Piero Antonio Conz

Assessment of Adequacy in Peritoneal Dialysis

Adequacy of peritoneal dialysis has been less well studied than that of hemodialysis. Fractional urea removal, total creatinine removal, and various indices have been proposed to reflect or predict patient morbidity and mortality. No prospective study has been published in this regard. To evaluate this area further, in addition to reviewing selected literature, 45 continuous ambulatory peritoneal dialysis (CAPD) patients were recruited in two dialysis centers for a prospective study on treatment adequacy. Patients were well rehabilitated and had no peritonitis or hospitalization in the 6 months before the study. Urea and creatinine kinetics were analyzed, as were dietary intake and fluid balance. The weekly Kt/V, calculated to include peritoneal and residual renal clearance (KprT/V), averaged 1.77 with a Kt/V hemodialysis equivalent of 0.59. Patients with residual renal function (58% of the studied population) had an average residual renal clearance of 3.42 mL/min, and had lower steady-state concentrations of urea nitrogen and creatinine in the plasma than patients with no residual renal function. As a consequence, a lower percent excretion of urea and creatinine in the peritoneal fluid was observed in the former patients compared with the latter, where the peritoneal route was the only one for solute excretion. The concentration profiles in blood appear to be the critical factor in achieving the final target of the treatment, ie, the excretion of the overall amount of waste products derived from protein and other metabolic pathways. The constant blood levels in CAPD explain why such a low Kt/V can be adequate whereas, in hemodialysis, a higher Kt/V is required.(ABSTRACT TRUNCATED AT 250 WORDS)

Campylobacter pylori in Uremic Dialyzed Patients

P. Conz, Department of Nephrology, S. Bortolo Hospital, Vicenza (Italy) Dear Sir, Patients with chronic renal failure have a high incidence of gastric disease, and gastrointestinal symptoms are early manifestations of uremia [1]. A high content of NH3 has been demonstrated in the gastroduodenal environment of uremic patients. This seems the consequence of urea decomposition by urease-producing bacteria [2]. According to this observation, we have investigated the incidence of Campylobacter pylori infection in uremic dialyzed patients. Forty-three uremic dialyzed patients were examined by endoscopy. Fifteen patients (34,8%) showed a positive urease reaction by the Quick-Campyl test [3]: 10 of them presented an aspecific antral gastritis at the gastroduodenal endoscopic examination, and 5 presented an erosive antral gastritis (table 1). The incidence of detection of C. pylori in antral biopsies in our patients seems not to differ from that found in patients with gastric pathology and normal renal function [4–6]. However, we found a significant correlation between the presence of C. pylori and erosive antral gastritis by χ2 test with Yates correction for continuity (p < 0.05). It may be suggested that the erosive antral gastritis might be associated with C. pilory infection and that this microorganism may have a considerable role as an etiologic factor in the serious gastric pathology of uremic patients. As a consequence, the detection of C. pilory infection in uremic patients may be important in relation to the possible role of antimicrobial agents in the therapy of uremic gastritis. Table 1. Incidence of Campylobacter pylori related to gastric disease

Acute Renal Failure due to a Calculus Obstructing a Transplanted Kidney

Nephrolithiasis is a rare finding in kidney transplantation and anuria could be the only clinical sign. We report the case of a 52-year-old Caucasian male renal transplant recipient admitted due to acute renal failure (ARF) and anuria. He reported no symptoms and a palpable bulge in the right iliac fossa corresponding to the graft was present. Ultrasonography showed hydronephrosis of the graft. A double-J ureteral stent was inserted with resolution of ARF. ARF with anuria and the presence of a palpable non-tender, elastic mass over the graft could be the clinical picture of obstructive ARF in a transplanted kidney.

Stomach Phytobezoars in Two Uremic Anorexic Patients

Conglomerates of food and mucus or phytobezoars composed of vegetable matter are sometimes found in the stomach in the general population. Reports of phytobezoars in uremic patients are, however, scarce. Here we describe 2 uremic patients in which esophagogastroduodenoscopy was performed due to dyspepsia associated with weight loss and in which stomach phytobezoars were discovered. Theoretically, uremic patients should be at risk for producing bezoars. In fact, these patients frequently present predisposing conditions such as autonomic neuropathy, diabetes mellitus and delayed gastric emptying. Gastric bezoars cause anorexia. Anorexia is a frequent symptom in dialysis patients and is associated with malnutrition. In these patients, malnutrition is strongly associated with mortality and is quite difficult to reverse. Similarly, phytobezoars cause chronic anorexia. We suggest that clinicians working in dialysis units should consider the possibility of a gastric bezoar when evaluating anorexic uremic patients.