The results of this study provide evidence for safe conversion from Tacrolimus BID to QD with appropriate trough concentration monitoring.

The Comrades Marathon is a gruelling test of man’s stamina and only trained athletes participate. It is sur prising that of over 2,000 contestants each year on a 90-km (56.25-mile) course, severe cardiac and renal damage does not occur more often. We are able, however, to report 10 cases over 9 years when renal damage did occur. 3 cases required haemodialysis; 1 had peritoneal dialysis; 2 patients had renal biopsies. Possible idiosyncratic factors are discussed as is the pathogenesis of acute tubular necrosis.

The urine of 45 athletes, male and female, were studied after completing an ultra long-distance marathon race. Of these athletes, 24.4% were found on screening to have red blood cells in the urine. The urinary mean corpuscular volume (MCV) of red cells was used in an attempt to differentiate between lower and upper urinary tract haematuria. With the exception of 1 athlete, the red cells were not dysmorphic and had an MCV greater than 72 fl. This suggested that the haematuria had an origin from the lower urinary tract. The urinary changes disappeared within 7 days. No definite residual renal damage could be established.

SUMMARY.— A young woman developed widespread vascular spiders 9 months prior to admission. She was not pregnant and all tests of liver function were normal. A chronic hepatitis, possibly auto‐immune in origin, was diagnosed after a liver biopsy, and the hepatitis and the spiders cleared up after corticosteroid therapy. It is suggested that spiders may form in the blushing areas due to a loss of sphincter tone caused by impaired contractile cells in cutaneous arteriovenous shunts.

This study describes our experience with continuous ambulatory peritoneal dialysis (CAPD) over a four year period, during which 88 patients were offered CAPD. It compares and contrasts the response to CAPD among four racial groups in Natal viz asiatics, blacks, coloureds and whites. Peritonitis -the major complication, occurred with an overall incidence of one episode every 4.41 patient months. CAPD remains a useful alternative therapy in developing countries where a high percentage of patients with chronic renal failure would be denied a chronic renal failure program because of lack of expertise in hemodialysis and/or renal transplantation, or limited financial resources. Continuous ambulatory peritoneal dialysis (CAPD) was first described by Moncrief and Popovich (1) and, since its modification by Oreopoulos and his group (2), this technique has gained world wide usage. South Africa, like many developing countries has a high incidence of end-stage renal disease (ESRD) but because of lack of resources and economical problems, few patients with ESRD can be treated by dialysis or renal transplantation. CAPD affords a relatively simple and inexpensive form of therapy for these patients. At the present time about 200 patients are on CAPD in South Africa. Natal, the smallest of four provinces in South Africa, has a population of about five million, the majority being blacks. The minority groups include whites, asiatics and coloureds. There is only one chronic dialysis centre in Natal; situated in Durban, it serves the entire province including parts of the Transkei. This paper describes a four-year experience with CAPD in this mixed population and discusses problems unique to this situation.

A patient is described who had undergone bilateral nephrectomy for renal cell carcinoma and who had been maintained on hemodialysis for the last 2 years. A total of 3 months after acceptance into the program he was found histologically to have metastatic pleural lesions, which had regressed spontaneously 1 1/2 years ago. Repeat clinical and radiological assessment has shown no tumor recurrence.

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