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Combined liver-kidney transplantations (CLKT) and kidney after liver transplantations (KALT) are established treatments for patients with end-stage hepatic and renal disease and the number of transplantations has continuously increased over the past few years. The most frequent indications for CLKT in adults are polycystic kidney disease with severe liver involvement and liver cirrhosis of different origins with concomitant chronic kidney failure due to chronic glomerulonephritis or diabetic nephropathy. In children, CLKT is most frequently required due to primary oxalosis type I. At present the main indication for KALT still is calcineurin inhibitor-induced chronic nephrotoxicity, emphasizing the need for a nephron-sparing long-term immunosuppression in liver transplant recipients. Compared to KALT, the indications for CLKT are not as well defined and the decision must therefore be made on a case-by-case basis by a multidisciplinary team of experienced clinicians to avoid unnecessary transplantations of both organs in patients with reversible kidney failure, given the scarcity of organs for transplantation worldwide. In hepatorenal syndrome CLKT should only be considered if the GFR is lower than 20 ml/min for more than three months or if the patient has been on renal replacement treatment for more than one month. In CLKT, there appears to be a certain immunological protection for the kidney transplant by the liver transplant., (© Georg Thieme Verlag KG Stuttgart · New York.)

Appraisal of the long-term prognosis of primary glomerulonephritis at the time of diagnosis, i.e. when there are no longitudinal observations, is based on the constellation of clinical findings as well as on the morphological changes in glomeruli and interstitial renal tissue which can be detected in histological examinations of biopsy specimens. A favorable long-term prognosis is to be expected with reasonable probability when 1. an isolated proteinuria of less than 1 g/24 hour and/or erythrocyturia (no cell casts in the sediment) are present in normal kidney function (glomerular filtration rate) as well as normal blood pressure characteristics, and the renal parenchyma shows normal sonographic findings; 2. Only slight mesangial cell proliferations can be detected histologically, and interstitial lesions (cell infiltration, fibrosis) are absent.

In 182 patients suffering from bioptical-proved and functional adapted chronic glomerulonephritis the relation between clinical course, morphological type and progression of disease has been evaluated. The presented results show a significant relation between the clinical course of chronic glomerulonephritis and the progression trend of this disease. The early finding of sclerotic changes may follow a benign course of the disease.

400 children (141 boys and 259 girls) in a renal disease care system were analyzed regarding their most frequent diagnoses of renal diseases and their age and sex distribution. Furthermore, the familiary situation, the time of observation, the number of consultations and the frequency of morphological changes of the kidney and the urinary tract were examined. 72% of the children suffered from urinary tract infection and in 10% a glomerulopathy and in 5.5% an urolithiasis were found. The symptoms of enuresis occurred in 22.2% of the patients. Infants were the most frequent age group (18%), 70% of which were boys. We found no differences in the incidence of renal diseases in comparison with other reports.