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Renal Transplant Rejection
0022-534 7/79/1211-0133$02. 00/0 Vol. 121, January Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1979 by The Williams & Wilkins Co.
Letters to the Editor RENAL TRANSPLANT REJECTION
To the Editor. I was interested in the urographic observation of Seymour and Rittenberg, concerning non-visualization of renal calices during excretory urography (IVP) as an indicator of a renal transplant rejection. 1 This study confirms what we reported in 1973. 2 In our transplantation unit an IVP is a routine procedure to diagnose (and sometimes predict) a rejection crisis. As soon as the allograft diuresis becomes satisfactory and stable (sometimes as early as 2 or 3 days postoperatively) we do an IVP to serve as a control for subsequent studies. Another IVP is done as soon as rejection is suspected. Failure of visualization of renal calices and good concentration in the pelvis, ureter and bladder constitute good evidence of renal edema. This finding correlated with the diagnosis of transplant rejection in our experience. However, an IVP is less helpful in the followup of the rejection crisis because the reappearance of the calices occurs later than clinical and biochemical evidence of improvement. We fully agree that one must be cautious when studying allografts with an IVP in the early post-transplantation period. However, if the electrolytes and hydration are maintained adequately and if low dose infusion IVPs are performed in patients at risk the incidence of irreversible impairment of renal function in previously stable grafts is low. We have performed hundreds of IVPs under these stated conditions and have observed no complications related to renal function. Consequently, we consider the technique safe if done carefully. Respectfully, Rene Kuss Clinique Urologique Hopital de la Pitie 83 Bd de l'hopital 75634 Paris, Cedex 13, France 1. Seymour, E. Q. and Rittenberg, G. M.: Non-visualization of
renal calices during excretory urography as an indicator of renal transplant rejection. J. Urol., 119: 720, 1978. 2. Kuss, R., Poisson, J. and Le Guillou, M.: L'urographie intra veineuse au cours de la crise de rejet du transplant. J. d'Urol. et Nephrol., 7-8: 605, 1973. RETRIEVAL OF THE GIBBONS URETERAL STENTS UNDER FLUOROSCOPIC CONTROL
To the Editor. The distal collar of a Gibbons catheter usually prevents it from migrating up the ureter but, if the stent does migrate, its long retrieval tail usually makes it easy to recover. However, in 1 of our patients a stent migrated so far that all of the retrieval tail had passed beyond the ureteral orifice. Flexible alli-
133
gator forceps was inserted through the cystoscope approximately 4 cm. into the ureter, Under fluoroscopic control we rotated the forceps, grasped the radiopaque retrieval tail and extracted the stent. This procedure is easy in removing stents that have migrated but fluoroscopic control is essential since blind groping with forceps could damage the ureteral wall. However, because the jaws of the forceps are small it is virtually impossible for them to pull on the ureter after they have engaged the retrieval tail. Respectfully, Arthur D. Smith and Kiumars Hekmat Department of Urologic Surgery University of Minnesota School of Medicine Minneapolis, Minnesota 55455 INCREASE OF GLYCEROL PHOSPHORYL ETHANOLAMINE IN HUMAN ADENOCARCINOMATOUS PROSTATE TISSUE
To the Editor. In a study on free amino acids and related positive substances in the human prostate we found a pronounced increased concentration of glycerol phosphoryl ethanolamine in 4 cases of well differentiated adenocarcinoma. The values were 16.34, 20.66, 37 .51 and 9.52 µmol./gm. protein (mean 20.01 µmol./gm.). In 47 cases of benign prostatic hyperplasia the mean value of glycerol phosphoryl ethanolamine was 4.66 µmol./gm. protein (standard error of mean 0.28 µmol./gm.). The only previous study on glycerol phosphoryl ethanolamine and prostatic tissue that we were able to find was by Kochakian, who studied the rat prostate and found a decreased concentration of glycerol phosphoryl ethanolamine after castration and restoration of normal concentration after administration of testosterone proprionate. 1 Glycerol phosphoryl ethanolamine is involved in many metabolic processes. The transport of glycerol phosphoryl ethanolamine in and out of the cell might be altered by changes in the cell membrane and, also, the internal and external milieu of the cell. To our knowledge an increase of glycerol phosphoryl ethanolamine in adenocarcinomatous prostatic tissue has not been reported previously. Its determination in prostatic tissue could be a valuable method for a biochemical differential diagnosis. Respectfully, M. vanSandeandK. Van Camp Urology Unit University ofAntwerp Wilrijk-Antwerpen, Belgium 1. Kochakian, C. D.: The free amino acids of the reproductive
organs of the male rat: regulation by androgen. Ala. J. Med. Sci., 12: 336, 1975.
