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Books: 236	Journals: 18	Articles: 21486

Abstract

A. Stragier and M. Jadoul

Department of Nephrology, University Clinic St-Luc, Université Catholique de Louvain, Brussels, Belgium
Background: The interdialytic weight gain (IDWG) and protein catabolic rate (PCR), expressed per 24 hours (daily), are usually assumed to be stable over the week in chronic hemodialysis (HD) patients. Methods: We studied different HD patient groups at different time points (study 1 in 1993: n = 48, study 2 in 1999: n = 16, study 3 in 2000: n = 112). Daily IDWG (calculated from post- and pre-dialysis body weight and interdialytic interval) and nPCR (calculated from kinetic modeling) were compared over short (2 days) and long (3 days) intervals. Results: In all groups of HD patients studied, both daily IDWG and nPCR were significantly (p < 0.05) lower (IDWG by 7 ? 15%, nPCR by 5 ? 6%) over long than short interdialytic intervals. This difference was observed whether or not blood sampling was planned after the long interval. This suggests selfrestriction of dietary intake over the long interdialytic interval. Conclusions: Daily IDWG and nPCR are lower over the long interdialytic interval. Studies should thus define or even standardize the period of time over which IDWG and nPCR are calculated.

Abstract

M. Sato, Y. Matsumoto, H. Morita, H. Takemura, K. Shimoi and I. Amano

¹Department of Dialysis Therapy, Social Insurance Chukyo Hospital, Nagoya, ²School of Nursing, University of Shizuoka, and
³Institute for Environmental Sciences, University of Shizuoka, Shizuoka, Japan
Aims: Dysfunctional endothelium caused by oxidative stress is thought to play a role in pathogenesis of a variety of conditions including atherosclerosis. We investigated whether a microcirculatory disturbance in hemodialysis (HD) patients was associated with increased oxidative stress and endothelial injury. Patients and methods: Transcutaneous oxygen tension (TcPO2) on the dorsum of the foot at rest was measured as a marker of microcirculation in 33 patients undergoing HD without clinical manifestations of peripheral arterial disease and 20 healthy controls. Furthermore, in order to examine whether TcPO2 was affected by antioxidants, oral supplementation with a combination of vitamin C (200 mg daily) and vitamin E (600 mg daily) was administered for 6 months to 8 patients with microcirculatory disturbance (TcPO2 values of 50 mmHg or less). Serum biochemical parameters including vitamins were also measured. Results: Mean TcPO2 value was significantly lower in HD patients than in control subjects (47.9 ± 13.5 mmHg versus 62.4 ± 11.9 mmHg, p < 0.001). After vitamin supplementation, TcPO2 values remarkably increased (40.6 ± 10.0 mmHg versus 57.4 ± 6.5 mmHg, p < 0.005). Serum vitamin C and vitamin E levels increased significantly as well, while serum levels of thrombomodulin, a marker of endothelial injury, and thiobarbituric acid reactants, a marker of lipid peroxidation, were significantly decreased in comparison with those before supplementation. Conclusions: Our results suggest that the microcirculatory disturbance in HD patients seems to be associated with endothelial damage caused by oxidative stress. Combined supplementation with vitamin C and vitamin E may be of clinical benefit in improving the cutaneous microcirculation by reducing oxidative stress.

