[Show abstract][Hide abstract] ABSTRACT: Reports on quality of life of kidney donors include small populations with variable response rates. The aim was to evaluate quality of life in kidney donors in a large cross-sectional study. Through the Norwegian Renal Registry we contacted all 1984 kidney donors in the period 1963-2007 with a response rate of 76%. All received the Short-Form-36 (SF-36) survey form and a questionnaire specifically designed for kidney donors. SF-36 scores for a subgroup (n = 1414) of kidney donors were not inferior to a general population sample, adjusted for age, gender and education. When asked to reconsider, a majority stated that they still would have consented to donate. Risk factors for having doubts were graft loss in the recipient (OR 3.1, p < 0.001), medical problems after donation (OR 3.7, p < 0.001), unrelated donor (OR 2.2, p = 0.01) and less than 12 years since donation (OR 1.8, p = 0.04). Older age at donation was associated with lower risk (OR 0.98, p = 0.03). Compared with other donors, those expressing doubts had inferior SF-36 scores. Norwegian kidney donors are mostly first-degree relatives. They are fully reimbursed and offered life-long follow-up. All inhabitants are provided universal healthcare. This should be considered when extrapolating these results to other countries.
Full-text · Article · Jun 2011 · American Journal of Transplantation
[Show abstract][Hide abstract] ABSTRACT: Abstract A 25-year-old man presented with severe hypertension associated with hypokalemia, elevated plasma renin level and secondary hyperaldosteronism. Malignant phase hypertension and renal artery stenosis were ruled out, and a preoperative diagnosis of renin-secreting renal tumour was made on the basis of higher concentrations of renin in the left than in the right renal venous plasma in spite of normal findings on selective renal arteriography. By removal of the affected kidney the tumour was found and it had a very high content of renin. Following the operation the plasma renin level, serum aldosterone concentration and BP became normal. We present a histopathological description and an ultra-structural study of the tumour.
No preview · Article · Apr 2009 · Journal of Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: The new vasodilating agent prazosin has been used in 14 patients with strictly defined refractory hypertension. In the 10 patients who completed the study there was an average reduction in blood pressure of about 20%. Six of these patients became normotensive. During the study only 1 patient had a reduction in renal function, as measured by endogenous creatinine clearance.
Combination of prazosin with other antihypertensive drugs caused no orthostatic hypotension of practical importance. Side-effects were few and negligible in all patients except in 1 who could not tolerate the drug.
No preview · Article · Aug 2008 · Current Medical Research and Opinion
[Show abstract][Hide abstract] ABSTRACT: Following the introduction of cyclosporine as basic immunosuppression in our national transplant programme in 1983, the pool of grafts from living donors (LDs) was expanded 2 years later by also accepting LDs mismatched for 2 HLA haplotypes and living unrelated donors (LURDs), mostly spouses. A policy of approaching family members to promote donation was consistently pursued. During 1983 through 2002, nephrectomy was performed on 1519 LDs without mortality. From 1983 through 1988, our learning phase in managing cyclosporine-immunosuppression, 382 patients received first grafts from LDs. One-year graft survival (GS) rates were 94.4%, 90%, 89%, and 82% in 71 HLA identical, 260 haploidentical, 18 2-haplotypes disparate, and 33 LURD graft recipients, respectively. Corresponding half-lives were 15.8, 10.3, 11, and 9.1 years, respectively. Results improved in 1028 patients receiving first LD grafts from 1989 through 2002. Corresponding 1-year GS rates were 96.6% (n=117), 93.5% (n=650), 90.4% (n=73), and 88.8% (n=188), and half-lives were 30, 13.3, 13.5, and 12.3 years, respectively. Similar GS rates were observed in 109 recipients of repeat grafts from LDs. LDs contributed 44% and 21.6% of all first and repeat grafts transplanted, providing grafts to 11 patients (in 1983) increasing to 23 patients (in 2002) per million population per year (pmp/y). When added to grafts from cadaveric donors, 40 to 48 pmp/y were provided with a first or repeat graft since 1990, thus covering at least 65% of the national need for kidney transplantations.
