Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post‐transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre‐transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre‐transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy. OBJECTIVE To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation. PATIENTS AND METHODS A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken. RESULTS There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43–65). Twenty patients were in the pre‐transplant nephrectomy group, 12 in the post‐transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre‐transplant group and three in the post‐transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post‐transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre‐transplant group and one in the bilateral nephrectomy post‐transplant group died in the immediate post‐operative period. No complications were noted in the sandwich technique group. CONCLUSION Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre‐transplant group. Post‐transplant unilateral nephrectomy appears to be the safest approach with fewest complications.

For earlier literature and survey of studies, see Edwards (1993), Brander (1992 1 Marwah and Klein (1996) show a strong impact of openness on growth through a trade-2 based entropy index. Harrison (1996) finds the relationship between openness and economic growth weak.

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Main Conclusion The drought conditions and the application of ABA reduce the photosynthetic activity, and the processes related to the transpiration of Dracocephalum moldavica L. At the same time, the plant increases the production of phenolic compounds and essential oil as a response to stress conditions. Abstract In the semi-arid regions, drought stress is the most important environmental limitations for crop production. Abscisic acid (ABA) plays a crucial role in the reactions of plants towards environmental stress such as drought. Field experiments for two consecutive years in 2016 and 2017 were conducted to evaluate the effect of three watering regimes (well-watered, moderate and severe drought) and five exogenous ABA concentrations (0, 5, 10, 20 and 40 μM) on growth, photosynthesis, total phenolic and essential oil content of Dracocephalum moldavica L. Without ABA application, the highest photosynthetic rate (6.1 μmol CO2 m−2 s−1) was obtained under well-watered condition and, moderate and severe drought stress decreased photosynthesis rate by 26.39% and 34.43%, respectively. Some growth parameters such as stem height, leaf area, leaf dry weight and biological yield were also reduced by drought stress. ABA application showed a decreasing trend in photosynthesis rate and mentioned plant growth parameters under all moisture regimes. The highest seed yield (1243.56 kg ha−1) was obtained under well-watered condition without ABA application. Increasing ABA concentration decreased seed yield in all moisture regimes. The highest total phenolic content (8.9 mg g−1 FW) and essential oil yield (20.58 kg ha−1) were obtained from 20 and 5 μM ABA concentration, respectively, under moderate drought stress.

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