Abstract

A. Falk, V. Teodorescu, W.Y.W. Lou, J. Uribarri and J.A. Vassalotti

Departments of ¹Radiology, ²Surgery, ³Biomathematical Sciences, and ⁴Medicine, Mount Sinai-NYU Medical Center, New York, NY, USA
Aim: This is a retrospective study of percutaneous transluminal balloon angioplasty (PTA) efficacy for treatment of surgical vein mobilization site (?swing point?) stenoses in hemodialysis arteriovenous fistulae (AVF) that fail to mature or are poorly functioning. Method: Between February 1, 1999, and February 28, 2001, 65 non-maturing or poorly functioning AVF were studied in 63 consecutive hemodialysis patients (30 male, 33 female, aged 26 ? 92 years). All AVF underwent contrast angiography to study the inflow artery, AVF, outflow and central veins. PTA of stenotic sites was performed to initiate or restore AVF function. Results: Seventy-eight venous and 2 arterial stenoses were found and treated with PTA in the 65 AVF. All PTA were technically successful. A total of 55 stenoses were identified in the vein at the site of surgical mobilization (?swing point?). Additionally, 19 cephalic and 4 central venous stenoses were found. During the study, 13 AVF underwent repeat PTA at the ?swing point?. Of the 65 AVF treated, 50 were being successfully used as an access site, 4 AVF were lost during follow-up (34 ? 688 days; mean: 258 days) and 8 patients died within the study period. The duration of functional patency of the treated AVF was 39 ? 660 days (mean: 280 days). Conclusion: Non-maturing or poorly functioning AVF frequently have stenoses in the outflow vein at the original site of surgical vein mobilization. These ?swing point stenoses? are amenable to PTA, which is a safe and effective treatment for prolonging AVF patency and function.

Abstract

P. Gerke and L.C. Rump

¹Renal Division, University Hospital Freiburg, and ²Marienhospital Herne, Ruhr-University Bochum, Herne, Germany
Leptospirosis is an infectious disease of variable severity characterized by sudden onset of headache, myalgia and prostration. Although most common in the tropics, an increasing number of cases is reported in Europe and Northern America. Severe forms referred to as Weil?s disease commonly involve kidneys, liver, lungs, CNS and heart and require early recognition and immediate initiation of adequate therapy. We describe 3 patients with Weil?s syndrome from an urbanized region in Southern Germany, who developed renal and respiratory failure. PCR facilitated early diagnosis, and therefore, specific treatment before serological tests were positive. Illustrating the case histories, initial presentations and clinical courses, we point out difficulties with early diagnosis and treatment. Furthermore, we offer a comprehensive overview on leptospirosis with emphasis on renal involvement, current diagnostic tools and evidence-based therapy.

Abstract

Y. Akashi, M. Inoh, N. Gamou, N. Yoshimune, M. Kinashi, S. Ohbayashi and N. Kurata

Department of Internal Medicine, Kinashi Ohbayashi Hospital, Tahamatu City, Kagawa, Japan
A 72-year-old female was admitted to our hospital for massive proteinuria. She had previously been diagnosed with hepatitis C virus (HCV) infection and macroglobulinemia. Renal histological examination demonstrated membranoproliferative glomerulonephritis (MPGN), and type 2 cryoglobulinemia was positive in her serum. It is generally recognized that MPGN is the most common nephritis associated with HCV infection and cryoglobulinemia, but this is the first report of an HCV-infected patient with macroglobulinemia associated with MPGN. After treatment with prednisolone and melphalan, proteinuria disappeared, but macroglobulinemia and cryoglobulinemia were not improved.

Abstract

R. Sam, S.B. Chebrolu, C.V. Reyes, K.L. Pierce, Z. Molnar, R. Dhand and T.S. Ing

Departments of Medicine, Radiology and Pathology, ¹Veterans Affairs Hospital, Hines, ²Stritch School of Medicine, Loyola University Chicago, Maywood, and ³Cook County Hospital, Chicago, Illinois, USA
Aim: Transjugular renal biopsy is a relatively new technique that has often been applied to patients with concomitant renal and liver diseases. It is believed that with this particular biopsy approach, one can avoid the high risk of conventional renal biopsy-related bleeding in patients who also often suffer from coagulopathy. However, other indications for this procedure have not been clearly defined. Herein, we describe an unconscious patient afflicted with acute renal failure and maintained on mechanical ventilation in whom the performance of a renal biopsy was deemed necessary. Methods: The transjugular renal biopsy technique was carried out because this unconscious patient could not follow breathing instructions for a conventional biopsy to be performed. Also, it would have been difficult for the patient to lay prone during the conventional biopsy procedure. Results: A total of 7 glomeruli were obtained and a diagnosis of vasculitis-related necrotizing glomerulonephritis and acute tubular necrosis was made. Subsequently, the patient was treated successfully with steroid therapy. Conclusion: Transjugular kidney biopsy should be considered in unconscious renal biopsy-requiring patients maintained on mechanical ventilation.

