Peripheral blood catalase in patients undergoing renal transplantation

Oxygen free radicals are mediators of tissue injury and catalase is an enzyme which is involved in limiting this process. We examined peripheral blood catalase activity (PBCA) to assess its value as a marker in detecting tissue injury related to renal allograft rejection. Thirty-one consecutive recipients of kidney (n = 29) or simultaneous kidney/pancreas (n = 2) transplants and 10 normal volunteers were studied. Catalase activity, measured by the disk-flotation method, was expressed as Sigma units x 10-3/ml (SU/ml) of whole blood. Normal PBCA was determined to be greater than 76 SU/ml. Twenty-nine episodes of renal allograft rejection (diagnosed by clinical criteria +/- biopsy [79%]) were observed in 26 patients. PBCA (mean +/- SEM) was found to be low (64 +/- 1 SU/ml) in 28/29 episodes ([chi]2 = 46.3, P < 0.001), and the decrease (at least two consecutive daily catalase values < 76 SU/ml) occurred 2 days prior to the clinical/biopsy diagnosis of rejection in 26/28 episodes. The sensitivity of PBCA as a discriminant of rejection was 97%, specificity was 96%, and test accuracy was 96%. PBCA less than 50 SU/ml on two or more occasions occurred in five cases and transplant nephrectomy was required in four of these because of uncontrollable rejection. Nine episodes of cyclosporine nephrotoxicity occurred in 7 patients and none of these episodes was associated with a decreased PBCA. Our data suggest that decreased PBCA is a sensitive and specific indicator of renal allograft rejection. PBCA remains normal during episodes of cyclosporine nephrotoxicity and therefore provides a rapid and inexpensive discriminant from allograft rejection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27320/1/0000343.pd

Cyclosporine A

Cyclosporine A (CsA) is a neutral lipophilic compound that was first isolated in the 1970s from the fungal species Tolypocladium inflatum gams. CsA is a cyclic polypeptide that consists of 11 amino acids and that has a molecular weight of 1202 daltons.1 It was found to have potent immunosuppressive properties and was initially used in the late 1970s to prevent organ rejection following transplantation. CsA first became available for general use in North America in 1983 and is now perhaps the most widely used drug to prevent graft rejection in transplantation medicine. The spectrum of conditions for which CsA is now being used has broadened, with recent reports of its benefit in several autoimmune and cutaneous diseases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27861/1/0000274.pd

Primary Nonfunction of Renal Allograft Secondary to Acute Oxalate Nephropathy

Primary nonfunction (PNF) accounts for 0.6 to 8% of renal allograft failure, and the focus on causes of PNF has changed from rejection to other causes. Calcium oxalate (CaOx) deposition is common in early allograft biopsies, and it contributes in moderate intensity to higher incidence of acute tubular necrosis and poor graft survival. A-49-year old male with ESRD secondary to polycystic kidney disease underwent extended criteria donor kidney transplantation. Posttransplant, patient developed delayed graft function (DGF), and the biopsy showed moderately intense CaOx deposition that persisted on subsequent biopsies for 16 weeks, eventually resulting in PNF. The serum oxalate level was 3 times more than normal at 85 μmol/L (normal <27 μmol/L). Allograft nephrectomy showed massive aggregates of CaOx crystal deposition in renal collecting system. In conclusion, acute oxalate nephropathy should be considered in the differential diagnosis of DGF since optimal management could change the outcome of the allograft

The Story of Sāvitrī in the Mahābhārata

This paper presents a new interpretation of the story of Savitri as presented in the Mahabharata. Savitri is viewed as an intended putrika, or lineal daughter, for her father, and the death of her husband and the misfortunes of her father-in-law are explained as corollaries of this circumstance; but at the last minute Savitri switches her allegiance to her husband and his line, becoming a pativrata rather than a putrika. Following a prompt in the Mahabharata text, the paper concludes with an exploration, on the Savitri model, of Draupadi’s relationship to the Pandava line. The death of the Draupadeyas and the resuscitation of Parikshit are viewed in terms of a symbolic switch from the putrika to the pativrata mode of operation