THE JOURNAL OF UROLOGY
Copyright © 1979 by The Williams & Wilkins Co.
Letters to the Editor RENAL TRANSPLANT REJECTION
To the Editor. I was interested in the urographic observation of Seymour and Rittenberg, concerning non-visualization of renal calices during excretory urography (IVP) as an indicator of a renal transplant rejection. 1 This study confirms what we reported in 1973. 2 In our transplantation unit an IVP is a routine procedure to diagnose (and sometimes predict) a rejection crisis. As soon as the allograft diuresis becomes satisfactory and stable (sometimes as early as 2 or 3 days postoperatively) we do an IVP to serve as a control for subsequent studies. Another IVP is done as soon as rejection is suspected. Failure of visualization of renal calices and good concentration in the pelvis, ureter and bladder constitute good evidence of renal edema. This finding correlated with the diagnosis of transplant rejection in our experience. However, an IVP is less helpful in the followup of the rejection crisis because the reappearance of the calices occurs later than clinical and biochemical evidence of improvement. We fully agree that one must be cautious when studying allografts with an IVP in the early post-transplantation period. However, if the electrolytes and hydration are maintained adequately and if low dose infusion IVPs are performed in patients at risk the incidence of irreversible impairment of renal function in previously stable grafts is low. We have performed hundreds of IVPs under these stated conditions and have observed no complications related to renal function. Consequently, we consider the technique safe if done carefully. Respectfully, Rene Kuss Clinique Urologique Hopital de la Pitie 83 Bd de l'hopital 75634 Paris, Cedex 13, France 1. Seymour, E. Q. and Rittenberg, G. M.: Non-visualization of
renal calices during excretory urography as an indicator of renal transplant rejection. J. Urol., 119: 720, 1978. 2. Kuss, R., Poisson, J. and Le Guillou, M.: L'urographie intra veineuse au cours de la crise de rejet du transplant. J. d'Urol. et Nephrol., 7-8: 605, 1973. RETRIEVAL OF THE GIBBONS URETERAL STENTS UNDER FLUOROSCOPIC CONTROL
To the Editor. The distal collar of a Gibbons catheter usually prevents it from migrating up the ureter but, if the stent does migrate, its long retrieval tail usually makes it easy to recover. However, in 1 of our patients a stent migrated so far that all of the retrieval tail had passed beyond the ureteral orifice. Flexible alli-
133
gator forceps was inserted through the cystoscope approximately 4 cm. into the ureter, Under fluoroscopic control we rotated the forceps, grasped the radiopaque retrieval tail and extracted the stent. This procedure is easy in removing stents that have migrated but fluoroscopic control is essential since blind groping with forceps could damage the ureteral wall. However, because the jaws of the forceps are small it is virtually impossible for them to pull on the ureter after they have engaged the retrieval tail. Respectfully, Arthur D. Smith and Kiumars Hekmat Department of Urologic Surgery University of Minnesota School of Medicine Minneapolis, Minnesota 55455 INCREASE OF GLYCEROL PHOSPHORYL ETHANOLAMINE IN HUMAN ADENOCARCINOMATOUS PROSTATE TISSUE
To the Editor. In a study on free amino acids and related positive substances in the human prostate we found a pronounced increased concentration of glycerol phosphoryl ethanolamine in 4 cases of well differentiated adenocarcinoma. The values were 16.34, 20.66, 37 .51 and 9.52 µmol./gm. protein (mean 20.01 µmol./gm.). In 47 cases of benign prostatic hyperplasia the mean value of glycerol phosphoryl ethanolamine was 4.66 µmol./gm. protein (standard error of mean 0.28 µmol./gm.). The only previous study on glycerol phosphoryl ethanolamine and prostatic tissue that we were able to find was by Kochakian, who studied the rat prostate and found a decreased concentration of glycerol phosphoryl ethanolamine after castration and restoration of normal concentration after administration of testosterone proprionate. 1 Glycerol phosphoryl ethanolamine is involved in many metabolic processes. The transport of glycerol phosphoryl ethanolamine in and out of the cell might be altered by changes in the cell membrane and, also, the internal and external milieu of the cell. To our knowledge an increase of glycerol phosphoryl ethanolamine in adenocarcinomatous prostatic tissue has not been reported previously. Its determination in prostatic tissue could be a valuable method for a biochemical differential diagnosis. Respectfully, M. vanSandeandK. Van Camp Urology Unit University ofAntwerp Wilrijk-Antwerpen, Belgium 1. Kochakian, C. D.: The free amino acids of the reproductive
organs of the male rat: regulation by androgen. Ala. J. Med. Sci., 12: 336, 1975.