A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access.

Background: The National Kidney Foundation has established detailed guidelines due to increasing morbidity and costs related to haemodialysis vascular access in the end-stage renal disease population.

Methods: A quality assurance multidisciplinary committee was formed to implement the Dialysis Outcome Quality Initiative (DOQI) guidelines in September, 1999. Beginning January 2000, a 'Save the Vein Programme' was implemented and native fistulae became the angioaccess of first choice for new patients.

Nephropathy after combination chemotherapy of lymphoma.

Two patients with malignant (Hodgkin's and non-Hodgkin's lymphoblastic type) lymphoma developed chronic renal failure following prolonged combination chemotherapy and a course of radiotherapy to the para-aortic lymph nodes. The individual drugs used in both patients are believed to have very low or no nephrotoxic potential. The kidneys were shielded in a standard manner and no more than 200 rads reached the organs.

Active and chronic phases of Berger's disease (IgA nephropathy).

Berger's disease, or IgA nephropathy, is generally considered as pursuing a chronic course, often with recurrent attacks of gross hematuria or persistent microscopic hematuria. However, little attention has been paid to the acute changes that may accompany this nephropathy, and there are few reports of follow-up renal biopsy studies in these patients. We have had the opportunity to study two patients with Berger's disease (IgA nephropathy) in whom initial and follow-up renal biopsy studies were available.

Malignant hypertension and uremia in scleroderma: efficacy of nephrectomy and hemodialysis.

Two cases of scleroderma are presented in which malignant hypertension developed abruptly, accompanied by rapidly progressive renal failure. The malignant hypertension was associated with high plasma renin levels and like other forms of hyperrenninemic hypertension and uremia, was refractory to both antihypertensive medication and extracellular fluid volume control with hemodialysis. Blood pressures became controllable only after bilateral nephrectomy was performed, and in each case resulted in a reversal of a rapidly progressive downhill course.

Appearance of circulating DNA during hemodialysis.

The appearance of circulating DNA during hemodialysis was investigated by use of a modified counterimmunoelectrophoresis assay capable of detecting as little as 0.02 to 0.05 microng of native DNA per milliliter of plasma.