Inhibition of immunoglobulin production by parathyroid hormone. Implications in chronic renal failure.

Available data indicate that B cell proliferation is inhibited in chronic renal failure and this is due to excess blood levels of PTH. This defect may also affect immunoglobulin production. We examined production of IgG, IgM and IgA by B cells stimulated with Staphylococcus aureus Cowan I (SAC) or with pokeweed mitogen (PWM) after eight days of culture and evaluated the effect of PTH on this process in 34 hemodialysis patients and 44 normal subjects. IgG, IgM and IgA production by B cells from patients was lower (P less than 0.01) than by B cells from normal subjects. Both 1-34 and 1-84 PTH inhibited (P less than 0.01) immunoglobulin production by B cells from normal subjects and dialysis patients. However, this inhibitory effect was evident in dialysis patients only with the higher dose of PTH. The inhibition of immunoglobulin production by PTH occurred only when the hormone was added at the initiation of the B cell culture. Inactivation of PTH abolished its inhibitory effect on immunoglobulin production. Agents that stimulate cAMP production (forskolin, cholera toxin) and the cAMP analogue, 8-bromoadenosine 3',5' cyclic monophosphate inhibited immunoglobulin production by B cells from both normal and dialysis patients, and the degree of inhibition was not different between the two groups. The calcium inophore A23187 also inhibited IgG, IgA and IgM production by B cells from normal subjects and dialysis patients; there was no significant difference in the degree of inhibition between the two groups. The resting levels of cytosolic calcium in B cells of dialysis patients was significantly (P less than 0.01) higher than that of B cells from normal subjects. The data show that: (1) immunoglobulin production is impaired in dialysis patients; (2) B cells of dialysis patients have elevated resting levels of cytosolic calcium; (3) PTH inhibits IgG, IgA and IgM production and this effect is at least partly mediated by PTH-induced cAMP production and alterations in cytosolic calcium into B cells; (4) this inhibitory effect is mediated by events that affect initial stages of B cell proliferation and maturation; (5) the requirement for high dose of PTH for its inhibitory effect on B cells from dialysis patients is probably due to desensitization and/or down-regulation of PTH receptors on B cells. The results are consistent with the proposition that impaired immunoglobulin production by B cells from dialysis patients is at least partly due to the state of secondary hyperparathyroidism in these patients.

Parathyroid hormone inhibits B cell proliferation: implications in chronic renal failure.

B cell proliferation is impaired in patients with chronic renal failure, but the mechanisms underlying this defect are not known. Lymphocytes have receptors for parathyroid hormone, and it is possible that the state of secondary hyperparathyroidism of renal failure is responsible for the B cell defect. Our studies were designed to (a) examine T cell-independent B cell proliferation [3H)thymidine incorporation) induced by Staphylococcus aureus Cowan 1 after 5 days of culture, (b) evaluate the effect of parathyroid hormone on S. aureus Cowan I-induced B cell proliferation, and (c) investigate the mechanisms through which parathyroid hormone may exert its effect on B cell proliferation. Lymphocytes were obtained from 37 normal subjects and 21 dialysis patients. S. aureus Cowan I induced significant stimulation (P less than 0.01) of the proliferation of B cells from both groups, but the effect was smaller on B cells from dialysis patients (10.0 x 10(3) +/- 1.4 x 10(3) cpm) than on those from normal subjects (21.8 x 10(3) +/- 2.0 x 10(3) cpm). Both the intact molecule of parathyroid hormone (1-84 PTH) and its amino-terminal fragment (1-34 PTH) caused significant inhibition of proliferation of B cells from normal subjects in a dose-dependent manner, with the effect being significantly greater (P less than 0.01) with an equimolar concentration of 1-84 PTH than that of 1-34 PTH. Inactivation of 1-84 PTH by oxidation abolished most of its inhibitory effect on B cell proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of parathyroid hormone on human T cell activation.

