Impact of short term use of interdialytic 60% ethanol lock solution on tunneled silicone catheter dysfunction.

INTRODUCTION: Ethanol lock (EL) is used to reduce catheter infections, but its impact on dialysis catheter dysfunction has not been studied. METHODS: We analyzed the rate of dialysis silicone catheter dysfunction after an interdialytic 60% EL in an open prospective controlled non crossover cohort study, with each patient being his or her own control. The study was divided into three consecutive 2-week periods: the pre- and post-intervention periods, in which interdialytic standard locks (SL) were used, and the intervention period, in which one EL was instilled during the first week, and two consecutively in the second week. We analyzed the rate of catheter dysfunction (exchange, use of fibrinolytic, reversing the lines, difficulty in instilling or withdrawing fluid) after EL or SL. RESULTS: In 30 patients, 90 EL were instilled. The rate of catheter dysfunction increased during the EL period (2 - 13%, p < 0.001), and between the two consecutive dialysis sessions before and after EL (p < 0.05). It decreased between the two consecutive dialysis sessions after EL and the following dialysis session after an SL (p < 0.05). No catheter was removed. The urea reduction ratio did not differ in dialysis after an SL and after an EL (0.77 vs. 0.73, p = 0.17). CONCLUSION: Short term EL is associated with a transient increase in catheter dysfunction, without resulting in catheter removal or decreasing dialysis efficiency.

Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis.

BACKGROUND: The indwelling venous catheter such as Dual-Cath or Twin-Cath is widely used in haemodialysis. Although the manufacturer recommends filling the catheter lumen with heparin after the dialysis session to prevent clotting, little is known about the systemic effects of such a procedure. METHODS: Twenty haemodialysis patients with Dual-Cath were studied. Dialysis anticoagulation was achieved by injecting a bolus of dalteparin. The patient/control ratio of activated partial thromboplastin time (aPTT) was determined at the end of the session immediately before and 10 min after locking with 2 ml of undiluted heparin (10,000 U/catheter). We also determined the catheter volume for each patient and measured aPTT immediately before and 10 min after heparin locking with this patient-specific volume. Catheter patency was followed over a 2-week period. RESULTS: The aPTT values determined at the end of two consecutive dialysis sessions were nearly normal, respectively 1.29 (+/-0.17) and 1.33 (+/-0.22), whereas all patients had uncoagulable blood (aPTT >3.75) 10 min after locking with 2 ml of heparin. When catheter volumes were individually calculated, they were found to be substantially lower than 2.0 ml (1.21+/-0.12 for the arterial branch and 1.27+/-0.13 for the venous branch). aPTT was only 2.42+/-0.73 10 min after locking with the estimated volumes except in one patient (aPTT >3.75). No catheter clotting was observed despite these smaller locking volumes. CONCLUSIONS: A risk of inducing serious bleeding does indeed exist with Dual-Cath heparin locking, especially in postoperative patients. This risk can be reduced by measuring catheter length at the time of placement in order to ensure an appropriate lock volume. Sodium citrate, polygeline, or urokinase are possible alternatives to heparin.

Potential nephrotoxicity of intravenous infusions of naftidrofuryl oxalate.

We report two cases of acute renal failure in patients with arteriosclerosis obliterans treated by intravenous infusion of naftidrofuryl oxalate. At renal biopsy the histological lesions were identical with those found in ARF due to hyperoxaluria of other causes, revealing tubular epithelial necrosis and massive intratubular precipitation of calcium oxalate monohydrate (C1) crystals. A second study was then conducted in four other patients with arteriosclerosis obliterans to evaluate serum and urinary levels of oxalate, and crystalluria during the intravenous administration of 800 mg of naftidrofuryl oxalate per day for 10 days. During the course of treatment, the serum and urinary oxalate levels were found to increase substantially, with the gradual onset of massive C1 crystalluria. These results indicate that naftidrofuryl oxalate was responsible for the acute renal failure in the first two patients. High intravenous doses of naftidrofuryl oxalate must be used cautiously, with close surveillance of renal function.

Urinary lithiasis induced by sulfamethoxazole in a patient with tetraplegia. Case report.

Bladder lithiasis is a frequent complication in paraplegics and tetraplegics. We report on a patient where treatment of a urinary infection with antibacterial sulfamides was the causative factor in the formation of bladder stones.