No preview · Article · Apr 2004 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Treatment of renal artery stenosis with angioplasty may be performed in patients with renovascular hypertension, ischaemic renal failure, or to preserve renal function.
From 1982 to 1993 Rikshospitalet performed 591 renal angioplasties in 419 patients with significant renal artery stenoses. Clinical and angiographic follow-ups were performed up until 1996.
In patients with atherosclerotic disease, the acute success rate was 94%, primary patency 60%, and secondary patency 74%. The results were better for fibromuscular dysplasia. Patients with the highest blood pressure and those with recent onset of hypertension had the largest decrease in blood pressure. Renal angioplasty of bilateral stenosis or stenosis to a single functioning kidney preserved renal function in patients with normal to moderately reduced renal function. There were no overall positive effects on blood pressure and renal function in patients with serum creatinine > 250 mumol/l.
Renal angioplasty can be done in selected patients with renal artery stenosis. The selection of patients for renal angioplasty is important in order to increase the clinical success rate. Clinical as well as angiographic follow-ups for detection of restenosis are mandatory.
No preview · Article · Nov 2001 · Tidsskrift for Den norske legeforening
[Show abstract][Hide abstract] ABSTRACT: Hypercalcaemia may cause acute renal failure.
We present and discuss two patients with acute renal failure caused by hypercalcaemia.
Patient no. 1 was treated with too high doses of vitamin D for hypoparathyroidism. Patient no. 2 had been taking extremely high doses of calcium carbonate for dyspeptic pain. Volume depletion and renal vasoconstriction are the mechanisms that lead to acute renal failure. Long-lasting hypercalcaemia will lead to calcium deposits in the kidneys (nephrocalcinosis), which is known to cause chronic renal failure.
It is mandatory to start early treatment for serious hypercalcaemia. If treatment is started in time, the renal failure may be reversible. Constant vigilance is essential when patients are treated with vitamin D.
No preview · Article · Jul 2001 · Tidsskrift for Den norske legeforening
[Show abstract][Hide abstract] ABSTRACT: Glucose intolerance is an untoward side effect of some immunosuppressive and anti-hypertensive drugs. The primary aim of the present prospective observational study was to test the hypothesis that tapering off prednisolone and cyclosporin (CsA) the first year after transplantation may have beneficial effects on glucose tolerance in renal transplant recipients.
Ninety-one non-diabetic recipients were included, and 87 patients underwent a 75 g oral glucose tolerance test both 10 weeks and 1 year after renal transplantation. The change over time in 2-h blood glucose was compared with a number of variables potentially influencing glucose tolerance.
The proportion of glucose intolerant recipients was reduced from 55 to 34% during the study. Univariate linear regression analysis showed a significant association between the reduction in daily prednisolone dose down to 5 mg and decline in blood glucose (P=0.001), whereas weight gain was associated with increasing blood glucose (P=0.031). Each 1-mg reduction of prednisolone dose leads to an estimated decline in 2-h blood glucose of 0.12 mmol/l based on the multiple linear regression model (P=0.003). Twelve out of 22 patients with post-transplant diabetes mellitus (PTDM) at baseline improved to normal or impaired glucose tolerance. Ten PTDM-subjects who remained diabetic 1 year after transplantation had lower serum insulin levels during the oral glucose challenge, and five patients treated with anti-diabetic drugs at baseline required hypoglycaemic drugs also at follow up. The decline in CsA level of 100 microg/l and the lower number of patients treated with beta-blockers at follow-up, did not alter glucose tolerance significantly.
Tapering off prednisolone, but not CsA, significantly improves glucose tolerance during the first year after renal transplantation.
Full-text · Article · May 2001 · Nephrology Dialysis Transplantation
[Show abstract][Hide abstract] ABSTRACT: Autosomal dominant polycystic kidney disease is the most frequent inheritable kidney disease. Epidemiological studies have not been performed in Norway.
Based on the Norwegian Renal Registry, we retrospectively studied 375 patients diagnosed with this disease taken into renal replacement therapy between 1980 and 1997. They were compared with patients with glomerulonephritis.
