Induction therapy has established itself as an integral component of modern-day renal transplantation. Carefully selected induction therapy helps not only to avoid early rejection of grafts but also allows grafts with delayed function to recover prior to introduction of potentially nephrotoxic immunosuppressants. While the place of induction therapy and reduction in early acute rejection is well established, its overall impact on long-term graft and patient survival is still unclear, especially in the ‘lowrisk’ transplant recipient. Considering the substantial initial costs of induction therapy and their potential adverse reactions, transplant clinicians in developing countries have had to weigh the true advantages in induction against affordability and sustainability in the ‘free’ state health care systems. This review looks at the place of induction therapy in the current clinical setting with special emphasis on the ‘low-risk’ transplant candidates in limited resource settings.

Phenazopyridine, an azo dye, is commonly used to relieve dysuria caused by bladder irritation or infection. We report the case of a 64-year-old lady who presented with unexplained sub-acute onset hemolytic anaemia followed by acute kidney injury (AKI) and jaundice. This created a diagnostic dilemma until concealed phenazopyridine abuse was discovered. Discontinuation of Phenazopyridine improved renal function and hemoglobin level to baseline without any other intervention. Prompt urinalysis proved crucial in solving the diagnostic challenge. We also present a review of literature highlighting the association of this commonly used medication with renal tubular dysfunction, interstitial nephritis and hemolytic anemia.

Encapsulating peritoneal sclerosis (EPS), is a rare but devastating complication of long-term peritoneal dialysis (PD) with a high mortality rate. The incidence is between 0.5 and 3.3%, decreasing with time. EPS is defi ned as a clinical syndrome with major signs of gastrointestinal obstruction, infl ammatory parameters, radiological and macroscopic changes. Duration of treatment and cessation of PD are the main risk for development of EPS: about 75% of EPS occurred in patients transferred on hemodialysis or in the two years after kidney transplantation. Morphological alterations are disappearance of mesothelial layer, sub-mesothelial fi brosis, interstitial sclerosis and vasculopathy, ultrafi ltration failure, fast transport status of the peritoneal membrane, and loss of sodium sieving are the most predicting functional abnormalities. Some biomarkers could be found in the peritoneal effl uent. The pathophysiology is probably a consequence of a multiple-hit process in which expression of growth factors and cytokines play a role. Medical strategies (corticosteroids, immunosuppressive drugs, tamoxifen) in association with parenteral nutrition and/or surgery (enterolysis) are discussed. Prevention is the use of physiological peritoneal solutions, icodextrine instead of high glucose concentration solution, and peritoneal lavage fter peritoneal dialysis cessation for any reason.

About 30-40% of patients with chronic kidney disease (CKD) patients also have concomitant diabetes (1). Diabetes has been shown to have signifi cantly stronger association with CKD in patients with younger age (2). Diabetes management in CKD poses signifi cant challenge because of the increased risk of hypoglycaemia, renal excretion of most oral antidiabetics, variable appetite of patients with CKD and the effects of hemodialysis and peritoneal dialysis on glycemic control. Management of diabetes after renal transplantation is a separate entity with different challenges due to the effect of immunosuppressants especially steroids on carbohydrate metabolism and will not be discussed in this review.

Research in Tolerance and Chimerism by Transplant immunologists for over half a century is akin to the pursuit of the Holy Grail. Animal experiments for inducing tolerance may not have been successful initially but in that process, our knowledge of the fascinating immune system has been greatly enriched. Understanding of innate and adaptive immune systems has paved the way for development of potent immunosuppression. However, achieving clinical or operational tolerance long term in renal transplant recipients in the absence of immunosuppression is the ultimate goal for clinicians. Reduction in immunosuppression will lower morbidity and mortality associated with heavy burden of immunosuppression. This review article will be of particular interest to clinicians involved in delivering care to renal transplant recipients. We have elucidated mechanisms of self-tolerance through central and peripheral tolerance, evolution of tolerogenic strategies,difference between macro and micro-chimerism, overview of successful protocols for inducing tolerance and recent work in the development of expanding regulatory cell lines. It is most encouraging to note progress using cellular therapies as reported by Immune Tolerance Network and by Transplant Research & Immunology group at Oxford. We may not be far from achieving clinical tolerance albeit with minimal if not completely immunosuppression free regimens in the longer term.

Background: Unroofi ng is a controversial procedure to avoid catheter removal in the treatment of the chronic exit site and tunnel infection, but is now rarely recommended. Here we aimed to evaluate the effects of the unroofi ng procedure on peritoneal catheter survival.