Supplemented low-protein diets - are they superior in chronic renal failure?

No Abstract

Transplantation for diabetic nephropathy at Groote Schuur Hospital

Over a period of 6 years, 9 patients with diabetic nephropathy received renal allografts at Groote Schuur Hospital. This low figure represents 2,8% of the total number of renal transplants done at our institution, and is evidence of concern about the apparent poor results of transplantation in these patients. After 2 years, patients and graft survival rates in diabetics were 87% and 62% respectively. Vascular disease was a major problem. Six patients developed limb gangrene, and symptomatic coronary and cerebrovascular disease developed in 2 patients. Infections were common and included wound sepsis, cellulitis, candidiasis and urinary tract infections. Diabetes was poorly controlled after transplantation in 5 patients. Proliferative retinopathy was present in 6 patients but remained stable after transplantation.Despite very strict selection criteria, the results of renal transplantation in diabetic patients remain poor. Better treatment strategies are needed to justify acceptance of these patients for transplantation

New-onset diabetes after transplant: Incidence, risk factors and outcome

Background. The outcome of renal transplantation depends on achieving effective immunosuppression while minimising the consequences of such treatment. The occurrence of new-onset diabetes in the post-transplant period has been associated with several risk factors including some immunosuppressive medication. Better understanding of the clinical and genetic risk factors associated with new-onset diabetes after transplant (NODAT) could enable risk stratification of patients in the pre-transplant period, with the goal of applying measures that will reduce the incidence.Objectives. To ascertain the incidence of and clinical and genetic risk factors that predispose to NODAT, and to examine its effect on the outcome of renal transplantation.Methods. We performed a retrospective cohort review of all renal transplants at Groote Schuur Hospital, Cape Town, South Africa, between 2004 and 2008. Patients who were lost to follow-up or had pre-transplant diabetes or primary non-function were excluded. A subset of the cohort who gave informed consent was enlisted for genetic tests.Results. We identified 111 patients who met the inclusion criteria. The incidence of NODAT was 18.0% (n=20 patients). Risk factors for NODAT included age at transplant (p=0.03), body weight (p=0.04), treatment for acute cellular rejection (p=0.02) and polycystic kidney disease as the cause of renal failure (p=0.005). None of the genes investigated (TCF7L2 rs11196205, rs12255372 and rs7903146 and HNF1β rs1800575, rs121918671 and rs121918672) was found to be significantly associated with the risk of NODAT. The genotype frequencies for the single-nucleotide polymorphisms studied were closer (although not identical) to those reported for Caucasians than to those reported for the Yoruba (black) population in West Africa. Overall patient survival was 78% at five years, while graft survival was 72%. There was no significant difference in patient or graft survival between the group with NODAT and the group without.Conclusions. NODAT was common in renal transplant recipients. Some risk factors predate transplant and could be used to risk-stratify patients to determine appropriate risk-reduction strategies. The genetic determinants for NODAT in this population may differ from those reported elsewhere. NODAT had no impact on patient or graft survival in this cohort

Book Reviews

Book Review 1Book Title: Avery's Drug Treatment. A Guide to the Properties, Choice, Therapeutic Use and Economic Value of Drugs in Disease Management Book Authors: Trevor M. Speight & Nicholas H.G. Holford (Eds.)Pp. ix + 1852. 1997. Auckland: Adis International Limited. ISBN 0-86471-036-4.Book Review 2Book Title: Management of Injuries in ChildrenBook Authors: John F.T. Glasgow & H. Kerr Graham (Eds.)Pp. x + 423. Illustrated. 1997. London: BMJ. ISBN 0-7279-0925-8

Production of nepheline/quartz ceramics from geopolymer mortars

This research has investigated the mechanical properties and microstructure of metakaolin derived geopolymer mortars containing 50% by weight of silica sand, after exposure to temperatures up to 1200°C. The compressive strength, porosity and microstructure of the geopolymer mortar samples were not significantly affected by temperatures up to 800°C. Nepheline (NaAlSiO 4) and carnegieite (NaAlSiO 4) form at 900°C in the geopolymer phase and after exposure to 1000°C the mortar samples were transformed into polycrystalline nepheline/quartz ceramics with relatively high compressive strength (∼275MPa) and high Vickers hardness (∼350 HV). Between 1000 and 1200°C the samples soften with gas evolution causing the formation of closed porosity that reduced sample density and limited the mechanical properties.</p

Spatial patterns of large African cats: a large-scale study on density, home range size, and home range overlap of lions Panthera leo and leopards Panthera pardus

Environmental Biolog