Lymphocytes have receptors for PTH and patients with chronic renal failure have high blood levels of PTH and impaired lymphocyte function. It is possible, therefore, that PTH affects lymphocyte function. We studied the interaction between PTH and proliferation of human lymphocytes in vitro and examined potential mechanisms for such an interaction. 1-84 PTH stimulated in a dose dependent manner PHA-induced proliferation of T cells but had no effect on PWM-induced proliferation. The hormone did not alter CD4/CD8 ratio. Inactivation of PTH abolished its stimulatory effect. PTH augmented IL-2 production by PHA-activated T cells but did not increase expression of IL-2R. 1-34 PTH also stimulated PHA-induced T cell proliferation. TPA augmented PHA-induced T cell proliferation but the addition of PTH to the culture stimulated by PHA and TPA did not augment further the proliferation of T cells. Staurosporin reversed the stimulation by PTH of the PHA-induced lymphocyte proliferation. Both 1-34 and 1-84 PTH stimulated cyclic AMP production by lymphocytes. Forskolin did not affect PHA-induced T cell proliferation although it stimulated cyclic AMP generation. The results show that: 1) PTH acts on T cells; 2) acute exposure to PTH augments PHA-induced T cell proliferation and IL-2 production; 3) this action of PTH is related to its biological activity and is most likely due to the ability of PTH to enhance entry of calcium into cells and/or stimulation of protein kinase C but is independent of cyclic AMP generation.

Evidence of impaired T cell function in hemodialysis patients: potential role for secondary hyperparathyroidism.

Previous studies in our laboratory showed that the T cell is a target for parathyroid hormone (PTH) action. It is theoretically possible, therefore, that chronic exposure of the T cells to high blood levels of PTH in patients with chronic renal failure may adversely affect T cell function. We examined in both normal subjects and dialysis patients several aspects of T cell function, including (1) T cell proliferation in response to phytohemagglutinin (PHA) mitogen with and without PTH and with and without exogenous interleukin 2 (IL-2); (2) the IL-2 production induced by PHA with and without PTH, and (3) resting levels of cytosolic calcium--[Ca2+]i--and the increment in [Ca2+]i in response to anti-CD3 antibody. Although PHA significantly (p less than 0.01) stimulated proliferation of T cells from both normal subjects and dialysis patients, the magnitude of the stimulation was significantly (p less than 0.01) smaller in the latter group. In both normal subjects and dialysis patients, exogenous IL-2 alone stimulated T cell proliferation, and the magnitude of the stimulation was similar to that produced by PHA. Also, IL-2 augmented PHA-induced proliferation of T cells from normal subjects, but failed to do so in T cells from dialysis patients. PHA did not augment IL-2 production by T cells from dialysis patients, and PTH did not correct this defect. The resting levels of [Ca2+]i in T cells from dialysis patients were significantly (p less than 0.01) higher, and the increments in [Ca2+]i in response to anti-CD3 antibody were significantly (p less than 0.01) lower than in T cells from normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of selective oxidation of 1-34 bovine parathyroid hormone on its renal actions in the rabbit.

Oxidation of both of the methionine residues (positions 8 and 18) in parathyroid hormone (PTH) eliminates many of its biological effects. The present studies were performed to examine the actions of 1,34 bovine PTH and 1-34 bovine PTH oxidized selectively at Met 8, at Met 18, and at both sites on renal electrolyte handling and on adenylate cyclase (AC) stimulation. In clearance studies in anesthetized rabbits, PTH caused a phosphaturia and an anticalciuria. PTH also stimulated renal proximal tubular AC in vitro and increased renal cortical cAMP content in vivo. PTH oxidized at Met 18 was anticalciuric, but not phosphaturic, stimulated renal AC and increased cortical cAMP content. PTH oxidized at Met 8 also produced an anticalciuria without a phosphaturia, but only weakly stimulated AC and did not alter cortical cAMP content. PTH oxidized at both Met 8 and Met 18 was phosphaturic but not anticalciuric, was a weak agonist for AC and decreased cortical cAMP content. In the isolated perfused rabbit proximal straight tubule, PTH inhibited fluid and phosphate transport, whereas the doubly oxidized peptide was inactive. The data are consistent with the possibility that the effects of PTH on renal tubular phosphorus transport are mediated by more than one mechanism and are, in part, independent of the cAMP messenger system.

Rapid separation and quantitation of major phospholipids in biological samples by combined high-performance liquid chromatography and automated phosphorus analyzer.

