Case reports
Late onset seizures, hemiparesis and blindness in hemolytic uremic syndrome
B. Bennett, T. Booth and A. Quan
Volume 59 (2003) p. 196 - 200
Abstract
B. Bennett, T. Booth and A. Quan
1Children’s Medical Center of Dallas, USA, and
2University of Texas Southwestern Medical Center, Dallas, USA
Neurologic complications of hemolytic uremic syndrome, including seizures, usually occur early during the acute phase of the illness. We report a 3-year-old girl with classic diarrhea-associated hemolytic uremic syndrome who developed late onset seizures, hemiparesis and transient blindness on the 17th hospital day, at which time her recovery was characterized by improvement in her blood pressure, serum electrolytes, renal function, hematocrit and platelet count. A CT and MR revealed brainstem and posterior parietal and occipital infarct/edema. The association of these radiologic findings within the posterior distribution along with visual loss and seizures are unique to posterior reversible encephalopathy syndrome. Within 7 days, she regained motor function and vision and had no further seizure activity. At 6 months follow-up, physical examination revealed normal motor function and vision and a repeat MR showed near resolution of the previous findings with minimal occipital lobe gliosis. This case report describes the uncommon finding of late onset seizures occurring during the recovery phase of hemolytic uremic syndrome with MR findings consistent with posterior reversible encephalopathy syndrome.
Case reports
Steroid-induced tumor lysis syndrome in a patient with preleukemia
S.-S. Yang, T. Chau, M.-S. Dai and S.-H. Lin
Volume 59 (2003) p. 201 - 205
Abstract
S.-S. Yang, T. Chau, M.-S. Dai and S.-H. Lin
1Division of Nephrology, and 2Division of Hematology and Oncology,
Department of Medicine, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan, R.O.C.
Tumor lysis syndrome (TLS) is a well recognized complication of chemotherapy and radiotherapy for leukemia, lymphoma as well as rapidly growing malignancies. Less described is the occurrence of TLS following steroid therapy alone. Herein, we report on a 32-year-old male with myelodysplastic syndrome, characterized by refractory anemia with excess blasts in transformation, who developed acute oliguric renal failure 12 hours after methylprednisolone 1.0 g for presumed autoimmune thrombocytopenia. Laboratory investigations revealed typical findings of TLS, including hyperkalemia, marked hyperuricemia, hyperphosphotemia, hypocalcemia and urine uric acid to creatinine ratio 1.8 (> 1.0). Long hemodialysis (8 hours) was initiated for 3 consecutive sessions. Renal function recovered 1 week later. This case high-lights that single-dose steroid administration in a patient with hematological malignancy may cause the potential life-threatening complications of TLS. Prophylactic management prior to the use of steroid therapy for a variety of purposes is absolutely required in high-risk patients.
Case reports
Recurrent angiolymphoid hyperplasia with eosinophilia mimicking temporal arteritis associated with nephrotic syndrome
E. Sandstad, H. Aksnes, S. Sund and F.P. Reinholt
Volume 59 (2003) p. 206 - 211
Abstract
E. Sandstad, H. Aksnes, S. Sund and F.P. Reinholt
1Department of Pathology, 2Department of Internal Medicine, Oppland Central Hospital, Lillehammer, 3Department/Institute of Pathology, Rikshospitalet University Hospital, University of Oslo, and 4Department of Pathology, Förde Central Hospital, Förde, Norway
We report on a middle-aged Caucasian male who presented with nephrotic syndrome that on 2 consecutive recurrences was accompanied by a pulsating tumor suggesting temporal arteritis. Renal biopsies showed features of a low-grade mesangial-proliferative glomerulonephritis. The resected tumor in the temporal region revealed a lesion consistent with angiolymphoid hyperplasia with eosinophilia (ALHE), with moderate inflammatory involvement of the temporal artery. The patient was successfully treated with oral prednisolone in addition to removal of the tumor, but has remained steroid-dependent. To our knowledge, only 2 cases of ALHE and nephrotic syndrome have been reported so far in non-Japanese individuals [Altman et al. 1995, Sonkodi et al. 1987], and we are not aware of any previous case combining these features while simultaneuosly mimicking temporal arteritis.
