Keiko Nakajima

Acute Hydrothorax in Continuous Ambulatory Peritoneal Dialysis – A Collaborative Study of 161 Centers

Follow-up studies on 3,195 patients from 161 centers in Japan undergoing continuous ambulatory peritoneal dialysis (CAPD) were performed for 1-104 months to clarify the incidence as well as the clinical features of acute hydrothorax. In these studies, 50 patients (1.6%) developed this complication. Twenty-seven (54%) were men, and 23 (46%) were women, ranging in age from 6 to 79 (average 49) years. The interval between onset of CAPD and hydrothorax ranged from 1 day to 8 years. Four had left-sided, and 2 had bilateral hydrothorax, but the majority (88%) were right-sided. Dyspnea was experienced by 37 of these 50 patients, but the remaining 13 (26%) patients were asymptomatic. Hydrothorax was fully resolved in 27 of them following a brief interruption of CAPD or the combined use of small exchange volumes in a semi-sitting position and pleurodesis with tetracycline or other agents. The remaining 23 patients (46%) were switched to hemodialysis permanently. Despite recurrence, 1 patient continued successfully on CAPD. It was concluded that acute hydrothorax is one important possible complication, although the risk may be low. Constant surveillance is necessary to detect pleural effusions in patients during CAPD.

Homozygous C3 Deficiency Associated with IgA Nephropathy

A 23-year-old male patient with homozygous C3 deficiency who developed asymptomatic proteinuria and hematuria was reported. Renal biopsy disclosed typical IgA nephropathy with deposition of early- and late-complement components except for C3 deposition. C9 and membrane attack complex were detected in the glomeruli despite the absence of C3. It was suggested that there might be some unknown complement activation mechanism which does not require C3 component.

Long-term use of hemodiafiltration in two patients undergoing continuous ambulatory peritoneal dialysis

Two patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure developed restless leg syndrome associated with increased serum β2 microglobulin and methylguanidine levels, suspected to be due to inadequate dialysis. Results of peritoneal function tests were normal in both patients, suggesting inadequate dialysis and increased production of uremic toxins by unknown mechanisms. Biochemical results and clinical symptoms were improved by concurrent hemodiafiltration. The patients used CAPD combined with biweekly hemodiafiltration with good clinical results over the 6-year period from 1989 to 1995. Periodic hemodiafiltration may enable patients who must otherwise discontinue CAPD treatment due to insufficient dialysis to continue long-term CAPD without affecting rehabilitation.

Migration of peritoneal catheters in patients undergoing continuous ambulatory peritoneal dialysis.

末期腎不全患者に対する腹膜透析療法 (CAPD療法) は全世界的に普及しているがCAPD療法の継続を危なくする合併症の一つとしてカテーテルの先端の位置異常 (dislocation) をきたし注排液が困難になることが挙げられる.今回我々は当院にてCAPDを導入した100例についてカテーテルの挿入位置と位置異常の頻度について検討した.その結果カテーテル先端が常に骨盤腔より逸脱しているもの5%, 時々逸脱するもの19%で残りの76%は常に骨盤腔に留まっていた. カテーテル挿入部位の左右差による移動率の差異は認められなかった. また閉塞により再挿入を要した症例は3例ですべて挿入後14日以内に発生していた. カテーテル先端の移動に関して出口の方向による有意差は認めなかった.以上, 我々の観察ではカテーテルの先端の位置異常は一時的なものまで含めると24%にのぼるがCAPD導入後2週間以上を経たものでは大網のencasementのため注排液不能となるか外科的に再挿入を要したものはなかった.