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In patients dialysed with two different membranes (cuprophan and high-flux polysulphone) and using three radioimmunoassays recognizing either intact molecule (iPTH), C terminal (cPTH) or median fragments (mPTH), we compared parathyroid hormone levels at the beginning of and during dialysis. At the beginning of dialysis, cPTH and mPTH levels were always increased but iPTH levels were sometimes within the normal range; during dialysis only iPTH distinctly decreased whichever membrane was used. The behaviour of iPTH cannot be explained by crossing through the membrane because its molecular weight is too high; it cannot be explained by the variation of calcium and phosphate parameters during the session because no correlation exists between the variations in plasma levels of iPTH and the variations in phosphorous and calcium levels. In vitro experimentation with radiolabelled intact iPTH was performed to confirm the specific behaviour of iPTH: these experimental data agree with our in vivo results and suggest an adhesion to the dialysis membrane. Our study shows a specific singular property of iPTH during dialysis and demonstrates the necessity of considering the time of sampling during dialysis and the moiety of parathyroid hormone being measured in patients undergoing dialysis in order to assess osteodystrophy.

THE QUALITY of a kidney transplant plays a determining role in long-term graft survival. Indeed, recent studies have confirmed that, apart from immunologic factors, nonimmunologic factors influence the outcome of renal allografts. 1 It is important to understand these factors to decide the allocation of kidney transplants. We therefore performed a retrospective study in our center to assess the influence of certain donor characteristics on long-term graft survival.

Nephrotic syndrome causes hypercholesterolemia. Chronic renal failure results in hypertriglyceridemia, low HDL cholesterol and, more often, apolipoprotein abnormalities. This dyslipidemia is not corrected by hemodialysis. Transplantation corrects it but leads to other kinds of lipid abnormalities. Whether the treatment of these potentially atherogenetic abnormalities is beneficial of not remains unproved. There is some evidence of lipid contribution to the constitution of glomerulosclerosis in animals but it remains hypothetical in man.

No nutritional criteria have been validated in uremic patients. Chronic renal failure directly alters biological nutritional criteria. Anthropometric criteria are inadequate to routine follow up, but advisable to compare groups of patients. Quantitative evaluation of nitrogen ingestion and excretion allows to control dietetic compliance. They can not be used to check long term nitrogen balance. Nutritional criteria fail to diagnose mild undernutrition in uremic patients but they help to detect patients at risk to develop undernutrition when ascribed to low protein diets. Food inquiries, conducted by well trained dietitians are quite advisable, and helpful to the patients.

Ultrasound techniques and radionuclide studies are very often used to assess vascularization of renal transplants. Although, in acute tubular necrosis or acute rejection, it is difficult to choose between these two techniques, in 3 recent cases of renal artery thrombosis, we conclude that color coded Doppler is preferable to nuclear medicine or duplex system to diagnose this form of thrombosis.

The development of a vaccine against hepatitis B prepared with purified and inactivated HBs Ag is described. This vaccine has been applied in patients and staff members of haemodialysis centres. Safety and efficiency of the vaccine are very satisfactory. The response of patients to immunisation was significantly lower compared to the response of the staff members. None of the volunteers who had a primary response to immunisation developed signs of clinical or biological hepatitis.

A case of recto-sigmoid adenocarcinoma, developing 25 years after bilateral uretero-sigmo dostomy for extrophia vesicae in a 29 year old man. A study of the literature emphasises the long delay before its appearance, the gastrointestinal nature of the tumour and its grave prognosis. The pathogenesis of this lesion is unknown at present, and consideration should be given to the effects of urine on the digestive mucosa and the role of a possible inflammatory granuloma, but also the possibility of a urinary tract origin, despite the apparent histological contradiction.

The preparation of a vaccine against hepatitis B is described. The vaccine is prepared from the HB viral coat (HBs Ag) purified and formalin inactivated. The HBs Ag is isolated and purified from the blood of healthy HBs Ag positive donors by means of an immunoadsorbent technique. The inocuity and efficacy were tested on chimpanzees. Vaccination was then applied in an attempt to protect patients and ward staff in a high risk haemodialysis unit. The efficacy of the vaccine was assessed by humoral and cellular anti-HBs immune reactions. The study of HBs antigenaemia in vaccinated and non-vaccinated subjects indicate that this vaccine protects against hepatitis B. Many arguments are in favor of aetiological role of the hepatitis B virus in the genesis of primary liver cancer in tropical areas. Immunization against hepatitis B could be the first example of prevention of a potentially oncogenic viral infection.

The authors report on 4 cases of acute oligo-anuric renal failure that followed intravenous urography (IVU) independently from myeloma or cardiovascular collapse. Eighty other cases can be found in the literature. Post-IVU renal failure only occurs in patients already presenting with chronic renal insufficiency, those with diabetic or geriatric arterial disease being particularly at risk. It is reversible in only one out of two cases when serum creatinine levels exceed 440 mumol/l. The various triiodide contrast media with a high osmolality are equally nephrotoxic. The pathophysiology and prevention of this complication of IVU are discussed.

From February 1976 to January 1980, 123 staff members and 84 hemodialysis patients were immunized against hepatitis B in an adult hemodialysis unit. The vaccine was prepared by purification of HBs Ag from human sera and was formalin inactivated. Vaccines were tested for seric markers of HB virus (HBs Ag, anti-HBs, anti-HBc) and serum transaminases (ALT, AST) before immunization and every month during the follow up. Tests for markers of auto-immunity were performed. The vaccinees were followed from 4 to 48 months. No evidence of long-lasting reactions to the HB vaccine or auto-immunity was observed. 91% of the staff members sero-converted for anti-HBs; none of them showed clinical, biologic or serologic signs of active HB infection; 62% of the hemodialysis patients sero-converted for anti-HBs; none of them became HBs Ag chronic carrier. These results were obtained despite the fact that the prevalence of HBs Ag chronic carriers was 32.7% when the study began. Active immunization proved to be a safer and efficient method to prevent HB infection in a hemodialysis unit.

Three children with a Bartter's syndrome have been investigated: all of them had growth retardation, hypokalemia (less than 3 mmol/l), raised plasma renin activity and urinary prostaglandins (PGE2 and PGF2 alpha) and a decreased sensibility for angiotensin. In the siblings two children had also growth retardation with mild biological signs of Bartter's syndrome, and two children had normal growth slight hypokalemia raised RPA and urinary PH, and normal sensibility for angiotensin. These data suggest mild forms of this syndrome which could be the Bartter's syndrome diagnosed in adults after laxatives or diuretics absorption. Besides these data stated a negative correlation (p less than 0,01) between plasma K+ and RPA, negative correlation (p less than 0,01) between plasma K+ and urinary PGE2 and a positive correlation (p less than 0,01) between RPA and urinary PGE2. From these observations physiopathology of Bartter's syndrome is discussed.

An inactivated vaccine against hepatitis B was prepared from blood-donor HBs antigen purified on immunoadsorbents. Its safety and efficacy were tested in chimpanzees. Vaccination was then applied in an attempt to protect patients and staff in a haemodialysis unit. The efficacy of the vaccine in man was assessed by observing humoral and cellular immune reactions and by comparing changes in HBs antigenaemia in vaccinated and non-vaccinated subjects. The results indicate that this vaccine protects against hepatitis B in the circumstances in which it was administered.

Leiomyoma of the kidney is a rare tumor, for which little investigational imaging data is available, and which is poorly characterized by histological methods. We are here concerned with one case that benefitted from an extensive radiological workup, and we provide a comparison with other cases mentioned in the literature.