N. Dabir Vaziri

Thyroid function studies in the nephrotic syndrome.

Total serum and urinary thyroxine (T4), triiodothyronine (T3), and thyroxine-binding globulin (TBG) as well as serum free T4, thyroid-stimulating hormone (TSH), and T3 resin uptake (T3RU) were measured in seven patients with the nephrotic syndrome. The nephrotic syndrome was defined by proteinuria exceeding 3 g/24 h. All patients were clinically euthyroid. Most values for total serum T4, free T4, T3, T3RU, TBG, and TSH were within normal limits. However, the mean serum T3 and TBG values were significantly lower in patients compared with the control group. The values (mean +/- 2 SD) for urinary T4 were 24.3 +/- 20.3 in the patient group and 1.5 +/- 0.7 microgram/24 h in the control group. Urinary T3 values for patients and the control group were 2100 +/- 856 and 848 +/- 253 ng/24 h respectively. Urinary TBG was 2.1 +/- 1.8 mg/24 h in the patients and undetectable in the control group. There was no correlation between daily urinary T3 and T4 and urinary TBG. There was a weak correlation between daily urinary protein excretion and urinary T4 (r = 0.5).

Bicarbonate-buffered peritoneal dialysis: An effective adjunct in the treatment of lactic acidosis

Severe lactic acidosis is associated with poor prognosis. Usually, the patient is treated with massive amounts of intravenous sodium bicarbonate, which in itself carries many undesirable consequences such as fluid overload and hypernatremia. We have successfully used peritoneal dialysis with a bicarbonate-buffered dialysate in the management of severe acidosis. Bicarbonate-buffered peritoneal dialysis provided an unlimited supply of physiologic buffer over a prolonged period without causing hypervolemia or hypernatremia. Furthermore, significant amounts of lactate were removed by dialysis. We, therefore, recommend the use of bicarbonate-buffered peritoneal dialysis as an adjunct in the treatment of severe lactic acidosis.

Nephrotic syndrome associated with adenocarcinoma of the breast

Although the nephrotic syndrome has been reported in association with a wide variety of neoplastic diseases, it has only rarely been noted as a complication of breast carcinoma. We describe a patient who presented with the nephrotic syndrome and who was subsequently found to have carcinoma of the breast. The findings on renal biopsy were indicative of membranous nephropathy with positive immunofluorescent staining for immunoglobulin G (IgG) and the third component of complement (C3). The nephrotic syndrome completely resolved following successful treatment of the cancer. We have now followed this patient for over two years and there has been no recurrence of tumor or the nephrotic syndrome.

Special Uses of Cimetidine

Excerpt To the editor: We read with interest the recent article by Swartz and colleagues that described hemodialysis with a high-chloride, low-acetate dialysate as a successful treatment for metabo...

Peritoneal Dialysis Clearance of Endogenous Lactate

Four patients with severe lactic acidosis were treated with peritoneal dialysis using a bicarbonate-buffered dialysate. Peritoneal dialysis clearance of lactate averaged 9.1 ml minute, and the total lactate removed during dialysis ranged between 88 and 352 mEq. Removal of excess lactate by dialysis contributes to the control of acidosis and prevention of alkalosis once the metabolic defect is reversed.

Dialysability of Theophylline

We have shown that theophylline is highly dialysable with an average dialysis clearance of 76 ml/min approaching 63% of urea clearance with hemodialysis. Implications include dose adjustment during dialysis and efficacy of dialytic technique in the treatment of theophylline intoxication.

Control of bleeding from cannulation sites with topical thrombin in dialyzed patients.

Topical thrombin was applied to the cannulation sites during and after withdrawal of the needles. The duration of bleeding was reduced by 50% compared to the control period in patients with various internal arteriovenous communications undergoing maintenance hemodialysis treatment. Accordingly, use of topical thrombin appears effective in saving patients and staffs time, minimizing the blood loss in these anemic patients, and preventing the possible injurious effect of prolonged compression of vascular access to accomplish hemostasis.

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.