The aim of this study was to determine the occurrence of gingival overgrowth (GO) among renal transplant recipients and to analyze possible background factors causing GO among cyclosporine-treated (CsA) patients as compared with others receiving azathioprine (Aza). A total of 32 recipients, 22 treated with CsA and 10 with Aza (ages 22 to 68 years) participated. The examination included determination of renal function, whole blood CsA concentration, and periodontal status. The tooth surface data were analyzed in terms of the given background variables for GO in the whole patient sample by logistic regression analysis. The occurrence of GO was significantly higher in the CsA group as compared with the Aza group (P less than 0.03). The CsA responders had significantly more gingival units overgrown as compared with the Aza responders (P less than 0.005). There were no differences in age, sex, whole blood concentration of CsA, or duration of CsA medication between the responders and non-responders. Expressed as individual means, the gingival inflammation scores were significantly higher among the CsA responders than among the CsA non-responders (P less than 0.005). Analysis of the surface data showed that CsA had an independent major effect on GO. Furthermore, simultaneous gingival bleeding increased the risk of overgrowth (odds ratio = 2). The results show that CsA medication is a significant factor for GO and the risk of the occurrence of GO is further increased by simultaneous gingival inflammation.

Thirteen patients in the predialysis phase of chronic renal failure (CRF) were treated with calcitriol (0.25 μg/day) and 12 with placebo. After 1 year of study, an increase in bone mineral density in the calcitriol group measured by dual-energy X-ray absorptiometry was seen for the femoral neck and lumbar spine when compared to the placebo group (p < 0.001 and p < 0.01, respectively). We conclude that a steady low dose of calcitriol started in the predialysis phase of CRF is beneficial to the patients with CRF. This may be partly due to suppression of secondary hyperparathyroidism.

Low-density lipoprotein (LDL) was in vitro carbamylated with potassium cyanate and the clearance was studied in man. A minor carbamylation of LDL decreased the clearance of LDL by 41% (94% of amino groups free) and by 18% (90% of amino groups free). When LDL was extensively carbamylated its clearance was substantially accelerated. Moreover, the clearance of LDL isolated from 14 haemodialysis patients (uremic-LDL) was studied in rabbits. Uraemic-LDL, injected into rabbits simultaneously with the LDL of a healthy control subject, was cleared more slowly than the control-LDL (difference in fractional catabolic rate -6.5%, P = 0.02). We also examined the lipid peroxidation of the carbamylated LDL by measuring the amount of thiobarbituric-acid reactive substances (TBARS) and formation of conjugated dienes during exposure of carbamylated LDL to 5 microM Cu2+. The carbamylated and native LDL had similar lipid peroxidation and propensity for oxidation. In summary, both the uraemic-LDL and minimally carbamylated LDL had a decreased clearance in vivo, which may contribute to the accelerated atherosclerosis in uraemic patients.

SUMMARY Thirteen patients with chronic renal failure and uraemia were investigated by echocardiography preoperatively before and after haemodialysis and again after a successful renal transplantation to evaluate the cardiac changes caused by renal transplantation.After renal transplantation, the left ventricular end-diastolic and end-systolic diameters, as well as the cardiac index, decreased, probably because of the decreased left ventricular filling pressure. The left ventricular wall thickness and mass decreased, apparently as a result of the decrease of the left ventricular preload and also of the decrease of the afterload, because the systolic blood pressure decreased. The left atrial diameter decreased in response to the decreased left ventricular preload and wall hypertrophy.The changes in the indices of left ventricular function as a result of haemodialysis appeared to predict the changes seen after renal transplantation.Renal transplantation appears to have a tendency to result in normal left ventricular and left atrial volumes, as well as to lessen left ventricular hypertrophy, without significantly improving left ventricular function.In chronic renal failure the heart and circulation are affected by several pathological conditions. Increased oxygen demand of the tissues, chronic volume overload, and anaemia, in addition to the presence of an artificial arteriovenous fistula, increase cardiac output, leading to left ventricular dilatation and increased cardiac size.'-6 In uraemic patients pronounced left ventricular hypertrophy often occurs principally because of arterial hypertension,6 which is frequently severe and difficult to control adequately. Uraemic

An analysis was made of the ultrasonographic findings in 112 patients with renal parenchymal disease verified histologically, or with an unambiguous clinical picture. The diseases were divided into glomerular and tubulo-interstitial types. The duration of the disease and renal insufficiency and, in cases of glomerular diseases, the presence of a nephrotic syndrome and the severity of the histological changes were also taken into account. An abnormal sonographic finding was recorded in 67% of the cases. A highly echogenic cortex was the most common abnormality, being slightly more frequent in the tubulo-interstitial diseases (75%) than in the glomerular ones (61%), but the difference was not significant. Changes in the medullary region were significantly more frequent in tubulo-interstitial cases (46%) than in glomerular ones, and significantly more frequent in acute than in chronic conditions. Parenchymal thinning was associated with chronic cases and thickening with acute tubulo-interstitial cases. The nephrotic syndrome increased the number of abnormal sonographic findings. No specific sonographic features could be established for either glomerular or tubulo-interstitial renal diseases.