[Scabies in a dalysis unit. Mystery and prejudice]. / La scabbia in un centro dialisi. Mistero e pregiudizio.

BACKGROUND: Pruritus is one of the most common symptoms of uremia. The etiology of uremic pruritus is steel incompletely known. Scabies may be a cause of itching in these patients. METHODS: Retrospective analysis of beginning and developing of a scabies outbreak in a Dialysis Unit with 160 patients. RESULTS: Sixteen cases of scabies were observed in the Dialysis Unit from April 1998 and January 1999: in 6 of them the scarification was positive. In 10 the scarification was negative, but itching disappeared after treatment with benzyl benzoate 20%. Many courses were necessary (max 6). Prophylaxis (treatment with benzyl benzoate 20% for 3 days and lingery cleaning) was applied to approximately 400 people. No cases were observed among health care workers of the Dialysis Unit. CONCLUSIONS: In a Dialysis Unit the diagnosis of scabies is difficult because the patients often have generalized itching; moreover some of them are affected by neuropathy that may make the infestation of scabies more difficult to identify. The most important factor to limitate the outbreak seems to be the prophylaxis of people who take care of patients (health-care workers, family members and car-drivers). It seems also necessary to repeat the treatments many times. The most exposed patients seemed to be those with diminished independence, diabetes and malnutrition.

[Effectiveness of influenza vaccination in patients undergoing regular dialysis treatments]. / Efficacia della vaccinazione antifluenzale nei pazienti in trattamento dialitico regolare.

BACKGROUND: The influenza vaccination is considered useful in preventing influenza and its complications, but its efficacy is variable. Recent data on clinical effectiveness of influenza vaccination in renal patients are lacking. MATERIALS AND METHODS: The clinical efficacy in our Hemodialysis Unit during the last three years has been evaluated: 287 patients have been vaccinated. The rate of vaccination achieved has been of 81.3%. RESULTS: The efficacy has been of 46.7%. The difference of efficacy noted among young people (< 60 years) and elderly (> 60 years) in general population is not observed among our hemodialyzed patients. Bronchopulmonary complications (radiographically proven) have been low: 1.7%. No mortality increase has been observed. CONCLUSIONS: These findings suggest that influenza vaccine can reduce the incidence and severity of influenza virus infections also among hemodialyzed patients.

[Uremic pruritus]. / Il prurito uremico.

Among the various dermatologic abnormalities that can be associated with advanced chronic renal failure and dialysis therapy, pruritus is certainly the most disturbing disorder. Pruritus is an unpleasant, vexing sensation that provokes an intense desire to scratch. In the past the pruritus was considered from the neurophysiologic point of view as a submodality of pain, but more recent research showed that pain and pruritus are sensations which are carried through different populations of primary sensory neurons. The causes of pruritus in uremic patients are still unknown: xerosis, intradermic microprecipitation of divalent ions, hyperparathyroidism, peripheral neuropathy, allergic reactions and hypersensitivity, histamine and others have been considered as pathogenetic factors. The uncertainty on the causes is in part responsible for the different approach and results, unsatisfactory in many cases. In this paper we will review the neurophysiology, the pathogenesis and the possible therapeutic approaches to uremic pruritus.

Optimizing sodium balance in hemodialysis.

this paper develops and tests a mathematical model for Na+ kinetics applied to standard hemodialysis. The volume of distribution of exchangeable Na+, dialyzer surface area, blood and dialysis fluid flow rate, target weight loss, treatment duration and the Na+ diffusibility constant are taken into account. The model is used to compute the optimal hour by hour dialysis fluid Na+ concentration required to achieve the prescribed end-dialysis natremia and maintain a constant end-dialysis body Na+ pool, while providing a nearly uniform removal of Na+ over dialysis. The model was preliminary tested on 10 consecutive dialyses in a single patient using special dialyzer which generates a part of ultrafiltrate uncontaminated by dialysate.

[Evolution of the serum aluminum values in the Piedmont dialysis population. Dialysis Centers of the Piedmont]. / Evoluzione dei valori di alluminio serico nella popolazione dialitica piemontese. Centri Dialisi del Piemonte.

