Fibrinous pericarditis in hepatorenal failure.

During a period of two years pericarditis was observed in five patients with decompensated cirrhosis who had only slightly raised blood-urea-nitrogen and serum-creatinine. Although this association has not been previously described, some patients with hepatic failure seem to have pericarditis in the absence of severe uraemia.

Chromatographic studies of uremic plasma.

In order to characterize the spectrum of possibly toxic retention compounds in uremia we have developed a simple reproducible method of separating fractions of uremic serum by Sephadex G-15 column chromatography. This technique, which requires no prior deproteinisation and is carried out at ambient temperatures, allowed the separation of uremic serum into several well defined fractions. Subsequent thin layer chromatography (TLC) showed that each peak represented a mixture of peptides, and that there were qualitative and quantitative differences between the plasma of normal and uremic patients as well as between patients with acute renal failure and chronic renal failure.

Dialysis dementia -- the Chicago experience.

In the four years between 1972 and 1976 twenty out of 160 maintenance dialysis patients developed dialysis dementia. Their illness was characterized by an insidious onset of mental deterioration, speech disturbance, apraxia, and myoclonus. The disease progressed inexorably to a fatal outcome, the onset of seizures being an ominous sign, and the average duration of the illness being seven months. Routine biochemical studies were unremarkable, and osteodystrophy was not a prominent feature. Serial electroencephalograms (EEG) showed progressive slowing of the rhythm, usually antedating the neurologic symptoms. Brain scan and flow studies were normal. Radio-iodinated serum albumin (RISA) scans in seven patients showed changes suggesting altered cerebrospinal fluid (CSF) dynamics. Treatment was generally ineffective, but ventriculo-peritoneal shunting produced transient neurologic improvement in one patient. Epidemiologic investigations showed high aluminum levels in city water during the period of the outbreak.

Charcoal hemoperfusion for chronic renal failure.

16 patients with end-stage renal disease were treated with a fixed-bed, uncoated-charcoal hemoperfusion device, used either alone or in series with a hemodialyzer. 3 patients had one of their thrice weekly dialyses replaced by one 3 hour combined treatment for up to 6 months, and 3 patients had 150-min combined treatments thrice weekly for up to 5 months. The procedure was well tolerated. Transient hypotension occurred and interfered with fluid removal by ultrafiltration. Platelet counts were reduced, but there was no clinical bleeding. Pretreatment of the device with albumin provided no advantage over heparinized saline, and dextran caused a more severe reduction in the platelet count. The changes in platelets, white blood cells, and hematocrit were transient and noncumulative. Considerable amounts of creatinine and uric acid were removed. Regular charcoal hemoperfusion appears to be safe, and long-term studies of clinical efficacy are indicated.

High-dose bolus urography. A superior technique in advanced renal failure.

High-dose bolus urography was evaluated in 38 patients with severe renal failure. Iothalamate meglumine (Conray 60) (2 ml/kg of body weight) was injected within one minute and nephrotomograms were taken for 30 minutes, with delayed films until 24 hours. Immediate nephrograms were obtained in all cases. The collecting systems, seen in 29 cases, were dilated in three. In the rest, obstruction could be ruled out by a combination of roentgenographic criteria. No untoward reactions occurred, and all the required information was obtained within 30 minutes. The results were superior to plain nephrotomography or infusion pyelography. We conclude that bolus nephrotomography is the procedure of choice in the investigation of severe renal failure.