Case reports
Efficacy of mycophenolate mofetil on recurrent glomerulonephritis after renal transplantation
K. Harzallah, C. Badid, D. Fouque, N. Lefrancois, J.-L. Touraine and M. Laville
Volume 59 (2003) p. 212 - 216
Abstract
K. Harzallah, C. Badid, D. Fouque, N. Lefrancois, J.-L. Touraine and M. Laville
1Service de Néphrologie, and 2Service de Chirurgie et Médecine de la Transplantation, Hôpital Edouard Herriot, Lyon Cedex, France
Recurrent glomerulonephritis in transplanted kidneys is not rare despite classical immunosuppressive drugs and depends on the etiology of nephropathy. Treatment of recurrence of renal disease on graft remains controversial. We report 6 cases of patients with recurrent glomerulonephritis after renal transplantation treated with mycophenolate mofetil (MMF). The glomerular diseases were Wegener’s granulomatosis (n = 1), membranoproliferative glomerulonephritis type I (n = 1), focal and segmental glomerular sclerosis (n = 1), membranous glomerulonephritis (idiopathic membranous nephropathy (n = 1) and systemic lupus erythematous) (n = 1)) and immunoglobulin A nephropathy (n = 1). MMF was introduced because of intolerance of classical immunosuppressive treatment in 2 cases and because of its inefficiency in the other cases. MMF was introduced between 3 months and 36 months (13.5 ± 7 months) after recurrence of the primitive glomerulonephritis. During combined MMF/cyclosporine/prednisone therapy, only 3 patients responded to MMF. MMF was disrupted precociously in 1 out of 3 patients who stabilized renal function because of discovery of lung cancer and in 2 out of the 3 other patients because of gastrointestinal intolerance and severe anemia. We supposed that MMF could represent a new effective alternative therapy of recurrent glomerulonephritis on renal graft in some cases.
Case reports
Hemodynamically relevant hematuria several months after biopsy of a kidney graft: an unusual cause
A. Voiculescu, M. Brause, V. Engelbrecht, W. Sandmann, T. Pfeiffer and B. Grabensee
Volume 59 (2003) p. 217 - 221
Abstract
A. Voiculescu, M. Brause, V. Engelbrecht, W. Sandmann, T. Pfeiffer and B. Grabensee
1Department of Nephrology and Rheumatology, 2Department of Diagnostic Radiology, and 3Department of Vascular Surgery and Renal Transplantation, Heinrich Heine University, Düsseldorf, Germany
We report the case of a 52-year-old female patient, who after a complicated living donor kidney transplantation, underwent kidney biopsy for suspected rejection. Duplex scanning revealed a small, asymptomatic arteriovenous (AV) fistula which was assessed as being hemodynamically unimportant. During follow-up, several urinary tract infections occurred and recurrent short episodes of hematuria were attributed to cystitis, urethritis and urosepsis. Eight months later, the patient developed suddenly massive hematuria, tamponade of the urinary bladder and hemorrhagic shock as well as urosepsis. Duplex sonography showed a massive pseudoaneurysm in addition to the AV fistula. Arteriography confirmed the Duplex sonographic findings and embolization was performed after treatment of concomitant urosepsis. The fistula was closed completely and bleeding ceased. Although AV fistulas are rare complications of kidney biopsies and in most cases they remain asymptomatic, life-threatening hematuria can present several months after a biopsy due to the development of a pseudoaneurysm. Concomitant infectious complications of the urinary tract, bleeding disorders and other factors can be misleading during the assessment of the cause of gross hematuria. Regular Duplex sonographic follow-up examinations in patients with AV fistulas are advisable.
