Dialysis and transplant patients in the long term.

The history of renal replacement therapy is traced from the early days of dialysis and kidney transplantation through the era of miraculous technology and the alleged certainties of anti-rejection therapy. Attention is focused on the newly found or anomalous biotypes that are common to both dialysis and transplantation. In dialysis not only the patient but also uremia is maintained and either hyper- or hyporeactivity in different biological systems may occur with or without clinical symptoms. In transplantation, while the balance between immunomodulation and immunotolerance is far from ideal, extrarenal complications may occur with an atypical mode of presentation, serious immunological renal lesions may develop asymptomatically and clinical signs of rejection may appear without noticeable laboratory alterations.