Obese patients are at risk for developing proteinuria and chronic renal failure after unilateral nephrectomy. Regular and long-term follow-up are recommended in these patients.

We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3-24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) (P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was euro198 and that of a hospital visit was euro177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B (P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.

Simultaneous double kidney transplantations make it possible to use kidneys from extremely elderly donors (>75 years) or those whose GE>15%. In addition, kidneys from donor 60-74 years old in which the GE<15% can be used for single kidney transplantations in two different recipients with excellent results.

No abstract

after nephrectomy was 40 and 70%, respectively, in obese pa-Influence of obesity on the appearance of proteinuria and renal tients at nephrectomy. At 20 years after nephrectomy, these insufficiency after unilateral nephrectomy. percentages were 8 and 35%, respectively. In contrast, in non-Background. Some patients develop proteinuria and proobese patients, the probability of negative proteinuria and norgressive renal failure after unilateral nephrectomy, although mal renal function was 93 and 98%, respectively, at 10 years the majority of patients maintain normal renal function. Rea-(P Ͻ 0.001) and 77 and 91%, respectively, at 20 years (P Ͻ sons to explain this different evolution are not known. 0.001). Multiple logistic regression analysis showed that the Methods. A cross-sectional study was performed in 73 parisk of developing renal disease was only statistically correlated tients who had undergone unilateral nephrectomy 13.6 Ϯ 8.6 with BMI at the time of unilateral nephrectomy (odds ratio years before. Patients with morphologic abnormalities in the 1.34, 1.03 to 1.76 CI). remaining kidney, systemic disorders, or abnormal renal func-Conclusions. Obese patients are at risk for developing protion at the time of nephrectomy were excluded. All of the 73 teinuria and chronic renal failure after unilateral nephrectomy. included patients showed normal renal function and negative Regular and long-term follow-up are recommended in these proteinuria at nephrectomy. The patient's medical records patients. were reviewed, and clinical and analytical data throughout follow-up were obtained. Results. Fifty-three out of the 73 patients (group I) showed a normal renal function and negative proteinuria at the cross-Laboratory studies in animals have shown that a sectional study. The remaining 20 patients (group II) showed marked reduction in renal mass leads to structural and proteinuria (3.4 Ϯ 3.1 g/day). The time elapsed between nephrectomy and proteinuria appearance was 10.1 Ϯ 6.1 years. functional changes in the remaining nephrons [1, 2]. Pro-Thirteen patients of group II had developed renal insufficiency gressive sclerosis of glomeruli, clinically expressed by (serum creatinine at the cross-sectional study of 3.9 ϩ 3.2 mg/ proteinuria, hypertension, and azotemia, is the final re-dL) in addition to proteinuria. The time elapsed between prosult of these maladaptive mechanisms [3, 4]. A clinical teinuria appearance and the onset of renal insufficiency was counterpart of this process, known as glomerular hyper-4.1 Ϯ 4.3 years. Renal insufficiency showed a slowly progressive course in most of these patients. There were no significant filtration or hyperfiltration nephropathy, has been redifferences between group I and group II patients in age, genported in humans with extensive renal mass reductions der, renal function, or blood pressure at the time of nephrec-[5, 6]. However, the long-term consequences of the retomy. In contrast, group II patients showed a body mass index moval of one kidney remain controversial. Several stud-(...