Case reports
Staghorn calculi complicating renal transplantation in patients with persistent post-transplantation hyperparathyroidism
S.A. Jayawardene and D.J.A. Goldsmith
Volume 59 (2003) p. 222 - 224
Abstract
S.A. Jayawardene and D.J.A. Goldsmith
Departments of Nephrology and Transplantation, Guy’s and St. Thomas’ Hospitals, London, UK
Renal stones rarely complicate renal transplantats. Their causation is diverse. We describe 2 patients with significant staghorn calculi caused by metabolic factors.
Case reports
Successful retransplantation using rapamycin in a patient with previous calcineurin inhibitor-induced posterior leukoencephalopathy syndrome
B. Afzali and D.J A. Goldsmith
Volume 59 (2003) p. 225 - 228
Abstract
B. Afzali and D.J A. Goldsmith
Nephrology and Transplantation, Guy’s Hospital, London, UK
Posterior Leukoencephalopathy Syndrome (PLES) is a rare but serious neurological condition with many aetiologies. In the era of organ transplantation there have been sporadic reports of calcineurin-inhibitor associated PLES. We describe a case, with subsequent uneventful retransplantation using sirolimus.
Case reports
Successful perioperative blood purification therapy in patients with maintenance hemodialysis therapy who underwent living donor liver transplantation
J.J. Kazama, N. Takahashi, Y. Ito, Y. Watanabe, N. Iino, S. Iguchi, A. Oyanagi, H. Obayashi, S. Ito, H. Maruyama, I. Narita, S. Yamamoto, Y. Sato, A.Tsuchiya, T. Ichida and F. Gejyo
Volume 59 (2003) p. 229 - 233
Abstract
J.J. Kazama, N. Takahashi, Y. Ito, Y. Watanabe, N. Iino, S. Iguchi, A. Oyanagi, H. Obayashi, S. Ito, H. Maruyama, I. Narita, S. Yamamoto, Y. Sato, A.Tsuchiya, T. Ichida and F. Gejyo
1Division of Clinical Nephrology and Rheumatology, 2Division of General Surgery, and 3Division of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Living donor liver transplantation (LDLT) is a treatment for end-stage liver failure, and was developed to overcome the distinct insufficiency of cadaveric donors. Case 1 is a 56-year-old man who had undergone maintenance hemodialysis therapy for 4 years. An LDLT was performed for the treatment of advanced liver cirrhosis and hepatocellular carcinoma. Continuous hemodiafiltration (CHDF) was performed from the 2nd to 5th days after the operation. Case 2 is a 55-year-old man with primary amyloidosis and chronic renal failure. An LDLT was performed for the treatment of severe abdominal distention caused by a large liver volume. Although CHDF was started at the 3rd day after the operation, it was discontinued within 24 hours because of an increased urinary volume. CHDF was required again from the 6th ? 8th days, after which the blood purification mode was switched to regular intermittent hemodialysis. Meanwhile, no major problems occurred in either case. In conclusion, CHDF was required for about 5 days from the 2nd day after the operation. The application of careful and aggressive blood purification therapy during the perioperative period is a key to successful LDLT in dialysis patients.
Letters to the Editor
Behçet’s disease and focal segmental glomerulosclerosis
N. Cengiz, M. Karaoglanoglu, K. Cengiz and T. Akpolat
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Volume 59 (2003) p. 234 - 235
Abstract
N. Cengiz, M. Karaoglanoglu, K. Cengiz and T. Akpolat
Letters to the Editor
A case of giant condylomata acuminata involving anus after renal transplantation
H.C. Yu, B.H. Cho, M.J. Chung, M.J. Kang, B.J. La, W. Kim, S.K. Kang and S.K. Park
###ENGLISH_ABSTRACT_LINK###
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Volume 59 (2003) p. 235 - 236
Abstract
H.C. Yu, B.H. Cho, M.J. Chung, M.J. Kang, B.J. La, W. Kim, S.K. Kang and S.K. Park
Letters to the Editor
Acute hyponatremia and renal failure following percutaneous nephrolithotomy
C.-H. Chou, T. Chau, S.-S. Yang and S.-H. Lin
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Volume 59 (2003) p. 237 - 238
Abstract
C.-H. Chou, T. Chau, S.-S. Yang and S.-H. Lin
Obituary
Prof. Dr. Erwin Hecking?
