Didier Hauglustaine

Silicon Nephropathy: a Possible Occupational Hazard

A 37-year-old white male, working in a tile factory, presented proteinuria with no obvious tubular dysfunctional. Renal biopsy disclosed a mild focal segmental proliferative glomerulonephritis. Distinct alterations were found by electron microscopy, especially in the proximal tubular cells. Because of a history of heavy dust exposure the silicon content was determined in the kidney biopsy tissue. The finding of 150 mg/kg silicon on tissue dry weight supports the diagnosis of silicon nephropathy.

OESTROGEN CONTAINING ORAL CONTRACEPTIVES, DECREASED PROSTACYCLIN PRODUCTION, AND HAEMOLYTIC URAEMIC SYNDROME

Dr. Ylikorkala and colleagues (January 3, p. 42) present evidence for lowered (PGI2) prostacyclin production in normal women after prolonged use of estrogen-containing (OCs) oral contraceptives but not after use of a progestagen-only OC. We have seen a 23-year old multiparous normotensive woman whohad a (HUS) hemolytic uremic syndrome 5 months postpartum and 4 months after starting on a combined OC (Mestranol + chlormadinone acetate). HUS recurred 8 years later, 5 years after a successful cadaver kidney transplantation and 10 months after resumption of combined OC intake (thinyl estradiol levenorgestrel). In the interim, a progestagen-only OC (lynestrenol) was used without problems for 7 years. Other causes of HUS (systemic disease, malignant hypertension, transplant rejection, infection) were excluded. Details of this case will be published elsewhere. A disorder in PGI2 production has been proposed as the underlying basic abnormality in some patients with HUS. In the light of the observation of Ylikorkala et al, the recurrence of HUS in a transplanted kidney after resumption of an estrogen-containing OC could be seen as a confirmation of the role of PGI2 in HUS. HUS-related to OCs is rare is view of the large numbers of women on the pill; thus a genetically determined predisposition is likely. This is supported by the observation of HUS in adult sisters taking OCs. Further data are needed to discover if this predisposition is a dificient production of PGI2 as suggested by Remuzzi et al.

Protein-Losing Enteropathy in Systemic Lupus erythematosus

A 33-year-old woman presented a recurrent steroid-sensitive protein-losing enteropathy as the major manifestation of systemic lupus erythematosus. An increased capillary permeability for proteins is considered to be the most likely explanation.

Bicarbonate dialysis using a single concentrate.

Bicarbonate Dialysis Using a Single Concentrate J. Josy Martens D. Didier Hauglustaine R. René Verberckmoes P. Paul Michielsen Josy Martens, MD, Didier Hauglustaine, MD, René Verberckmoes, MD, Paul Michielsen, MD, Division of Nephrology, Universitair Ziekenhuis Gasthuisberg, Herestraat, 49, B-3000 Leuven (Belgium) Dear Sir, Haemodialysis with bicarbonate-containing dialysate may offer many advantages over acetate dialysis as improved vascular stability, prevention of dialysis-induced hypoxaemia, more adequate base repletion and improved patient well-being [1–4]. Bicarbonate dialysis is now more frequently used since automated techniques have been developed to prevent precipitation of calcium and magnesium carbonates. However, the present systems require a two-stream proportioning and monitoring device and two separate concentrates. These systems are more complicated and expensive than those used in standard acetate dialysis [4, 5]. We propose an alternative method for bicarbonate dialysis that circumvents the aforementioned problems. Our method of bicarbonate dialysis uses a single concentrate, composed of sodium chloride and sodium bicarbonate. Calcium, magnesium and potassium chloride are omitted from the dialysate but administered by a continuous intravenous infusion. The concentrate was prepared long in advance by dissolving sodium choride and sodium bicarbonate in deionized water to achieve, after dilution 1/12, a final dialysate composition of Na+ 137 mmol/l, Cl 102 mmol/l and HCOj 35 mmol/l. The concentrate and reverse osmosis water were mixed and monitored by a conventional single patient dialysis machine ( < Monitral > , Hospal). A sterile solution containing CaCl2–2 aqua 51.35 g/l, KC115.53 g/l and MgCl2 · 6 aqua 21.18 g/l, was infused by a calibrated pump at a constant rate of 0.5 ml/min into the blood being returned to the patient (i.e. 7 mg elemental calcium/min [6] and 25 mmol potassium and magnesium/4 h). In the event of a shutdown of the blood pump the infusion was stopped. Table I. Laboratory measurements (preand postdialysis) in 7 patients during six bicarbonate dialysis (mmol/l)

Urinary Erythrocytes and Glomerular Disease

Excerpt To the editor: In a recent editorial Morrin reminds us of the importance of microscopic examination of freshly voided urine in detecting a glomerulopathy (1). He emphasizes a careful search...