[The heart in chronic kidney failure patients]. / Le coeur de l'insuffisant rénal chronique.

Risk factors for heart disease in patients with chronic renal failure (CRF) are the same as in general population; moreover CRF and renal replacement therapies (dialysis, immunosuppressive drugs for kidney transplantation) induce further specific cardiac risks. In practice, the commonest heart diseases associated with CRF are coronary artery diseases, myocardiopathies from various aetiologies, valve diseases and arrhythmias. Uremic pericarditis are quite unusual nowadays. Advances in therapy authorize easier control of congestive heart failure, the major complication of heart disease in CRF patients. Furthermore, it was observed that correction of anemia with erythropoietin therapy or kidney transplantation can ameliorate or reverse partially some cardiac diseases.

[Diagnosis and urologic development of urinary lithiasis. Revealing manifestations, radiologic diagnosis, course complications]. / Diagnostic et évolution urologique de la lithiase urinaire. Manifestations révélatrices, diagnostic radiologique, complications évolutives.

The presence and migration of stones in the urinary tract are the consequences of lithiasis, a pathological process whose evolutive potential determines the frequency of recurrence. The stones produce haematuria and above all obstruction which manifests itself by pain and may be complicated by infection. The most suggestive type of pain is renal colic, but other revealing manifestations may occur. Such signs require radiological exploration with plain X-ray of the abdomen, renal ultrasonography and intravenous urography. These three indispensable examinations complete each other, provide the diagnosis and in the vast majority of cases point to the appropriate treatment. The haemodynamic repercussions of urinary tract obstruction have been thoroughly documented and now form the basis of treatment of renal colic with non-steroidal anti-inflammatory drugs. Obstruction and infection are the causes of all complications of urinary stones. Their management has been facilitated by recent advances in urology and should prevent the disease from destroying the kidneys and eventually causing chronic renal insufficiency.

Identification of flumequine in a urinary calculus.

Various analytical methods are available to help identify the presence of drugs in urinary calculi. Using infrared spectrophotometric analysis, nonmetabolized flumequine was identified in a protein calculus from a patient who had taken the drug for a urinary tract infection. Free flumequine can precipitate in an acidic environment.

[Identification of a metabolite of floctafenine in urinary calculi]. / Identification d'un métabolite de la floctafénine dans un calcul urinaire.

There are three 4-amino-quinolines used for their analgesic properties: glafenine, antrafenine and floctafenin. Urinary calculi due to glafenine have been described since 1980. Recently two cases of renal calculi containing antrafenic acid have been reported. We discovered a metabolite of floctafenin in a bladder calculus and describe its identification by infrared spectrophotometry and thin-layer chromatography.

[Aminopenicillin crystalluria: identification by infrared spectrophotometry]. / Cristalluries d'aminopénicillines: identification par spectrophotométrie infrarouge.

Renal stones and crystalluria can be characterized unambiguously by global physical methods. The authors report four cases of crystalluria induced by aminopenicillin (ampicillin and amoxicillin). Identification of these drug-induced crystalluria was made by high-pressure liquid chromatography and infrared spectrophotometry. The physico-chemical data and infrared absorption characteristics can give us diagnostic for various forms of ampicillin and amoxicillin.

[Chronology of vascular access in hemodialysis. Apropos of 244 accesses in 150 hemodialysis patients]. / Chronologie des abords vasculaires en hémodialyse. A propos de 244 abords chez 150 hémodialysés.

Out of an experience of 244 vascular access in 150 patients the authors try do find the best chronology of the angioaccess procedures. 68% of the patients see their need in vascular access definitely resolved by the first classical forearm internal arterio-venous fistula and everything must be done in the dialysis population to avoid the failure of the fistula. This would lead to internal shunt procedures using graft materials of which we know the limited potency, leading to periodic operations. Emergency situations are approached by use of the femoral vein catheterization for hemodialysis. Only the impossibility of femoral or jugular catheterization would lead to the use of the external A.V. Shunt which would be placed on the leg to preserve the vessels of the arms. For some patients the repeated failure of the successive A.V. fistula and shunts have drived us towards either peritoneal dialysis or "hemasite" vascular access system.