The Kidney : an Important Target for HIV Infection

HIV-infected patients may present with a variety of patterns of renal involvement. Acute renal failure is common and most often a result of sepsis; hypotension and nephrotoxic agents. It is potentially avoidable; and support through the period of renal failure may lead to resolution of the renal dysfunction. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy that ranges in prevalence form 1 to 10 per cent of the HIV infected population in different geographic locales. This complication of HIV infection will likely present a growing challenge to the medical community as HIV infection continues to spread worldwide. Deciphering the pathogenitic mechanisms of this most rapidly progressive form of focal segmental glomerulosclerosis is not only clinically relevant; but will hopefully provide valuable insights into the medication of the more common idiopathic form of the disease. The potential for improved renal survival of patients with HIV-associated nephropathy ahs become more realistic with the development and the use of antiretroviral agents; as well as studies on the role of immunosuppression and Angiotensin Converting Enzyme (ACE) inhibition in this population

"Prevention and Treatment of Acute Renal Failure Using Diuretis and ? or Low (""renal"") Dose of Dopamine : a Critical Review"

The currently available evidence suggest that diuretics and/or low dose dopamine increases renal blood flow (RBF); glomerular filtration rate (GFR) and natriuresis in experimental animals; and limits ATP utilisation and oxygen needs in nephron segments at high risk of ischaemic injury; actions that could potentially limit renal injury and accelerate recovery in acute renal failure (ARF). These effects have indeed been confirmed in most experimental animals while using mannitol or low dose dopanime. Frusemide; however; for unknown reasons; has been effective in some animal models; but not others. In humans; it can be said that diurectics have a limited value to prevent; reverse or speed recovery from acute renal failure. Most clinical studies have failed to demonstrate convincingly that low dose dopamine either prevents ARF in high risk patients or improves renal function or outcome in patients with established ARF. This confusing scenario is further complicated by the fact that both diuretics and low dose dopamine can result in severe metabolic and cardiovascular complications in critically ill patients

Prevention and Control of Tuberculosis

Tuberculosis is again becoming a major public health problem. In order to control this complex disease; case-management; chemoprophylaxis and vaccination are used. The aim of case-management is to virtually stop transmission of tuberculosis infection by multidrug chemotherapy. This is; however; hampered by poor drug compliance and the high cost of the most effective drugs. Bacilli-Calmette-Guerin (BCG) vaccination has been used for a long time but with contentious efficacy. Though recent studies put the efficacy at 50; its cost-effectiveness has yet to be established. Isoniazid preventive therapy (1PT) for control of tuberculosis is also rapidly gaining acceptance. In patients who adhere to 80of medication taken; the efficacy is usually high. As for the control of tuberculosis among health care workers; engineering; administrative and personal respiratory measures have been introduced. Following the introduction of these measures in USA; dramatic decline in the risk of tuberculosis among these workers has occurred

Continous Ambulatory Peritoneal Dialysis and the Human Immunodeficiency Virus

This review looks at the clinical performance of Immunodeficiency Virus (HIV) infected individuals with end stage renal disease (ESRD) treated using continuous ambulatory peritoneal dialysis (CAPD). It also considers the potential infectious nature of the peritoneal dialysis effluent (PDE) and offers suggestions on how to circumvent this risk