voici la description du cas : incroyable pour l’époque quand même. On pourrait encore en tirer un roman. Avec un rein de chimpanzé, mais la physiologie étant différente, elle est morte d’un déséquilibre ionique.
A 23-year-old schoolteacher was admitted in November 1963 with chronic glomerulonephritis and progressive uremia. She had experienced an episode of acute glomerulonephritis at age 14, and demonstrated persisting proteinuria. She had remained asymptomatic until approximately 5 months before admission, when she noted weakness and dizziness.
On admission her blood pressure was 190/120 mmHg, and laboratory studies included BUN of 184 mg%, creatinine of 40 rog%, and creatinine clearance of 4 ml/min. Rapid deterioration of her condition necessitated peritoneal dialysis.
On January 13, 1964, she received a renal heterotransplant. Diuresis occurred with a urinary output on the day of operation of 7 liters. By the 3d day following transplantation the BUN had fallen from a preoperative level of 116 mg% to 12 mg%, and the serum creatinine from a preoperative level of 21 mg% to 0.9 mg%. Creatinine clearance was 50 ml/min. Her blood pressure fell to normotensive levels (110/70 mmHg). Her subsequent course demonstrated satisfactory renal function until the 23d day following operation when threatened rejection was expected.
Urinary output decreased to 1,000 ml/24 h, BUN creatinine rose to 28 and 1.9 mg%, respectively. Creatinine clearance fell to 23 ml/min, and urinary sodium content to 11.6 mEq for a 24-hour period. Gradual reversal of rejection occurred during the following 2 weeks, although unexplained fever persisted for 3 months. She became asymptomatic and had normal renal function 8 months after transplantation.
Serial renograms in this patient demonstrated a delay in peak activity, which coincided with clinical and biochemical evidence of threatened rejection. Following reversal of rejection, the renogram resumed a more normal pattern. An intravenous urogram 12 weeks after transplantation showed function of both transplanted kidneys.
Agglutination studies demonstrated a slight rise in titer at approximately 3 weeks after transplantation. The agglutation titer subsequently returned to previous levels.
This patient died 9 months after transplantation. The cause of death was thought to be acute electrolyte imbalance. Autopsy showed no other cause of death. Histology of the transplanted kidneys showed no other cellular infiltration, but subintimal hyperplasia of the arterioles (Reemtsma and others 1964).