ABSTRACT
We report two cases of retroperitoneal fibrosis that emerged during a clinical course of moderate chronic kidney disease. In both cases, we observed an elevation in the serum CRP and IgG4 levels without an increase in the white blood cell count. The patients were treated with prednisolone. Their clinical conditions improved with a decrease in the serum IgG4 to total IgG ratio. The present cases suggest the importance of a differential diagnosis of retroperitoneal fibrosis in the medical care of chronic kidney disease patients, and we propose a useful biomarker for retroperitoneal fibrosis, which we suspect is associated with IgG4-related disease.
ABSTRACT
Two uremic patients gradually advanced in years were successfully treated with dialysis, even though they had some medical and social problems. The first case was a 97-year-old female, in whom hemodialysis could be introduced because one of her neighbors offered to support her to get the dialysis therapy. The second case was an 87-year-old male. He had rejected dialyis, when he had suffered from pulmonary edema as a complication of uremia. He finally accepted dialysis after his general condition was remarkedly improved by forced hemodialysis. These two cases show difficulty in initiating dialysis in very old patients. A decision not to offer or to discontinue dialysis should be made after sufficient discussion and counselling among the medical staff, patients, and their families, since it is difficult to establish indication criteria for dialysis therapy in such high-aged patients.