A team's three-dimensional approach to assisting the end-stage renal disease family.

This review will identify ways in which the interdisciplinary team assists a family confronting end-stage renal disease (ESRD) for the first time. The developmental models of the family life cycle and the ESRD life cycle are used to understand the family's needs. The treatment team uses a three-dimensional approach of education, support, and communication to enhance family coping.

Evaluation of voiding cystourethrography prior to renal transplantation.

In many centers, voiding cystourethrography is a routine part of pretransplantation assessment of the lower urinary tract. To assess the value of this investigation, a retrospective review of transplant candidates evaluated in our center over 2 years was undertaken. A total of 517 patients were fully evaluable. Only 13 voiding cystourethrograms (VCUGs) (2.5%) of 517 were found to be abnormal. Three patients with reflux alone did not require intervention before transplantation. Four patients with decreased bladder capacity underwent hydrodistention. Two patients increased their capacity to over 150 ml and two patients failed distention, one requiring an ileal conduit and the other requiring an augmentation cystoplasty. Three patients had increased postvoid residual (PVR). Two patients started clean intermittent catheterization. One required prostate resection for benign prostatic hypertrophy. One patient with reflux and decreased bladder capacity refused treatment. One patient with reflux combined with increased PVR started clean intermittent catheterization and was cleared for transplant surgery. One patient with decreased bladder capacity and increased PVR had a stroke and was excluded from transplantation. All 13 patients with abnormal VCUGs had a prior urologic history. In total, only 56 of 517 patients evaluated had a prior urological history. Each VCUG costs approximately $500. Limiting VCUG studies to those patients with a prior urological history would have resulted in a significant cost savings. Hence, we recommend that only patients with a prior urological history should undergo this costly and often distressing examination.

Mitomycin-induced hemolytic-uremic syndrome. Successful treatment with corticosteroids and intense plasma exchange.

Mitomycin has been associated with microangiopathic hemolytic anemia and renal failure. We describe a patient with the adult hemolytic-uremic syndrome due to mitomycin who was successfully treated with intense plasma exchange therapy and corticosteroid therapy. Patients receiving mitomycin should have their conditions monitored closely for acute renal failure, thrombocytopenia, and hemolytic anemia.

Cisplatin-induced hypocalcemia and hypomagnesemia.

Cisplatin (cis-diamminedichloroplatinum), a chemotherapeutic agent active against solid tumors, is a known cause of acute renal failure and renal tubular dysfunction. We saw a case of renal magnesium wasting and hypomagnesemia in a 58-year-old woman with genital pelvic malignancy. Her initial manifestation was that of chronic symptomatic hypocalcemia of four months' duration. The relatively reduced parathyroid hormone level in this patient and the possible sites of cisplatin-induced renal tubular dysfunction resulting in hypermagnesuria were evaluated. This case emphasizes the importance of serially observing cisplatin-treated patients for the possible development of hypomagnesemic hypocalcemia.