ABSTRACT
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Subject(s)
Humans , Kidney Transplantation , Kidney , Living Donors , Prospective StudiesABSTRACT
Exit-site infection(ESI) is a troublesome catheter related complication of CAPD that may lead to peritonitis and require catheter removal, ESI is variably defined and classified. The rate of ESI and the outcome of treatment are also variably reported in literature. We conducted a retrospective study of 58 episodes of ESI(40 patients) between August 1997 and February 1999, and evaluated the episodes and types of ESI, organism isolated from ESI and their sensitivity, outcome of ESI, number and reason for catheter loss, and the current modality. The mean age was 48.9+/-11.5 years(31-70) and the male to female ratio was 22:18. The mean duration of CAPD before ESI was 34.1+/-29.6 months (1.5-114.2), and diabetic nephropathy was the cause of ESRD in 17.5% of cases. The types of catheter were two-cuff, coiled Tenckhoff in 17 patients, two-cuff, coiled swan-neck in 10 patients, two-cuff, straight swan-neck in 10 patients, and two-cuff, straight Tenckhoff in 3 patients. According to Twardowski's classification, acute infection in 33 patients and chronic infection in 25 patients were noted. Causative organisms of ESI were S. aureus, S. epidermidis, Pseudomonas, and E. cali in diminishing order of frequency. S. aureus was the most common organism in acute infection, and S. epidermidis was the most common organism in chronie infection. The mean duration of CAPD before ESI was 27.6+/-27.2 months in acute infection, and 42.8+/-30.8 in chronic infection (p<0.05). The duration of antibiotic treatment was 19.9+/-14.4 days in acute infection, and 42.7+/-27.2 days in chronic infection(p<0.05). In acute infection, peritonitis developed in 2 patients and 1 catheter was removed. In chronic infection, peritonitis developed in 1 patient and the catheter was removed. Three patients had the external cuff shaved due to persistent ESI which was unresponsive to antibiotics and local care. By the end of the study, 36 patients(90%) were still on CAPD, 2 patients(5%) had transferred to hemodialysis, and 2 patients(5%) had died. The cause of death was peritonitis in 1 patient, and cachexia in the other patient. In conclusion, exit-site infection responded relatively well to conservative treatment. However, exit-site infection is one of the major causes of catheter failure in CAPD. Therefore, careful exit-site care and examinations are needed.
Subject(s)
Female , Humans , Male , Anti-Bacterial Agents , Cachexia , Catheters , Cause of Death , Classification , Diabetic Nephropathies , Kidney Failure, Chronic , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Pseudomonas , Renal Dialysis , Retrospective StudiesABSTRACT
OBJECTIVE: Diabetic nephropathy is one of leading causes of end stage renal disease(ESRD). The ability to control anemia and hypertension without sudden drastic body fluid changes was thought to favor CAPD over hemodialysis for the management of diabetic ESRD with severe cardiovascular disease. To assess survival and risk factors in diabetic end stage renal failure, clinical studies were carried out on the 68 cases on CAPD who had been treated from January 1988 to February 1997. Methods - The mean age was 55.5 years and the sex distribution was 43 males to 25 females. Mean CAPD duration was 16.4 months ranged from one to 68 months. Five patients had insulin-dependent dia- betes ; 63 had non-insulin-dependent diabetes. Mean duration of diabetes was 13.8 years. All patients used curl catheter. Blood glucose was controlled by oral hypoglycemics(n=17) or subcutaneous regular insulin(n=51). Results - The incidence of peritonitis was 1.1 episodes/patient-year and exit site infection was 0.3 episodes/patient-year. Other complications were lea- kage, catheter dislodgement, transient hypotension. Mean hospital stay was 48.6 days/patient-year. Patient survival rates at 1, 2, 3, and 4 years were 73, 51, 30, and 30%, respectively for diabetic CAPD patients and 92, 85, 72, and 68%, respectively for non-diabetic patients. Diabetic CAPD patients had significantly lower survival when compare to nondiabetics(p<0.01). Catheter survival rates were 85% at one year, and 42% at three years in diabetics. Catheter were removed in 19 cases and the causes were peritonitis(84.2%) and catheter obstruction and malfunction(15.8%). By the end of the study, 38.2% of the patients were still on CAPD, 44.19% had died, 17.6M had transferred to hemodialysis. Common cause of deaths were cachexia, CAPD peritonitis with sepsis, cerebrovascular accidents and cardiovascular complications. CONCLUSION: Although diabetic CAPD patients had significantly lower survival compared to non-diabetics, CAPD seems a good renal replacement modality for patients with diabetic renal failure as yet.
Subject(s)
Female , Humans , Male , Anemia , Blood Glucose , Body Fluids , Cachexia , Cardiovascular Diseases , Catheter Obstruction , Catheters , Cause of Death , Diabetes Mellitus , Diabetic Nephropathies , Hypertension , Hypotension , Incidence , Kidney Failure, Chronic , Length of Stay , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Renal Dialysis , Renal Insufficiency , Risk Factors , Sepsis , Sex Distribution , Stroke , Survival RateABSTRACT
Nodular glomerulosclerosis was first described by Kimmelstiel and Wilson in 1936. Diabetic retinopathy and nephropath y are manifestation of the microangiopathy associated with diabetes. The severity of diabetic nephropathy and the occurrence of retinopathy correlate with the duration of clinical diabetes. However, there have been few reports of patients presents presenting with the classic lesions of diabetic microangiopathy in the absence of a known history of diabetes. These reports raise questions regarding the relationship and significance of carbohydrate intolerance to these pathologic abnormalities. A 34-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic disease is reported. Renal biopsy showed the nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) characteristic of diabetes. Direct opthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.
Subject(s)
Adult , Humans , Male , Biopsy , Diabetes Mellitus , Diabetic Angiopathies , Diabetic Nephropathies , Diabetic Retinopathy , Fluorescein Angiography , Glucose , Glucose Tolerance Test , Hypertension , ProteinuriaABSTRACT
OBJECTIVES: Renal transplantation has become the ther apy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the num ber of ideal kidneys available for transplantation, increas ing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal def inition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we per formed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mis matched living related kidney transplantation. METHODS: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(> OR =55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retro spectively reviewed. Patient death with a functioning graft was considered graft loss. RESULTS: Demographic characteristics between 2 groups were similar. The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regard less of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly dif ferent (91.4% and 63.9% vs 92.7% and 79.3%, respec tively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). CONCLUSION: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kid neys may be used from donors over 55 years old on con dition that the donors undergo complete and exhaustive work-up.