Francisco Maduell

Loss of renal graft due to recurrent IgA nephropathy with rapidly progressive course: an unusual clinical evolution.

Recurrence of IgA nephropathy following renal transplantation has been described in 40-50% of patients, and it usually has a good outcome. We present the case of a 54-year-old man with IgA nephropathy who developed terminal renal failure in 1985, 3 years after the onset of the disease. In March 1986 he received a cadaveric renal allograft following treatment with ciclosporin and steroids. Eight months later he developed microhaematuria and proteinuria and 10 months later he developed acute nephritic syndrome and rapidly progressive renal failure. Renal biopsy disclosed an IgA nephropathy with epithelial crescents in 60% of glomeruli. Treatment with plasma exchange and cyclophosphamide was unsuccessful and the patient lost his graft and returned to regular haemodialysis 15 months after renal transplantation.

Eight-Year Experience with Nocturnal, Every-Other-Day, Online Haemodiafiltration

Background: New haemodialysis therapeutic regimens are required to improve patient survival. Longer and more frequent dialysis sessions have produced excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. Methods: In this single-centre observational study, 57 patients on 4-5-hour thrice-weekly OL-HDF were switched to nocturnal every-other-day OL-HDF. Inclusion criteria consisted of stable patients with good prospects for improved occupational, psychological and social rehabilitation. The aim of this study was to report our 8-year experience with this schedule and to evaluate analytical and clinical outcomes. Results: Nocturnal, every-other-day OL-HDF was well tolerated and 56% of patients were working. The convective volume increased from 26.7 ± 2 litres at baseline to 46.6 ± 6.5 litres at 24 months (p < 0.01). Increasing the dialysis dose significantly decreased bicarbonate, blood-urea-nitrogen and creatinine values. Predialysis phosphate levels fell markedly with complete suspension of phosphate binders from the second year of follow-up. Although haemoglobin was unchanged, there was a 50.4% reduction in darbepoetin dose at 24 months and a significant decrease in the erythropoietin resistance index. Blood pressure significantly decreased in a few months. Antihypertensive medication requirements were decreased by 60% after 3 months and by 73% after 1 year and this difference was maintained thereafter. Conclusions: Nocturnal, every-other-day OL-HDF could be an excellent therapeutic alternative since it is well tolerated and leads to clinical and social-occupational rehabilitation with satisfactory morbidity and mortality. These encouraging results strengthen us to continue and invite other clinicians to join this initiative.

Red cell distribution width: a method that improves detection of iron deficiency in chronic hemodialysis patients.

Rafael Díaz-Tejeiro, MD, Department of Nephrology, University Clinic, School of Medicine, University of Navarra, E-31080 Pamplona (Spain) Dear Sir, The pathogenesis of anemia of maintenance hemodialysis patients is multifactorial. Superimposed iron deficiency because of the repetitive blood losses associated with dialyzer use and bleeding secondary to uremic gastroenteritis and platelet dysfunction is a common feature [1]· The sensitivity of various iron measurements varies with the severity of iron lack. On this basis iron deficiency is commonly divided into three stages: storage iron depletion, iron-deficient erythropoiesis and iron deficiency anemia [2]. Red cell indices, such as mean corpuscular volumen (MCV), mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration, are sensitive only in the second and the third stages [2]. Moreover, several reports have shown that the serum iron and trans-ferrin saturation are of little value in identifying iron deficiency in these patients [3]. Serial measurements of serum ferritin levels provide an acceptable alternative for monitoring iron balance in chronic hemodialysis patients [4]. The majority of studies have suggested that iron deficiency is associated with serum ferritin values of less than 55 ng/dl [5]. The use of a new red blood cell parameter, the red blood cell distribution width (RDW), which is offered as a routine parameter on automated blood count, in combination with MCV improves the classification of anemias and the early detection of iron deficiency [6, 7]. It has been demonstrated that RDW values greater than 14.6% are associated with decreased iron stores [6]. To evaluate the usefulness of the RDW in detecting iron deficiency we examinated blood samples from 27 patients in maintenance hemodialysis. Patients with morphologically identified red cell abnormalities and patients with MCV values greater than 100 fl were excluded because these abnormalities may also cause RDW elevation. All patients were treated with phosphate binders Table 1. Relation of MCV and MC V/ RDW with serum ferritin in 27 patients in chronic hemodialysis

A unidimensional diffusion model applied to uremic toxin kinetics in haemodiafiltration treatments

Kinetic modelling in haemodialysis is usually based upon the resolution of volume-defined compartment models. The interaction among these compartments is described by purely diffusive processes. In this paper we present an alternative kinetic model for uremic toxins in post-dilutional haemodiafiltration treatments by means of a unidimensional diffusion equation. A wide range of solutes such as urea, creatinine,

Effects of Xipamide on Transmembranary Potassium Movements and Prostacyclin Production

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Alterations of the Cl−/NaCO−3 Anion Exchanger in Erythrocytes of Uraemic Patients

-microglobulin, myoglobin and prolactin were studied by imposing appropriate boundary and initial conditions in a virtual [0,1] domain. The diffusivity along the domain and the extraction rate at the dialyser are the kinetic parameters which were fitted by least-squares for every studied solute. The accuracy of the presented volumeless model as well as the behavior of the proposed kinetic parameters could be an alternative to the compartment description for a variety of molecular weight uremic toxins undergoing different treatment configurations.

Successful Treatment with Ciprofloxacin of Multiresistant Salmonella Arthritis in a Renal Transplant Recipient

Several observations suggest a possible interaction between ion transport mechanisms and the arachidonic acid cascade in the natriuretic and in the antihypertensive effects of diuretics(1). Moreover, several studies have established that some diuretic drugs may act on the arachidonic acid cascade(2). In fact, it has been recently reported that the modification of K+ transmembrane gradient by some diuretic drugs may stimulate the generation of prostacyclin, PGI2,(3), Xipamide, X, is a sulfonamide type drug with diuretic and antihypertensive effects but whose mechanism of action remains unknown(4). We, thus, have investigated whether X does modify transmembranary K+ movements and PGI2 production.