A questionnaire enquiry was undertaken to assess aspects of quality of life of 100 older patients (60 women, 40 men; mean age 73.2 [65-88] years) who underwent haemodialysis for an average of 35.6 +/- 28.3 months. The majority of patients (85%) showed a positive attitude towards the haemodialysis treatment, but 14 signified that they would not again submit to this form of treatment. The replies of these patients in other ways, too, corresponded to a depressive state (P less than 0.001) with problems of coping with therapeutic measures (P less than 0.005). Reasons for this were, first, severe physical impairment by additional disease and, secondly, psychosocial factors. Nine of the 14 patients were women living alone who showed signs of loneliness. It would seem that a "negative" attitude towards haemodialysis is largely determined by a patient's social environment.

Uraemic patients are in general infertile. Ovarian function is, however, restored after successful renal transplantation, thus making conception possible. We followed up 14 patients after renal transplantation involving 16 pregnancies. Two patients became pregnant twice, one with twins and the other following renal and pancreatic transplantation--the first recorded in the world. Caesarean section was performed in all patients due to increasing serum creatinin levels, avoid pre-eclampsia or premature rupture of membranes. Both, mother and child in all cases progressed without complications, although these pregnancies are associated with high risk for both. Therefore, a close co-operation between the mother, the nephrologist, the transplantation centre, the gynaecologist and the paediatrician is a prerequisite for a possible favourable course.

Neben der Nierentransplantation und der Hämodialyse ist die CAPD mittlerweile eine anerkannte Methode zur Behandlung der terminalen Niereninsuffizienz des Diabetikers geworden. Da sie erst seit 1979 eine weitere Verbreiterung in Europa gefunden hat, liegen nur über kurze Zeiträume Erfahrungsberichte vor. Aus diesem Grunde soll im folgenden über eine bis zu dreijährige Erfahrung mit der CAPD bei Typ I-Diabetikern berichtet werden.

Women patients on permanent dialysis treatment or after transplants display on the whole an increased rate of malignomas; however, it has so far not been possible to assess the relevant incidence in a uniform manner. Hence, regular gynaecological examination should be the rule in order to detect and treat carcinoma risk changes in the genital region. Within the framework of a special gynaecological consultation for renal patients we found in 81 women patients under dialysis treatment one patient with carcinoma of the cervix and one patient with corpus carcinoma. In two cases a cystic ovarial tumour was operated on. To date the 21 patients who had undergone renal transplant surgery did not show any malignant change in the genital region. Choice of contraceptives should rule out the intrauterine device because of the increased hazard of infection under immunosuppressive treatment. Ovulation inhibitors with higher oestrogen doses represent an additional hypertensive risk. Treatment with low-dosage gestagens should produce the lowest rate of side effects.

The effect on transepithelial Na transport of tizolemide was investigated in isolated frog skin (Rana temporaria). It was found that tizolemide (2–5 mM, serosal side) decreased transepithelial Na transport (measured as short circuit current and as net sodium flux) within 60 min to 25–40% of the control level resulting from reduction of the unidirectional sodium influx. Intracellular recording with microelectrodes revealed that these changes were associated with depolarization of the intracellular space to less than 40% of the control values (averaging −71.7±5.1 mV) which is a consequence of a decrease in conductance of the basolateral border to about 25% of the control values. The conductance of the apical border was only slightly reduced. It is suggested that tizolemde blocks the partial conductance of potassium at the basolateral border which secondarily diminishes trans-epithelial Na transport due to a decrease of the driving force for apical border Na entry. A certain degree of inhibition of the Na-K-ATPase by tizolemide cannot be excluded. When vasopressin (ADH) was added to frog skin after treatment with tizolemide, the response was markedly reduced compared to that of untreated control preparations. Under these conditions, the conductance of the basolateral border increased while the apical border remained little influenced by the hormone — opposite to the response of frog skins under control conditions. It is concluded that the mode of action of ADH is more complex than has been recognized hitherto and includes effects at the basolateral border.

Women with uremia are usually infertile. Following successful renal transplants ovarian function resumes and conception becomes possible. Two cases of pregnancy following renal transplants are reported. The first patient had a Caesarean section at 33 weeks gestation for maternal indications, the second patient had a Caesarean section at 36 weeks gestation because of premature spontaneous rupture of the membranes. Both mothers and infants are in satisfactory condition. The problems of pregnancies following renal transplants are discussed and the literature since 1963 is reviewed. Pregnancy following renal transplantation is a high risk pregnancy for both the mother and the fetus. These high risks are acceptable if close supervision of the pregnancy by the nephrologist, gynaecologist and paediatrician are possible and if co-operation of the mother is satisfactory.

Women with uremia are usually infertile. Following successful renal transplants ovarian function resumes and conception becomes possible. Two cases of pregnancy following renal transplants are reported. The first patient had a Caesarean section at 33 weeks gestation for maternal indications, the second patient had a Caesarean section at 36 weeks gestation because of premature spontaneous rupture of the membranes. Both mothers and infants are in satisfactory condition. The problems of pregnancies following renal transplants are discussed and the literature since 1963 is reviewed. Pregnancy following renal transplantation is a high risk pregnancy for both the mother and the fetus. These high risks are acceptable if close supervision of the pregnancy by the nephrologist, gynaecologist and paediatrician are possible and if co-operation of the mother is satisfactory.

Oliguria, an easily recognizable symptom of postoperative acute renal failure, is analyzed schematically in terms of various diagnostic aspects and a pragmatic therapeutic procedure. Differentiation among pre-, intra-, and postrenal disturbances is important. Acute renal failure caused by simultaneous and often severe insufficiency of other organs, especially in combination with septicemia, still has a bad prognosis. Prophylaxis in the form of adequate volume substitution and shock therapy is urgent in each case.

Oligurie als leicht zu erfaBendes Leitsymptom des akuten postoperativen Nierenversagens (a. p. N.) wird anhand eines Schemas (Abb. 2) in differentialdiagnostischer und pragmatisch therapeutischer Hinsicht analysiert. Wichtig ist dabei zunächst die Differenzierung in pra-, intra- und postrenale Störungen. Für die immer noch schlechte Prognose des a. p. N. ist die Kombination mit anderen Organinsuffizienzen bei postoperativen - insbesondere septischen — Komplikationen verantwortlich, eine Prophylaxe des a.p.N. durch adäquate Volumensubstitution und Schockbekämpfung aber in jedem Fall dringlich.

Summary Oliguria, an easily recognizable symptom of postoperative acute renal failure, is analyzed schematically (Fig. 2) in terms of various diagnostic aspects and a pragmatic therapeutic procedure. Differentiation among pre-, intra-, and postrenal disturbances is important. Acute renal failure caused by simultaneous and often severe insufficiency of other organs, especially in combination with septicemia, still has a bad prognosis. Prophylaxis in the form of adequate volume substitution and shock therapy is urgent in each case.

Release of arginine vasopressin (AVP) from rat neurohypophysis in in vitro studies is significantly augmented by the addition of angiotensin (AII), and in in vivo studies in dogs renin and AII were found to stimulate secretion of AVP. Both these results suggest the existence of a direct relationship between the salt regulating renin-angiotensin-aldosterone system and the water controlling AVP system.