M.M. Couttenye

Immunogenicity of a recombinant DNA hepatitis B vaccine in renal transplant patients

In renal transplant patients hepatitis B infection is associated with a higher morbidity and mortality. Therefore, we investigated the immunogenicity of an enhanced vaccination scheme with a recombinant DNA hepatitis B vaccine in renal allograft recipients. Injections of 40 micrograms were given at months 0, 1, 2 and 6. Conversion rate (anti-HBS antibody titre > 10 mIU ml-1) was only 36%. On the other hand, in patients vaccinated before transplantation, a booster injection of 40 micrograms was highly successful, resulting in a rise of antibody titre > 10 mIU ml-1 in 86%. In view of the poor vaccination results after transplantation, we strongly recommend hepatitis B vaccination prior to transplantation.

Oxidative Injury to Erythrocytes, Cell Rigidity and Splenic Hemolysis in Hemodialyzed Patients before and during Erythropoietin Treatment

The oxidative injury to erythrocytes, red blood cell (RBC) rigidity and splenic hemolysis was assayed in 17 chronically hemodialyzed patients before and during recombinant erythropoietin (EPO) treatment. When a stable hematocrit between 30 and 35% had been established for at least 4 months, a statistically significant increase in RBC volume, hemoglobin concentration, hematocrit, reticulocyte count, and several RBC enzymes (2,3-diphosphoglycerate, glucose 6-phosphate dehydrogenase, pyruvate kinase, hexokinase) was noted. This indicated significant RBC rejuvenation under the influence of EPO. However, no significant improvement in the RBC oxidative sensitivity, RBC deformability, splenic RBC volume, slow mixing splenic RBC volume, and the intrasplenic RBC transit time could be disclosed. These data confirm the existence of an extra-erythrocytic factor in uremic plasma, which is partly responsible for a reduced RBC life span in hemodialysis patients despite EPO treatment.

Unusual D‐Lactic Acid Acidosis from Propylene Glycol Metabolism in Overdose

Objective: To report a case of D‐lactic acid acidosis owing to massive oral ingestion of propylene glycol. Case Report: A 72‐year old man with known congestive failure was admitted to the ICU with encephalopathy. Twelve hours prior to admission he had erroneously ingested a large amount of propylene glycol (PG). The laboratory revealed high anion gap (anion gap = 27 meq/l) acidosis (arterial pH = 7.16) and an increased osmolal gap. Toxicological analysis revealed a low serum propylene glycol level. Biochemical analysis indicated that very high amounts of D‐lactic acid (up to 110 mmol/l), but not of the usual type of L‐lactic acid, were responsible for the metabolic acidosis. Hemodialysis was initiated and associated with a decline of both the acidosis and D‐lactic acid levels. The patient regained conciousness. Conclusion: Ingestion of massive doses of propylene glycol, previously not reported as a cause of D‐lactic acidosis, should be added to the differential diagnosis of this rare condition.

Functional Acute Renal Failure in a Patient with Carcinoid Syndrome

Acute renal failure occurred in a patient with a carcinoid syndrome whenever he developed a flushing episode. Renal biopsy performed during one of these oliguric episodes did not reveal any lesions which could explain this reversible form of renal insufficiency. Urinary indices were not conclusive. Alteration of intrarenal hemodynamics by vasoactive compounds is proposed to be the causative mechanism of this relapsing acute oliguric renal failure.