John P. Fitzgibbons

Hemoperfusion for Treatment of N-Acetylprocainamide Intoxication

Excerpt The pharmacokinetics of procainamide and its major metabolite,N-acetylprocainamide, are significantly altered in patients with chronic renal failure (1-4). BecauseN-acetylprocainamide is no...

Renal Angiomyolipoma with Arteriovenous Shunting

We describe a patient with arteriovenous shunting during renal arteriography who at operation was found to have an angiomyolipoma rather than renal cell carcinoma or an arteriovenous malformation. Renal angiomyolipoma should be added to the list of causes of gross hematuria with angiographically demonstrable arteriovenous shunting.

Impaired Potassium and Magnesium Homeostasis in Acute Tubulo-Interstitial Nephritis

Although acute tubulo-interstitial nephritis is increasingly recognized as a cause of acute renal failure, little is known about renal tubular function in this disease. We report on two patients with acute tubulo-interstitial nephritis who demonstrated abnormalities in proximal and distal tubular function. The first patient developed hyperkalemia presumably from a potassium secretory defect in the distal nephron. The second patient developed an incomplete Fanconis syndrome with glycosuria and aminoaciduria and two heretofore unreported complications of acute interstitial nephritis: hypokalemia and hypomagnesemia secondary to urinary losses of these cations. Careful monitoring of renal tubular function is indicated in patients with acute tubulo-interstitial nephritis.

Amelioration of hemodialysis-induced fall in PaO2 with exercise.

The hypoxemia of acetate hemodialysis may result from a decrease in alveolar ventilation (VA) related to a reduction in pulmonary carbon dioxide excretion (VCO2). To test this theory, ventilation was increased by exercise during dialysis on 6 patients and the effect on arterial oxygen tension (PaO2) measured. With hemodialysis the PaO2 fell from 102 to 92 mm Hg and with exercise rose to 102 mm Hg. These changes in PaO2 paralleled changes in VA and VCO2 induced by acetate dialysis and then exercise. The correlation coefficient between VA and VCO2 was 0.997. This close correlation suggests that CO2 load may be the main controlling factor for ventilation under these conditions. We conclude that the fall in PaO2 that occurs with acetate hemodialysis is due to decreased ventilation secondary to decreased VCO2 and that exercise can ameliorate the fall in PaO2 by increasing ventilation.

Urinary Doubly Refractile Lipid Bodies in Nonglomerular Renal Diseases

Urinary doubly refractile lipid bodies (DRLB) are a characteristic finding in patients with glomerular renal diseases causing heavy proteinuria. DRLB are felt to be an uncommon finding in glomerular diseases without heavy proteinuria, and a rare finding in nonglomerular renal diseases. In order to determine whether DRLB are found in nonglomerular renal diseases, we reviewed the medical records of all patients who had urinalyses performed in our laboratory from February 1975 to June 1983. Three hundred sixty one patients demonstrated less than or equal to +2 proteinuria, and at least two DRLB. Of these, 290 were identified as having a single renal diagnosis. One hundred forty eight patients (51%) had a variety of acute and chronic glomerular diseases, and 125 patients (43.2%) had nonglomerular renal diseases, including acute tubular necrosis (ATN), prerenal azotemia, chronic interstitial nephritis, polycystic kidney disease, acute interstitial nephritis, renal neoplasia, and acute myeloma kidney. Ten patients had transient proteinuria associated with acute illness, and seven patients had no renal disease at all. Only two patients with nonglomerular renal disease had more than five DRLB per 20 high power microscopic fields. The frequency of DRLB in patients with nonglomerular renal diseases was: chronic interstitial nephritis, 26%; polycystic kidney disease, 38%; prerenal azotemia, 20%; ATN, 15%; and acute interstitial nephritis, 33%. These data suggest that at lower levels of proteinuria, DRLB are found frequently in nonglomerular renal diseases, and that DRLB do not differentiate glomerular from nonglomerular renal diseases unless more than five DRLB are found on urinary sediment examination.

Syndrome of inappropriate antidiuresis in waldenström's macroglobulinemia☆

Hyponatremia due to the syndrome of inappropriate antidiuresis rather than due to isotonic hyponatremia from hyperproteinemia developed in a patient with Waldenströms macroglobulinemia. The patient was unable to excrete a water load normally despite suppression of antidiuretic hormone to normal levels. The temporal relationship between control of the tumor and resolution of the hyponatremia suggests that the tumor either produced a substance that enhanced the hydro-osmotic effect of endogenous antidiuretic hormone or produced an antidiuretic substance immunologically different from antidiuretic hormone. The syndrome of inappropriate antidiuresis should be suspected in hyponatremic patients with Waldenströms macroglobulinemia.

Mild Steady-State Exercise During Hemodialysis Treatment

In brief: The purpose of this study was to determine the feasibility and physiological effects of mild steady-state exercise during hemodialysis treatment. Three men and three women pedaled a Monark bicycle ergometer at 150 kgm min1 for five minutes during the first hour of hemodialysis treatment. Heart rate, blood pressure, pH, Hco3, and respiratory and blood gases were analyzed before hemodialysis treatment, at rest just before exercise, during exercise, and at selected times during the first hour of recovery. The authors concluded that all the physiological responses during hemodialysis treatment were typical of a deconditioned person responding to low-level exercise. The rise in blood pressure and arterial oxygen tension may have positive implications for hemodialysis treatment. Further investigation is warranted into the value of using exercise during hemodialysis treatment as a means of training.