To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF were preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age ofer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall mortality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.

It is currently accepted that Helicobacter pylori (Hp) infection is crucial in the pathogenesis of peptic ulcer. Therefore, we developed a prospective study to assess the prevalence of Hp infection by the ¹³C Urea Breath Test (¹³C UBT) in 52 hemodialysis patients, and we evaluated the efficacy of two consecutive eradication regimens in 23 positive patients with dyspepsia and/or on a transplantation list. The correlation between anti-Hp serology and ¹³C UBT results was also analyzed in 34 patients who were followed up during 18 months. The Hp prevalence by ¹³C UBT was 63.5% (33/52). The eradication rate after the first cycle of therapy (amoxicillin 500 mg/8 h and omeprazole 20 mg/12 h, 14 days) was 60.8% (14/23). After the second cycle (clarithromycin 500 mg/ 12 h plus omeprazole 20 mg/12 h, 14 days), the eradication rate reached 82.6% (19/23). The serological procedure showed a good correlation with ¹³C UBT (about 80% sensitive and specific) when very restrictive diagnostic and eradication criteria were adopted. We conclude that an eradication rate higher than 80% can be reached after two consecutive cycles of dual therapy in hemodialysis patients. Anti-Hp serological tests must be cautiously interpreted in these patients.

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Patients with chronic renal failure on hemodialysis have a high risk of infections with viruses such as hepatitis B (HBV), hepatitis C (HCV), GB virus C/hepatitis G (GBV-C/HGV) and TT (TTV) viruses. The prevalence of HBV, HCV, GBV-C/HGV and TTV in patients with chronic renal failure who are on conservative management before entering into a hemodialysis program (predialysis) in comparison with hemodialyzed patients was studied to elucidate whether the high prevalence of these viruses is influenced by that observed in the predialysis stage. The presence of hepatitis B virus surface antigen (HBsAg), HCV RNA, GBV-C/HGV RNA and TTV DNA was analyzed in sera from 80 patients with chronic renal failure (35 on predialysis and 45 on hemodialysis). HBsAg, HCV RNA, GBV-C/HGV RNA and TTV DNA were detected in one (2.8%), six (17.1%), eight (22.5%) and 16 (45.7%) of the 35 patients on predialysis. Two (5.7%) of these patients were coinfected with HCV and GBV-C/HGV, whereas six (17.1%) had GBV-C/HGV and TTV coinfection. In the 45 hemodialyzed patients, HBsAg, HCV RNA, GBV-C/HGV RNA and TTV DNA were detected in one (2.2%), two (4.4%), seven (15.5%) and 26 (57.7%). One (2.2%) patient had HBV and TTV coinfection, two (4.4%) HCV and TTV coinfection whereas four (8.8%) were coinfected with GBV-C/HGV and TTV. No differences regarding age, gender, previous surgery and number of transfusions were found between infected and uninfected patients within and between both groups. In conclusion, the prevalence of the viruses studied in predialysis may influence their prevalence in dialysis units.

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