Studying the role of calcium concentration in dialysate in the rise of blood pressure during hemodialysis sessions

Background: The change of blood pressure during hemodialysis has been noted for long time. However, there were few studies on the rise of blood pressure during hemodialysis. The clinical meaning of hypertension during hemodialysis has not been understood clearly. Objective: To study the role of calcium concentration in dialysate in the rise of blood pressure during hemodialysis sessions. Subjects and method: Prospective study performed on 9 stable patients on chronic hemodialysis treated at Viet Duc Hospital including 5 female and 4 male patients. The mean age of patients was 47.6 years. The patients had period 1 of 10 weeks of treatment using dialysate 1 A (with calcium concentration 1.8 mmol/l) and then they were switched to period 2 of 10 other weeks using dialysate 3A (with calcium concentration 1.25 mmol/l). Results:The blood pressure of patients during the period 2 using 3A dialysate was better controlled during hemodialysis sessions. The response to erythropoietin treatment was similar in both periods. The serum calcium was lower after using 3A dialysate. Conclusions: Using dialysate with lower calcium concentration can be helpful for controlling the hypertension during hemodialysis sessions. The appropriate calcium concentration in dialysate needs to be selected to avoid the hypocalcaemia in chronic hemodialysis patients.

Evaluation of the general therapies in the treatment of the adult patients with primary nephrotic syndrome

Background: Primary nephrotic syndrome in adult patients is a common sign of patients with primary glomerular disease. Objective: To evaluate the responsiveness of adult patients with primary nephrotic syndrome to corticosteroid alone or in combination with cyclophosphamid and the treatment - related complications. Subjects and method: Based on pathological findings 91 patients with primary nephrotic syndrome divided into 2 groups: group 1 (75 patients) were assigned to receive corticosteroid alone at 1 mg/kg/day, group 2 (16 patients) were assigned to receive the corticosteroid at 0.5 mg/kg/day and cyclophosphamid at 2 mg/kg/day. 11 non - responders from group 1 were switched to group 2 after 6 months of treatment by \r\n', u'corticosteroid alone. The response to therapy was assessed after 3 months and 6 months of treatment. Results:In group 1 the number of patients responding to corticosteroid alone was increasing from 38 after 3 months to 50 after 6 months. In group 2 the number of patients responding to combined protocol was increasing from 4 (14.8%) to 12 (44.4%). The most frequently seen corticosteroid - related complication was cushingoid which is reversible after reducing dose or stop treatment. Severe complications were not common. For the whole group taking cyclophosphamid leucocytopenia, was seen in 4/27 (14.8%) patients, in subgroup of women hypo - amenorrhea was observed in 3/15 (20%) of cases. Conclusions: Results of study encourage the prolongation of treatment. Sterility and if possible preventive measures should be taken into consideration when cyclophosphamid is selected for young patients in reproductive age.\r\n', u'

Some remarks on protein electrophoresis of the urine in adults suffered from primary nephrotic syndrome

The authors compared the results from urine protein electrophoresis of nephrotic adults with those from routine examinations, anapathologic findings and corticomonotherapy response. Urine electrophoresis was performed in Central Bio-Medical Laboratory of Hanoi Medical school, on Paragon-Beckman apparatus in 1% agarose gel, 100V in 30 minutes. Urine protein are estimated in percent directly on densitometer. Renal biopsy by aspiration needle under the US guidance was realized in BachMai Hospital and histological interpretations were given from the Department of Anapathology of Hanoi Medical school. Response to corticoid monotherapy was obtained by evaluation of 24h protein in the urine after 4 weeks of treatment. The obtained results from 8 primary nephrotic adults showed that the glomerular minimal changes were not always in accordance with the results from urine protein electrophoresis. Responses to therapy were met in patients having selective proteinuria and in some having nonselective proteinuria. All the studied patients having glomerular minimal changes responded completely the usual corticoid monotherapy

Contribution to the study on the play of some immunological factors in patients with primary nephrotic syndrome in adults

20 patients with glomerular nephritis received a biopsy through the skin to study the histological lesion by photomicroscopy and the direct fluorescent immune including the electromicroscopic immune and super structure for some cases. Some lesion were classified by the photomicroscopy comprise the minimal lesion glomerular disease (46%), the glomerular nephritis with intervascular proliferation (35%); glomerular nephritis with membrane proliferation with reduction or increase of crescent cells (15%). The results of comparison of the photomicroscope with the direct fluorescent immune found 1 patient with the glomerular nephritis IgA. In addition to, there is a deposition of IgG, IgM and IgA accompanied with C19 and/or C3c in the basal membrane of the glomerular and membrane Bowman. These showed that pathology of glomerular has an immunopathological mechanism. The deposition of the immunological complexes in the glomerular helped the prognosis of the clinical correspond of old patients to the treatment