Adequate body iron stores are crucial to assuring rapid and complete response to recombinant human erythropoietin (rHuEPO). In the present study, markers of iron storage were examined in 27 patients with normochromic, normocytic anemia undergoing acute rHuEPO (150 to 300 U/kg t.i.w.) treatment for anemia. We calculated projected iron needed for new hemoglobin synthesis from the difference between initial and target hemoglobin concentrations, initial iron reserves available from initial serum ferritin levels, and net projected surplus or deficit from the difference between needs and reserves. Of 22 patients predicted to develop iron deficiency (mean projected deficit 268 +/- 70 mg), 20 developed evidence of exhausted iron stores (transferrin %sat less than 16 or ferritin less than 30 micrograms/liter) before reaching target hemoglobin; two predicted to become deficient (projected deficit less than 100 mg) did not; and all five predicted to avoid iron deficiency (mean projected surplus 177 +/- 20 mg) remained iron replete. During acute rHuEPO therapy net body iron balance remained neutral in patients receiving no iron supplements and increased 5 mg/kg in patients prescribed oral ferrous sulfate. However, in patients given iron dextran i.v. less than 60% of elemental iron administered became measurable as iron stores or usable for hemoglobin synthesis.
Six patients with terminal uremia due to glomerulonephritis or pyelonephritis were treated with heterografts from East African baboons. Immunosuppressive therapy was provided both before and after operat,ion with azathioprine and prednisone and postoperatively local transplant irradiation and actinomycin C were administered intermittently. The individual rejection episodes in the post-transplant period could be reversed rclatively easily but these reemred vigorously and repetitively, making it impossible to relax the stringent requirements of antirejectmion t,herapy. The continued need for high-dose immunosuppressive therapy precipitated lethal infections in the majority of cases. The patients lived for 19 to 98 days after heterotransplantation. Four died with the baboon kidneys still in placc after 19,23,35, and 49 days. I n the other two cases the heterografts were removed after 60 and 49 days respectively, at a time when urine excretion was still present, and homografts from volunteer convict donors were placed on the opposite side. Both the latt'er recipients died of septic complications following the second operation, after 39 and 44 days. Complete cessation of heterograft urine excrelion appeared only in two cases, although rend function was failing in the remainder prior to death or before removal of the heterografts. The relation of renal function to changes in heteroagglutinin and hemagglutinin titers is described. After residence in the host for 19 to 60 days, all the heterotransplants were heavily infiltrated with plasma cells and large lymphoid cells with pyroninophilic cytoplasm. There was also disruption of peri-t>ubular capillaries, interstitial edema, widespread tubular damage, swelling of endothelial cells lining arterioles, fibrinoid necrosis of the walls of arterioles and interlobular arteries, and narrowing and obstruction of interlobular arteries by fibrin and platelet deposits on the
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