The authors have evaluated the evolution of values of serum aluminium concentration (Als) in the whole pool of patients undergoing RDT in Piedmont in the years 1982-1990. We have compared the data of the Piedmont Regional Registry of Dialysis and Transplantation at the end of 1990 to those obtained in 1982, 1986 and 1989. A progressive reduction has been observed in the percentage of patients with Als > 100 micrograms/l, who were 13.5% of the pool in 1982 and 7.5% in 1986 and finally decreased to 1.5% in 1990. This is yet more evident for patients dialyzing at home as in 1982 43% of them had a Als > 100 micrograms/l, whereas in 1986 only 8.2% did and in 1990 this percentage had decreased to 3.6%. The values of Als (distinguished by type of treatment of chronic renal failure) show end confirm the improvement of the situation of aluminium accumulation, specially as regards bicarbonate HD where the percentage of patients with Als > 100 micrograms/l decreases from 10.5% in 1986 to 1.7% in 1990. These data point out the efficacy of prevention and control programs regarding aluminium pathology performed in the last years in Piedmont. This has led to a reduction of the severe accumulation syndromes observed in the first years of '80 and has allowed the nephrologist to prepare more correct therapeutic prescriptions.

Erythrocyte Na+, K+ pump inhibition after saline infusion in essentially hypertensive subjects: effects of canrenone administration.

The effects of a 2-litre isotonic saline infusion, with and without prior oral canrenone (150 mg) administration, on erythrocyte Na+, K+ pump, urinary sodium excretion and arterial pressure were evaluated in nine patients with essential hypertension. Ouabain-sensitive Na+ efflux in fresh erythrocytes was used as an index of Na+, K+ pump activity, and the inhibitory effect on this ion efflux of preincubation of erythrocytes in plasma was used to test the presence of a circulating ouabain-like substance. Erythrocyte Na+, K+ pump activity decreased significantly (P less than 0.01) after saline infusion; canrenone administration was able to prevent this inhibition. Plasma from hypertensive patients obtained before saline infusion significantly (P less than 0.01) inhibited the Na+, K+ pump of erythrocytes from normal subjects, while plasma taken after the saline infusion plus canrenone was unable to produce any significant inhibition. Both systolic and diastolic arterial pressure fell significantly (P less than 0.05) only at the end of saline infusion with prior canrenone administration. This study supports the hypothesis that protection of Na+, K+ pump against endogenous inhibitors, other than exogenous, seems to be a pharmacological effect of canrenone, and may partly explain its antihypertensive activity.

Erythrocyte Na,K pump activity and arterial hypertension in uremic dialyzed patients.

We have evaluated in 26 uremic patients [21 on hemodialysis, 5 on continuous ambulatory peritoneal dialysis (CAPD)], 11 normotensive, and 15 hypertensive (MAP greater than 110 mm Hg) patients the following properties: a) erythrocyte (RBC) Na concentration [Nai] and ouabain-sensitive and -resistant Na effluxes; b) the effect of uremic sera on ouabain-sensitive Na efflux in normal RBC; c) serum digoxin-like immunoreactivity; d) cardiac index and total peripheral resistance. In 19 healthy subjects a) and c) were also evaluated. RBC Na,K pump activity was lower in uremic patients than in normal subjects (P less than 0.0005), and lower in hypertensive (P less than 0.02) than in normotensive patients. Serum from uremic patients inhibited ouabain-sensitive Na efflux in normal RBC, the inhibition being correlated with both the rate constant for ouabain-sensitive Na efflux (r = -0.67; P less than 0.005) and [Nai] (r = 0.43; P less than 0.05) of RBC of patients from whom the serum was obtained. Inhibition of ouabain-sensitive Na efflux was significantly higher with serum from hypertensive than from normotensive patients (P less than 0.05). Serum digoxin-like immunoreactivity was present in all uremic patients (0.402 +/- 0.054 ng/ml in normotensive and 0.428 +/- 0.040 ng/ml in hypertensive, P = ns), while it was not detectable in normal subjects. Hypertensive patients had peripheral resistance significantly higher than normotensive (P less than 0.05), while cardiac index was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)