Risk of peritonitis during peritoneal dialysis in carriers of Staphylococcus aureus and coagulase-negative staphylococci

The presence of Staphylococcus aureus in the nasal cavities and pericatheter skin of peritoneal dialysis patients put them at high risk of developing peritonitis. However, it is not clear whether the presence of coagulase-negative staphylococci (CNS) in the nasal passages and skin of patients is related to subsequent occurrence of peritoneal infection. The aim of the present study was to verify the relationship between endogenous sources of S. aureus and CNS and occurrence of peritonitis in patients undergoing peritoneal dialysis. Thirty-two patients on peritoneal hemodialysis were observed for 18 months. Staphylococcus species present in their nasal passage, pericatheter skin and peritoneal effluent were identified and compared based on drug susceptibility tests and dendrograms, which were drawn to better visualize the similarity among strains from extraperitoneal sites as well as their involvement in the causes of infection. Out of 288 Staphylococcus strains isolated, 155 (53.8 percent) were detected in the nasal cavity, 122 (42.4 percent) on the skin, and 11 (3.8 percent) in the peritoneal effluent of patients who developed peritonitis during the study. The most frequent Staphylococcus species were CNS (78.1 percent), compared with S. aureus (21.9 percent). Among CNS, S. epidermidis was predominant (64.4 percent), followed by S. warneri (15.1 percent), S. haemolyticus (10.7 percent), and other species (9.8 percent). Seven (64 percent) out of 11 cases of peritonitis analyzed presented similar strains. The same strain was isolated from different sites in two (66 percent) out of three S. aureus infection cases. In the six cases of S. epidermidis peritonitis, the species that caused infection was also found in the normal flora. From these, two cases (33 percent) presented highly similar strains and in three cases (50 percent), it was difficult to group strains as to similarity. Patients colonized with multidrug-resistant S. epidermidis...

Insuficiência renal aguda: estudo do quadro clínico e prognóstico / Acute renal failure. Clinical statement study and prognosis

A insuficiência renal aguda orgânica (IRAo) é complicaçao freqüente em pacientes hospitalizados, associando-se a altas taxas de mortalidade. OBJETIVO. Analisar os aspectos clínicos e o quadro anatomopatológico de pacientes portadores de IRAo, bem como determinar fatores de prognóstico. MÉTODOS. Foram estudados, de forma prospectiva, 20O pacientes portadores de IRAo internados durante o período de janeiro de 1987 a julho de 1990. RESULTADOS. A freqüência de IRAo foi de 4,9/1.000 internaçoes. As causas mais comuns foram isquemia renal (50 por cento) e drogas nefrotóxicas (22 por cento). O diagnóstico anatomopatológico realizado em 43 pacientes revelou: necrose tubular aguda (53 por cento); degeneraçao) hidrópica tubular (l6 por cento), glomerulopatias (l6 por cento) e outras lesoes (l5 por cento). Tratamento dialítico foi realizado em 50,5 por cento dos pacientes; as principais indicaçoes foram: uremia (l38 vezes, 67 por cento), hipervolemia (45 vezes, 22 por cento), hiperpotassemia (19 vezes, 9 por cento). A taxa de mortalidade foi de 46,5 por cento, sendo as principais causas de óbito: septicemia (38 por cento), insuficiência respiratória (19 por cento) e falência de múltiplos órgaos (11 por cento). Somente dois pacientes (nos quais o tratamento dialítico foi suspenso) morreram por causas ligadas diretamente à insuficiência renal. Houve maior mortalidade entre pacientes oligúricos (62,9 por cento) do que em pacientes nao oligúricos (34,5 por cento) (p<0,05). Pacientes com IRAo isquêmica apresentaram maior mortalidade (56,7 por cento) do que pacientes com IRAo nefrotóxica (14,7 por cento) (p<0,05). Essas diferenças mantiveram-se quando essa comparaçao foi feita apenas entre os pacientes submetidos a tratamento dialítico. CONCLUSAO. As principais causas de óbito nao foram diretamente relacionadas à IRAo. Desta forma, os dados do presente trabalho sugerem que a IRAo é um importante marcador de gravidade de doença de base, e nao um fator determinante do óbito.

Effects of dietary protein, angiotensin I converting enzyme inhibition and mesangial overload on the progression of adriamycin-induced nephropathy

Adriamycin, a commonly used antineoplastic antibiotic, induces glomerular lesions in rats, resulting in persistent proteinuria and glomerulosclerosis. We studied the effects of dietary protein and of an angiotensin I converting enzyme inhibitor on the progression of this nephropathy and the evolution of the histological lesions, as well as mesangial macromolecule flow. Adriamycin nephropathy was induced by injecting a singl iv dose of adriamycin (3 mg/kg body weight) into the tail vein of male wistar rats (weight, 180-200 g). In Experiment I animals with adriamycin-induced nephropathy were fed diets containing 6 percent (Low-Protein Diet Group = LPDG), 20 percent (Normal-Protein Diet Group = NPDG) and 40 percent (High-Protein Diet Group = HPDG) protein and were observed for 30 weeks. In Experiment II the rats with adriamycin nephropathy were divide into 2 groups: ADR, that received adriamycin alone, and ADR-ENA, that received adriamycin plus enalapril, an angiotensin I converting enzyme inhibitor. The animals were sacrificed after a 24-week observation period. Six hours before sacrifice the animals were injected with 131I-ferritin and the amount of 131I-ferritin in the glomeruli was measured. In Experiment III, renal histology was performed 4, 8 and 16 weeks after adriamycin injection. At the end of Experiment I the tubulointerstitial lesion index was 2 for LPDG, 8 for NPDG, and 7.5 for HPDG (P,0.05); the frequency of glomerulosclerosis was 19 + or - 6.1 percent in LPDG, 42.6 + or - 6 percent in NPDG, and 54 + or - 9 percent in HPDG (P,0.05); and proteinuria was 61.1 + or - 25 mg/24 h in LPDG, 218.7 + or - 27.5 mg/24 h in NPDG, and 324.5 + or - 64.8 mg/24 h in HPDG (P,0.05). In Experiment II, at sacrifice, 24-h proteinuria was 189 + or - 16.1 mg in ADR, and 216 + or - 26.1 mg in ADR-ENA (P.0.05); the tubulointerstitial lesion index was 5 for ADR, and 5 for ADR-ENA (P.0.05); the frequency of glomerulosclerosis was 40 + or - 5.2 percent in ADR and 44 + or - 6 percent in ADR-ENA (P.0.05); the amount of 131I-ferritin in the mesangium was 214.26 + or - 22.71 cpm/mg protein in ADR and 253.77 + or - 69.72 cpm/mg protein in ADR-ENA (P.0.05). In Experiment III, sequential histological analysis revealed an acute tubulointerstitial cellular infiltrate at week 4, whigh was decreased at week 8. Tubular casts and dilatation were first seen at week 8 and increased at week 16 when few glomerular lesions were found. The results suggest that the tubulointerstitial lesions may play a role in the development of glomerulosclerosis in adriamycin-induced nephropathy