Uraemic gangrene syndrome: is parathyroidectomy always necessary?

This report presents a case of uraemic gangrene syndrome with multiple ulcerations and calcium (Ca) deposits in the vessel walls. High-dosage oral calcium carbonate (CaCO3) treatment alone resulted in rapid wound healing with decreased serum phosphorus (P), Ca x P product and parathormone and only slightly increased Ca levels. We suggest that this should be the first choice of treatment in such cases because positive clinical response can achieve symptom-free status for the patient until kidney transplantation, thus making parathyroidectomy unnecessary.

The effect of calcitriol on renal anaemia in patients undergoing long-term dialysis.

In long-term haemodialysis patients suffering from secondary hyperparathyroidism Se iPTH could be suppressed by an intravenous calcitriol therapy. As the Se iPTH level became reduced, lower doses of Rh-EPO were already sufficient for the maintenance of the target haematocrit, while in two patients not requiring Rh-EPO treatment an improvement of their moderate anaemia could be observed. These data corroborate the view that calcitriol is an effective drug in secondary hyperparathyroidism. The results suggest that in the improvement of renal anaemia of dialysed patients the reduction of the Se-PTH level also plays a role.

[The effect of calcitriol on renal anemia in patients under chronic hemodialysis]. / Calcitriol hatása a renális anaemiára krónikus hemodialízissel kezelt betegeken.

The authors reached the suppression of serum intact parathormone (iPTH) by calcitriol therapy in chronic hemodialyzed patients with secondary hyperparathyroidism. Parallel with the depression of iPTH levels it was enough a lower doses of recombinant human erythropoietin (Rh-EPO) to maintain the target hematocrit, while on two patients non-treated with Rh-EPO they founded an improvement in moderate anemia. Their data confirm that the calcitriol is an effective drug in the treatment of secondary hyperparathyroidism. The results speak in favour that in the improvement of renal anemia on regular hemodialysis patients play an important role the suppression of serum iPTH levels too.

[Experience with chronic hemodialysis in diabetic patients with kidney failure]. / A veseelégtelenségben szenvedö cukorbetegek krónikus hemodialízisével szerzett tapasztalataink.

Between 1978 and 1992, 534 patients--including 35 (25 IDDM and 10 NIDDM) diabetics--were accepted to chronic hemodialysis (HD) at our Dialysis Center. The 1-year cumulative survival rate (CSR) was significantly lower in diabetic vs. non-diabetic group (66 +/- 8% vs. 78 +/- 2%), p < 0.05). At the onset of diabetes the mean age of IDDM patients vs. NIDDM patients was 18.2 +/- 2.7 years vs. 51.3 +/- 3.1 years, respectively. At the beginning of HD treatment the mean age of IDDM patients vs. NIDDM patients was 38 +/- 2.4 years vs. 58.3 +/- 2.6 years. In IDDM group until the start of HD treatment the mean duration of diabetes was 20 +/- 1.3 years and it did not depend on the quality of preuraemic metabolic control (p = 0.825); mean duration of diabetes until their death was 22.5 +/- 1.3 years. Mean age of IDDM and NIDDM patients at their death was 38.8 +/- 3 years and 60.5 +/- 3.7 years. Average duration of HD treatment was 16 +/- 2.5 months in IDDM group and 21.5 +/- 5.8 months in NIDDM group. Major causes of death were cardiovascular complications of diabetes (39%) and infections (33%). We found no difference in CSR related to gender, age, type of diabetes, quality of metabolic control during the HD treatment, but CSR was significantly higher in patients with good metabolic control from the onset of diabetes (1-year CSR of adequately vs. poorly controlled diabetics: 80% vs. 62%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Auditory brainstem potentials in uraemia.

Evoked response audiometry was carried out to assess the viability of the auditory pathway in haemodialysed patients. The latency of the waves III and V and I-V interpeak latencies were significantly longer in the renal patients compared to the control group. The I-V interpeak latency was longer in 8 of our 13 patients than the upper limit (4.38 ms) in our laboratory. The possible cause for the central auditory dysfunction may be multifactorial, including the effect of metastatic calcifications, repeated occurrence of disequilibrium syndrome, or some small, molecular, toxic, metabolic substance. The significance of the different factors may vary among different haemodialysis centres.

