Rituximab treatment of idiopathic membranous nephropathy.

Idiopathic membranous nephropathy is a common cause of nephrotic syndrome whose pathogenesis may involve B-cell functions. Rituximab is a monoclonal antibody that binds to the CD20 antigen on B cells thereby deleting them. We conducted an open-label pilot trial of rituximab treatment in 15 severely nephrotic patients with proteinuria refractory to angiotensin-converting enzyme inhibition and/or receptor blockade but with adequately controlled blood pressure.

Auto-Rejection of Renal Donor-Origin Metastatic Melanoma.

We report a case of metastatic malignant melanoma discovered in a living related donor shortly after renal transplant and subsequently diagnosed in the recipient. The recipient hepatic metastases were followed with serial computed tomography (CT) during regression/rejection of tumor after cessation of immunosuppression and allograft removal. Correlation made with serial liver mass biopsies.

Acute rapamycin nephrotoxicity in native kidneys of patients with chronic glomerulopathies.

Background: Based on its success as a transplant immunosuppressor, there is intense interest in using rapamycin in the treatment of progressive glomerulopathies involving native kidneys. However, we call attention to the potential toxicity associated with the use of rapamycin in this setting.

Methods: We conducted a study to examine the efficacy and safety of rapamycin in patients with progressive chronic renal failure.

Nutritional assessment of intensive-care unit patients.

The decision about whether to institute aggressive nutritional support, with its attendant expense and potential morbidity, in critically ill patients remains controversial. We studied numerous commonly used variables for assessment of nutrition to identify critically ill patients at increased risk for the development of infection, for becoming ventilator dependent, and for mortality. We enrolled 111 patients in this study on their third day in the intensive-care unit (ICU).

Results of treatment of center hemodialysis patients.

Four hundred eighty-three patients were maintained by hemodialysis in an outpatient hemodialysis center at the Mayo Clinic between 1963 and 1977. Although only 18 patients had experienced a myocardial infarction and 6 had had a cerebral infarction before beginning dialysis, 30 subsequently had acute myocardial infarction and 45 had a stroke. These two complications accounted for 48 of the 98 deaths that occurred during maintenance dialysis.

Status epilepticus as a complication of concurrent electroconvulsive and theophylline therapy.

Status epilepticus that occurs after electroconvulsive therapy is a rarely reported event. Seizures associated with use of theophylline usually result from severe toxicity. We report a case in which status epilepticus occurred after electroconvulsive therapy in a patient who had a theophylline level above the accepted therapeutic range but below that generally associated with seizures.

Acute renal failure treated by slow continuous ultrafiltration. Preliminary report.

We report our initial experience with the use of slow continuous ultrafiltration in the treatment of acute renal failure. Advantages of slow continuous ultrafiltration over conventional hemodialysis are greater blood pressure stability, no need for systemic anticoagulation, augmented fluid input and removal, and enhanced ease of operation. Our results in two patients confirm other reports that this method can be successfully performed in hemodynamically unstable patients with acute renal failure.

Acute intrinsic renal failure induced by indomethacin: role of prostaglandin synthetase inhibition.

Nonsteroidal anti-inflammatory agents are often used to treat acute inflammatory arthritis because of their effectiveness and the infrequency of reported serious side effects. This report describes two patients who had acute intrinsic renal failure that was triggered by indomethacin. Both patients were volume contracted and had other circulatory impairments.

The utility of serum albumin values in the nutritional assessment of hospitalized patients.

Nutritional assessment was performed on 47 patients admitted to a nephrology service; renal failure was present in 39 of the 47 patients. Values for serum albumin, total iron binding capacity, arm muscle circumference, triceps skin fold, and percent of ideal body weight for height and sex were determined. The 25 patients who had low serum albumin values at admission stayed in the hospital significantly (P less than 0.

Serum lipids in chronic renal failure.

The serum lipids and lipoprotein patterns in 100 adult patients with nonnephrotic chronic renal failure were analyzed retrospectively. Hypertriglyceridemia was found in 43% of these patients. Forty-nine of the 100 had a normal lipoprotein pattern, whereas 42 had type IV hyperlipoproteinemia.