Renal involvement in Behçet's disease. Case report and review of the literature.

A female patient has suffered from Behçet's disease (BD) for 15 years. During one recurrent episode proteinuria and microscopic hematuria were discovered. Renal biopsy revealed focal segmental glomerulopathy with IgA deposits. Renal involvement in BD is uncommon and includes amyloidosis, crescentic glomerulonephritis and IgA nephropathy. BD is a cause of secondary IgA nephropathy. Immunologic features of the two diseases, particularly increased serum IgA, are reviewed.

Insufficient dialysis shunts: improved long-term patency rates with close hemodynamic monitoring, repeated percutaneous balloon angioplasty, and stent placement.

Over 54 months, 70 short stenoses of 63 shunts (32 Brescia-Cimino fistulas, 31 grafts) in 59 patients necessitated a first percutaneous transluminal angioplasty (PTA). Restenosis led to 63 redilations in 38 lesions. Nine stents were inserted in seven grafts and two proximal veins in seven patients, the indication being that stenosis had recurred twice in 6 months. In three of these stenoses, five delayed intrastent redilations were necessary. Three previously dilated occluded grafts were recovered with local thrombolysis. Morbidity was 4.08%, with one immediate rupture, four delayed pseudoaneurysms (1-28 months), and two periprocedural bacteremias. Half (15 of 29) of graft stenoses and only 14% (four of 27) of Brescia-Cimino fistula stenoses had a mean restenosis interval of less than 6 months. The mean restenosis interval increased from 3.6 months +/- 0.5 (standard deviation) before stent placement to 15.2 months +/- 0.4 after stent placement (P < .001). Insertion of a stent can be advised when stenoses of graft venous anastomoses have recurred twice in less than 6 months. The combination of all interventional radiologic procedures allowed a significant improvement in secondary patency rates after PTA, with 82% at 1 year, 79% at 2 years, and 71% at 3 years.

Changes in parathyroid hormone during haemodialysis sessions with two different dialysis membranes: specific adsorption of intact parathyroid hormone.

In patients dialysed with two different membranes (cuprophan and high-flux polysulphone) and using three radioimmunoassays recognizing either intact molecule (iPTH), C terminal (cPTH) or median fragments (mPTH), we compared parathyroid hormone levels at the beginning of and during dialysis. At the beginning of dialysis, cPTH and mPTH levels were always increased but iPTH levels were sometimes within the normal range; during dialysis only iPTH distinctly decreased whichever membrane was used. The behaviour of iPTH cannot be explained by crossing through the membrane because its molecular weight is too high; it cannot be explained by the variation of calcium and phosphate parameters during the session because no correlation exists between the variations in plasma levels of iPTH and the variations in phosphorous and calcium levels. In vitro experimentation with radiolabelled intact iPTH was performed to confirm the specific behaviour of iPTH: these experimental data agree with our in vivo results and suggest an adhesion to the dialysis membrane. Our study shows a specific singular property of iPTH during dialysis and demonstrates the necessity of considering the time of sampling during dialysis and the moiety of parathyroid hormone being measured in patients undergoing dialysis in order to assess osteodystrophy.

Iododerma and acute respiratory distress with leucocytoclastic vasculitis following the intravenous injection of contrast medium.

A 72-year-old woman with chronic renal failure requiring haemodialysis developed acute iododerma twice, after receiving iodide contrast dye for radiological procedures. Iododerma was localized to the face, scalp and elbows and was associated with papular purpura of the legs. Histopathology of the skin lesions showed acute necrotizing vasculitis. During the second skin eruption the patient developed acute respiratory distress, which was treated with corticosteroids. During the first eruption asymptomatic infiltrates were present on chest X-ray which disappeared 2 months later. At the present time iododerma seems more frequent in patients with renal failure. Iodides may also be responsible for pulmonary abnormalities, which are sometimes asymptomatic. All these features may be due to leucocytoclastic vasculitis following iodide ingestion.