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Volume 59 (2003) p. 239 - 240
Originals
Clinical relevance of microalbuminuria screening in self-reported non-diabetic/ non-hypertensive persons identified in a large health screening - The Nord-Trøndelag Health Study (HUNT), Norway
S. Romundstad, J. Holmen, K. Kvenild, O. Aakervik and H. Hallan
Volume 59 (2003) p. 241 - 251
Abstract
S. Romundstad, J. Holmen, K. Kvenild, O. Aakervik and H. Hallan
1HUNT Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Verdal,
2Department of Internal Medicine, Hospital Levanger, Levanger, and
3Nærøy Health Centre, Nærøy, Norway
Aim: The aim of this study was to investigate the clinical relevance and consequences of screening for microalbuminuria (MA) in a randomly selected, apparently healthy population sample. Material and methods: A total of 2,113 individuals (³ 20 years) without known diabetes and treated hypertension, all identified in the large population-based Nord-Trøndelag Health Study (HUNT) 1995 – 1997, (n = 65,258), delivered 3 morning urine samples for MA analysis. Those with MA, defined as at least 2 out of 3 urine samples with albumin-to-creatinine ratio (ACR) ³ 2.5 mg/mmol, were invited to a second clinical examination. Results: In total, 54 men and 54 women had MA, and 42 men (84%) and 42 women (78%) attended the second examination. All with MA had 1 or more cardiovascular risk factors, like elevated cholesterol, c-peptides and blood pressure, and they were older than those without MA. Ten men (25%) and 19 women (46%), who were defined as MA-positive at the screening, had normal albumin excretion in the overnight collected urine sample in the second clinical examination. Five men (12%) and 2 women (5%) were still followed-up at the hospital out-patient clinic 3 years later. Conclusions: Several individuals in the second examination had cardiovascular risk factors and other pathology, but the clinical benefit of discovering this was not obvious. Due to low positive predictive value and reduced reliability and validity, MA did not satisfy the criteria for a good screening test in this apparently healthy population.
Originals
Urinary transferrin, high molecular weight proteinuria and the progression of renal disease
B. Mackinnon, L. Shakerdi, C.J. Deighan, J.G. Fox, D.St.J. O’Reilly and M. Boulton-Jones
Volume 59 (2003) p. 252 - 258
Abstract
B. Mackinnon1, L. Shakerdi2, C.J. Deighan1, J.G. Fox1, D.St.J. O’Reilly2 and M. Boulton-Jones1
1Renal Unit, and 2Department of Pathological Biochemistry, Glasgow Royal Infirmary, Glasgow, Scotland
Aims: Proteinuria predicts rate of progression in a variety of nephropathies. There is considerable evidence that iron-transferrin is toxic to proximal tubular cells in vitro, and recent clinical work suggests that selectivity of proteinuria influences the outcome of renal disease. The aim of this study was to examine the relationship between the nature of proteinuria and progression of renal disease. Methods: This was a prospective, cross-sectional study in 66 patients with primary glomerulonephritis, diabetic nephropathy and a variety of other renal diseases. Urinary transferrin was measured by sandwich ELISA and correlated with rate of change in estimated creatinine clearance (ECC). Urinary SDS-PAGE was undertaken to divide proteinuria into tertiles according to molecular weight and to quantify the protein in each tertile. The magnitude of each tertile was then correlated with rate of change in ECC over a median period of 20 months. Results: Rate of change of renal function correlated with total proteinuria (r2 = 18%, p < 0.001) and albuminuria (r2 = 17%, p < 0.001), but not urinary transferrin (r2 = 0%, p = 0.235). On univariate analysis high molecular weight proteinuria (r2 = 21%, p < 0.001), intermediate molecular weight proteinuria (r2 = 15%, p = 0.001) and low molecular weight proteinuria (r2 = 10%, p = 0.005) correlated with rate of change in ECC as did total fasting cholesterol (r2 = 7%, p = 0.003). On multivariate analysis, however, the only independent predictors of rate of change in ECC were high molecular weight proteinuria (r2 = 19%, p < 0.001), and total fasting cholesterol (r2 = 5%, p = 0.035). Conclusions: We found no evidence to support the hypothesis that iron-transferrin is important in the development of human renal injury. High molecular weight proteinuria correlates more strongly with rate of progression of renal disease than intermediate molecular weight, low molecular weight or even total proteinuria. This suggests either, that one or more high molecular weight proteins are implicated in causing progressive renal impairment, or that loss of size selectivity at the glomerular basement membrane is associated with accelerated tubulointerstitial damage.
