Management of scleroderma-related end-stage renal disease with automated peritoneal dialysis

Kidney failure is the principal cause of death in scleroderma and accounts for at least 50% of deaths in this disease. Management of scleroderma-related end-stage renal disease requires some form of renal replacement therapy. Survival up to 18 months has been reported in one patient on continuous ambulatory peritoneal dialysis. Surviving for more than 1 year on automated peritoneal dialysis has not been reported. We report a patient with scleroderma-related end-stage renal disease treated with automated peritoneal dialysis with steady state control of uremia and hypertension at 18 months of follow-up

Prevalência da síndrome das pernas inquietas em pacientes em terapias de hemodiálise em um centro na região sul de Santa Catarina – Brasil / Restless legs syndrome prevalence in patients in haemodialysis therapy in a reference service in south Santa Catarina – Brazil

Introdução: A síndrome das pernas inquietas (SPI) tem sido relacionada a diversas doenças, entre elas doença renal e anemia. Objetivo: Descrever a prevalência da síndrome das pernas inquietas (SPI) nos pacientes em terapia de hemodiálise na região da Associação dos Municípios da Região de Laguna, Santa Catarina, Sul do Brasil (AMUREL). Métodos: 117 indivíduos submetidos à terapia de hemodiálise na região da AMUREL foram entrevistados para se avaliar a presença, o tipo (primária ou secundária) e a gravidade da SPI, creatinina, ureia, ferro e ferritina séricos. Resultados: A prevalência de SPI foi de 30,8% (n=36). Dos portadores, 33,3% tiveram o diagnóstico de SPI primária e 66,7% (n=24) o de SPI secundária .Quanto à gravidade, 58,3% foram classificados como intermitente, 16,7% em persistente leve, 8,3% em persistente moderada e 16,7% em ersistente grave. A maior parte dos casos de SPI não tinha sido diagnosticada anteriormente. Não foi encontrada correlação com os parâmetros bioquímicos nem diferenças significativas entre os sexos. Conclusão: A síndrome das pernas inquietas é comum e pouco diagnosticada. Sua prevalência é considerável e aumenta substancialmente em indivíduos urêmicos. Não encontramos nenhuma evidência de que anemia por deficiência de ferro e ferritina, nem índices altos de ureia e creatinina séricos possam desempenhar um importante papel patogênico.

Introduction: Restless legs syndrome (RLS) has been related to several diseases, including renal disease and anaemia. Aim: To determine the prevalence of restless legs syndrome in patients under haemodialysis therapy in the region of the Association of Municipalities of the Region of Laguna (AMUREL), in the state of Santa Catarina, South Brazil. Methods: 117 patients undergoing haemodialysis in the AMUREL region were interviewed in order to evaluate the presence, type (primary or secondary), and severity of RLS, as well as their serum creatinine, urea, iron, and ferritin levels. Results: The prevalence of RLS was 30.8% (n=36). Among the affected individuals, 33.3% were diagnosed with primary RLS and 66.7% (n=24) with secondary RLS. Concerning severity, 58.3% were rated as intermittent, 16.7% as mildly persistent, 8.3% as moderately persistent, and 16.7% as severely persistent. Most of the cases of RLS had not been diagnosed before. No correlation of RLS was detected with the biochemical measures, nor differences between the sexes. Conclusion: Restless legs syndrome is common and underdiagnosed. Its prevalence is considerable and increases significantly in uraemic individuals. We failed to find any evidence that iron and ferritin deficiency anaemia, or high serum urea and creatinine, can play an important pathogenic role.

