Systemic streptokinase infusion for declotting of hemodialysis arteriovenous fistulas.

In 17 out of 29 hospitalized patients (58.6%) with internal arteriovenous fistula (AVF) thrombosis a systemic streptokinase infusion was used as an alternative to urgent surgical declotting. In the remaining 12 patients (41.4%) fibrinolytic treatment was contraindicated due to the necessity for immediate dialysis, uncontrolled hypertension, active peptic ulcer, known multilevel stenoses of the fistula, or operation 8 days prior to the thrombosis. The systemic streptokinase therapy alone was successful in 9 of 17 patients treated (52.9%), 5 of 17 patients (29.4%) needed the combined therapy (streptokinase plus surgery) and in 3 of 17 patients (17.6%) the fibrinolytic therapy was unsuccessful. No serious complications attributable to the streptokinase infusion were observed. Systemic streptokinase treatment for acute AVF declotting followed by the radiological evaluation of the vessels can be a reasonable alternative to 'blind' surgical emergency reconstruction. The method makes it possible to identify those underlying anatomic abnormalities of the draining vein which may be localized at some distance from the anastomosis and so overlooked during surgery.

[Renal biopsy in the aged]. / Biopsja nerki u osób w wieku podeszlym.

Pathological findings in urinalysis in the aged persons are usually thought to be caused by pathologic processes other than glomerulopathy. Histological evaluation of renal tissue in older patients is extremely difficult due to coexistence of involuntary changes-hyalinosis, increase in mesangial matrix content, and vascular changes. The aim of the study was to evaluate frequency of glomerulonephritis, both primary and secondary in persons older than 60. In this group, as compared to the younger people the secondary glomerulonephritis was more frequent, amyloidosis and vasculitis nodosa being the most frequent. In primary glomerulonephritis mesangiocapillary type dominate, quite often some tendency to hyalinization could be observed. Renal biopsy is useful as a diagnostic tool in both the aged and young. It should be performed regardless the patients age.

[Reversible renal failure in female patients with acute interstitial nephritis caused by cloxacillin]. / Odwracalna niewydolnosc nerek u chorej z ostrym sródmiazszowym ich zapaleniem wywolanym kloksacylina.

Cloxacillin was not listed as one of the drugs causing the acute interstitial nephritis, yet. A case of a 50-year female patient treated with cloxacillin is presented. Therapy was followed by nausea, vomiting, myalgia and arthralgia, and the symptoms of the acute renal failure which completely diminished after prednisone therapy despite of co-existing peptic ulcer. Low doses of corticosteroids seem helpful in the treatment of the acute interstitial nephritis following therapy with cloxacillin even after a long time of the onset.

[Many-year observations of 4 cases of Wegener's granulomatosis]. / Wieloletnia obserwacja 4 przypadków ziarniniakowatosci Wegenera.

Four cases of Wegener's granulomatosis were presented. Pathologic lesions and symptoms were observed in numerous organs but in all patients upper airways, lungs and kidneys were involved. Patients were observed from 3 to 12 years and two patients are still alive after more than 10.5 years.

[Wegener's granulomatosis--evaluation of diagnostic problems and the progress in its treatment based on the review of 54 cases published in Poland in 1959-1990]. / Ziarniniakowatosc Wegenera--problem diagnostyczny i postep w leczeniu na podstawie przegladu 54 przypadków opublikowanych w latach 1959-1990 w Polsce.

54 cases of Wegener's granulomatosis published in Polish literature in 1959-1990 are presented. There were 37 women and 17 men from 17 to 70 years of age. The diagnosis was histologically proved during life in 30 cases and by autopsy in 14 others. In 10 patients it was based on clinical symptoms only. Diagnosis was established after 1 months to 4 years of symptoms, mean equals 10.3 months. The delay of diagnosis was caused by the ineffectiveness of biopsy, usually from the upper airways and also by the wrong interpretation of histopathological pictures. All patients had upper airways disease, 56% of patients had lung involvement, 66% renal lesions, 37%--eye changes, 35% skin lesions and 11%--nervous system involvement. In addition in 83% of patients systemic symptoms were observed. The prognosis of WG ameliorate with the time of publications due to cyclophosphamide and other cytotoxic drugs introduction to WG treatment.

Intradialytic erythrocyte volume changes.

Haemodialysis (HD) should affect the erythrocytes, which constitute more than 99% of blood cells. The aim of this study was to reinvestigate the intradialytic changes in erythrocyte water content (MCV). MCV was measured during 81 HD (47 uncomplicated, 34 with hypotension), and 16 isolated ultrafiltrations (UF) performed in stable, haemodialysed adults (12 males and 8 females). The MCV following uncomplicated HD (n = 32) did not differ from the predialysis value. Significant MCV increase accompanied the HD initiation (4.9 +/- 9.0 fl, P less than 0.001), UF (2.99 +/- 1.49 fl, P less than 0.001) and hypotension (1.8 +/- 3.1 fl, P less than 0.01). This was independent of sodium and potassium within the cells and plasma. Erythrocyte oedema occurred in situations known to accompany both bioincompatibility reactions and blood volume decrease. Intradialytic MCV increase may reflect a response to these events, possibly hormonal, and needs further investigation.

[Diagnostic value of the lupus band test in patients treated by chronic hemodialysis]. / Wartosc diagnostyczna lupus band test u chorych przewlekle dializowanych.

The diagnosis of systemic lupus erythematosus in cases with advanced renal failure is a serious clinical problem. The purpose of the study was an analysis of the incidence of various non-renal criteria (according to ARA) for the diagnosis of SLE in patients with chronic renal failure of various aetiology and find out whether the lupus band test in these patients may serve as an additional criterion for the diagnosis of SLE. The studied group comprised 39 patients with chronic renal failure (28 men and 13 women) aged 17-58 years. In this group 29 cases were treated with dialyses and 10 conservatively. The most frequent clinical sign (apart from renal changes) accepted as diagnostic criteria for the SLE was polyserositis and leucopenia and thrombocytopenia. In no case antinuclear antibodies, antibodies against DNA and against soluble nuclear antigens were found. Positive LBT was obtained in 72.4% of cases with chronic renal failure, particularly frequently in the dialysed patients. A positive result of the LBT cannot be of decisive importance in the diagnosis of SLE but may suggest a need of more detailed investigations (determination of Ro antibodies) for confirmation of the diagnosis.

[Mannitol for the prevention of decompensation symptoms in hydrated patients undergoing long-term hemodialysis]. / Mannitol w zapobieganiu objawom zespolu niewyrównania u chorych przewodnionych, dlugotrwale dializowanych.

Symptoms of decompensation syndrome were frequently noted during sequential ultrafiltration/hemodialysis. In 9 adult patients chronically dialysed 101 cases of overhydration were seen. Mannitol was administered in a 20% solution (250 ml) in a continuous intravenous infusion during 49 dialyses. Changes in body weight were measured, arterial blood pressure, pulse rate, hematocrit, total plasma protein levels, urea, creatinine, sodium and potassium were determined as well as plasma osmolality. Mannitol significantly decreased muscular contractions during dialysis, weakness after dialysis, and incidence of various symptoms of decompensation. The values of analysed clinical parameters and laboratory tests did not differ from those determined without mannitol. Plasma creatinine, total plasma protein levels and hematocrit were significantly lower after several hours after the end of ultrafiltration/hemodialysis. We suggest that mannitol decreases the incidence of the symptoms of decompensation syndrome and is safe. Beneficial effect of mannitol is most probably produced by the changes in body fluids distribution.