Renal transplantation in patients with atypical haemolytic uraemic syndrome: a tailor made approach is necessary.

A 33-year-old woman with a history of chronic transplant dysfunction because of repeated bouts of haemolytic uraemic syndrome (HUS) was considered for a second transplant. Extensive genetic investigation of the complement system was executed to rule out known mutations prone to development of HUS. This case illustrates the importance of genetic screening in patients with recurrent HUS.

Effects of atorvastatin and vitamin E on lipoproteins and oxidative stress in dialysis patients: a randomised-controlled trial.

OBJECTIVES: The objective of this study was to examine the effects of treatment with atorvastatin, alpha-tocopherol and the combination of both, on lipoproteins and oxidative stress in dialysis patients. DESIGN AND SETTING: This double-blind randomised placebo-controlled trial was performed at the dialysis department of a non-university hospital. SUBJECTS, INTERVENTION AND MEASUREMENTS: A total of 44 clinically stable, non-diabetic patients on dialysis therapy (23 on haemo- and 21 on peritoneal-dialysis) without manifest cardiovascular disease were included in this study. They were randomised for treatment during a period of 12 weeks with 40 mg atorvastatin + placebo alpha-tocopherol (group 1) once daily, 800 IU alpha-tocopherol + placebo atorvastatin once daily (group 2), 40 mg atorvastatin + 800 IU alpha-tocopherol once daily (group 3), or placebo atorvastatin + placebo alpha-tocopherol once daily (group 4). Assessment of lipid profile and oxidative stress was performed at the start of the study and after 12 weeks of treatment. RESULTS: Treatment with atorvastatin reduced total cholesterol, triglycerides (TG), low-density lipoprotein (LDL) cholesterol, apolipoprotein B (apoB) and levels of oxidised LDL (oxLDL) with 30-43%. It had no influence on LDL oxidisability. Additional supplementation with alpha-tocopherol had no effect on lipid profile and oxLDL levels but decreased in vitro LDL oxidisability. No side-effects were observed. CONCLUSIONS: Treatment with atorvastatin is effective in lowering plasma total cholesterol, TG, LDL, apoB and oxLDL in a population of stable dialysis patients and might therefore be an effective tool in improving the poor cardiovascular outcome in these patients. Supplementation of alpha-tocopherol to atorvastatin had beneficial effects on in vitro LDL oxidisability and might therefore be of additional value. Further research on the clinical effects of treatment with atorvastatin in combination with alpha-tocopherol is necessary.

Adequacy testing in peritoneal dialysis: a five years experience in a single dialysis center.

BACKGROUND: An increasing number of patients is treated with peritoneal dialysis (PD). Adequacy testing in PD has gained wide interest because of its shown relation with morbidity and mortality. METHODS: We describe retrospectively the 5 years follow-up (1993-1998) of adequacy testing of our PD patient population on 1 January 1998. We were used to change the PD regime if Kt/Vurea was < 1.7. RESULTS: On 1 January 1998 there were 57 patients on PD treatment (41 patients on CAPD, 16 on CCPD). The total PD group adequacy values are given on 1 January 1998. During the 5 years follow-up residual renal Kt/Vurea declined, from a mean value of 0.51 to zero. Mean values of total Kt/Vurea remained unchanged (2.01 at the start, 1.83 at 3 years, 1.91 at 5 years) as a consequence of an increase in peritoneal Kt/Vurea. CONCLUSIONS: We were able to maintain a reasonable dialysis adequacy in time by adjusting the total daily PD fluid amount, despite the total loss of residual renal function in 5 years. However, it will be difficult to reach the newest DOQI guidelines, especially in patients with total loss of their residual renal function and in patients with a larger body surface area.

[Generalized side effects with the use of carbamazepine]. / Gegeneraliseerde bijwerkingen bij gebruik van carbamazepine.

Since 1973, 42 cases of generalized adverse reactions to carbamazepine were reported to the Netherlands Centre for Monitoring of Adverse Reactions to Drugs and the Belgian Centre for Drug Monitoring. The organ involvement can be very diverse in an allergic reaction to carbamazepine. Serious and protracted disturbances in pulmonary diffusion capacity may be present even in the absence of changes on the chest X-ray. Analysis of the type IV mechanism involved suggests that caution is warranted with regard to administration of other drugs during the acute phase of the allergic reaction particularly if these drugs have a propensity to cause type IV allergic reactions themselves.

[Outpatient adjustment to insulin in patients with diabetes mellitus]. / Poliklinische instelling op insuline bij patiënten met diabetes mellitus.

Starting insulin treatment of patients with diabetes mellitus commonly takes place during hospital admission. Home blood glucose monitoring and specially trained nurses, however, enable the physician to start insulin treatment on an outpatient basis. Consistent application of this procedure starting 1-10-1986 resulted in a fall of hospital admissions from 98.3% to 13% in this category of patients. Severe hypo- or hyperglycaemic episodes did not occur. Starting insulin treatment as an outpatient is a safe and cost-saving procedure.

Absence of relation between nutritional parameters and renal function in non-seminomatous testicular cancer patients.