Abstract

P. Carmichael and J.P. O?Donnell

Abstract

S. Lee, K.P. Kang, W. Kim, S.K. Kang, H.B. Lee and S.K. Park

Abstract

K.C. Tse, F.-K. Li, T.-M. Chan and K.-N. Lai

Abstract

T. Yamada and T. Satoh

Abstract

M. Gajdos and R. Dzúrik

Abstract

J. Soma, K. Sato, T. Sakuma, H. Saito and H. Sato

Abstract

N.D. Madala, S. Naicker, B, Singh, M. Naidoo, A.N. Smith and K. Rughubar

¹Department of Medicine, ² Department of Virology, and ³ Department of Anatomical Pathology, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa
Idiopathic membranoproliferative glomerulonephritis (MPGN) is a well-defined clinicopathological entity with a poor prognosis, with 50% of patients progressing to end stage renal disease (ESRD) within 10 years. It was reported in about 36% of adult Black patients with nephrotic syndrome in our center previously [Seedat et al. 1988]. Hepatitis C virus (HCV) infection has been shown to be associated with cryoglobulinemic as well as non-cryoglobulinemic (or idiopathic glomerulonephritis). The aim of this study was to determine whether an association exists between HCV infection and idiopathic MPGN in a population with a relatively high prevalence of MPGN. We studied adult patients referred with glomerular disease over a two-year period, 104 patients had primary glomerulonephritis. All 23 (22%) patients with idiopathic MPGN were enrolled, as well as 32 age-matched patients presenting with other primary glomerular diseases. We examined serum from all 55 patients for evidence of HCV antibodies and HCV RNA. None of the 55 patients showed evidence of HCV infection. Chronic renal failure was present in 82.6% of the patients with idiopathic MPGN and it was advanced in 52,2%, who either were dialysis-requiring at presentation or progressed to ESRD soon thereafter; 30.4% had moderate chronic renal failure, while only 17.4% had normal renal function. HCV infection is not associated with idiopathic MPGN in our patients. Idiopathic MPGN remains an idiopathic disease, possibly with a poor prognosis in our population.

Abstract

R.L. Siegler, J.R. Sherbotie, N.D. Denkers and A.T. Pavia

¹Division of Nephrology and Hypertension, and ²Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
Aims: 1. To study the epidemiological and clinical features of Shiga toxin (Stx)-mediated (post-diarrheal) hemolytic uremic syndrome (HUS) occurring in more than 1 family member. 2. To compare familial with non-familial episodes, and concurrent familial with non-concurrent familial cases. 3. To determine the likelihood of Stx HUS occurring in a second family member. Methods: A retrospective review from January 1970 through September 2001 of families in whom Stx HUS occurred in more than 1 family member was conducted using a computerized HUS registry. It contains information on 373 episodes that occurred in 356 families from Utah and neighboring states. Cases were categorized as being either concurrent (i.e., occurring within a month of one another) or non-concurrent, and the study was limited to those with typical (post-diarrheal) episodes. Results: HUS occurred in 2 or more family members in 17 (4.8%) of the families in our registry. In 12 (3.4%) of these families episodes occurred with days to weeks of each other; in 5 families (1.4%) episodes were separated by intervals of several years. There were no statistically significant differences in demographic, seasonal, laboratory, clinical, or outcome variables between familial subsets (concurrent versus non-concurrent) or between familial and non-familial cases. Conclusions: When a child is diagnosed with D+ HUS, there is an increased risk that a second family member will also develop HUS; most often within days to weeks (i.e., within a month), but in some cases episodes may be separated by intervals of years. Non-concurrent cases suggest common environmental risk factors, or perhaps a genetic predisposition. Concurrent cases suggest a common source of infection or person-to-person transmission; a genetic predisposition cannot be excluded. These observations suggest that siblings of an index case who develop diarrhea should be kept under close surveillance.

