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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

C.-S. Chang, A.-H. Yang and C.-H. Chang

¹Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ²Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital, Taipei, and ³School of Medicine, Fu Jen Catholic University, Tipei County, Taiwan
The duration of diabetes mellitus and presence of hyperglycemia appear to be important in the development of diabetic nephropathy. Here, we present three patients with edema, heavy proteinuria, chronic renal failure, in whom no past or present symptomatic glucose intolerance or diabetic retinopathy were found. The kidney biopsy of these patients showed diffuse glomerular basement membrane thickening and nodular glomerulosclerosis, which resembled diabetic nephropathy. The renal function of these patients deteriorated rapidly and renal replacement therapy started later in the average of 11 months since the first visiting. These cases were diagnosed as diabetic nodular glomerulosclerosis, although there was no obvious evidence for diabetes. The absence of overt diabetes and diabetic retinopathy at presentation of nodular glomerulosclerosis in these cases does not refute the hypothesis that metabolic consequence of hyperglycemia is a prerequisite for the pathogenesis of diabetic microangiopathy, but some factors other than hyperglycemia may be responsible for renal damage in our patients. The modifiable risk factors in such a condition are postulated and discussed.Correspondence to:
Dr. C.-H. Chang
Division of Nephrology
Department of Internal Medicine
Shin Kong Wu Ho-Su Memorial Hospital
95 Wen-Chan Road, Shih-Lin district
Taipei, Taiwan
Email: [email protected]

Abstract

C.-H. Chang¹,², Y.-W. Fang¹ and H.-S. Chen¹

¹Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei and ²Department of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
Aim: The incidence and prevalence of end-stage renal disease (ESRD) are extremely high in Taiwan. It is an interesting fact that both the husband and wife in some families of Taiwan suffer from ESRD. Therefore, we attempted to identify the potential risk factors of such couples. Methods: This is a retrospective observational study. Six couples receiving maintenance dialysis in our hospital from 1996 to 2006 were enrolled in this study. Detailed medical history; drugs history including over-the-counter drugs (OCD), analgesics and herbal remedies; occupational history and onset of transitional cell carcinoma (TCC) were recorded. These data are correlated with pre-dialysis laboratory findings. The outcomes of dialysis and TCC were also recorded and analyzed. Results: Two males were Chinese herbal medicine practitioners. All the patients (12/12) had taken Chinese herbs and most of them (10/12) had also taken OCD (especially cold remedies and analgesics). We found all of them had bilateral contracted kidneys, mild proteinuria and trace glucosuria. One patient’s renal biopsy revealed Chinese herb nephropathy. Four patients (33%) suffered from TCC. Three patients expired during follow up due to hyperkalemia, extensive TCC and suicide, respectively. Conclusions: The prevalence of Chinese herbs or compound analgesics abuse is high in couples with ESRD. The clinical features and high incidence of TCC are compatible with drug related chronic tubulointerstitial nephritis. Abuse of offending agents should be considered as a risk factor in family members with ESRD.Correspondence to:
C.-H. Chang, MD
Division of Nephrology
Department of Internal Medicine
Shin Kong Wu Ho-Su Memorial Hospital
95, Wen-Chan Road
Taipei 111, Taiwan
Email: [email protected]

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