Renal Transplantation 1

RENAL TRANSPLANTATION

The  history of tissue and organ transplantation is ancient,  but

successful transplantation is a recent event.

It  has been a by product of our undertanding the immune  system,

its   role  in  xeno* and  autotransplants  and  the  advent   of

immunosuppressive drugs.

Thus in 1960, successful kidney and other organ  transplantations

become a reality.

1.1 KIDNEY FAILURE

Causes of end stage renal failure include:

* Glomerulonephritis

* Chronic pyelonephritis

* Diabetes mellitus

* Obstructive Uropathies

* Polycystic disease

In   the  end  stage  of  kidney  failure,  dialysis  (haemo   or

peritoneal)  has  the potential of maintaining life  and  provide

alternate  therapy for these patients. Patients on dialysis  have

anaemia, hypertension, lower vitality and increased dependence on

hospital    facilities.   Transplantation   under   ideal    home

circumstances provides a cost effective alternative ensuring near

normal productive quality of life and life span

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STD HIV 3 transmission testing

Test For HIV Infection

Elisa, the test is inexpensive and easy to perform. It is  likely

to be the main HIV antibody screening test for some time to come.

The  ELISA  test is highly sensitive. There are  very  few  false

negatives. A small percentage of false positive results do occur.

The  newer  ELISA  tests  hve  both  high  sensitivity  and  high

specificity.

6.6 Transmission Of HIV

Scientists  have  isolated HIV from most body fluids.  They  have

found  the  virus in blood, semen,  cerebrospinal  fluid,  tears,

saliva,  breast  milk,  colostrum, urine,  cervical  and  vaginal

secretions.  In  theory,  any of these body fluids  from  an  HIV

infected  person  could  transmit  the  virus.  The  presence  of

generalised  Kaposi's  sarcoma  or  cryptococcal  meningitis  are

sufficient by themselves for the diagnosis of AIDS.

Transmission Of HIV After Exposure To An Infected Source.

In  64% of all reported cases of AIDS in adults in the USA,  upto

the  end of 1987, sexual contact was the only known risk  factor.

Most  of the cases were homosexual or bisexual  men.  Hetrosexual

intercourse  is the main route of transmission in  Africa,  where

there are as many women infected as men. Hetrosexual transmission

is becoming more common in the USA and Europe. We know that it is

possible to be infected by a single act of intercourse though the

chance is small.

The  pattern  of  HIV transmission is very like  the  pattern  of

transmission   of  hepatitis  B  virus.  However,  HIV  is   less

infectious than hepatitis B

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STD HIV 2 population at risk clinical

At risk population

- Known HIV positive patients

- Homosexuals males

- Haemophilia patients who have received HIV positive blood

- Children of seropositive mother

- Sexual partner of seropositive females.

Clinical Presentation

The  manifestations of AIDS are due not to virus itself,  but  to

the immune abnormalities that you may see in patients with immune

damage due to HIV infections and these are:

*  Decreased T4 lymphocytes in the blood

*  Hypergammaglobulinaemia

*  Impaired  cutaneous delayed hypersensitivity (for example,  to

   the tuberculin test)

Many conditions can temporarily suppress the cell-mediated immune

response, notably tuberculosis, malaria, manifestations of  viral

infections  such  as measles. However, with HIV  infections,  the

immune deficiency is permanent.

*  Sometimes after infection, the person sero-converts, that  is,

   they start to produce antibodies to HIV

*  A few patients may experience an acute febrile illness at  the

   time of seroconversion

*  The illness  lasts about 14 days, and is similar to  influenza

   or glandular fever

*  Many patients have no such fever

*  Most people infected with HIV have no symptoms. The  infection

   is latent, and they are asymptomatic carriers

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STD Human Immunodeficiency Virus 1

HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION

6.1 The virus

The  virus was first isolated from the blood of AIDS patients  in

1983  by Montagnier in France. He called it  the  lymphadenopathy

associated virus, or LAV.

*  In  1984  a virus  was isolated by  Gallo  and  colleagues  in

   America  and  they called it the  Human  T-Cell  Lymphotrophic

   Virus III

*  We now know that LAV and HTLV III are the same virus

In  May  1986,  the International Committee on  the  Taxonomy  of

Viruses renamed the virus Human Immunodeficiency Virus or HIV.

Since the discovery of another virus HIV-II, HIV is often  called

HIV-I.  The  Human Immunodeficiency Virus which  causes  AIDS  is

1/100,000  of millimeter in diameter. The outer coat is  made  of

lipid  membrane (Fig. 28.1). Inside the core there is  an  enzyme

called reverse trascriptase.

There  is  also some RNA which is the viral genetic  material  or

genome;  HIV  belongs to the family of  retroviruses,  which  can

incorporate  their genome into the genome of the host  cell,  and

cause a permanent infection. In most groups of viruses the genome

remains separate from the host of cell genome and the  infections

can be eliminated.

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