Originals
Distal nephron sodium-potassium exchange in children with nephrotic syndrome
R.A.M.G. Donckerwolcke, A. France, A. Raes and J. Vande Walle
Volume 59 (2003) p. 259 - 266
Abstract
R.A.M.G. Donckerwolcke, A. France, A. Raes and J. Vande Walle
1Department of Pediatrics, University Hospital Maastricht, The Netherlands, and 2Division of Pediatric Nephrology, Department of Pediatrics, University Hospital Gent, Belgium
While recent literature data suggest that a primary impairment in sodium excretion is the basic abnormality in the pathogenesis of edema formation in the nephrotic syndrome, there is ample evidence that functional hypovolemia contributes to stimulation of renal sodium and fluid retention. Vasoactive hormones such as renin and aldosterone are involved in this process. Discrimination between both mechanisms would be possible by assessment of aldosterone bioactivity and will have therapeutical consequences by indicating the need for administration of i.v. albumin or diuretics. In this paper, several indices of aldosterone bioactivity were assessed in 85 patients with minimal lesion nephrotic syndrome (118 measurements were performed in patients while in remission and 210 following relapses), and in 41 nephrotic patients with different types of nephropathy and were related to plasma renin and aldosterone levels. A better correlation was found between log aldosterone and UK+/UNa+ + UK+ ratio than with other parameters measuring renal potassium handling such as transtubular potassium gradient, fractional excretion of potassium and urine K+/urine Na+ or urine K+ creatinine ratios. In patients with renal sodium retention (FENa% less than 0.5), an UK+/UNa+ + UK+ ratio higher than 0.60 identifies patients with increased aldosterone levels and indicates functional hypovolemia. This index may therefore be used to assess which patients will benefit from i.v. albumin administration.
Originals
Effects of hypokalemia and hypomagnesemia on zidovudine (AZT) and didanosine (ddI) nephrotoxicity in rats
A.C. Seguro, M. de Araujo, F.S. Seguro, M. Rienzo, A.J. Magaldi and S.B. Campos
Volume 59 (2003) p. 267 - 272
Abstract
A.C. Seguro, M. de Araujo, F.S. Seguro, M. Rienzo, A.J. Magaldi and S.B. Campos
1Nephrology, Faculdade de Medicina da Universidade de São Paulo, LIM-12, São Paulo, and 2Instituto de Infectologia Emílio Ribas, São Paulo, Brazil
Background: Zidovudine (AZT) and didanosine (ddI) are antiretroviral drugs widely used in AIDS patients. Hypokalemia and hypomagnesemia are frequently encountered in AIDS patients using AZT and/or ddI. Objective: To verify the effects of AZT and ddI on rat renal function submitted to normal diet, low potassium diet and magnesium-free diet. Methods: Glomerular filtration rate and renal hemodynamic were measured in Wistar rats submitted to a normal or a potassium-depleted diet. The animals were given AZT, ddI for 15 days. Six groups of rats were studied: normal diet, normal diet + AZT, normal diet + ddI, low K diet, low K diet + AZT and low K diet + ddI. Three additional groups of rats submitted to magnesium depletion for 15 days were also studied: magnesium-free diet, magnesium-free diet + AZT and magnesium-free diet + ddI. Results: AZT and didanosine did not modify renal function of rats on a normal diet. However, in hypokalemic rats, both drugs produced a decrease in glomerular filtration rate and in renal blood flow consequent to renal vasoconstriction and associated with alterations in tubular function (characterized by an increased fractional excretion of sodium). Hypomagnesemia induced a decrease in glomerular filtration rate and in renal blood flow only in AZT-treated rats. Conclusion: Our data suggest that hypokalemia predisposes to AZT and ddI nephrotoxicity, while hypomagnesemia predisposes only to AZT nephrotoxicity. Thus, chronic AZT and ddI administration may produce acute renal failure in AIDS patients with hypokalemia and/or hypomagnesemia. Serum K and Mg levels should be carefully monitored in these patients.