Phospholipids extracted from tissue samples were separated by an isocratic high-performance-liquid-chromatographic (HPLC) method and simultaneously quantitated by an automated phosphorus analyzer. Results from various tissues were compared with previously published data obtained by thin-layer chromatography (TLC). Liver, heart, skeletal muscle, kidney and brain cortex synaptosomes from rats were examined. Optimal separation of major phospholipids of these tissues was achieved in a single HPLC run using a mobile phase of acetonitrile, methanol and sulfuric acid 100:2.1:0.05 (v:v:v). Recoveries of pure phospholipids injected onto the column averaged 75-80%. Similar recoveries were obtained with heart and skeletal muscle phospholipids, whereas liver, kidney and synaptosomes yielded lower recoveries (50-66%), suggesting the presence of other phospholipids in these tissues which did not elute from the column. The composition of total and individual phospholipids varied among the tissues and was generally similar to previously reported findings with TLC. The intraassay coefficients of variation ranged from 5 to 11%. We conclude that this technique is a reliable, rapid, and reproducible method for separation and quantitation of the major phospholipid species of tissues and subcellular fractions.

Hyperparathyroidism and 1,25-dihydroxyvitamin D deficiency in mild, moderate, and severe renal failure.

It has been postulated that hyperparathyroidism in chronic renal failure results from hypocalcemia, occurring, in part, from phosphate retention and/or deficient 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] synthesis. However, many studies have failed to demonstrate hyperphosphatemia or low 1,25-(OH)2D levels in patients with mild renal failure. We measured creatinine clearance (CCr), fractional excretion of phosphorus (FEP), and serum phosphorus, ionized calcium, and plasma N-terminal PTH, and 1,25-(OH)2D concentrations in 21 normal subjects and 51 patients with renal failure. Patients with mild renal failure (Ccr, greater than 40 mL/min.1.73 m2) had normal mean serum phosphorus and ionized calcium and decreased mean 1,25-(OH)2D levels compared with those in normal subjects. In patients with moderate renal failure (CCr, 20-40), the mean ionized calcium level was normal, plasma PTH levels and FEP were elevated, and the decrement in 1,25-(OH)2D was more pronounced. The mean ionized calcium level was decreased only in the group of patients with severe renal failure (CCr, less than 20). The 1,25-(OH)2D values correlated positively with CCr and negatively with the log of plasma PTH and serum phosphorus concentrations. Log of plasma PTH correlated negatively with CCr and positively with FEP. The ionized calcium concentration correlated very weakly with CCr and the log of the plasma PTH level. These data demonstrate the presence of hyperparathyroidism, normocalcemia, and 1,25-(OH)2D deficiency in renal failure and are consistent with a role for 1,25-(OH)2D in the suppression of parathyroid activity through as yet unidentified mechanisms.

Inhibitory effects of volume expansion performed in vivo on transport in the isolated rabbit proximal tubule perfused in vitro.

To examine the renal tubular sites and mechanisms involved in the effects of hypooncotic volume expansion (VE) on renal electrolyte excretion, we performed clearance and isolated tubular perfusion studies using intact and thyroparathyroidectomized (TPTX) rabbits. We also examined the effect of VE on luminal brush border transport. In the microperfusion studies, proximal convoluted (PCT) and straight (PST) tubules were taken from rabbits without prior VE or after 30 min of 6% (body wt) VE. Acute VE increased the percentage excretion of Na, Ca, and P in TPTX animals and the percentage and absolute excretions of these ions in intact rabbits. In PST from VE animals, fluid flux (Jv) was depressed compared with Jv in PST from nonVE rabbits: Jv = 0.18 +/- 0.03, (VE) vs. 0.31 +/- 0.03 nl/mm.min, (nonVE) P less than 0.02. Phosphate transport (Jp) in the PST from VE animals was also depressed: JP = 1.58 +/- 0.10 (VE) vs. 2.62 +/- 0.47 pmol/mm.min, (nonVE) P less than 0.05. Similar results were obtained with TPTX animals. In the PCT from VE animals, Jv was decreased (0.49 +/- 0.10 (VE) vs. 0.97 +/- 0.14 nl/mm.min, (nonVE) P less than 0.02), but JP was not affected significantly. Transport inhibition was stable over approximately 90 min of perfusion. In the brush border vesicle studies, sodium-dependent phosphate transport was inhibited compared with that in control animals, at the 9-, 30-, and 60-s time points. These findings indicate that the inhibition of renal ionic transport by VE occurs in both PCT and PST and is, in part, the result of a direct effect of VE on tubular transport mechanisms.

The effects of atrial natriuretic peptide on whole-kidney and proximal straight tubular function in the rabbit.