Response of the growth plate of uremic rats to human growth hormone and corticosteroids

Children with chronic renal failure in general present growth retardation that is aggravated by corticosteroids. We describe here the effects of methylprednisolone (MP) and recombinant human growth hormone (rhGH) on the growth plate (GP) of uremic rats. Uremia was induced by subtotal nephrectomy in 30-day-old rats, followed by 20 IU kg-1 day-1 rhGH (N = 7) or 3 mg kg-1 day-1 MP (N = 7) or 20 IU kg-1 day-1 rhGH + 3 mg kg-1 day-1 MP (N = 7) treatment for 10 days. Control rats with intact renal function were sham-operated and treated with 3 mg kg-1 day-1 MP (N = 7) or vehicle (N = 7). Uremic rats (N = 7) were used as untreated control animals. Structural alterations in the GP and the expression of anti-proliferating cell nuclear antigen (PCNA) and anti-insulin-like growth factor I (IGF-I) by epiphyseal chondrocytes were evaluated. Uremic MP rats displayed a reduction in the proliferative zone height (59.08 ± 4.54 vs 68.07 ± 7.5 æm, P < 0.05) and modifications in the microarchitecture of the GP. MP and uremia had an additive inhibitory effect on the proliferative activity of GP chondrocytes, lowering the expression of PCNA (19.48 ± 11.13 vs 68.64 ± 7.9 percent in control, P < 0.0005) and IGF-I (58.53 ± 0.96 vs 84.78 ± 2.93 percent in control, P < 0.0001), that was counteracted by rhGH. These findings suggest that in uremic rats rhGH therapy improves longitudinal growth by increasing IGF-I synthesis in the GP and by stimulating chondrocyte proliferation.

Correction of imbalance of serum elements and hemoglobin using metal-metal interaction in uremic patients

Oral zinc administration or zinc chloride addition to the dialysate solution were used to correct the imbalance of serum elements concentration regarding serum Zn, Cu, Fe and Mn. Moreover this treatment reduced the amount of methmoglobin and has a role in overcoming the chronic anemia in uremic patients

Radiological cardio-pulmonary changes in patients with chronic renal failure

Renal failure is a relatively common phenomenon in hospital practice, much of its aspects are known as regards to both fields of diagnosis and treatment, but, still there are some points in the topic which still not completely covered as cardio-pulmonary changes in renal failure. This work included 50 patients proved to have uremia [clinical and laboratory investigations], 35 of them undergone dialysis either peritoneal or haemodialysis. Chest x-ray were made to all subjects and their findings were arranged under the following scheme; [a] Looking at the thoracic cage; [b] Evaluation of pulmonary vasculature; [c] Assessment of the radiologic state of lung fields; [d] Checking of the clearity of the costophrenic sinus; [e] Assessment of cardiac size and configuration; [f] Looking at the hila. From this work it was found that the following changes were obtained; increase bone density, exaggerated or oligaemic pulmonary vasculature, fibrotic strands, calcification, pneumonic shadow, obliteration of costophrenic sinus, increase cardiac size, and hiler shadowing. From these radiological changes it can be concluded that plain radiography of chest and heart has an efficient role in diagnosing the cardiopulmonary complications which may occur secondary to uremia

Changes in the metabolism of collagen in uremic patients without and after hemodialysis

The aim of the present work is to throw some light at the metabolism of collagen regarding both synthesis and degradation in uremic patients without and after hemodialysis. Serum procollagen III peptide and hydroxyproline were studied in twenty chronic renal failure [CRF] patients [ten hemodialysed and ten non dialysed] and ten normal control subjects. Levels of serum PIIIP showed a significant elevation [p< 0.01] in uremic cases [both non dialysed and dialysed groups] when compared with the normal control group. Levels of serum hydroxyproline showed a significant elevation in non dialysed CRF patients [p< 0.01] when compared with the normal control group. These returned to normal after hemodialysis

Evaluation of different therapeutic regimens for the treatment of uremic pruritus

