Bioimpedance analysis of fluid compartments in female CAPD patients.

Dry weight is difficult to determine in continuous ambulatory peritoneal dialysis (CAPD) patients. Bioimpedance spectroscopy using a multi-frequency analyzer was used to measure total body water, extracellular water, and intracellular water in 7 female CAPD patients and, for comparison, in 6 normal female controls. One patient was measured a second time after a 10-kg fluid loss.

Clinical significance of erosive azotemic osteodystrophy: a prospective masked study.

Objective: To determine the relationship between joint symptoms and radiographically identifiable erosions in patients on maintenance hemodialysis for 4 or more years.

Patients And Design: A prospective study was carried out on 21 patients, who underwent rheumatological evaluation and radiographic surveys of all clinically examined joints. The radiologist was masked to the clinical information and the clinicians were masked to the radiographic findings.

A randomized trial of sevelamer hydrochloride (RenaGel) with and without supplemental calcium. Strategies for the control of hyperphosphatemia and hyperparathyroidism in hemodialysis patients.

Objective: We have previously shown sevelamer hydrochloride (RenaGel) to be an effective and well-tolerated treatment for hyperphosphatemia in hemodialysis patients.

Patients And Methods: We performed a randomized clinical trial to compare the efficacy of RenaGel alone and RenaGel with calcium, using the serum phosphorus concentration and intact parathyroid hormone (PTH) as the principal outcomes of interest. Calcium (900 mg elemental) was provided as a once-nightly dose on an empty stomach.

Henoch-Schoenlein purpura due to streptokinase.

The syndrome of Henoch-Schoenlein purpura developed in a 74-year-old woman after receiving streptokinase as thrombolytic therapy for an acute myocardial infarction. Renal biopsy revealed mesangial hypercellularity with deposits of IgA. Skin biopsy also revealed IgA deposition.

Pulse oral calcitriol for the treatment of hyperparathyroidism in patients on continuous ambulatory peritoneal dialysis: preliminary observations.

A direct effect of calcitriol on the regulation of the secretion of parathyroid hormone (PTH) has been shown in vitro and in vivo. In patients with renal failure on maintenance hemodialysis, it has been shown that intravenous (IV) administration of calcitriol appears to be superior to continuous oral administration. This may be due to the higher levels of calcitriol obtained in blood with consequent improved delivery of calcitriol to peripheral target tissues including the parathyroid glands.

Failure of CAPD patients to respond to an oral iron absorption test.

CAPD patients require supplemental iron to maintain a response to erythropoietin. Because of limited availability of parenteral iron dextran, oral iron must be used. However, oral iron may not be effective in most dialysis patients.

Combined aspirin and sulfinpyrazone in the prevention of recurrent hemodialysis vascular access thrombosis.

We carried out a pilot study in 15 hemodialysis patients with recurrent vascular access thrombosis to examine whether the combination of low dose aspirin (85 mg once daily) and sulfinpyrazone (200 mg three times daily) is safe and effective in the prevention of vascular access thrombosis. Hemostatic measurements were performed prior to and after four weeks of starting the drug combination. Baseline values for fibrinopeptide A were elevated in all patients while those for platelet factor 4, fibrinogen, antithrombin III and protein C were generally within normal limits.

Androgens potentiate the effects of erythropoietin in the treatment of anemia of end-stage renal disease.

Since androgens may increase the sensitivity of the erythroid progenitors to erythropoietin, the present studies were designed to investigate the effect of administration of androgens on the actions of exogenous erythropoietin (EPO) in hemodialysis patients. Studies were performed in a group of 15 adult male hemodialysis patients. Seven patients were treated with EPO alone at a dose of 2,000 U intravenously (IV) three times a week.

Characterization of eosinophils in a continuous ambulatory peritoneal dialysis patient with eosinophilic peritonitis.

A continuous ambulatory peritoneal dialysis patient developed eosinophilic peritonitis and was followed for 7 months. After 1 month, the peritonitis resolved, with a concomitant drop in percentage of hypodense eosinophils (Eos) recovered from peritoneal dialysate (PD) as well as a drop in fluid major basic protein levels. Blood eosinophil differential percentages were low, but the percentage of hypodense Eos in the blood tended to be relatively increased.

Efficacy of streptokinase in resistant, relapsing or recurrent CAPD peritonitis.

