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Biomedical subjects

C J Rudge

Publications and source records attributed to C J Rudge.

At least 37 records · Page 2Linked to original sources
PubMed1986

Morphological differentiation between rejection and cyclosporin nephrotoxicity in renal allografts.

In a prospective study of renal dysfunction in 60 consecutive allograft recipients treated with cyclosporin and prednisolone routine renal biopsies at one week and one month after transplantation, as well as for all episodes of renal dysfunction, were performed. The one year graft survival of this group was 88%. In a retrospective clinical analysis of these patients 35 episodes of dysfunction due to rejection, defined by a response to antirejection treatment alone, and 30 episodes due to cyclosporin nephrotoxicity, defined by a response to reduction in cyclosporin dose alone, were identified. The morphological findings from these biopsies were compared with 20 samples from routine biopsies taken from patients with stable renal function. All patients diagnosed as having rejection had a diffuse, interstitial mononuclear cell infiltrate (32 of 35) or arteritis (19 of 35), or both. In contrast, focal mononuclear cell infiltrates were common in both patients with nephrotoxicity and those with stable function (17 of 30 and 14 of 20, respectively). There were no important differences between biopsies from those with nephrotoxicity and those with stable function, except that arteriolar hyalinosis was considerably more common in the nephrotoxic patients than in those with stable function. Many patients with stable function were, in retrospect, in a state of stable mild nephrotoxicity. In our experience rejection should only be diagnosed when there is at least a diffuse interstitial infiltrate or an arteritis. Focal mononuclear cell infiltrates do not denote rejection. The development of arteriolar lesions in the absence of rejection is indicative of nephrotoxicity.

Adolescent↗
PubMed1986

Transplantation. Kidneys.

Nearly 2000 patients each year commence renal replacement therapy in the UK. Renal transplantation offers a return to a near-normal lifestyle and has considerable financial advantages over long-term dialysis. Recent developments have increased the success rate to nearly 90%, and there is a real need to improve the supply of cadaver kidneys available for transplantation.

Blood Transfusion↗
PubMed1985

Differentiation between allograft rejection and cyclosporin nephrotoxicity in renal-transplant recipients.

In a retrospective study of 60 renal-transplant patients immunosuppressed with cyclosporin no specific clinical features differentiated allograft dysfunction responsive to anti-rejection therapy from dysfunction responsive to reduction in cyclosporin dosage. Histologically, allograft dysfunction responsive to anti-rejection therapy was strongly associated with diffuse interstitial infiltration by mononuclear cells, oedema, and haemorrhage, vascular endothelial-cell proliferation, and infiltration of arterial walls by mononuclear cells. Arteriolar medial hypertrophy and hyalinosis were more commonly found in biopsy specimens from allografts with dysfunction responsive to reduction in cyclosporin dose than in those with dysfunction responsive to anti-rejection therapy and those with stable or improving function. Whole-blood cyclosporin concentrations were significantly lower in patients with dysfunction reversed by anti-rejection therapy than in those with dysfunction reversed by reduction in cyclosporin dose or in those with stable function. There was, however, considerable overlap between these groups, so that individual cyclosporin measurements were of little diagnostic value.

Adolescent↗
PubMed1985

The use of pressimmune in renal transplantation: a four-year study.

Over a three year period, 22 diabetic and 87 non-diabetic patients received 120 cadaver kidney transplants at Dulwich Hospital. Horse antilymphocyte globulin (ALG), azathioprine and low-dose intra-muscular methyl prednisolone were used as immunosuppressive agents. A control group of 98 non-diabetic patients (113 transplants) at Guy's Hospital during the same period were treated with a standard azathioprine and oral steroid regime. Four main findings emerged: Firstly, survival rates for first grafts in the non-diabetic patients were similar in both centers. This suggests that neither the ALG or more conventional immunosuppressive regime holds any advantage in this patient group. Secondly, the first grafts in diabetic patients did significantly worse than similar grafts in the non-diabetics. Thirdly, in patients receiving the more conventional regime, second grafts did significantly worse than first grafts. Fourthly, and in contrast, the ALG regime gave similar survival figures for both first and second grafts. Thus, ALG had no apparent advantage over conventional steroid regimes on the survival of first grafts but it did produce a marked improvement in the outcome of subsequent grafts.

Adult↗
PubMed1984

Renal transplantation after removal and prevention of resynthesis of HLA antibodies.

Plasma exchange and immunosuppression with prednisolone and cyclophosphamide were used to remove HLA antibodies and prevent their resynthesis in five patients awaiting renal transplantation. After treatment HLA antibody titres and reactivities against a panel of donor lymphocytes were considerably reduced and, as a result, these patients received transplants. Four of these patients have successfully functioning transplants; the other patient died as a result of septicaemia with a poorly functioning allograft.

Adolescent↗
PubMed1984

Successful removal and prevention of resynthesis of anti-HLA antibody.

