RESUMO
The present studies were undertaken to determine whether treatment with recombinant human erythropoietin (epoetin beta [Marogen Sterile Powder, Chugai-Upjohn, Rosemont, IL] ) necessitates an alteration in dialysis prescription or in heparin requirements. All patients had end-stage renal disease (ESRD), were on chronic hemodialysis (either high-flux or conventional) for more than 3 months, and had participated in large-scale, multicenter epoetin beta clinical trials. Nine patients were entered into the clearance study. Blood chemistry values, dialyzer clearances, and hematocrit values were determined before beginning epoetin beta administration and after approximately 40 weeks of treatment. The mean hematocrit value at the beginning of the study was 0.229 (22.9%); by week 40, it averaged 0.313 (31.3%). The mean percent change in urea clearance was -1.9%, and a mean percent change of +12.7% in blood urea nitrogen (BUN) was noted. The mean percent change in creatinine clearance was -15.3, while the mean percent change in serum creatinine was +0.2%. The mean percent change in phosphate clearance was -10.1%, and the mean percent change in serum phosphate was +44.1%. Heparin profiling was performed for nine patients (four participated in the clearance study). Seven patients showed increased requirements for heparin, with a mean percent change of +24.3%. These results underscore the necessity for careful attention to the changing status of the dialysis patient on epoetin beta. While epoetin beta treatment does not, in general, adversely affect either clearance or blood chemistry values, these values may fluctuate in individual patients in response to the increasing hematocrit values and to dietary changes that result from an increased sense of well-being.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Eritropoetina/uso terapêutico , Heparina/administração & dosagem , Diálise Renal , Anemia/etiologia , Anemia/terapia , Creatinina/metabolismo , Feminino , Hematócrito , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Masculino , Fosfatos/metabolismo , Proteínas Recombinantes , Ureia/metabolismoRESUMO
Thirteen patients had placement of a subclavian vein catheter for temporary vascular access for hemodialysis. Peripheral venography was performed within two to six weeks of catheter placement. Forty-six percent (six of 13 patients) developed subclavian vein narrowing, which resolved in two patients. The duration of catheter placement had no impact on the incidence of this complication. Subclavian vein catheterization can frequently lead to subclavian vein stenosis, which often will resolve spontaneously. Consideration should be given to placement of subclavian lines on the contralateral side of a planned permanent vascular access.
Assuntos
Cateterismo/efeitos adversos , Diálise Renal , Veia Subclávia/diagnóstico por imagem , Constrição Patológica/etiologia , Humanos , Flebografia , Risco , Fatores de TempoRESUMO
Eosinophilia (E) has been noted in hemodialysis (HD) patients, but its etiology is not clear. In an effort to clarify this phenomenon, we prospectively studied patients initiating dialysis in our outpatient HD and peritoneal dialysis programs. Rate of E was greatest for a small group of four continuous cycling peritoneal dialysis patients (75%), less for 63 HD patients (41%), and least for 66 continuous ambulatory peritoneal dialysis (CAPD) patients (21%, P less than .05, HD v CAPD). Increasing E rates among the groups paralleled increased frequency of tubing changes. There were no differences in etiology of renal disease, medications, types of dialyzers, types of access, or transfusion frequency that could account for the E. IgE levels did not correlate with E. The data suggest that the dialysis procedure or the tubing changes may be causing the E, but the possibility that uremia, itself, is important in the pathogenesis of dialysis E is also discussed.
Assuntos
Eosinofilia/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Renal/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Rins Artificiais/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
The nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery which results in renal vein and left gonadal vein varices. This is an unusual but well accepted cause of hematuria. We report a case of the nutcracker syndrome and present the radiologic workup including computerized tomography (CT) and renal venography with venous pressure measurements.
Assuntos
Hematúria/etiologia , Pelve Renal/irrigação sanguínea , Ovário/irrigação sanguínea , Varizes/complicações , Adulto , Circulação Colateral , Feminino , Humanos , Flebografia , Veias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Varizes/diagnóstico por imagemRESUMO
Three patients had renal failure due to obstructive nephropathy associated with processes that prevented dilatation of the collecting systems. Thus, various radiologic procedures, including renal sonography, angiography, and isotope renography, all failed to identify an obstructing process. Because of the high index of clinical suspicion, surgical exploration and nephrostomy were performed on each patient. This confirmed the presence of obstructive nephropathy and led to marked improvement of renal function in each case. When renal failure develops in a setting with a high probability of ureteral obstruction, this diagnosis should be vigorously pursued despite normal radiologic results.
Assuntos
Injúria Renal Aguda/etiologia , Obstrução Ureteral/complicações , Adulto , Idoso , Creatinina/sangue , Humanos , Rim/cirurgia , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Nefropatias/cirurgia , Pelve Renal/cirurgia , Masculino , Radiografia , Artéria Renal/diagnóstico por imagem , Diálise Renal , Ultrassonografia , Ureter/cirurgia , Obstrução Ureteral/diagnóstico , Cateterismo UrinárioRESUMO
We describe our experience at the Booth Memorial Medical Center with the development and growth of a Continuous Ambulatory Peritoneal Dialysis program. This initial experience includes the training and close follow-up of 41 patients with End Stage Renal Disease over a period of 15 months. The status of our program with respect to medical complications encountered and their management is described. Our results, in terms of biochemical control, success with training, and patient satisfaction with CAPD are outlined.
Assuntos
Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Adolescente , Adulto , Idoso , Análise Química do Sangue , Feminino , Hérnia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Organização e Administração , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/etiologia , Risco , Fatores de TempoRESUMO
The development of cloudy peritoneal dialysis effluent is of great concern to the patient undergoing therapy with Continuous Ambulatory Peritoneal Dialysis. As described in this study, not all cloudy fluid represents bacterial infection. We describe the occurrence of cloudy fluid in eight patients in whom culture of the dialysate did not yield any growth, and whose cell count was characterized by the presence of significant numbers of the eosinophiles. As outlined, the entity of eosinophilic peritonitis has a characteristic presentation which allows for its distinction from the more common bacterial peritonitis.
Assuntos
Eosinofilia/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Humanos , Contagem de Leucócitos , Peritonite/sangueRESUMO
A prospective study was carried out in 25 patients with systemic lupus erythematosis (SLE) on the effect of normalizing serum complement (CH50) and anti-DNA antibodies on the course of lupus nephritis. In 16 of the 25 patients, CH50 was maintained within the normal range for two years. Urinary protein excretion increased or remained low in all 16. Repeat renal biopsies were performed in 10 of these 16, and disclosed either stabilization of glomerular disease or diminution. In the nine patients in whom CH50 could not be normalized with tolerated doses of drugs, urinary protein excretion increased or remained increased. Repeat renal biopsies in six of these nine patients were carried out and showed worsening of glomerular disease in five. No clear-cut correlation was found between urinary protein excretion or renal disease and the serum levels of anti-DNA antibody. We conclude from these observations that continuous normalization of CH50 by drug therapy in patients with SLE is associated with stabilization or diminution of lupus nephritis.