Originals
Chlamydia pneumoniae IgA seropositivity is associated with increased risk for atherosclerotic vascular disease, myocardial infarction and stroke in dialysis patients
S.C. Wolf, O. Mayer, S. Jürgens, R. Vonthein, G. Schultze, T. Risler and B.R. Brehm
Volume 59 (2003) p. 273 - 279
Abstract
S.C. Wolf1, O. Mayer1, S. Jürgens2, R. Vonthein3, G. Schultze4, T. Risler1 and B.R. Brehm1
1Medical Clinic III, 2Institute of Virology, 3Department of Medical Statistics, University of Tübingen, Tübingen, and 4Dialysis Institute of Villingen Schwenningen, Villingen-Schwenningen, Germany
Background: Atherosclerotic cardiovascular disease is the major cause of morbidity and mortality in patients with chronic renal failure undergoing dialysis therapy. Aim of the study was to evaluate whether there is a correlation between a past infection with Chlamydia pneumoniae inducing antibody production and the manifestation of symptomatic atherosclerotic disease in patients with chronic renal failure on hemodialysis. Methods: A retrospective study was designed including 151 dialysis patients with a clinical apparent atherosclerotic disease (case subjects) and 116 dialysis patients without any symptomatic atherosclerotic manifestation (control group). An ELISA was used to measure seropositivity for IgA and IgG titers. Results: Elevated IgA titers against Chlamydia pneumoniae were found in 67% of the case subjects, but only in 29% of the controls (OR 5.34, CI 2.98 – 9.56). Forty-five patients of the case subjects had a history of myocardial infarction (OR 5.14, CI 2.38 – 11.09). Prior stroke was found in 30 patients in case subjects (OR 4.37, CI 1.73 – 11.01). The follow-up after 3 years showed that only 20 patients died from cardiovascular disease in the control group in comparison to 57 patients in the case group (OR 2.51). IgG seropositivity revealed an OR of 1.02 (CI 1.0 – 2.1). Conclusion: These results indicate that IgA seropositivity is associated with an increased frequency of symptomatic atherosclerotic manifestations. Especially an increased number of patients was found with prior myocardial infarction or stroke when elevated IgA titers were detected. IgA positivity seems to be a separate prospective risk factor in patients with chronic renal failure and hemodialysis for premature cardiovascular death.
