J. Saiki

Femoral Neuropathy: a Complication of Renal Transplantation

Femoral neuropathy occurred in 3 patients after renal transplantation. This appeared to be due to compression of the femoral nerve by medial and inferior blades of the self-retaining retractors used during renal transplantation surgery. The condition resulted in weakness of quadriceps muscles, loss of patellar reflex, and sensory deficit on the side of transplantation surgery. The rate of recovery from neurologic deficits appeared to depend on the level of transplant renal function.

Dialysis-induced changes in muscle strength.

Little is known about the acute effects of hemodialysis on muscle strength. Rapid changes in hemodynamic and biochemical parameters are known to occur during dialysis and may alter muscle performance. Ten patients maintained on chronic hemodialysis had measurements of quadriceps muscle and handgrip strength performed before and after dialysis. In seven of these patients maximum static inspiratory and expiratory pressures (PI max and PE max respectively) were similarly determined. Quadriceps muscle strength improved in 6 patients, decreased in 3 and remained unchanged in 1. Handgrip strength increased in 5 patients, decreased in 3, and remained unchanged in 1. PI max decreased in 6 patients and increased in 1, and PE max decreased in 4 patients and increased in 3. No significant correlation was found between the changes in strength of the tested muscle groups and the serum concentrations of sodium, potassium, calcium, phosphorus, urea nitrogen, and creatinine, changes in blood pressure of fluid balance. The dialysis-induced changes in biochemical parameters may exert opposing effects on neuromuscular performance. This may explain the diversity of the results obtained in this study.

Hemodialysis studies of antidiuretic hormone.

Hemodialyzability of antidiuretic hormone (ADH) was studied in 14 patients undergoing hemodialysis procedure. In addition hemofiltration (dry dialysis) was performed in 8 patients and hemofiltrate samples were collected for ADH assay. The mean values for plasma ADH level in ingoing and outgoing blood were nearly identical. Moreover, no ADH was detectable in the hemofiltrate samples. These findings suggest lack of significant ADH removal by dialysis or hemofiltration.

Antidiuretic Hormone in End-Stage Renal Disease

Quantative data on plasma levels of antidiuretic hormone (ADH) in renal failure are limited. We measured predialysis plasma ADH levels using a double antibody radioimmunoassay in 14 patients with end-stage renal failure. Plasma ADH was inappropriately elevated in the majority of tested patients despite normal plasma osmolality, moderately elevated blood pressure, and hypervolemia. The etiology of increased plasma ADH in our population is unclear.

Reassessment of Fistula Puncture Site Blood Loss

Fistula puncture site blood loss during and after hemodialysis was measured in 12 patients with end-stage renal disease. It was found to be 0.74 +/- 0.32 ml per dialysis and 115.4 +/- 49.9 ml per year in patients with Cimino A-V fistulas. Puncture site blood leak in patients with heterologous grafts was 1.77 +/- 0.36 ml per dialysis and 276.1 +/- 56.1 ml per year. The values obtained in this study are 5 to 10 folds less than those found in the original reports. Recent advances in dialytic technology are probably responsible for the observed improvement. The results also suggest that Cimino A-V fistulas are superior to the heterologous graft.