[Arthropathies of the limbs in dialyzed renal failure patients]. / Arthropathies des membres chez les insuffisants rénaux dialysés.

During the last few years, articular symptoms have been reported in chronic renal failure patients on maintenance haemodialysis. A prospective study of arthropathies of the limbs was conducted in 73 such patients: 20 had experienced periarthritis, 32 had tendinous calcifications (3 or more in 16 cases), 29 had destructive arthropathies (especially of the hands) and 10 had calcium pyrophosphate dihydrate deposition. The periarthritis attacks were associated with the presence of tendinous calcifications. The destructive arthropathies could be due to calcium apatite microcrystal deposition, but the study provided no direct evidence of this mechanism. However, the pattern of erosive lesions, their location and their possible association with tendinous calcifications in the same joint were suggestive of calcium apatite deposition. Calcium pyrophosphate deposition, which affected the oldest patients, did not seem to be due to chronic renal failure treated with dialysis. The most important arthropathies were found in patients who had been haemodialysed for a long time, although the correlation was not statistically significant. The dialysis pattern did not seem to influence the articular disorders. There were more cases of calcification and periarthritis among patients whose phosphocalcium product (in mg) exceeded 6000, but the difference with other patients was not statistically significant. Periarthritis and arthropathies are truly disabling for these patients.

Primary bone oxalosis: the roles of oxalate deposits and renal osteodystrophy.

Primary oxalosis is a rare congenital disorder. The excessive oxalate biosynthesis induces deposits in many organs, particularly in kidney and bone. The late onset of primary oxalosis is reported in a 50-year-old man. His chronic renal failure was treated by maintenance hemodialysis for 3 years. He then developed a diffuse bone disease with osteosclerosis and roentgenographic features of hyperparathyroidism. A parathyroidectomy was performed, with debatable improvement of bone lesions. Laboratory results and histologic and histomorphometric studies before and after parathyroidectomy suggest a double histopathogenetic mechanism for this bone disease: renal osteodystrophy and massive bone oxalate deposits. Such deposits may induce both a heterogeneous osteosclerosis with dense metaphyseal bands and histologic bone lesions similar to those of hyperparathyroidism. The crystalline deposits induce in the bone tissue a granulomatous macrophagic reaction. These macrophages are unable to phagocytize the crystals and may be involved in active bone resorption. Bone lesions of oxalosis occur in patients with chronic renal failure, and hyperparathyroidism has a worsening role.

[Inappropriate secretion of antidiuretic hormone disclosing acute intermittent porphyria]. / Sécrétion inappropriée d'hormone antidiurétique révélatrice d'une porphyrie aiguë intermittente.

The authors report a case of acute intermittent porphyria in a 31-year old woman, revealed by inappropriate secretion of the antidiuretic hormone, a diagnosis confirmed by radioimmunoassay. Measurements of red cell urosynthetase made the diagnosis of porphyria certain and showed that the disease was familial, although clinically asymptomatic. Antidiuresis is not the only cause of hyponatraemia in acute intermittent porphyria. Similarly, psychic disorders are frequent in SIADH, but they are not necessarily due to acute intermittent porphyria.

[Peritonitis in renal failure patients treated by continuous ambulatory peritoneal dialysis. Treatment by intraperitoneal administration of a group M penicillin]. / Les péritonites des insuffisants rénaux traités par dialyse péritonéale continue ambulatoire. Traitement par administration intrapéritonéale d'une pénicilline du groupe M.

From February 1980 to February 1983, 55 patients with chronic renal failure were put on continuous ambulatory peritoneal dialysis. Eighty-four episodes of peritonitis occurred., i.e one episode every 9.9 months of treatment. Since staphylococci accounted for 58% of the germs identified, intraperitoneal therapy with a penicillin M was instituted while dialysis was continued through chambers. Cure was obtained in 85.7% of all episodes, either with the penicillin M alone (57% of the cases) or after adjustment of the antibiotic therapy to bacteriological results (28.6% of the cases). Dialysis was discontinued in 10 patients (18%) on account of the peritonitis. The duration of hospital stay for peritonitis was 3.6 days per patient per year. These results were compared with those obtained by other groups. The advantages of penicillin M are its ease of administration, its narrow spectrum and high activity against the pathogens most commonly encountered, and its very low toxicity.

[Calcium oxalate microcrystalline arthropathy in primary oxalosis]. / Arthropathie microcristalline à oxalate de calcium au cours d'une oxalose primitive.

This paper dealt with the case of a 53 years old man, affected by a chronic renal failure as the initial symptom of a primary oxalosis and treated by hemodialysis three years ago. Two years after the onset of renal failure, the left knee was painful and swollen but no cartilage or bone joint lesion was observed. Presence of intra synovial calcium oxalate crystals suggests that this arthropathy may be related to the primary oxalosis. However the role of other calcium salts under identification evidenced by synovial electron microscopy (apatite ? pyrophosphate ?) is discussed.

Hepatitis B vaccine: simultaneous passive and active immunization. Indications in pre- and post-exposure.

An alum bivalent hepatitis B vaccine (HB vaccine) containing 5 micrograms/dose of formalin-inactivated and purified HBsAg has been used for active immunization of dialysis patients since the fall of 1975. Elderly patients had a weak and delayed response to three injections of HB vaccine. They were thus at risk of being infected by HBV before the completion of immunization. To prevent these early infections a four-way passive-active immunization trial was undertaken. Patients received three or four injections of HB vaccine in combination with one or two injections of hyper-immune anti-HBs globulin (HBIG). Results show that passive anti-HBs did not impair the immune response to the vaccine. Moreover, immediate administration of HBIG upon entry in the dialysis centre significantly reduced early-acquired chronic HBs antigenaemia as compared to a group of patients receiving the HB vaccine alone. Passive-active immunization can also be used for post-exposure prophylaxis after accidental inoculation of HBsAg blood (needle-stick) or for the prevention of mother-infant transmission of HBV in children born to HBsAg/HBeAg positive mothers.

Vaccine against hepatitis B--18 months prevention in a high risk setting.

The development of a vaccine against hepatitis B prepared with purified and inactivated HBs Ag is described. This vaccine has been applied in patients and staff members of haemodialysis centres. Safety and efficiency of the vaccine are very satisfactory. The response of patients to immunisation was significantly lower compared to the response of the staff members. None of the volunteers who had a primary response to immunisation developed signs of clinical or biological hepatitis.