Iron Supplementation is crucial in raising hematocrit as well as dosage saving for recombinant human erythropoietin therapy (rHuEPO) in maintenance hemodialysis patients. Intravenous iron has proved to be both safe and efficacious in this patient's population. However, the exact iron requirement has not been worked our. In this study we found that 1000 mg of element iron (given as iron saccharate) per moth was effective in maintaining hematocrit and hemoglobin at 33% and 110 gm/L respectively, and reducing the erythropoietin (EPO) dosage by about 20% in maintenance hemodialysis patients who were iron-replete. The serum ferritin increased from 219±144 to 320±234 µg/L (P<0.05). There were no major side effects and patients tolerated the monthly iron therapy well. Our study suggests that intravenous iron saccharate (100 mg/month) is effective and safe in patients on maintenance hemodialysis receiving RHUEPO.

Cyclosporine (CsA) is an effective immunosuppressant drug. Recently a new oral formulation, Sandimune Neoral (SIM-NOF) has been developed to overcome the problems of poor bioavailability, unpredictable blood levels and variable gastro-intestinal absorption seen with the use of traditional Cyclosporine, Sandimune (SIM). We conducted a prospective, open label crossover tolerability, efficacy and safety of SIM-NOF and (2) to compare SIM-NOF with SIM for their bioavailability, absorption pattern and consistence of 12-hour trough levels. Fourteen renal transplant recipients, with stable renal function (serum creatinine stable for more than six immediate previous months) and SIM dosages, were randomly selected for the study. Their age mean ± SD 38.2± 11.1 years, ad had completed 3.8± 2.2 years after transplantation. All patients were on triple drug immunosuppression with prednisone, azathioprine and SIM. The study consisted of an initial 12-week period, where SIM was used and cyclosporine 12-hour trough levels were monitored t least every four weeks. This was followed by a run-in period of two weeks, where a 12-hour cyclosporine profiling was done while patients were on SIM. This was followed by a 12-week period, Where SIM-NOF replaced SIM on a 1:1 dose conversion ratio. During this latter period, 12-hour trough levels (at 1,2,3,8 and 12 weeks) were measured. The doses of the SIM-NOF were adjusted to maintain blood cyclosporine trough levels at 50-180 μg/ml. On cyclosporine profiling, SIN-NOF showed a predictable and constant absorption profile peaking at two hours in all instances with steady declining levels through the following ten hours. With SIM the levels were unpredictable and erratic. The Tmax for SIM-NOF was 2.0± 0 hours and for SIM 3.7± 1.7 hours (p<0.0001). The Cmax for SIM- NOF was 2149 and for SIM 1942 (p=0.008). The 12-hour trough studies for SIM-NOF is a superior preparation to SIM in clinical practice. No specific adverse effects were observed.

Hepatitis C viral infection (HCV) is presently a major problem in renal transplant recipients (RTR) with a high risk of chronicity resulting in liver cirrhosis. We screened 120 RTR (50 live related, 53 live unrelated, and 17 cadaveric); mean age of 45.2 years and mean post-transplant period of 6.8 years. Positive HCV antibodies using RIBA-2 test were detected in 43 patients (35.8%). Polymerase chain reaction was performed on 37 seropositive patients and confirmed viremia in 100% of hem. Forty-one seropositive patients (95.3%) had previous dialysis prior to transplantation; a mean of 4.5 years. Liver disease manifested in only five (11.6%) of the seropositive patients and hypertransaminasemia was detected in 14 (32.6%). Twelve seropositive patients with elevated transaminase levels and/or clinical evidence of liver disease, who all had positive PCR, underwent liver biopsy. Inflammation restricted to portal area was noticed in two, persistent hepatitis in three, chronic active hepatitis in four and cirrhosis in three. There was significantly higher incidence (P<0.03) of acute graft rejection in the seropositive (23.3%) compared to the seronegative patients (9.1% ). While the difference did not amount to statistical significance for chronic rejection (9.3% and 6.5% respectively). Two patients had acute cellular rejection related to interferon therapy. The leading cause of death was related to liver failure in the seropositive patients and coronary artery disease in he seronegative RTR. In conclusion, there is high incidence of HCV in or renal transplant recipients associated with relatively high morbidity and mortality. At present we are lacking an efficient and well­tolerated antiviral drug.

Urological complications in 211 consecutive primary and secondary cadaveric renal transplants, performed t our institution between March 1993 and December 1996, were encountered in 13 patients (6.2%). The complications included urine leakage in four cases (1.9%)., obstruction of the upper urinary tract in seven (3.3%), urethral strictures in two (1%) and stone formation in one. Successfully treated complications amounted to 86%. Associated infection and urinary leak resulted in the loss of two grafts.

Alpha1-antitrypsin (D,1AT) is the most abundant circulating protease inhibitor (Pi) in human plasma. It has central function in controlling tissue degradation by inhibiting a large number of proteases including neutrophil elastase and proteinase 3 (PR3). PR3, the Wegner's autoantigen, has been suggested to be involved in the pathogenesis of small­vessel systemic vasculitides. α₁ AT deficiency (PiZ) is frequent in Caucasian populations, and its homozygous state (PiZZ) is known to predispose to lung emphysema and chronic liver disease. A strong correlation between heterozygous (PiZ) and homozygous (PiZZ) α₁ AT deficiency and anti-neutrophil cytoplasmic autoantibodies (ANCA) associated systemic nocrotizing vasculitides has recently been reported in various populations. In this review the pathogenesis of small-vessel vasculitides is outlined, focusing on the role of α₁ AT deficiency. α₁ AT has been suggested to have a crucial role as a protective protein in ANCA-associated vasculitic syndromes.

Percutaneous femoral vein catheterization is a safe procedure to perform and major complications are rarely reported. WE present a case of death following such procedure in a chronic hemodialysis patient. This case is to emphasize the importance of taking utmost care during insertion of he catheter and not to underestimate the dangers of what may look like a minor tear in the vein when surgical exploration is needed.