (grupo C); isquemia + conservación mediante hipotermia simple en solución UW y autotrasplante (grupo D); 100 mg vo sildenafilo preoperatorio+isquemia+perfusión en bomba y autotrasplante (grupo D); 100 mg vo sildenafilo preoperatorio+ isquemia+ autotrasplante inmediato (grupo E). Evaluamos durante los 60 minutos de reperfusión postrasplante los valores medios de flujo vascular renal (FVR), resistencia vascular renal (RVR), presión arterial sistémica (PAS) y concentración de óxido nítrico en vena del injerto renal (ON). Realizamos estudio histológico mediante microscopia electrónica y convencional en todos los casos.obtuvimos unos valores medios de flujo vascular renal (fvr) mayores, resistencia vascular renal menor (rvr) y concentraciones de óxido nítrico en vena del injerto (on) mayores en los primeros 60 min de reperfusión renal postrasplante en los grupos e y f frente a a,b,c y d (tabla 1, fig. 1). desde el punto de vista histológico, los órganos sometidos a trasplante sin isquemia, perfundidos tras la isquemia o tratados preoperatoriamente con sildenafilo mostraron integridad túbulo-endotelial en los estudios microscópicos.Mostramos, por primera vez en la literatura específica, un efecto beneficioso de sildenafilo en los parámetros obtenidos en la reperfusión postrasplante en los riñones sometidos a isquemia normotérmica durante un periodo crítico.To evaluate the preconditioning effect of sildenafil administered preoperatively in kidneys subjected to a period of warm ischemia (WI), hypothermic perfusion (HP) or cold storage (CS) and finally, autotransplant (AT).We studied 6 groups of autotransplanted kidneys: no-WI-inmediate AT (Group A); 45 min of WI + immediate AT (Group B); 45 min of WI + 60 min of HP + autotransplant (Group C); 45 min of WI + 60 min of CS + autotransplant (Group D); 100 mg of oral sildenafil preoperatively + 45 min of WI + autotransplant (Group E); 100 mg of oral sildenafil preoperatively + 45 min of WI+60 min of HP + autotransplant (Group F). Belzer solution was used for HP; UW-Viaspan for CS. Inmediately after the autotransplant (reperfusion period), we recorded in real time for 60 min the values of Renal vascular Flow (RVF) and Renal Vascular Resistance (RVR). Nitric Oxide levels in the cava and renal graft vein were recorded every 15 min during the 60 min of the reperfusion-study period. Conventional & Electronic microscopy were completed after the process.We obtained significant higher values of RVF and lower values of RVR in sildenafil groups (E and F) in comparison to the other groups (A-D) (Table 1). NO levels were also significantly higher in groups E and F (Fig. 1). Groups A, B, E and F showed integrity of tubule and endothelium in comparison to groups C and D in the microscopic study.We showed a beneficious effect of sildenafil in inmediate post-transplant reperfusion hemodynamic and biochemical parameters of kidneys subjected to a critical period of warm-ischemia.

To date no diagnostic procedure has been able accurately to stage carcinomas of the urinary bladder. Parietocystotomography by means of instillation of air and nitrous oxide was used in an attempt to distinguish between the tumour infiltration stages T3A , T3B and T4 and to depict them radiologically. Using this method it is possible to achieve a high degree of concurrence between radiological findings and the pathological-anatomical substrate. The methods, results achieved and the limits of the procedure are demonstrated.

The chance on a complete compensation of the residual kidney is the larger the earlier the nephrectomy as performed. Infections of the urinary tract, pyelonephritis, affection with calculi and functional disturbances are the most frequent diseases of the residual kidney particularly then, when the contralateral organ was also removed for these reasons. Specific tuberculous inflammations and tumorous affection of the residual kidney rarely appeared.

It is reported on haemodialyses which were carried out in the period from 1959--1978 in 157 patients with acute renal failure. Here in 25 cases developed exogenic intoxications. The surgically conditioned cases of acute renal failure were subdivided into 7 groups according to the basic diseases. The lethality of about 47% significantly differs in the individual surgical noxes from the data of literature. It is dealth with the general principles of treatment in these acute pictures of disease, which 1. consist in a basic treatment--maintenance of vital functions--and 2. in an elimination of the damaging noxe--elimination of the exogenic poison and removal of the surgical basic diseases and tiding over of the temporary deficiency of the renal function. Of the deceased patients about 16% came ad exitum in uraemia. The others died of the basic disease which could not be controlled. Thus the prognosis depends on the prognosis of the basic disease. In the intoxications the prognosis mainly depends on the dialysability and the quantity of the poison as well as on the time interval between intake of poison and beginning of the treatment.

After the historical description of transplantations in Europe since 1966 the essential new facts and constant data in donnor conditioning, transplantation and after-treatment are discussed on the basis of special literature. 63 own courses are evaluated with complications.

A survey of the at present possible vascular accesses and their valency for acute and chronic haemodialyses depending on age and body weight is followed by a comparison of the two most essential possibilities of access Scribner-shunt and fistula Brescia-Cimino. Thei main complications thombosis and infection are discussed and therapeutic directives are shown.

The progressive multifocal leukencephalopathy is mostly observed as paraneoplastic complication of malignant lymphoproliferative systemic diseases. It may develop also under the influence of a long-term immunosuppressive therapy, as it is necessary in the rejection treatment of recipients or organ transplantations. It is reported on a 44-year-old man in whom a progressive multifocal leukencephalopathy with exitus letalis developed 6 months after a kidney transplantation and following immunosuppressive therapy. In the oligodendroglia of the marginal region of leukodystrophic foci in the centrum semiovale of the right cerebral hemisphere by means of electron microscopy paracrystalline situated virions of the type Papova were proved in most cases.