The mechanisms by which atrial natriuretic peptide (ANP) produces a diuresis and natriuresis remain unclear. It has been suggested that the major if not sole mediator of ANP's renal effects is a hemodynamically induced increase in glomerular filtration rate (GFR). Data from clearance studies in anesthetized rabbits demonstrate that ANP administration can produce a significant increase in absolute and percentage sodium excretion (42.0 +/- 5.9----64.6 +/- 10.2 mu eq/min, P less than 0.01, and 1.97 +/- 0.28----3.12 +/- 0.35%, P less than 0.001, respectively) without increasing GFR (16.8 +/- 2.1----16.1 +/- 2.5 cc/min, P greater than 0.30). The natriuresis occurred despite a fall in renal plasma flow (RPF) (56.7 +/- 7.0----44.5 +/- 9.4 cc/min, P less than 0.01), a rise in filtration fraction (0.33 +/- 0.01----0.46 +/- 0.05, P less than 0.01), and an unchanged filtered load of sodium (2.28 +/- 0.27----2.16 +/- 0.32 mu eq/min, P greater than 0.10). Isolated tubular microperfusion studies demonstrated that ANP, present as a 10(-9) M concentration in the solution bathing perfused proximal straight tubules (PST), did not affect fluid flux (Jv) (0.38 +/- 0.07----0.41 +/- 0.07 nl/mm/min, P greater than 0.30) or phosphate reabsorption (Jp) (1.50 +/- 0.5----1.38 +/- 0.36 pmole/mm/min, P greater than 0.50). When ANP was infused into rabbits prior to harvesting the PSTs for isolated tubular microperfusion and the results were compared to tubules taken from control animals, there was again no effect on Jv (0.37 +/- 0.05 vs 0.42 +/- 0.05 nl/mm/min, P greater than 0.50) or Jp (2.41 +/- 0.27 vs 2.42 +/- 0.44 pmole/mm/min, P greater than 0.90). These findings suggest that ANP can inhibit sodium transport without increasing whole-kidney GFR or RPF, but does not directly inhibit transport in the proximal straight tubule.

Acute renal failure due to high-grade obstruction following therapy with epsilon-aminocaproic acid.

An 18-year-old man with mild factor VIII deficiency developed hematuria and, subsequently, acute renal failure due to high-grade urinary obstruction by clots during therapy with cryoprecipitate, epsilon-aminocaproic acid, and acetazolamide administered for ocular trauma. Discontinuation of therapy with the latter two agents and induction of a brisk diuresis with intravenous (IV) fluid therapy resulted in return of renal function concomitant with spontaneous clot passage. A review of previous literature suggests that hemophiliacs may be more susceptible than nonhemophiliacs to high-grade urinary obstruction due to clot formation when epsilon-aminocaproic acid is administered during episodes of hematuria. Acute flank pain, fever, and delayed dense nephrograms on IV pyelogram are characteristic of the syndrome and distinguish it from other forms of acute renal failure associated with epsilon-aminocaproic acid.

Disorders of the serum electrolytes, acid-base balance, and renal function in alcoholism.

This chapter reviews the disturbances of the serum sodium and potassium concentrations, acid-base imbalances, and acute renal dysfunction that are seen frequently in alcoholic patients. The hyponatremia common in decompensated cirrhotics is caused by an impairment of renal free water clearance and concomitant water ingestion. Excessive proximal renal tubular sodium reabsorption and nonosmotic vasopressin release underlie the defect in renal water excretion in cirrhosis. Restriction of water intake is the principal therapeutic measure for hyponatremia. Hypokalemia is common in alcoholics but when observed does not always represent true potassium depletion. Although most cirrhotics have a diminished total body potassium content, intracellular potassium concentration is usually normal. In some patients gastrointestinal and renal potassium losses and nutritional potassium deficiency may cause true potassium depletion. Respiratory and metabolic alkalosis are the acid-base disturbances seen most frequently in alcoholics. Acidosis is relatively uncommon and is usually due to renal insufficiency, lactic acid or keto-acid accumulation. Toxin ingestion (methanol, ethylene glycol, or isopropanol) may also cause severe acidosis. Rhabdomyolysis, common in severe alcoholism, may produce various electrolyte disturbances and acute renal failure. The prognosis for recovery is good although temporary dialysis may be necessary.

Urinary tract infections and renal papillary necrosis in alcoholism.