Abstract

J. Ronkainen¹, M. Ala-Houhala², N.-P. Huttunen³, T.Jahnukainen⁴, O. Koskimies⁵, T. Örmälä⁶ and M. Nuutinen¹

¹Department of Pediatrics, Oulu University Hospital, Oulu,
²Department of Pediatrics, Tampere University Hospital, Tampere,
³Department of Pediatrics, Jyväskylä Central Hospital, Jyväskylä,
⁴Department of Pediatrics, Turku University Hospital, Turku,
⁵Department of Pediatrics, Helsinki University Central Hospital, Helsinki, and ⁶Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
Patients and methods: All children with Henoch-Schoenlein glomerulonephritis (HSP-GN) and nephrotic-range proteinuria (> 40 mg/h/m2), treated at 5 university hospitals and in 1 central hospital in Finland during in 1990 ? 1997, were analyzed retrospectively. The mean age of these 19 patients (8 girls, 11 boys) at the time of diagnosis was 9.9 years (range 4.6 ? 15.1 years). A renal biopsy had been performed in all cases, giving findings according to the classification used in the International Study of Kidney Diseases in Children (ISKDC) of grade II (4 patients), grade III (10), grade IV (4) and grade V (1). Six patients underwent a second biopsy. Results: The yearly incidence of nephrotic-range HSP-GN in Finland was 2 per 1 million children under 15 years of age. After a mean follow-up of 4.6 years (range 9 months ? 9.1 years), 3 patients (15.7%) had no signs of nephritis, 11 (57.9%) had proteinuria < 1 g/day or microscopic hematuria, 2 (10.5%) had proteinuria > 1 g/day, and 3 (15.7%) had developed ESRD or uremia. 47% of the patients needed medication for proteinuria at the time of the latest follow-up. The first kidney biopsy did not predict the outcome of HSP-GN, since all the patients with the poorest outcome had only ISKDC II-III findings in their first biopsy. Conclusion: According to our series, the morbidity in cases of HSP-GN with nephrotic-range proteinuria is high and a close clinical follow-up is needed. The treatment of HSP-GN patients should be based on the clinical presentation rather than on the biopsy findings.

Abstract

K. Kano, K. Nishikura, Y. Yamada and O. Arisaka

Department of Pediatrics, Dokkyo University School of Medicine, Tochigi, Japan
Aim: In recent reports, some kinds of HMG-CoA reductase inhibitors were able to decrease proteinuria and to improve renal function. Here we aimed to clarify the effect of fluvastatin (an HMG-CoA reductase inhibitor) on proteinuria and renal function in children with mild IgA nephropathy. Patients and methods: We conducted a prospective controlled study of 30 children who had been recently diagnosed with normocholesterolemic IgA nephropathy following the detection of a minor lesion or of focal mesangial proliferation and moderate proteinuria. The 30 patients were randomly assigned to receive both of 20 mg of fluvastatin and 5 mg/kg of dipyridamole (group 1), or 5 mg/kg of dipyridamole only (group 2) for 1 year. Results: By the end of the trial, urinary protein, hematuria, BUN and serum creatinine levels had significantly decreased in the patients of group 1 as compared to baseline. Serum total cholesterol, triglyceride and LDL cholesterol levels had significantly decreased, while serum total protein and albumin, and creatinine clearance had significantly increased in group 1 as compared to baseline and group 2. The urinary protein level had significantly decreased in the group 2 patients as compared to baseline, but only slightly. Conclusions: The results of this study suggest that fluvastatin and dipyridamole treatment yields an antiproteinuric effect and leads to the amelioration of renal function in moderately proteinuric patients with mild histological IgA nephropathy.

