Comparison of prevention methods of intradialytic hypotension.

Our study evaluates the effectiveness of the different methods of prevention of intradialytic hypotension (IDH). We studied 16 hemodialysis patients who developed IDH at Ibn Rochd University Hospital. Each patient underwent three standard sessions with cellulose diacetate dialysers and bicarbonate dialysate with calcium concentration of 1.75 mmol/L and sodium (Na) concentration of 140 mmol/L, with dialysate temperature (T) of 37 degrees C. Then the patients were subjected to five successive sessions, each time using one of the following protocols: fixed Na dialysate concentration at 144 mmol/L, Na ramping from 152 to 138 mmol/L, one hour of ultrafiltration (UF) alone followed by three hours of standard dialysis session, dialysis with standard dialysate at T o C, or a combination of Na ramping and cold dialysate. Twelve (78%) patients underwent two sessions of HD per week of five hours each. The mean systolic blood pressure (SAP) in the interdialytic period was 110.7 (100.1-125.5) mmHg; two patients underwent anti-hypertensive treatment. The combination of ramping Na and cold dialysate as well as the cold dialysate were associated with fewer episodes of hypotension in comparison with the standard dialysate. We conclude that the combination modulation of Na and cold dialysate as well as the cold dialysate are the most effective techniques to decrease the number of IDH episodes and the average number of interventions.

Goodpasture's syndrome - four case reports.

Goodpasture's syndrome (GPS) is a rare but severe immunological disease, which is characterised by rapidly progressive glomerulonephritis and intraalveolar hemorrhage (IAH) with the presence of anti-glomerular basement membrane (GBM) antibodies. We report four cases of GP's syndrome referred to the nephrology unit at Ibn Rochd UHC in Casablanca from January 1995 to December 2003. All patients had rapidly progressive glomerulonephritis (RPGN) with proteinuria and microscopic hematuria. Elevated blood pressure was noted in one case. IAH was manifested as hemoptysis in two cases, radiological signs in three cases and confirmed by broncho-alveolar lavage in all cases. Laboratory assessment revealed anemia in all cases. Renal biopsy showed extracapillary glomerulonephritis with linear deposits of IgG along the GBM. Renal failure was severe and hemodialysis was required in all cases. All patients were treated with prednisone and cyclophosphamide and none recovered renal function. Two patients died due to severe lung hemorrhage.