Kinetics of cisplatin in an anuric patient undergoing hemofiltration dialysis.

After in vitro tests, a tracer dose of cisplatin was administered to an anuric cancer patient. Plasma total platinum levels were monitored as a function of time, as was filterable platinum elimination by hemofiltration dialysis. Based on the derived pharmacokinetic parameters, the patient was later given 50-mg doses of cisplatin, once as a single agent, then four times in combination with doxorubicin, VM-26, and cyclophosphamide. Plasma levels could be fitted by a sum of three exponentials after the infusion was stopped. The mean corresponding half-lives are 30 minutes, 6 hours, and 5 days. Depending on the rate of infusion, plasma peaks ranged between 1.1 micrograms/ml (5.7 X 10(-6) M) and 2.27 micrograms/ml (1.16 X 10(-5) M). During the hemofiltration process immediately following the infusion, the elimination rate was first-order, with a mean half-life of 60 minutes. The mean amount eliminated during the first hemofiltration session was 8% of the dose, decreasing to about 3% on Days 2 and 3. A partial tumor response was observed after two treatment courses, evidenced by the relief of abdominal pain and bowel obstruction episodes and a 50% decrease in peritoneal metastases.

Dense deposit disease with rapidly progressive renal failure in a narcotic addict.

A girl aged 17 developed a nephrotic syndrome with renal insufficiency after narcotic abuse. Renal biopsy showed a diffuse glomerulonephritis with crescents and dense deposits within the glomerular basement membrane; glomerular C3 deposits were present without immunoglobulin. The serum complement profile was typical of activation via the alternative pathway, and tests for C3 nephritic factor were strongly positive. Terminal renal failure occurred within 6 months and required chronic hemodialysis. It is likely that the narcotics used or their contaminants were responsible for the renal damage, presumably by activating the complement system via the alternative pathway.

Antiglomerular basement membrane nephritis after solvent exposure.

A rapidly progressive glomerulonephritis with definitive anuria was observed after solvent inhalation in two young women, aged 22 and 17 years. In both cases the renal biopsy specimen showed diffuse epithelial crescents in all glomeruli, with linear deposits of IgG along the glomerular basement membrane (GBM). High circulating anti-GBM antibody levels were found in sera by indirect immunofluorescence and radioimmunoassay. No anti-alveolar basement membrane antibodies were detectable by immunofluorescent microscopy in one patient. It is suggested that the solvent inhalation resulted in a chemical alteration of the alveolar basement membrane giving rise to anti-basement membrane antibodies, some of which may have cross-reacted with the GBM and initiated the glomerulonephritis.

[Use of the DIAPHANE information system for the monitoring of patients treated by home hemodialysis]. / Utilisation du système informatique DIAPHANE pour la surveillance des patients traités par hémodialyse à domicile.

Data of the DIAPHANE Dialyse-Informatique system of the Society of Nephrology have been collected by patients just on a home dialysis program after training in the hemodialysis Unit of the Hospital of Montreuil. 35 patients have been using the computerized records since January 1978. A critical analysis of the first year has been made and results obtained have been compared with those obtained during the same period in patients dialysed in the Hospital. Results show that home dialysis patients are well able to fill in the computerized medical record concerning the dialysis session follow-up, and that the quality of the recorded information is similar to that recorded in hospital by nurses. Nevertheless few simplifications of home dialysis data sheet are considered. Computerized treatment of data collected on home dialysis program should allow useful comparisons required to improve the quality of care and expansion of this dialysis method.

Thermography: an alternative to angiography for vascular access survey in haemodialysis.

Results obtained by thermography and angiography in surveying vascular access have been compared in 33 haemodialysis patients, including 23 with Cimino arteriovenous fistulae and 10 with homografts and heterografts. In 23 of 30 patients, blood flow stealing through collateral veins, or venous stenosis was detected by thermography and confirmed by angiography. Thermography seems a quick and simple method in routine conditions, restricting angiography to selected patients for whom a surgical revision of the fistula or of the graft is needed.

Prevention of hepatitis B in hemodialysis patients using hepatitis B immunoglobulin. A controlled study.

In a controlled study, the protection effect of hepatitis B immune globulin (HBIG) was evaluated in patients hemodialyzed for less than one month in two collaborating units. Fifteen randomly selected patients received HBIG at five to eight week intervals throughout the study, and 13 other control patients received no immunoglobulin. During a follow-up period of 14 to 30 months, none of the HBIG-treated and 12 of the control patients developed evidence of exposure to virus B hepatitis, including 10 with HBs Ag antigenemia (p is less than 0.001): five of these remained persistently antigen positive. Evidence of non-B hepatitis was found in 8 HBIG-treated and in 3 non-treated patients. Only two HBIG-treated patients developed active antibodies against hepatitis B surface antigen. Thus, HBIG seems effective in preventing hepatitis B in hemodialysis patients, provided the interval between two injections is not greater than two months. However, prolonged administration of HBIG may impair passive-active immunization to hepatitis B virus.