The efficacy of streptokinase to lyse biofilm in the catheters of CAPD patients with peritonitis was examined in a retrospective review of 10 infusions in 9 patients with difficult to resolve peritonitis. 750,000 units of streptokinase were used. This helped resolve peritonitis in 8 of 10 uses, including two cases due to gram negative bacteria.

Recurrent peritonitis need not be a cause of CAPD dropout.

Though excessive peritonitis is reported as the cause of 27% of CAPD dropout, over a five-year period, only 5 of 41 patients (12%) who had 5 or more episodes of peritonitis stopped CAPD because of excessive peritonitis. Their average time on CAPD prior to stopping was significantly longer than other dropouts with less peritonitis. Only one patient technically could not continue PD.

Continuous cyclic peritoneal dialysis--is it worth the extra effort?

Despite theoretical advantages of CCPD, only 1 of 13 patients trained in this modality continue on CCPD in a 3 year review period. Average duration on CCPD was only 7 months. When compared with our CAPD population higher transplant rates, death rates, and dissatisfaction with the dialysis technique, but not higher peritonitis rates were reasons for terminating CCPD.

Recurrent venous thrombosis associated with permanent internal jugular vein hemodialysis catheters.

Eight Permcaths were placed into seven patients without other alternative hemodialysis access sites. They lasted from 1-109 treatments. However, recurrent thrombi formed at the tip of two catheters.

Antibiotic treatment of chronic central venous hemodialysis catheter infection without catheter removal.

Most catheter or shunt infections in hemodialysis patients require the removal of the access before the infection is eradicated. A hemodialysis patient is reported who had multiple previous vascular accesses which failed and thus who had very limited sites for future access placement. When a recurrent Proteus mirabilis catheter infection occurred, a 6-week course of ampicillin intraluminal and tobramycin systematically, eradicated the infection and thus the central venous catheter was salvaged.

Removal of toxic levels of N-acetylprocainamide with continuous arteriovenous hemofiltration or continuous arteriovenous hemodiafiltration.

Two patients with renal failure developed N-acetylprocainamide toxicity while receiving procainamide. Treatment consisted of continuous arteriovenous hemofiltration in one and hemodialysis followed by continuous arteriovenous hemodiafiltration in the other. The efficacy of these treatments was compared with the efficacy of three-times-weekly hemodialysis as used in two patients on chronic hemodialysis who had elevated N-acetylprocainamide levels.

Aging and the kidney.

Numerous anatomic and physiologic alterations occur in the kidney with aging. These changes affect the ability of elderly patient(s) to maintain homeostasis and alter response to medications, stress, illness, or changes in diet, mobility, or environment. Drug-induced illness and drug interactions are major problems in the elderly.

Two years clinical experience with continuous arteriovenous hemofiltration in acute renal failure.

Clotting of hemofilters is the most frequent single cause of filter failure. These filters frequently clot in spite of acceptable hemodynamic and anticoagulation parameters. Sixty percent of filters which eventually clotted never filtered above 200 ml/hr.

H-2-dependent cell-mediated immunity in vivo: delayed-type hypersensitivity and contact sensitization induced by fluorescein isothiocyanate-conjugated cells.

Fluorescein isothiocyanate (FITC) was found to be a suitable hapten to study cell-mediated immunity in vivo in mice. Delayed-type hypersensitivity (DTH) footpad swelling reactions were induced and elicited by injection of FITC-conjugated syngeneic spleen cells, and contact sensitivity (CS) was induced and elicited by skin painting with reactive FITC. Cross-reactive specificity between DTH and CS was demonstrated.

The significance of electron dense deposits in mild lupus nephritis.

In patients with lupus nephritis, progression from a mild lesion to a diffuse proliferative glomerulonephritis has been reported in one to 35 percent of patients. Because of the wide variation in the rate of progression, this study was undertaken to determine those factors which would identify the patients most likely to progress. Of 21 patients with a mild lupus nephritis by light microscopy, progression to a diffuse proliferative lesion was seen in only those patients who had subendothelial deposits.

The ultrastructure of the adrenal zona glomerulosa of rats on patassium-supplemented or sodium-depleted diets.

Ultrastructural changes in the mitochondria and other organelles in zona glomerulosa cells of the adrenal cortex were noted in rats maintained for up to 8 days on a potassium-enriched or a sodium-deficient diet. In both groups of animals, aldosterone production is known to be increased. Principal ultrastructural changes in the rats maintained on a potassium-supplemented or a sodium-deficient diet consisted of a loss of electron density of the mitochondrial matrix and a change from plate-like cristae to tubular-vesicular cristae.