The successful removal and prevention of the resynthesis of an anti-HLA antibody by plasma exchange and immunosuppression in a patient awaiting renal transplantation is described. Before treatment, the patient's serum contained a high titer (greater than 1/50) anti-HLA antibody that reacted with 94% of our lymphocyte donor panel and produced positive cross matches with the lymphocytes from 40 cadaver kidneys. Following treatment, her anti-HLA titers fell to less than 1/10 and her sera reacted with 43% of our lymphocyte donor panel and produced negative crossmatches with lymphocytes from the first two cadaver kidney donors she was tested against. She was successfully transplanted with the second of these kidneys and is now well eight months later, with good graft function.

Adult↗
PubMed1983

Successful treatment of middle aged and elderly patients with end stage renal disease.

Many patients over the age of 55 with end stage renal disease in the United Kingdom are denied dialysis or transplantation. Although the reasons are complex, anticipation of a poor prognosis for these patients might explain why most British renal units impose an arbitrary age limit on the acceptance of patients for treatment. A study was therefore conducted to examine the prognosis and quality of life of 84 patients (mean age 59.6 years, range 55-72) accepted into our renal replacement programme from the beginning of 1975. The five year survival of the patients was 62.0% with 78.1% of the survivors either having successful transplants or caring for themselves using home haemodialysis or continuous ambulatory peritoneal dialysis. The results show that in terms of survival, economics, and rehabilitation it is both feasible and reasonable to treat middle aged and elderly patients with end stage renal disease. These patients should therefore not be denied dialysis or transplantation on the basis of age alone, and the lack of resources and other factors that allow this state to persist in Britain should be rapidly redressed.

Age Factors↗
PubMed1982

Renal transplantation in diabetics nephropathy.

Forty diabetics who had developed end-stage renal failure from diabetic nephropathy and underwent renal transplantation have been followed up from one to six years. After one and two years 63% and 42% survived (45% and 33% respectively with functioning kidneys). Older patients, those with coronary and peripheral vascular disease, and those with severe neuropathy are prone to higher postoperative morbidity and mortality. The presence of advanced retinopathy, on the other hand, does not appear to influence the outcome.

Adult↗
PubMed1982

Renal transplantation in sickle cell disease.

A 49 year old West Indian man with sickle cell disease and chronic renal failure was maintained on hemodialysis for 10 months before receiving a cadaveric renal transplant. Nine months post-transplant his renal function is good. His main problem has been high HbS levels needing repeated exchange transfusions. We conclude that hemodialysis and transplantation may be use successfully performed in patients with sickle cell disease with end-stage renal failure.

Anemia, Sickle Cell↗
PubMed1981

The urological complications of 1000 renal transplants.

Two hundred and one urological complications have been diagnosed and treated in 123 transplant recipients in a series of 1000 consecutive renal transplant operations (overall incidence 12.5%). Obstructive uropathies and urinary fistulae accounted for 95% of these complications and all of the mortality (22%). Details of management and patient and graft survival are given. A relationship between mortality from a urological complication and steroid dosage was found. A 30% incidence of recurrent or secondary urological complications was also noted with correspondingly worsened prognosis. Early diagnosis followed by early aggressive surgical treatment is advocated.

Adolescent↗
PubMed1980

Contaminated renal allografts.

Bacterial contamination of a renal allograft may cause infection of the transplant with eventual loss of the graft and possibly death of the patient. We report two cases that illustrate these complications and that support the suggestion that culture of the transport medium is a valuable investigation prior to transplantation.

Bacteroides Infections↗
PubMed1980

Risks and benefits of bilateral nephrectomy: an analysis of 134 cases.

In a retrospective survey of 134 patients undergoing bilateral nephrectomy from 1969 to 1980 it was found that the commonest indications were hypertension (60%) and infection/reflux (22%). Operation in hypertensive dialysis patients was followed by a fall in blood pressure in 70% (SE 9%) at one and 3 months while normotensive patients having their kidneys out for other reasons had a 47% (SE 11%) incidence of hypertension at one month and 7 out of 10 were still hypertensive at 3 months. When operation was performed in transplanted patients, 7 of 10 hypertensives had a fall in pressure, one of 6 normotensive persons had an increase, an use of antihypertensive drugs fell from 13/16 to 4 of 16 patients. The mortality was 10.4% (SE 2.6%) overall, the mortality of operations which included an unplanned splenectomy was significantly higher. There were 34 other complications in 25 patients. Complications, but not deaths, were more frequent in operations performed in dialysis patients rather than at the same time as, or after, a transplant. Over 12 years the ratio of bilateral nephrectomy to renal transplant operations has fallen from 8% (1969-1971) to 18% (1978 to present). The decrease is partly due to a fall in the number of operations for hypertension in dialysis patients and may be related to the appearance of beta-blocker and new vasodilator drugs.

Blood Pressure↗