[Determination of hepatitis C antibodies, using the Abbott and the Ortho anti-HCV EIA kits, in chronic liver diseases and patients under hemodialysis for chronic renal failure]. / Hepatitis C vírus ellenanyag meghatározása Abbott és Ortho anti-HCV EIA kittel krónikus májbetegségekben és haemodializált krónikus veseelégtelenségben szenvedökben.

The diagnostic usefulness of anti HCV EIA test of Abbott and Ortho companies were compared. The anti HCV levels determined in the sera of 173 patients with chronic liver diseases and of 17 haemodialysed kidney patients. 109 of 190 (57%) sera were found to be negative and 81 (43%) positive determined by Abbott kit, while 127 (67%) were negative and 63 (30%) were positive by the Ortho kit. Positive results in patients with chronic liver disease were found in 66 patients by Abbott and 58 patients with Ortho Kit. Distribution of positive cases according to the diagnosis is as follows: 29 (57%) out of 51 chronic hepatitis, 17 (61%) out of 28 cirrhosis. Conflicting results were obtained in 20 cases of 190 (11%) when 17 sera were positive by Abbott and negative by ORTHO, and 3 sera were negative by Abbott, and positive by Ortho. The samples close to the cut off and with low positivity with conflicting results were checked again by the neutralization HCV EIA Abbott assay. We found the Abbott HCV EIA test more sensitive in our excellent for screening of large numbers of samples, we recommend to confirm the positive results by a neutralization type test.

Use of Tensiomin in hypertensive patients with impaired renal function.

Tensiomin treatment was applied in 20 hypertensive patients with impaired renal function but not requiring dialysis therapy and in 18 patients undergoing regular dialysis. In patients still not requiring dialysis the slowing down of the progression of renal failure, in the dialysed patients insufficient earlier therapy were the indications of Tensiomin treatment. Tensiomin was found to be an effective hypotensive drug in both groups, the majority of the side-effects were mild and of temporary character. The progression of renal failure was slower in the non-dialysed patients compared to the control group but the differences were statistically insignificant.

Peritoneal dialysis in Hungary.

In 1991 the technical conditions and the number of patients receiving peritoneal dialysis were surveyed in the Hungarian nephrology and dialysing units. Not only the number of patients with chronic uraemia (undergoing dialysis + transplantation) is lower in this country as compared to the European average (106 and 236 per one million people, respectively), but also their distribution according to the type of treatment is different. For several years patients under intermittent peritoneal dialysis make up more than 10% of the cases and those under continuous ambulatory peritoneal dialysis less than 2% (in Europe: < 2% and 4-43%, respectively). The survey also included the types of solution, disinfection and connecting devices used in peritoneal dialysis, as well as the incidence of peritonitis and the administration of antibiotics. The principles of biocompatibility, the function of interleukin, as well as the effectiveness and the conditions of continuous ambulatory peritoneal dialysis are summarized.

Atrial natriuretic peptide (ANP) in patients with chronic renal failure on maintenance haemodialysis.

Atrial natriuretic peptide (ANP), a recently discovered cardiac hormone, is an important regulator of body fluid homeostasis. Twenty patients with established chronic renal failure and on maintenance haemodialysis were studied before and after dialysis with capillary dialysers. ANP was determined by RIA after extraction. Mean (+/- SD) pre-dialysis ANP concentration was 146 +/- 51 pg/ml and decreased significantly during dialysis to 68 +/- 38 pg/ml (p less than 0.001). Per cent and absolute changes in plasma ANP level correlated significantly with concomitant changes in body weight (r = 0.764; p less than 0.001 and r = 0.558; p less than 0.01, resp.) but not with changes in serum creatinine, blood pressure or serum electrolytes. The obtained results indicate that ANP levels in patients with chronic renal failure are elevated mainly due to fluid overload, and the rapid fall in ANP concentration observed during haemodialysis is caused by the removal of excess fluid from the body.

Combined peritoneal and haemodialysis therapy for chronic renal insufficiency.

