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Involvement of Renal Allograft by Fabry’s Disease

A man with Fabrys disease received a renal allograft from a heterozygous sister. Renal allograft dysfunction necessitated an allograft biopsy 5.5 years after transplantation. Extensive accumulation of Fabrys disease deposits in the glomeruli, tubules, blood vessels and interstitium was noted.

Increasing plasma phosphorus values by enriching with phosphorus the "acid concentrate" of a bicarbonate-buffered dialysate delivery system.

Each of seven hypophosphatemic hemodialysis patients was dialyzed with a phosphorus-enriched, bicarbonate-buffered dialysate. The latter was prepared by the introduction of sodium phosphate salts to the “acid concentrate” of a bicarbonate-buffered dialysate delivery system. The patients tolerated the procedure well and their hypophosphatemia improved.

Failure of neutrophils to recover their ability to produce superoxide after stunning by a conventional, acidic, lactate-based peritoneal dialysis solution.

Exposure of human neutrophils to conventional, acidic, lactate-based peritoneal dialysis solutions for 5 minutes results in a depression of superoxide generation. In spite of restoration of extracellular pH to 7.4, these stunned cells failed to recover their ability to generate the anion after a period of an hour.

Heparin-associated thrombocytopenia in maintenance hemodialysis patients.

Thrombocytopenia associated with the presence of a heparin-dependent platelet aggregating factor developed in two patients after hemodialysis with heparin. It resolved in one patient after heparin was stopped; but persisted in the other during a two-week heparin-free period and intermittently thereafter. We suggest that when heparin causes thrombocytopenia in dialysis patients the heparin should be stopped whenever possible, but this may not be necessary in all patients.

Poststreptococcal Crescentic Glomerulonephritis in a Patient with Preexisting Membranous Glomerulonephropathy

An adult male with idiopathic membranous glomerulonephropathy who developed crescentic glomerulonephritis after an episode of streptococcal pharyngitis is described.

Plasma Protein-Binding of Amantadine in Maintenance Hemodialysis Patients

Mean 267.6±58.7 109.0±24.2 40.9±6.2 59.1 ±6.1 REFERENCES It can be seen that in azotemic plasma, approximately 40% of amantadine is present free whereas the remaining 60% is bound to plasma proteins. Thus, amantadine behaves similarly to other basic drugs which show an affinity for plasma proteins (7). Because amantadine is largely protein-bound, the plasma free drug fraction rather than the plasma total drug level might be the more useful guide to optimum dosage in patients with renal functional impairment.

Treatment of refractory hemodialysis ascites with maintenance peritoneal dialysis.

In 5 patients who were receiving maintenance hemodialysis, ascites developed that was refractory to treatment by ultrafiltration during hemodialysis. Use of sequential isolated ultrafiltration and hemodialysis therapy either precipitated side effects or else required prolongation of total treatment time which the patients declined to accept. In 4 of the patients, ascites was believed to be primarily responsible for severe, progressive cachexia. Maintenance peritoneal dialysis was instituted in all patients, and abdominal fluid was removed gradually, over a period of 2 to 3 days. Ascites resolved promptly in each case. Three patients noted a dramatic improvement in appetite after relief of abdominal distension. Follow-up periods ranged from 6 to 4 1/2 years. Our results suggest that maintenance peritoneal dialysis can successfully control hemodialysis ascites.

Continuous ambulatory peritoneal dialysis using self-made, ultrafiltration-sterilized, L-lactate-based dialysis solution

Continuous ambulatory peritoneal dialysis was successfully carried out in 6 end-stage renal failure patients using self-made, ultrafiltration-sterilized dialysis solutions. A Y-set was used to deliver the above solutions to sterile plastic bags.

Preventing Influenza in Chronic Renal Disease

Theoretically, vaccination could worsen certain kinds of renal disease by stimulating the immune system, but this fear has not been substantiated by clinical experience, Thus in a study of 36 children with various forms of renal disease, Sheth et al, found that a bivalent vaccine did not precipitate proteinuria in any of the 29 patients who initially had normal protein excretion levels; while of seven children with proteinuria, four developed a transient rise in protein excretion, returning to pre-immunization levels within one week (3), In adult patients with renal insufficiency, Pabico et aL also found no deterioration in renal function (4), Influenza vaccines have been given to patients suffering from systemic lupus erythematosus (with or without lupus nephritis); the incidence of influenza-like illnesses after immunization was no higher than that in healthy control subjects, and no major flares of systemic lupus erythematosus itself were encountered (5-8). The interesting association between virus infection and renal allograft dysfunction (9-13) calls into question the safety of immunizing renal allograft recipients with influenza virus products. For example, Briggs and associates reported an outbreak of influenza in a renal transplant unit; of 5 transplant recipients contracting influenza infection, 3 developed acute allograft dejection (12). However, influenza vaccines have been given to many transplant recipients with no significant adverse effects (14-16) one possible exception being an inci-