115 uremic patients [72 males and 43 females] undergoing hemodialysis in 3 different dialysis units during the period December 1992-March 1994, and suffering from severe pruritus, were selected for the present study. The ages of the patients ranged from 28 to 57 years [mean age 39.5 years +/- SD 8.34]. They were randomly distributed in 4 therapeutic regimens: Activated charcoal, cholestyramine resin, ultraviolet light B [UV B] and erythropoietin [EPO]. Thirty patients who received only oral antihistaminic [loratadine 10 mg] and a topical antipruritic [menthol 0.6, paraffin oil 1.2 and cold cream to 120] for their pruritus served as control. The results showed that the highest response was with UV B 86.36% followed by EPO [85.71%], followed by activated charcoal [72.73%]; the weakest response being with cholestyramine resin [60%]. The response in the control group was 13.33%. It is possible that further studies in the near future may show that combined therapy using two or three of the above therapeutic regimens may even yield higher percentage of response

Prevalence of helicobacter like organisms in gastroduodenal mucosa in uraemic patients under haemodialysis

Our study has been conducted on 20 Egyptian uraemic patien on regular haemodlalysis and they were divided into two groups according to the presence of upper gastrointestinal symptoms Group [A], the symptomatic group. Group [B], Asymptomatic group. The incidence of endoscopic gastritis was found to be 55% while incidence of endoscopic duodenitis was 40%. None of our patients had peptic ulcer. The incidence of histologic gastritis was 65% [Antral gastritis was found in 50% and body gastritis in 55%]. The most common form of histologic gastritis met with the chromic type. The incidence of histologic duodenitis was found to be 45%. There is no correlation between endoscopic and histologic gastritis or duodenitis. The incidence of Helicobacter- like organims [HLO] in gastric mucosa was 40% and in duodenal mucosa was 25% of all patients. There is no significant correlation between the presence of HLO and special type of histologic gastritis. There is significant correlation between the presence of HLO at the antrum and the presence of symptoms. There is significant correlation between the presence of HLO and histologic inflammation at the antrum

Efecto de los ácidos grasos polinsaturados de pescado sobre la agregación plaquetaria y lipidos séricos en pacientes sometidos a dialisis peritoneal continua ambulatoria / Effect of fatty acids polyunsaturated of fish, about the platelet aggregation

Los pacientes urémicos en tratamiento con diálisis peritoneal continua ambulatoria (CAPD) poseen factores de riesgo (hipertrigliceridemia y aumento de la agregación plaquetaria) implicados en la patogénesis del proceso ateroesclerótico. En este trabajo se evaluó la función plaquetaria y el patrón lipídico de 36 pacientes urémicos, tratados con CAPD y la modificación que produce en estos patrones el suplemento con bajas dosis de ácidos grasos polinsaturados de pescado (1,8 gr/día de EPA), administrados por períodos prolongados. El análisis de la función plaquetaria de estos pacientes confirma la presencia de un estado de hiperactividad plaquetaria. En relación a los lípidos se observó un discreto aumento de los trigliceridos, colesterol total y c-VLDL, y un c-HDL en el límite inferior de la normalidad (Fenotipo IV). De los 36 pacientes, 23 recibieron tratamiento con ácidos grasos polinsaturados de pescado (MAXEPA), a la dosis de 6-9 gr/d durante el primer mes y posteriormente 3 gr/d. En este grupo se observó una tendencia en el tiempo a mejorar el atado de hiperactividad plaquetaria evidenciada por una disminución en el índice de MDAb/MDAa y de la agregación inducida con epidefrina. Los triglicéridos, el colesterol total, c-VLDL y c-HDL no sufrieron modificaciones significativas. El C-LDL aumentó significativamente. En el grupo de trece pacientes sin tratamiento, no se observaron, en evaluaciones sucesivas, modificaciones de la función plaquetaria ni del patrón lipídico. En base a nuestros resultados, podemos concluir que el MAXEPA, en la dosis bajas utilizadas, podría ser un agente antiagregante plaquetario efetivo en los pacientes en CAPD, cuando es utilizado por períodos prolongados. Esta acción beneficiosa pudiera verse contrarrestada por su efecto adverso de aumentar el c-LDL, lo que hace necesario evaluar cuidadosamente sus propiedades antiateromatosas a largo plazo