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Die Einführung der TNF-alpha-Blocker in die Therapie bei Patienten mit rheumatoider Arthritis (RA) führte zu einem Paradigmenwechsel in den Behandlungsstrategien. Der wesentliche Wert dieser Medikamente liegt nicht in der klinischen Wirksamkeit, sondern in ihrer Potenz, die Knochendestruktionen effektiv zu hemmen. Die derzeit kommerziell erhältlichen TNF-alpha-Blocker sind die beiden Antikörper Infliximab und Adalimumab sowie das Rezeptorfusionsmolekül Etanercept. TNF-alpha-Blocker können das Risiko von Infektionen erhöhen, und ein Screening hinsichtlich einer Tuberkuloseinfektion vor Therapiebeginn ist notwendig. Eine chronische Hepatitis B stellt eine Kontraindikation zur Behandlung dar. Weitere Nebenwirkungen sind u. a. demyelinisierende Erkrankungen sowie die Entwicklung von Autoantikörpern. Eine Herzinsuffizienz kann sich unter der Therapie verschlechtern. Eine allgemeine Zunahme von Malignomen dürfte nicht auftreten, allerdings scheint die Zahl an Hauttumoren erhöht zu sein. Die Indikation zur Therapie mit TNF-alpha-Blockern ist gegeben, wenn eine aktive RA bei Versagen von traditionellen DMARDs vorliegt.

Background: End-Stage Renal Disease (ESRD) in type 2 diabetic patients with renal disease can be observed after a varying duration of diabetes. The aim of the study was to investigate differences between type 2 diabetic patients with diabetic nephropathy (dNP) versus Vascular Nephropathy (vNP). Patients and Methods: We investigated 90 uremic type 2 diabetic patients before start of dialysis. According to clinical diagnosis 66 patients had dNP (72%) and 20 patients vNP (24%) and four patients a chronic glomerulo nephritis was diagnosed (4%). The clinical diagnose was confirmed by histological findings in 40 patients, of them in 28 patients with dNP and in 12 subjects a histological finding was available. In 14 cases a kidney biopsy performed and in 26 patients a post-mortem biopsy at autopsy. Differences in the onset of ESRD in the presence of dNP and vNP were evaluated. Additionally, at the start of dialysis we investigated the prevalence of vascular diseases in relation to renal disease and diabetes duration. Results: The patients were divided into 3 groups, depending on the duration of diabetes. In group 1 diabetes duration was 20 years (n=16). The majority of the patients with dNP had diabetes for 15-20 years (50%) while most of those with vNP usually had diabetes for

Preemptive simultaneous kidney-pancreas transplantation (SKPT) was performed in two patients with Type 1 diabetes and nephrotic syndrome due to diabetic nephropathy, although the native kidneys exhibited near-normal function. Before and 3 months as well as 12 months after SKPT S-creatinine, creatinine clearance (Cr-Cl) and urinary protein excretion were measured. Additionally, 99mTC scintigraphic examinations of the kidneys were performed 3 and 12 months after SKPT. Thereby, the injected 99mTC activities were assessed in the kidney graft as well as in the patient's native kidneys. Aim of the study was to find out the impact of successful SKPT on proteinuria and further functioning of the patient's own kidneys after transplantation. Indication for pancreas transplantation was severe diabetic autonomic neuropathy and Brittle diabetes, respectively. In Patient 1, we registered 3 months after SKPT a near-normal protein excretion of mean 0.20 g/24-h urine at a Cr-Cl of 82 ml/ min. The scintigraphic examinations showed 60% of the radioactivity in the kidney graft and 40% in the patient's own kidneys (22% right and 18% left). Data 1 year after SKPT were: mean protein excretion 0.28 g/24-h urine, Cr-Cl 78 ml/min and in the scan, furthermore, 30% of the activity in the patient's native kidneys (16% right and 14% left). In Patient 2 after 3 months we obtained a mean protein excretion of 0.18 g/24-h urine at a Cr-Cl of 80 ml/min. Scintigram of the kidneys: 58% of the injected activity were measured in the kidney graft and 42% in the patient's own kidneys (22% right and 20% left). After 12 months of SKPT we measured a mean protein of 0.26 g/24-h urine and Cr-Cl 78 ml/min. Scintigram of the kidneys: 36% of the activity was in the patient's native kidneys (18% right and left). We conclude that in diabetic patients with nephrotic syndrome and near-normal function of the native kidneys SKPT leads to rapid and nearly complete diminution of proteinuria although the residual function of the patient's native kidneys was about 40% at 3 months after transplantation and slightly lower at 12 months after SKPT.

DUE TO ADVANCING AGE the prognosis of renal tranplanted patients is considered to be uncertain since the risk of vascular complications is increased. Nevertheless, renal transplantation has been proposed to provide better survival rates compared to hemodialysis in older patients. However, cardiovascular complications, which are more frequently present in older recipients, are wellknown risk factors for kidney transplantation. Previous studies have reported the association between left ventricular hypertrophy and adverse outcomes following transplantation. Thus, an accurate assessment of the prognosis of patients after kidney transplantation appears to be highly dependent on appropriate preoperative screening for risk factors. In the present study, we evaluated predictors for poor patient survival among renal transplant recipients over age 50 years based upon the risk factors present in patients who survived less than versus more than 2 years.