Peptic ulcer and chronic renal failure.

PROBABLY the first real attempt to ascertain if any casual relationship existed between peptic ulcer and renal disease was contained in a survey of post mortem records by Perry and Shaw (1893). They found that some form of kidney disease was present in seven per cent of deaths and as their cases of duodenal ulcer numbered 70, they reasoned that seven per cent, or five cases, might have been expected to have coincident Bright's disease. In fact, 12 cases showed this association and they concluded that "there appears to be some reason for including Bright's disease as one of the predisposing causes of duodenal ulcer". Moynihan in his classical textbook on duodenal ulcer (1910) described 27 autopsy cases where ulceration affecting the duodenum was associated with an advanced pathological condition of the kidneys, and he hinted at an association between the two diseases. Thereafter the subject received little further attention until the early 1960s when attempts were made to prolong the lives of uraemic patients by regular dialysis and transplantation. Subsequently, peptic ulcer was recognised as a serious complication in uraemic patients receiving regular dialysis (Sokol, 1964), and in those undergoing kidney transplantation (Moore and Hume, 1969). In some centres, the incidence of upper gastrointestinal haemorhage and perforation following transplantation was so high it was even suggested that all uraemic patients should have vagotomy carried out prior to transplantation (Penn et al., 1968).