Earlier studies revealed that renal function is reduced in non-cancer patients with a malnutritional status. We have studied the effect of nutritional status on renal function in 46 patients with disseminated non-seminomatous testicular cancer treated with combination chemotherapy including cis-diammine dichloroplatinum (cDDP) according to the Einhorn regimen. The renal function was expressed as glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and filtration fraction (FF) measured by radioisotope infusion methods. Nutritional assessment of the patients was performed by means of three nutritional parameters: weight-for-height index (WHI), creatinine height index (CHI), and serum albumin concentration (Salb). The patients were also divided into two groups: group 1, patients with a sufficient nutritional status, defined as patients with only one abnormal nutritional parameter or none at all (n = 30); group 2, patients with an insufficient nutritional status, defined as patients with two or three abnormal nutritional parameters (n = 16). Median values of WHI, CHI and Salb in group 2 patients were significantly lower than the median values in group 1. Before treatment no correlation was found between the individual nutritional parameters and GFR, ERPF and FF respectively. The median GFR, ERPF and FF of both group 1 and group 2 did not differ significantly. Although the renal function of the total group of patients was reduced as a result of cDDP, this reduction was not influenced by the individual parameters and not higher in the group with an initially insufficient nutritional status. In this study no relation was found between nutritional status and renal function of patients with disseminated non-seminomatous testicular cancer.

The protective potential of the combination of verapamil and cimetidine on cisplatin-induced nephrotoxicity in man.

Nine patients (Group A) with histologically proven, nonseminomatous testicular cancer were treated with cisplatin (CDDP) according to the Einhorn regimen. Renal function studies including the measurement of the effective renal plasma flow (ERPF) and the glomerular filtration rate (GFR) were performed prior to the chemotherapy and then after treatment on days 10 and 21 of the first course. In order to prevent CDDP-induced nephrotoxicity, verapamil (a calcium entry blocker) and cimetidine were given along with CDDP. The results were compared with others from another group of nine patients (Group B) treated with CDDP, but without verapamil and cimetidine. In Group A there was much less of a decrease in ERPF as compared to Group B on day 21. In addition, the decrease in GFR on days 10 and 21 was totally prevented in the verapamil- and cimetidine-treated group.

The influence of verapamil on renal function in patients treated with cisplatin.

Nine patients with testicular cancer were treated with four platinum containing chemotherapy courses. In order to prevent cisplatin (CDDP)-induced nephrotoxicity, verapamil, a calcium entry blocker, was added to the chemotherapeutic regimen. Renal function studies, consisting of the measurement of the effective renal plasma flow (ERPF) and the glomerular filtration rate (GFR), were performed before, during and after the first dose of CDDP, at the end of the first course and at the end of the fourth course of chemotherapy. The results were compared with the results obtained previously in CDDP-treated patients not receiving verapamil. The initial decrease in ERPF during and after the first CDDP infusion was completely prevented by verapamil. Despite continuation of verapamil throughout all four courses, it failed to reduce the ultimate fall in GFR.

TNO-6-induced acute renal failure. A case report.

A case of fatal acute renal failure during treatment with 1,1-diaminomethyl cyclohexane sulphato platinum II (TNO-6) is reported. Pathologic investigation showed focal tubular necrosis with interstitial infiltration and edema. Despite the development of proteinuria no changes of the glomeruli were found, either by light or electron microscopic investigation. The pathologic changes caused by TNO-6 are similar to those found in renal failure caused by cisplatin (CDDP).

Nephrotoxicity of 1,1-diaminomethylcyclohexane sulphato platinum II (spiroplatin; TNO-6).

1,1-Diaminomethylcyclohexane sulphato platinum II (spiroplatin; TNO-6) is a new platinum-containing analog used as an antitumor agent. Renal function studies were performed in eight patients treated with this drug (30 mg/m2). During and after the first spiroplatin infusion there was a decrease in effective renal plasma flow (ERPF:P less than 0.05) and an increase in filtration fraction (P less than 0.01) without changes in glomerular filtration rate (GFR), suggesting changes in renal hemodynamics. During the same period there was an increase in relative N-acetyl-beta-D-glucosaminidase excretion (P less than 0.01), pointing to tubular cell damage. Also, an increase in relative beta 2-microglobulin excretion was established during and after spiroplatin infusion. On day 21 a decrease in GFR was found (median 7.4%), together with a decrease in ERPF (median 11.8%).

Influence of captopril on cis-diamminedichloroplatinum-induced renal toxicity.

Renal function studies were performed in 18 patients with nonseminomatous testicular cancer during four platinum-containing chemotherapy courses. The first 9 patients received chemotherapy alone, the second 9 also captopril, an angiotensin I converting enzyme inhibitor, in order to prevent cis-diamminedichloroplatinum-induced nephrotoxicity. In the first group a decrease in glomerular filtration rate, that was preceded by a fall in effective renal plasma flow, was observed. In the second group, captopril was able to prevent the initial decrease in effective renal plasma flow, but failed to prevent the ultimate decrease in glomerular filtration rate.

The effect of captopril on renal function in patients during the first cis-diamminedichloroplatinum II infusion.

On the assumption that hemodynamic changes in renal blood flow are the initial expression of cis-diamminedichloroplatinum (CDDP)-related nephrotoxicity, we treated patients with metastatic non-seminomatous testicular carcinoma during CDDP infusion with captopril. This angiotensin-converting enzyme inhibitor significantly attenuated the initial decrease in effective renal plasma flow and can probably be used to protect the kidneys against CDDP-induced nephrotoxicity.

Acute effects of cis-diamminedichloroplatinum (CDDP) on renal function.

Ten previously untreated patients with metastatic non-seminomatous testicular carcinoma received cis-diamminedichloroplatinum (CDDP). Renal function studies were performed before and following the first CDDP infusion. A decrease in effective renal plasma flow (ERPF) and an increase in filtration fraction (FF) was found in all patients. These findings suggest primary changes in renal hemodynamics during CDDP infusion.