Nagaaki Kotera

AA amyloid nephropathy with predominant vascular deposition in Crohns disease

A 44-year-old man with a 17-year history of Crohns disease (CD) was referred to our nephrology department on suspicion of drug-induced nephrotoxicity. Over the preceding 18 months, he had slowly progressive renal insufficiency with slight urinary abnormalities. His disease activity had been well controlled up to that point with 5-aminosalicylic acid and azathiopurine. Laboratory examination revealed slight proteinuria without hematuria and an elevated serum creatinine level of 1.4 mg/dl. Pathological examination revealed amyloid A (AA) deposition in the kidney, predominantly in the arterial and arteriolar walls with little to none in the glomerular capillaries. AA amyloidosis is typically accompanied by glomerular amyloid deposition and massive proteinuria. In the present case, however, vascular amyloid deposition was predominant, and the renal function was deteriorated with slight urinary abnormalities. The present case confirmed the importance of conducting a definitive pathological diagnosis of renal insufficiency in CD patients.

Peritoneal dialysis combined with extracorporeal ultrafiltration in refractory heart failure: a case report.

continuous or intermittent. The term “irrigating” is selected here instead of “continuous” to avoid confusion. Additionally, the optional term “boosted”—shown as a superscript letter b—could be added at the end of the resulting terms to signify a combination of automated and manual exchanges in some patients. Our effort is far from perfect, and yet we hope it is at least a sensible start. With input from readers of Peritoneal Dialysis International and probably meetings organized by the International Society for Peritoneal Dialysis, we are certain that the PD modality classification will eventually be nicely tidied up.

Age-Related Differences of Organism-Specific Peritonitis Rates: A Single-Center Experience

Peritonitis remains an important cause of morbidity and mortality in peritoneal dialysis (PD) patients, but its incidence and the distribution of causative organisms vary widely between institutions and age groups. This study was performed to investigate the recent status and risk factors of PD‐related peritonitis and to clarify differences between age groups. We retrospectively reviewed the medical records of 119 PD patients treated at our department between January 2002 and January 2013. We calculated both overall and organism‐specific peritonitis rates and also analyzed risk factors. Sixty‐three episodes of peritonitis occurred during 261.5 patient‐years for an incident rate of 0.24 episodes/patient‐year. Multivariate analysis showed that older age (≥65 years) and hypoalbuminemia (<3.0 g/dL) were associated with an increased risk of peritonitis (P = 0.035 and P = 0.029, respectively). In elderly patients (≥65 years old), the rate of peritonitis due to Gram‐positive and Gram‐negative bacteria was 0.17 and 0.08 episodes/patient‐year, respectively, and Gram‐positive peritonitis was markedly more frequent than in younger patients (<65 years old). In particular, there was a high frequency of Staphylococcus aureus peritonitis in elderly patients (0.09 episodes/patient‐year) and it had a poor outcome. At our department, the risk of peritonitis was increased in older patients and patients with hypoalbuminemia. The distribution of causative organisms was markedly different between age groups and analysis of organism‐specific peritonitis rates helped to identify current problems with our PD program.

Successful long-term peritoneal dialysis in combination with once-weekly hemodialysis: a case report.

Once peritoneal metastases were detected in our patient, we were unsure whether it was safe to continue PD. Our patient greatly preferred PD to hemodialysis, which had been used to supported him transiently after removal of the PD catheter for fungal peritonitis. We were concerned about repeated infectious peritonitis episodes, increased peritoneal permeability with ultrafiltration failure, and decreased effective peritoneal surface area causing decrease in small-solute clearance. In fact, peritonitis did recur even after the peritoneal catheter was replaced, but the organism was a skin Staphylococcus species rather than a fungus or enteric bacterium. However, over the 13-month period from discovery of the prostate cancer in the patient’s peritoneum to his death, small-molecule clearance and control of extracellular fluid volume were readily achieved.