Deaths from Occlusive Arterial Disease in Renal Allograft Recipients

The prevalence of coronary heart disease (58%) in 43 patients with analgesic nephropathy with moderate to severe chronic renal failure was significantly higher than in the general population of the same age and sex. Mean serum triglyceride concentration and mean diastolic blood pressure were significantly higher in the group with coronary heart disease (214 mg/dl and 102 mm Hg, respectively) than in the group without it (162 and 94). Serum triglyceride values correlated inversely with GFR, indicating that hypertriglyceridemia was largely due to associated chronic renal failure; a specific effect of analgesic abuse on prevalence of heart disease, noted by others, could not be assessed in the absence of GFR-matched controls. The prevalence of coronary heart disease was significantly higher (81 %) in the group with combined hyperlipidemia (hypertriglyceridemia and hypercholesteremia) compared to the groups without it or with normal serum triglyceride concentrations (44 and 41%, respectively). Hypotryptophanemia (a possible cause of hyperlipidemia in the nephrotic syndrome) was present in 77% of patients.

Section: Discussionmentioning

confidence: 99%

Increased Prevalence of Coronary Heart Disease in Analgesic Nephropathy: Relation to Hypertension, Hypertriglyceridemia and Combined Hyperlipidemia

Kaladelfos¹,

Edwards²

1976

“…Thus many patients receive immunosuppression for pro longed periods and the early problems of rejection are replaced by opportunistic infections, accelerated athero sclerosis [2] and perhaps most distressing of all an increased frequency of neoplasia development [3][4][5][6][7]. The majority of these tumours have arisen in the lymphoreticular system or the skin, depending on the geographical of the studies.…”

Section: Introductionmentioning

confidence: 99%

Neoplasia after Successful Renal Transplantation

Disler¹,

Macphail²,

Meyers³

et al. 1981

Neoplasia developed in 14 of the first 193 patients to receive renal transplants at the Johannesburg Hospital. No case of reticulum cell sarcoma was diagnosed and an extremely high incidence of squamous carcinoma of the skin occurred. Of the latter patients, 62.5% originally suffered from analgesic nephropathy, suggesting a possible relationship between the two conditions. Transplant recipients who later developed tumours were less likely to experience rejection episodes than other recipients, and this may suggest a generally depressed immune surveillance system in these particular patients.

“…Although the precise mechanisms contributing to the cardiovascular disease which limits the survival of both hemodialysis [1,2] and transplant [3] patients are un known, disturbances in lipoprotein metabolism mani fested as hypertriglyceridemia [4], increased very lowdensity lipoprotein (VLDL) levels [5], and reduced con centrations of high-density lipoproteins (HDL) [6,7] are believed to play some role. Two enzymes which play important roles in plasma lipid transport, the tissue en zyme lipoprotein lipase [4,8] estimated in plasma after heparin, and the plasma enzyme lecithin cholesterol acyl transferase (LCAT), have been reported to have reduced activity in renal failure patients [9], Earlier studies of LCAT in these patients suffer from the fact that no attempt was made to assess the effects of dialysis treatment and stabilization of the chronically uremic state on enzyme activity.…”

Section: Introductionmentioning

confidence: 99%

Lecithin: Cholesterol Acyltransferase Activity in Dialyzed and Undialyzed Chronic Uremic Patients

Bories

Subbaiah²,

Bagdade

1982

Lecithin cholesterol acyltransferase (LCAT) and lysolecithin acyltransferase (LAT) activities in plasma were significantly lower in undialyzed than in dialyzed uremic patients and controls. Both LCAT and LAT activities were normal in the maintenance dialysis group. The free/total cholesterol ratio was significantly increased in the undialyzed patients only. This ratio and LCAT were inversely related in the dialyzed group, unrelated in the undialyzed patients, and positively correlated in controls. Unlike non-uremic populations with hypertriglyceridemia in which LCAT is increased, no correlation was found between plasma triglyceride and LCAT in the uremic population studied. Our results show that both LCAT and LAT activities are reduced in undialyzed chronic uremic patients but are not significantly different from control levels in patients treated with chronic hemodialysis. These results indicate that the changes in LCAT activity contrast with those described in lipoprotein composition and metabolism which do not appear to be affected by chronic dialysis therapy.