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Abstract

C.-H. Chang, C.-C. Chang and S.-S. Chiang

Department of Internal Medicine, Division of Nephrology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Background: Iron deficiency is the most common cause of suboptimal response to recombinant human erythropoietin (rHuEPO) in chronic hemodialysis (HD) patients. Iron supply can correct this situation, however, optimal dosage, route of administration, and monitoring of iron status during rHuEPO therapy in maintenance HD patients remains controversial. Methods: We conducted a 12-month intravenous iron substitution trial in 149 iron-replete chronic HD patients receiving subcutaneous rHuEPO therapy. The available iron pool was maintained with 100 mg iron every 2 weeks or 1 month depending on serum ferritin and transferrin saturation levels, the rHuEPO dosage titrated depending on hematocrit (Hct) levels. Results: After 12-month protocol, the Hct increased (28.7 ± 4.1 vs 27.7 ± 2.6, p = 0.003), rHuEPO requirement reduced 25% (46.1 ± 28.9 vs 61.5 ± 67.8 U/kg/week, p = 0.006), serum ferritin increased (1383 ± 727 vs 930 ± 857 ng/ml, p < 0.001), so did the transferrin saturation (36.1 ± 12.7 vs 27.5 ± 12.8%, p < 0.001). The serum albumin decreased slightly but reached statistical significance (4.1 ± 0.48 vs 4.2 ± 0.36 g/dl, p = 0.006), so did the cholesterol levels (166 ± 41 vs 173 ± 38 mg/dl, p = 0.044) and pre-dialysis creatinine (11.3 ± 2.3 vs 11.5 ± 2.4 mg/dl, p = 0.015). Besides, the iPTH levels did not interfere with the rHuEPO dosage reduction and Hct increment in our patients. Conclusion: We conclude that maintaining high levels of serum ferritin and transferrin saturation could further reduce the requirement of rHuEPO in chronic HD patients, but the long-term effect of iron overloading to patients’ nutritional status must be further evaluated in contrast to the economic saving.

Abstract

P.-F. Chiou, C.-C. Chang, Y.-K. Wen and Y. Yang

Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
Background: In the hemodialytic population, infections are the second leading cause of death; access infections account for a large proportion of this mortality. The antibiotic lock technique has been applied to infected tunneled catheters as rescue or prophylaxis medication to reduce infection rates. In addition, application of topical antibiotic ointments to tunneled and non-tunneled catheters also prevents exit site infections. Methods: 17 patients with 25 catheters participated in our study from March 2004 – February 2005. The catheter lock comprised of mixed cefazolin (5 mg/dl) with heparin (2,500 IU/ml) and mupirocin was topically applied to the area (2 × 2 cm) surrounding the catheter exit site. Results: The catheter infection rate was reduced from 12.7 times/1,000 catheter days to 5.02 times/1,000 catheter days in patients with jugular vein catheters. The total catheter-related infection rate was 14.9 times/1,000 catheter days in the control group and 4.1 times/1,000 catheter days in the study group. The reduction in catheter infections was more evident in a subgroup of non-diabetic patients, and in those with femoral catheters. Conclusion: The use of antibiotic lock and topical antibiotics significantly reduces the incidence of temporary catheter-related infections, especially in non-diabetic patients and in those with femoral catheters. Correspondence to:
Dr. C.-C. Chang
Division of Nephrology
Department of Internal Medicine
Changhua Christian Hospital
135, Nan-Shiao Street
Changhua, Taiwan, R.O.C.
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (244-246)

Acute pancreatitis preceding an acute episode of thrombotic microangiopathy

H.-H. Chang¹, M.L. Chen³ and C.-C. Chang¹,²

¹Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, ²College of Health Sciences, Institute of Medical Research, Chang Jung Christian University, Tainan, and ³Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
Thrombotic microangiopathy (TMA) is a rarely reported complication of acute pancreatitis. The prognosis is generally good, if diagnosis is made early and treatment is adequate. We present the case of a 74-year-old man who visited our emergency department due to acute abdominal pain. He had no history of alcohol abuse or pancreatitis. Blood tests indicated elevated lipase and amylase. An abdominal computerized tomography (CT) indicated mild pancreatitis. After admission, the patient suffered a seizure and developed anemia, thrombocytopenia, elevated lactic dehydrogenase (LDH) and elevated unconjugated bilirubin. A peripheral blood smear indicated fragmented red blood cells. We diagnosed the patient as having TMA. After plasma exchange and plasma infusion therapy, the LDH and platelet levels gradually improved. A differential diagnosis of disseminated intravascular coagulation (DIC) and TMA following pancreatitis is necessary because of the different treatment strategies. Our patient had a good prognosis following therapy for TMA. Such therapy may include plasma exchange, plasma infusion, corticosteroid therapy and splenectomy.Correspondence to:
C.-C. Chang
Department of Internal Medicine
Changhua Christian Hospital
No 135 Nan-Siau Street
Changhua, 500 Taiwan
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 75 – Suppl. 1/2011 (S27-S31)

Unusual acute promyelocytic leukemia following de novo renal transplant: case report and literature review

C.-P. Lai¹, C.-C. Chang¹, C.-Y. Chung² and M.-L. Chen³

¹Nephrology Division, ²Hemotology Division, and ³Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
Abstract. Acute promyelocytic leukemia (APL) with transcripting three isoforms of mRNA from PML-RAR alpha fusion genes following renal transplantation has never been reported in the literature. A 39-year-old man received a cadaveric renal allograft for IgA chronic kidney disease in 2006 and was consecutively immunosuppressed by tacrolimus, mycophenolate mofetil, and prednisolone. In 2008, he presented with gum bleeding and weight loss. Following bone marrow biopsy, we diagnosed acute promyelocytic leukemia. Molecular analysis demonstrated atypical presence consisting of three isoforms of mRNA from PML-RAR alpha fusion genes. The patient was administered with three courses of consolidation chemotherapy plus atretinoin, resulting in complete remission and did not jeopardize his allograft function. This novel finding suggests that the leukemogenesis of APL may be polyclonal, sharing similar progenitor targeting on complicated karyotypes, responding well to current chemotherapy.Correspondence to:
C.-C. Chang, MD
Department of Internal Medicine
Changhua Christian Hospital
#135 Nan-Siau Street, Changhua, 500 Taiwan
Email: [email protected]

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