Twenty-three patients with chronic uraemia were treated for an average of 8.5 months with intermittent peritoneal dialysis. When hypervolaemia developed and/or the volume of low-molecular weight substances increased, the therapy was complemented by one or two sessions of haemodialysis per week. The combined treatment was carried on for 4.1 months on average, in consequence of which the general condition improved, body weight reached the optimum, blood pressure diminished, turned normal and could be controlled by drugs. In the wake of the therapy carbamide nitrogen and creatinine levels dropped significantly, serum total protein and albumin values increased. At the close of the observation period 3 patients remained under combined therapy, 2 had undergone cadaveric kidney transplantation, 18 were transferred to chronic haemodialysis. Thoughts are evolved about the advisability of intermittent peritoneal dialysis and combined therapy in the care for uraemic patients.

[Combination of peritoneal dialysis and hemodialysis in the treatment of chronic renal insufficiency]. / Peritonealis dialízis és haemodializis kombinációja a krónikus veseelégtelenség kezelésében.

In case of 23 patients, who had been treated for 8.5 (2-10) months with intermittent peritoneal dialysis, the peritoneal dialysis was supplemented once or twice a week by haemodialysis for 8.5 months. This combined way of treatment was favourable in cases of hypervolemia and/or of increased level of substances of small molecular weight. The average duration of this kind of treatment was 4.1 (1.5-11) months. In the course of treatment the general condition of the patients improved. When they regained their optimal bodyweight, their blood pressure got normalized or their hypertony decreased or it could be regulated by drug therapy. At the effect of this treatment, the carbamid nitrate and serum creatinin significantly decreased and the serum total protein and albumin levels increased. Two of the patients underwent cadaver kidney transplantation, and 18 of them have been treated by hemodialysis, 3 of them are being treated in this combined way even now. The authors discuss the role of intermittent peritoneal dialysis and that of the combined treatment in the management of uremic patients.

[False positive results of HIV virus tests in patients undergoing chronic hemodialysis]. / Anti-human immundeficiencia vírus (HIV) álpozitivitás vizsgálata krónikus haemodialysissel kezelt betegekben.

The sera of 173 haemodialysis patients treated in two dialysis centers in Hungary were tested for the presence of HIV (HTLV III/LAV) antibodies. Four different commercial enzyme immunoassay (EIA) kits and two types (CEM/LAV, and H9/HTLV III) of indirect immunofluorescence assay (IFA) were used. The Western blot technique was applied as confirmatory test in the study. No confirmed positive results were found in any of the cases. However, in 15 patients (8.7%) false positive (not confirmable by the Western blot assay) results were obtained in at least one but mostly in all of the three type 1 EIA kits (ORGANON, ELECTRONUCLEONICS, SORIN) applied. In 4 patients, the IFA assay also gave false positive results which could be repeated in sequential samples taken from the same patients. Increased reactivity in the control plate (coated with a concentrate of cellular material shed by uninfected H9 cell line) of the SORIN kit was found only in a few false positive samples and no fluorescence with the uninfected H9 or CEM cells was observed in any of the sera showing a false positive IFA. These results indicate that the false positive anti-HIV results frequently observable in haemodialysis patients are not simply the consequence of the presence of antibodies reacting with the uninfected H9 and/or CEM cells but they are most probably due to antibodies against antigens expressed on these cells only after infection with the human immunodeficiency virus.

Intracardiac calcification in patients under chronic haemodialysis.

Echocardiographic examination revealed intracardiac calcification in 20 out of 70 chronically dialysed patients. The process appeared more frequently in those suffering from severe renal osteodystrophy. It was often associated with rhythm disorder. Parathyroid hyperfunction is rated as one cause of intracardiac calcification.

Purulent pericarditis caused by Staphylococcus aureus in two patients undergoing haemodialysis.

Two cases of purulent staphylococcal pericarditis successfully treated in the course of chronic haemodialysis (HD) are reported. Pericardiac fenestration was carried out in both. In the second case the first pericardiac fenestration had yielded a sterile fluid and bacterial pericarditis developed only later. The significance of local therapy, side by side with surgery and chemotherapy, is stressed.