An enhanced frequency and morbidity of urinary tract infections (UTI) have been observed in association with alcoholism and liver disease. The causes of these phenomena may relate, in part, to the defects in humoral and cellular immune mechanisms that occur in alcoholism. Urinary catheterization is the most common cause of UTI in hospitalized alcoholics. The severity of the sequelae of UTI in alcoholism is demonstrated by the unusually frequent occurrence of renal papillary necrosis (RPN) in conjunction with pyelonephritis in these patients. Indeed, in over 90% of the reported cases of RPN occurring with alcoholism or liver disease, pyelonephritis has been a contributing factor. The proclivity to medullary ischemia and RPN in this patient group may be, at least in part, a result of interstitial renal edema secondary both to infection and the effect of ethanol per se and to renal arterial vasoconstriction that occurs in cirrhosis. The frequency with which death due to sepsis or renal failure occurs in association with UTI in alcoholics obliges the physician to exercise caution in the prevention and treatment of UTI in these patients.

The pathogenesis of renal sodium retention and ascites formation in Laennec's cirrhosis.

This chapter critically reviews our current understanding of the pathogenesis, clinical syndrome, and therapy of the disturbances of renal sodium handling, renal perfusion, and glomerular filtration rate that occur in patients with Laennec's cirrhosis. Avid renal sodium reabsorption, a characteristic feature of cirrhosis, occurs independent of moderate changes in renal function and precedes the onset of ascites. The initiation of sodium retention may be a direct consequence of the hepatic disease process and may also result from defective intravascular filling. In the presence of ascites the most important sodium retaining signal is a defective intravascular volume. The principal effectors of renal sodium retention and vasoconstriction are stimulation of the renin-angiotensin-aldosterone axis and augmentation of renal sympathetic nerve activity. Deficient production of natriuretic hormone(s) and endogenous renal vasodilators, such as prostaglandins and kinins, also contributes to the sodium retention and renal hypoperfusion seen in cirrhosis. The hepatorenal syndrome is an extreme imbalance in these renal vasoconstrictor and vasodilator forces. In the therapy of ascites in Laennec's cirrhosis, abstention from alcohol, sodium restriction, and cautious diuresis are the principal therapeutic measures. A grave prognosis accompanies the diagnosis of the hepatorenal syndrome although recoveries have been reported.

Disorders of divalent ions and vitamin D metabolism in chronic alcoholism.

This chapter reviews the pathogenesis of disordered divalent mineral and bone metabolism in alcoholism, emphasizing the role of impaired vitamin D physiology. Normally, vitamin D metabolites are derived principally from cholecalciferol, which is synthesized in the skin via the energy of sunlight. Most alcoholics have subnormal levels of 25-hydroxyvitamin D [25(OH)D]. Those with Laennec's cirrhosis also have low levels of vitamin D binding protein due to impaired hepatic protein synthesis and as a result, have low serum concentrations of total, but not free, 1,25-dihydroxyvitamin D. The causes of 25(OH)D deficiency in alcoholics include reduced hepatic 25-hydroxylase activity, lack of sun exposure, inadequate dietary intake, and malabsorption. Hypomagnesemia and hypophosphatemia, which are very common in hospitalized alcoholics, result from deficient intake, malabsorption, excessive renal losses, and cellular uptake of both ions. Hypocalcemia in alcoholics is caused primarily by hypoalbuminemia but can result also from deficient intake, malabsorption, hypomagnesemia, and renal calcium wastage. Low vitamin D activity may contribute significantly to the calcium and phosphate deficiencies. Osteoporosis is extremely common in alcoholics whereas osteomalacia is exceptional. However, both bone disorders respond well to vitamin D therapy. Thus, alcoholics should be screened periodically for vitamin D deficiency and osteopenia, and when either is detected they should receive vitamin D supplements.

Prostaglandin E2 and parathyroid hormone: comparisons of their actions on the rabbit proximal tubule.