The average age for autosomal dominant polycystic kidney disease patients at start of renal replacement therapy was 55.2 years with a significant difference (p < 0.003) between men (53.7 years) and women (57.1 years). 295 patients (78.7%) were transplanted while 80 (21.3%) were not transplanted. From start of renal replacement therapy autosomal dominant polycystic kidney disease patients had a significantly higher (p = 0.0002) five year survival rate (70%) compared with glomerulonephritis patients (60%). One and five year patient survival rates were significantly higher (p = 0.0006) for living donor recipients (95% and 90%) compared with necro-kidney recipients (90% and 75%). One year graft survival rates for kidneys from living donors was 90% and 80% for necro-kidneys, after five years the graft survival rate was 80% and 65% (p = 0.0026). After an average of five years, 227 (60.5%) patients are alive, 197 with functioning kidney grafts (87%) while 30 (13%) are on dialysis.
Male autosomal dominant polycystic kidney disease patients start renal replacement therapy earlier than female patients. Autosomal dominant polycystic kidney disease patients do have better patient survival in renal replacement therapy than patients with glomerulonephritis.
No preview · Article · Apr 2000 · Tidsskrift for Den norske legeforening
[Show abstract][Hide abstract] ABSTRACT: Non-melanoma skin cancer is frequent in organ transplant recipients. The risk of posttransplant cutaneous squamous cell carcinoma in Norwegian heart transplant recipients (n = 148) and kidney transplant recipients (n = 1020) on triple immunosuppressive therapy with cyclosporine, azathioprine, and prednisolone, transplanted between 1983 and 1992, were studied. After adjustment for age at transplantation in multivariable Cox models, heart transplant recipients had a significantly 2.8-times higher risk of developing squamous cell carcinoma relative to kidney transplant recipients. The risk relative to the general population (standardized incidence ratio) was higher in heart transplant recipients than in kidney transplant recipients. The results indicate that heart transplant recipients are more likely to be diagnosed with skin cancer than kidney transplant recipients, probably due to the higher doses of cyclosporine and azathioprine after heart transplantation used at our center in the study period.
Preview · Article · Feb 2000 · Transplant International
[Show abstract][Hide abstract] ABSTRACT: Chronic changes in biopsies from long-term stable kidney allografts have been reported to correlate with graft prognosis. Morphological changes in baseline ('zero-hour') biopsies have been described as well, but their importance for long-term prognosis have been less clear. The aim of the present study was to evaluate biopsy changes from baseline to 1 year after transplantation in patients receiving kidneys from living donors, and to assess the possible prognostic implications of these findings.
Light microscopical changes in 18 gauge full-core biopsies were scored semi-quantitatively in 33 patients 1 year after transplantation, and compared to baseline changes previously reported . All cases were also examined with transmission electron microscopy. The semi-quantitative data from baseline and at 1 year were correlated with kidney function 1 and 3 years after transplantation. The reproducibility of baseline findings regarding arteriosclerosis and arteriolar hyalinosis was tested by comparison with biopsies 1 week after transplantation (n = 43).
We found a significant increase in mesangial glomerular sclerosis (P<0.001), interstitial fibrosis/tubular atrophy (if/ta) (P = 0.002), and mononuclear cell interstitial infiltration (P = 0.003) after 1 year, compared to baseline changes. There was an increase of arteriosclerosis (P = 0.028) and arteriolar hyalinosis (P = 0.006) when compared to biopsies taken 1 week after transplantation, but not when compared to the 'zero-hour' findings. Electron microscopy revealed one case of recurrent immune-complex glomerulonephritis and another case of recurrent light chain deposition kidney disease. Comparing 1-week vascular findings with baseline gave a low level of reproducibility, probably due to sampling error. Baseline biopsy findings could not predict long-term kidney function. In the 1-year biopsy, if/ta was significantly correlated with serum creatinine (P = 0.007) and glomerular filtration rate (GFR) (P<0.001) at 1 year, with serum creatinine at 3 years (P = 0.011), and with the first-year cumulative dose of methylprednisolone (P = 0.004). Serum creatinine at 1 year, however, was found to be the most accurate predictor of 3-year kidney function (P<0.001). Donor age was correlated to kidney function at 3 years (P = 0.013) but not at 1 year after transplantation.