Abstract

T. Inoue, N. Shibahara, K. Miyagawa, R. Itahana, M. Izumi, T. Nakanishi and Y. Takamitsu

¹Blood Purification Center, Osaka Medical College, Osaka, and ²Department of Kidney and Dialysis, Hyogo College of Medicine, Hyogo, Japan
Aims: We evaluated the benefits and safety of nateglinide, a novel oral hypoglycemic agent, in type 2 diabetes patients with renal failure. Methods: Single-dose pharmacokinetics were studied in 8 patients with type 2 diabetes and a low creatinine clearance (range 1.8 ? 16.5 ml/min/1.73 m2) up to 6 hours after 90 mg nateglinide administration. Next, we treated another group of 8 patients undergoing regular hemodialysis with nateglinide 90 mg/day for 1 ? 3 months. The effect of hemodialysis on metabolite accumulation was then tested. Results: After a single 90 mg dose, nateglinide significantly increased the post-prandial secretion of insulin and thereby reduced plasma glucose levels. Mean pharmacokinetic parameters (AUC0-6 10.45 mg/l/h; t1/2 1.89 h, Cl/F 10.19 l/h) were comparable with those reported in healthy subjects. A much larger AUC value than those previously reported of M1, a major metabolite in the urine of healthy subjects, was observed, and the plasma concentration of M1 did not decline up to 6 hours after. In patients treated on a regular basis, there was marked accumulation of M1, while nateglinide could not be detected 24 hours after the last dose. Plasma M1 levels were significantly reduced by the hemodialysis sessions. Conclusions: Single 90 mg dose of nateglinide was safe and effective in patients with renal failure. However, repeated administrations could cause prolonged hypoglycemia due to accumulation of M1, which is known to have a modest hypoglycemic activity. Hemodialysis may help to eliminate excessive accumulation of M1.

Abstract

N.A. Mason, B.L. Neudeck, L.S. Welage, J.A. Patel and R.D. Swartz

¹College of Pharmacy, The University of Michigan, ²Department of Pharmacy Services, University of Michigan Health System, ³School of Pharmacy, University of Wisconsin, ⁴Clinical Pathology Laboratories, University of Michigan Health System, and ⁵Division o
Aims: Traditionally, vancomycin is administered following dialysis to minimize drug loss when high-flux membranes are employed. Unfortunately, this approach is extremely inconvenient for patients and staff, requiring the patients to remain in the unit for at least 1 hour following dialysis. This study was designed to evaluate the feasibility of administering vancomycin during hemodialysis. Specifically, this study was designed to compare the pharmacokinetics of vancomycin when administered during the last 1 ? 2 hours of dialysis (i.e. intra-dialytic administration) to that administered after completion of dialysis. Materials and methods: In a randomized, 3-way crossover trial, the pharmacokinetics of vancomycin were evaluated in 9 hemodialysis patients, comparing vancomycin 15 mg/kg following dialysis (Phase I), vancomycin 15 mg/kg during the last hour of hemodialysis (Phase II) or vancomycin 30 mg/kg during the last 2 hours of hemodialysis (Phase III). Vancomycin plasma concentrations were obtained over an 8-day period and subsequent comparisons between the treatment approaches were made with paired t-tests or ANOVA, as appropriate. Dialysate vancomycin concentrations determined on Day 1 and Day 3 of Phases II and III were used to calculate the fraction of vancomycin dose removed, and were compared to plasma data using paired t-tests. Results: Vancomycin was significantly removed (33.4 to 39.5%) during a 3- to 4-hour high-flux dialysis session occurring on Day 3 after vancomycin administration. Mean serum concentrations immediately following intradialytic vancomycin administration of 15 mg/kg over the last hour of dialysis or 30 mg/kg over the last 2 hours of dialysis were initially high (77.7 and 95.5 mcg/ml respectively), but fell to 25.9 and 40.5 mcg/ml, respectively, by 4 hours post-dialysis. Predialysis concentrations on Days 3, 5 and 8 were similar for vancomycin 30 mg/kg administered over the last 2 hours of dialysis as compared with a 15 mg/kg dose given after dialysis. Vancomycin 15 mg/kg over the last hour of dialysis resulted in significantly lower subsequent predialysis concentrations than the other dosing schemes. Conclusions: Vancomycin administration of 30 mg/kg over the last 2 hours of dialysis achieves serum concentrations similar to conventional dosing of 15 mg/kg after dialysis and would allow dosing on a weekly basis.

