Subject(s)
Health Care Costs , Kidney Failure, Chronic/therapy , Treatment Refusal , Adolescent , Adult , Emergency Medical Services/economics , Emergency Medical Services/statistics & numerical data , Female , Humans , Kidney Failure, Chronic/economics , Patient Selection , Renal Dialysis , Resource AllocationABSTRACT
Between July 1987 and January 1988, five patients dialyzed at a hemodialysis outpatient clinic developed systemic Mycobacterium chelonae abscessus (MCA) infections. Four of the five patients had arteriovenous graft infections, and two died during antimicrobial therapy. Case-patients were more likely than control-patients to have received high-flux dialysis during the 6 mo before their infection (100% vs. 30%, P = .009). MCA was cultured from the hose connected to a water spray device used for manual reprocessing of high-flux but not regular dialyzers. Renalin was the germicide used to manually disinfect dialyzers for reuse and was prepared at a concentration of 2.5%. Laboratory studies documented survival of MCA from two high-flux dialyzers that were reprocessed in a manner similar to that used in the clinic. Early diagnosis with complete rather than partial graft removal in combination with antimicrobial therapy is recommended for MCA graft infections. In addition, 2.5% Renalin did not appear to ensure complete killing of MCA in high-flux dialyzers that were manually reprocessed at this hemodialysis clinic.
Subject(s)
Acetic Acid , Hydrogen Peroxide , Mycobacterium Infections/etiology , Peracetic Acid , Renal Dialysis/adverse effects , Adult , Aged , Analysis of Variance , California , Case-Control Studies , Cohort Studies , Disinfectants , Drug Combinations , Equipment Contamination , Female , Humans , Male , Mycobacterium/isolation & purification , Mycobacterium Infections/epidemiology , Random Allocation , Renal Dialysis/instrumentation , Water Microbiology , Water SupplySubject(s)
Indomethacin/therapeutic use , Pericardial Effusion , Pericarditis/therapy , Humans , Renal DialysisSubject(s)
Pericarditis/therapy , Uremia/complications , Catheterization , Drainage , Humans , Pericarditis/etiologyABSTRACT
The course and outcome of 104 patients with acute renal failure were studied. Nephrotoxic drugs emerged as the second commonest cause of this disease. Overall mortality was 57 per cent; surgery, age, and sex had no significant effect on it. The mortality in the group caused by nephrotoxic drugs (36 per cent) was significantly lower than that in the groups caused by hypovolemic shock (64 per cent), cardiogenic shock (77 per cent) or arrhythmia (80 per cent). Oliguria was not observed in 25 per cent of patients; in this group mortality was lower (38 per cent) than in the oliguric group (62 per cent). The development of congestive heart failure and ascites adversely affected the outcome. Furosemide administration resulted in a sustained diuresis in 22 per cent, and transient diuresis in 14 per cent of patients. Except for a significant reduction in the need for dialysis, furosemide had no other salutary effect.
Subject(s)
Acute Kidney Injury/drug therapy , Furosemide/therapeutic use , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Peritoneal Dialysis , Prognosis , Renal Dialysis , Retrospective Studies , TexasABSTRACT
Symptomatic pericarditis occurs in the course of maintenance hemodialysis and often requires pericardiectomy in addition to other conventional measures. Three of 11 such patients were treated with frequent dialysis and general supportive treatment. Two of these required pericardiocentesis. The other eight received indomethacin; this was followed by prompt defervescence and abatement of pain within 6 to 24 hours. Only one patient required pericardiocentesis. On every occasion when treatment was discontinued during the first week, symptoms recurred. After three weeks to four months, the drug dosage could be tapered and discontinued. The pericardial aspirate was hemorrhagic in all three patients who required pericardiocentesis. Indomethacin appears to be effective in the treatment of the pericarditis associated with dialysis and precludes the need for invasive procedures.
Subject(s)
Indomethacin/therapeutic use , Kidney Failure, Chronic/complications , Pericarditis/drug therapy , Renal Dialysis , Adolescent , Adult , Blood Urea Nitrogen , Creatinine/blood , Drainage , Female , Glomerulonephritis/complications , Hematocrit , Humans , Indomethacin/administration & dosage , Kidney/abnormalities , Kidney Diseases, Cystic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Nephritis/complications , Pericarditis/diagnosis , Pericarditis/etiology , Pericarditis/surgery , Pyelonephritis/complications , Renal Dialysis/adverse effectsABSTRACT
A 28-year old patient with malignant hypertension developed endstage renal failure necessitating chronic maintenance hemodialysis for seven months and transplantation of a renal allograft that was rejected within a month. After this, with continued control of the hypertension, the patient's own kidneys gradually resumed function and achieved anendogenous creatinine clearance of 30 ml/min. She has not required further dialysis for more than nine months. Recovery of sufficient renal function to maintain homeostasis, one year after onset of uremia, indicates the prolonged antihypertensive treatment period that may be necessary to reverse the renal arteriolar changes associated with malignant hypertension. This experience further underlines the necessity of moderation in the use of nephrectomy in the management of severe hypertension.