Morphological changes in baseline biopsies of living donor kidneys tend to become more pronounced in well-functioning allografts during the first year after transplantation. In the 1 year biopsy, if/ta seems to be the most reliable variate for grading of chronic changes. However, 1-year serum creatinine predicted long-term kidney function more precisely than did the biopsy scores. Based on the results of the present study, a protocol 1-year biopsy does not seem warranted in the management of the graft recipient with a stable kidney function.
Preview · Article · Nov 1999 · Nephrology Dialysis Transplantation
[Show abstract][Hide abstract] ABSTRACT: A single bolus dose of LMW heparin at the start of haemodialysis effectively prevents clot formation in the dialyser and bubble trap. However, there are few studies on the appropriate dosage of LMW heparins in haemodialysis. Therefore we examined the relationship between the anticoagulant effect of dalteparin and clinical clotting during haemodialysis.
We performed an open, prospective study on the effect of decreasing doses of dalteparin in 12 haemodialysis patients during a total of 84 sessions (4-4.5 h). The normally applied dose of dalteparin in each patient was reduced by 25% for each session down to 50% of initial dose if no clotting was observed. Clinical clotting (grade 1-4) was evaluated by visual inspection after blood draining of the air trap every hour and by inspection of the dialyser after each session and compared to corresponding values for anti-FXa activity and dialysis time. Blood flow and ultrafiltration rate were kept within narrow limits throughout the study.
No episodes of grade 4 clotting occurred, and no session was interrupted. Eighteen episodes of grade 3 clinical clotting (11%) were observed in patients without warfarin treatment, none with an anti-FXa activity >0.43 IU/ml. Oral warfarin treatment reduced the clinical clotting, and only one grade 3 episode was observed in patients on warfarin therapy. Anti-FXa activity and haemodialysis time were the only factors independently correlated to clotting in a logistic regression model.
An anti-FXa activity above 0.4 IU/ml after 4 h of dialysis inhibits significant clotting during haemodialysis. A bolus dose of dalteparin of 70 IU/kg usually seems appropriate, but may be reduced in patients on warfarin treatment. Dialysis time is an independent risk factor for clinical clotting.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the effects of percutaneous transluminal renal angioplasty (PTRA) on preservation of renal function in patients with bilateral renal artery stenoses or stenosis of the artery of one functioning kidney.
A total of 227 PTRAs of 223 stenoses in 135 patients were performed from 1982 to 1993 in a single centre and retrospectively reviewed. The number of PTRAs per patient was 1.7, range 1-6. Angiographical follow-up was performed in 77%, 120+/-82 days after the first PTRA and 273+/-345 days after the last PTRA. Follow-up of serum creatinine and blood pressure was performed in 85% after 414+/-558 days. Long-term follow-up was performed for dialysis, surgical revascularization, renal transplantation and death, mean follow-up 8.8 years, range 5.5-14.8.
The immediate technical success was 90%, and another 5% were improved. The primary patency rate per patient was 43% and the secondary patency rate 64%. Improved renal function was achieved in 23% of the patients, stabilized in 56% and failed in 21%. Stabilized or improved function was higher when baseline serum creatinine was < or =250 micromol/l (85%) than >250 micromol/l (60%). Three of 99 (3%) patients with creatinine < or =250 micromol/l started dialysis during follow-up (41 days, 7.4 and 8 years), as did 13 of 36 (36%) patients with creatinine >250 micromol/l. Blood pressure and the number of antihypertensive drugs decreased in patients with creatinine < or =250 micromol/l, but was unchanged in those with creatinine >250 micromol/l. The 5-year survival rates were 84, 66 and 17% for patients with creatinine <125 micromol/l, 125-250 micromol/l and >250 micromol/l, respectively. Twelve patients (9%) experienced complications, including two deaths.
Our study shows that PTRA improved or preserved the renal function in most patients with normal to moderately impaired renal function. Close follow-up and possibly re-intervention are necessary to obtain satisfactory clinical and angiographical result.