Recent studies demonstrated that prostaglandin E2 (PGE2) participates in the regulation of glomerular and distal tubular function. A functional role for PGE2 on the proximal tubule has only recently been explored. Thus, we reported that PGE2 antagonizes the phosphaturic effect of PTH in the dog, which suggests that PGE2 may influence the transport functions of the mammalian proximal tubule. The present studies were designed to examine the direct effect of parathyroid hormone (PTH) and PGE2 on the fluxes of fluid (Jv) and phosphate (Jl-b PO4) in the rabbit proximal convoluted and straight tubules (PCT and PST). The activation of adenylate cyclase by the two agents was also examined. Finally, the combined effects of PTH and PGE2 on Jv and Jl-b PO4 were also studied in the PST. In the PCT, PTH (1 microgram/ml) inhibited Jv by 31% (P less than 0.05) but did not alter Jl-b PO4. PGE2 (10(-5) M) failed to act on either Jv or Jl-b PO4. In this segment, PTH stimulated adenylate cyclase but PGE2 did not. In the PST, PTH (1 microgram/ml) inhibited Jv and Jl-b PO4 by 34 and 20%, respectively (P less than 0.01). PGE2 (10(-5) M) also inhibited Jv and Jl-b PO4, by 33 and 12%, respectively (P less than 0.02). In contrast, PGF2 alpha, a related prostanoid, failed to influence these transport parameters. In the PST, PTH activated adenylate cyclase but PGE2 failed to do so. When both PTH (1 microgram/ml) and PGE2 (10(-7) M) were present simultaneously, Jv and Jl-b PO4 were comparable to that seen during control collections.(ABSTRACT TRUNCATED AT 250 WORDS)

Interference by prostaglandin E2 with the phosphaturic effects of nonhormonal agents.

The purpose of the present study was to evaluate the ability of prostaglandin (PG) E2 to alter phosphate excretory patterns induced by the nonhormonally mediated phosphaturic maneuvers, bicarbonate loading (BIC), volume expansion (VE) and acetazolamide administration (Az). Acute clearance studies were performed in chronically thyroparathyroid-ectomized dogs. The dosage of PGE2 utilized was free of excretory or hemodynamic effects. After BIC, percentage of phosphate excretion (%EP) increased from 4.8 to 14.0%, (P less than .05). In contrast, BIC preceded by PGE2 infusion produced no phosphaturia. Additionally, PGE2 blunted the increases in Na and HCO3 excretion associated with BIC. VE (5-6% b.wt.) increased %EP from 6.0 to 14.2%, (P less than .01). However, VE after PGE2 treatment did not result in a phosphaturia. Az increased %EP from 4.7 to 28.5%, (P less than .02). When PGE2 was infused before Az, %EP rose from 1.9 to 7.1%, (P less than .02) in response to Az. However, the increment in %EP over base line was reduced from 23.8 to 3.6% by PGE2 pretreatment (P less than .005). PGE2 did not alter the effects of VE or Az on sodium or bicarbonate excretion. Thus, PGE2 blunts or abolishes the phosphaturic effect of each of these maneuvers independent of its action on sodium or bicarbonate transport. We conclude that PGs have a specific action on phosphate transport events induced by certain nonhormonal factors, revealing a hitherto unappreciated role for these agents in modulating tubular reabsorptive processes.

Diabetic nephropathy: natural course, survivorship and therapy.

Diabetes mellitus is a disease with major social and economic consequences. End-stage renal disease (ESRD) due to diabetes occurs in as many as 30% of patients with juvenile diabetes, providing a large percentage (up to 33%) of all patients in need of therapy for ESRD. We have reviewed the natural course of the nephropathy in type I diabetes mellitus and the results of dialysis and transplantation therapy with particular regard to survival and morbidity. Comparisons of the survival of diabetic patients among peritoneal dialysis, hemodialysis, and transplantation are complicated by the lack of sufficient data for peritoneal dialysis and by the bias introduced by patient/treatment selection methods. Presently, it appears that transplantation with a living related donor graft offers the best survival for both graft and patient, with a definite reduction of morbidity associated with the complications of diabetes. Cadaveric transplantation is approximately the equivalent of hemodialysis in patient survival at 1 year and also appears to offer a somewhat diminished morbidity. Peritoneal dialysis data are sparse and skewed by patient selection. However, there is some emerging evidence that therapy with this modality may be associated with a delay in progression of retinopathy, when compared with hemodialysis.

Hemosiderosis secondary to chronic parenteral iron therapy in maintenance hemodialysis patients.

Autopsy data on 24 chronic maintenance hemodialysis patients who had received varying doses of parenteral iron as the iron-dextran complex were reviewed for evidence of iron overload (hemosiderosis) and tissue fibrosis or organ dysfunction (hemochromatosis). Hemosiderosis was frequent in patients who received high total doses of iron but absent in those who received little or no iron. The degree of tissue iron did not increase with increased iron administration above a total of 2.5 g. Hemochromatosis or organ dysfunction secondary to tissue iron deposition was not noted in any patient. Chronic parenteral iron administration may improve anemia and result in tissue iron deposition but does not lead to hemochromatosis.