Originals
Sleep quality and clinical correlates in patients on maintenance dialysis
M.L. Unruh, M.G. Hartunian, M.M. Chapman and B.L. Jaber
Volume 59 (2003) p. 280 - 288
Abstract
M.L. Unruh, M.G. Hartunian, M.M. Chapman and B.L. Jaber
1Division of Nephrology, University of Pittsburgh School of Medicine,
2Division of Nephrology, Department of Medicine, Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, and 3Dialysis Clinic, Inc., Boston, MA, USA
Background: Sleep quality is a subject of increasing interest to clinicians caring for dialysis patients. Self-assessed sleep disturbances have been associated with quality of life outcomes. The goal of this study was to identify clinical and laboratory parameters that are independently associated with overall sleep quality among prevalent dialysis patients. Methods: The Epworth Sleepiness Scale (ESS) and the Sleep Problems Index (SPI), a questionnaire derived from the Medical Outcomes Study, were administered to 71 dialysis patients and 68 subjects without known kidney disease (control group). The ESS and the SPI sleep item responses between the 2 groups were compared. The sleep items from the SPI were also aggregated into a sleep quality score. Multivariate linear regression analyses of sleep quality scores were used to identify clinical factors that were independently associated with poor sleep. Results: The ESS score was not significantly different between the 2 groups. However, the responses to the SPI sleep items demonstrated significantly impaired subjective sleep quality in dialysis patients compared with control subjects. In addition, overall sleep quality, as measured by the aggregated sleep score, was lower in dialysis patients compared with the control group (41 vs. 47, p < 0.001). In multivariate analyses, factors that were independently associated with poor sleep quality in dialysis patients were male gender (p = 0.006), history of coronary artery disease (p = 0.003), and high phosphate level (p = 0.05). Conclusion: This study demonstrates that global sleep quality of dialysis patients is substantially impaired. Poor sleep quality was associated with male gender, coronary artery disease and high serum phosphate level, a modifiable factor. Future studies are needed to examine the relationship of serum phosphate level to sleep quality in dialysis patients.
Originals
Effect of ultrafiltration on blood pressure variability in hemodialysis patients
S. Kürsat, B. Özgür and T. Alici
Volume 59 (2003) p. 289 - 292
Abstract
S. Kürsat, B. Özgür and T. Alici
Department of Nephrology, Department of Internal Medicine, Medical School of Celal Bayar University, Manisa, Turkey
Aim: Increased blood pressure variability (BPV) in end-stage renal disease (ESRD) patients is proved to be a risk factor for cardiovascular disease [Tozawa et al. 1999]. The effect of ultrafiltration (UF) on BPV in hemodialysis (HD) patients has not been reported in the literature. This study was undertaken to define the effect of a single UF on BPV in HD patients. Methods: Prior and after HD with UF, 24-hour ambulatory BP monitoring (ABPM) was applied to each patient and then diurnal and nocturnal BP and BPV parameters (both before and after UF) were compared and correlated with UF values. Results: Increase in BPV after single UF in all groups was statistically significant (p < 0.05). Only the daytime systolic (DS) BPV increase (median 42.4%) was in positive correlation with D body weight (body wt) (median 3.07%) or UF amount (r = 0.649, p < 0.01). Conclusions: Large volume depletions and sympathetic hyperreactivity could explain the increase in BPV. Increased interdialytic weight gain requires more UF and subsequently BPV, morbidity and mortality also increase. Thus, considerable efforts must be made to prevent great interdialytic weight gain in HD patients.
Case reports
Tacrolimus in resistant primary membranous nephropathy - a report of 3 cases
C.-C. Szeto, C.-B. Leung, F.M.-M. Lai and P.K.T. Li
Volume 59 (2003) p. 293 - 296
Abstract
C.-C. Szeto, C.-B. Leung, F.M.-M. Lai and P.K.T. Li
1Department of Medicine and Therapeutics, and 2Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
Aim: To study the efficacy and safety of tacrolimus in primary membranous nephropathy. Method: We describe 3 patients with primary membranous nephropathy who were either resistant to or could not tolerate steroid with or without cytotoxic agents. They were treated with tacrolimus 0.2 mg/kg/day for 6 months. The dosage of tacrolimus was adjusted to keep a whole blood tacrolimus level of 5 – 10 ng/ml. Results: One patient had almost complete disappearance of proteinuria while the other 2 had at least 50% reduction in proteinuria. Proteinuria increased again in 2 of the patients after tacrolimus was stopped, but in neither of them proteinuria returned to the pretreatment level 6 months after tacrolimus was stopped. Conclusion: We conclude that tacrolimus may have a modest efficacy in the treatment of resistant membranous nephropathy.
