The functional pattern in patients with renal disease

The functional pattern of the transplanted kidney during the first year

Prospective studies on kidney function have been carried out 1-14 months after transplantation in two groups of recipients of renal transplants. Both groups were characterized by immediate graft function. The first group had transplants from living donors, the second had received cadaveric kidneys. In the first group a functional maximum (as measured by 125iothalamate, creatine and 131I-hippuran clearances) was reached during the first three weeks after transplantation, approximating 70% of the donors' bilateral preoperative function. In the second group kidney function was constant during the period of study, the values being almost identical with those observed in the first group. At investigation 12-14 months after transplantation, the two groups were compared with the remaining cadaveric transplants carried out during the period of study, the latter being primarily graft anuric. Graft function in the primarily anuric grafts was found to be poorer than in those with initial function. Graft survival, too, was poorer at one year in the group characterized by primary graft anuria than in the other groups. Graft survival at one year was 68% in cadaveric kidney transplants with good initial function.

Renal excretion of pyruvate, lactate and alpha-ketoglutarate in kidney donors before and after nephrectomy and in patients with terminal uremia

The excretional patterns of lactate, pyruvate and alpha-ketoglutarate have been investigated in 7 patients with terminal uremia and in 10 kidney donors with normal renal function before and after unilateral nephrectomy. Methods for analysis of the three substances in urine were elaborated. In all patients, the levels of renal excretion of lactate and pyruvate were very low, and clearance values were independent of the glomerular filtration rate (GFR). alpha-ketoglutarate clearance varied to some extent with renal function, but no correlation to GFR was found, and exceeded the GFR in uremic patients, indicating that the net result of renal handling of alpha-ketoglutarate may be a tubular secretion.

The excretional patterns of lactate, pyruvate and alpha-ketoglutarate in renal transplants

The excretional patterns of lactate, pyruvate and alpha-ketoglutarate were investigated after renal transplantation in 36 patients. Fourteen patients had received a living-donor kidney with short ischemia time and good initial graft function, 22 had a cadaver transplant with an initial 125iothalamate clearance of more than 6 ml/min. The excretion of lactate and pyruvate did not vary significantly from that seen in normal controls or patients with uremia. In six patients with cadaver transplants, clearance values of alpha-ketoglutarate exceeded that of the glomerular filtration rate, indicating a net tubular secretion of this substance. During acute rejection episodes in 5 patients, no changes were seen in the excretional patterns of lactate, pyruvate and alpha-ketoglutarate.