Abstract

C.W. McIntyre, S.H. Lambie and R.J. Fluck

Department of Renal Medicine, Derby City General Hospital, Derby, UK
Background: It is now possible to link relative blood volume (RBV) measurements to a software loop designed to actuate a biofeedback response. This allows changes in RBV to determine constant alterations in both ultrafiltration rate and dialysate conductivity. RBV, plasma sodium and weight loss are driven throughout the treatment to achieve the best compromise. This system has been demonstrated to markedly reduce intradialytic hypotension in unstable patients. We have applied this treatment to stable, non-hypotension prone HD patients and report on the short-term outcomes. Methods: We prospectively studied all 15 patients in a dedicated 4-station minimal care treatment area. Patients were studied for 3 weeks of standard HD, to understand the morphology and response to RBV in that individual. BF-HD was then instituted for a similar period (after a 2-week optimization period). Dialysis adequacy was assessed with equilibrated Kt/V measurements and urea mass removed in spent dialysate. Results: We studied 263 treatment sessions. There was a reduction in symptomatic episodes (per patient over 3 weeks) from 3 ± 0.5 (0 – 9) to 0.13 ± 0.13 (0 – 2) with BF-HD, p < 0.001. Reductions in systolic BP > 40% fell from 1.4 ± 0.4 (0 – 4) to 0.46 ± 0.16 (0 – 2). Episodes of RBV falling > 10% fell from 6.3 ± 0.85 (1 – 13) to 1.13 ± 0.27 (0 – 4) with BF-HD, p < 0.001. Interdialytic weight gains fell from 2.08 ± 0.05 (0.35 – 3.8) kg to 1.82 ± 0.06 (0 – 3.7) kg, p = 0.009. Equilibrated Kt/V increased from 1.01 ± 0.03 (0.61 – 1.35) to 1.13 ± 0.03 (0.7 – 1.5), p = 0.01, and mass removed of urea increased from 24.9 ± 3 (12.8 – 45) g to 32.7 ± 1.9 (17.3 – 48.5) g. Conclusions: This is the first report of BF-HD increasing tolerability, reducing interdialytic fluid gains and enhancing urea clearance in non-hypotension prone chronic HD patients. These data suggest that the previously reported associated benefits of BF-HD may be applicable to the majority of HD patients.

Abstract

K.-H. Hung, C.-T. Lee, J.-B. Chen and K.-T. Hsu

Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, R.O.C.
Aims: To identify clinical features and treatment response of tuberculous peritonitis (TBP) in a uremic population, a retrospective case-control study was performed. Materials and methods: Thirteen uremic patients with TBP (Group I: 62.7 ± 6.8 years, male 54%) collected between January 1986 and January 2002 were compared with another two age- and sex-matched controls: 19 non-azotemic patients with TBP (Group II: 62.9 ± 7.3 years, male 47%) and 30 uremic patients without TBP (Group III: 61.1 ± 8.7 years, male 47%). Clinical information and data of ascites and blood examinations were evaluated. Results: Significant differences between Groups I and II were found in comorbidity, hypertension, anorexia, percentages of neutrophil and lymphocyte from blood and ascites, and serum calcium (sCa), phosphorus and albumin-adjusted calcium (sAACa). However, no significant differences in duration of symptoms, coexistent pulmonary tuberculosis (p = 0.061), duration or complications of therapy and mortality (p = 0.13) were detected. Significant differences between Groups I and III were found in peripheral white cell counts and percentages of neutrophil and lymphocyte as well as in serum creatinine (sCr), albumin, sCa, sAACa and intact parathyroid hormone (iPTH). Conclusions: Non-specific symptoms make the diagnosis of TBP in a uremic population difficult. However, neutrophil predominance in blood and ascites, hypoalbuminemia, relatively lower sCr and hypercalcemia with suppressed serum iPTH were found to be characteristic. In TBP uremic patients, therapy complications were not common and there was a tendency for higher mortality, largely due to septic shock.

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