Robert A. Peraino

Pericardial effusion in patients treated with maintenance dialysis

Pericarditis with or without effusion as a complication of end-stage renal disease responds to the institution of chronic dialytic therapy. The management of pericardial effusion which has its onset after some time of chronic dialytic therapy is less well established. Since a surgical pericardial drainage procedure is often performed on an emergency basis in some patients with pericardial effusion treated with maintenance dialysis, it would be advantageous to be able to predict which patients would subsequently require an operation which then could be performed electively. Thus, we reviewed our experience with pericardial effusion in patients treated with maintenance dialysis in order to ascertain whether one or more factors would predict the ultimate need for a surgical pericardial drainage procedure. Our analysis of 22 patients with pericardial effusion demonstrates that those with a large effusion are best treated by elective pericardial drainage using a subxiphoid approach with instillation of triamcinolone hexacetonide into the pericardial sac. Those patients with a small or moderate effusion can be subjected to a trail of nonsteroid anti-inflammatory drugs and/or intensive dialysis. Evidence of an enlarging effusion should prompt surgical drainage before hypotension or tamponade require the patient to undergo an emergency operation.

Influence of Calcium on Renal Handling of Phosphate

The renal handling of phosphate is homeostatically controlled by a number of hormonal and nonhormonal stimuli—acting directly upon the renal tubule or indirectly by altering the metabolism of this ion elsewhere in the body—which influence its excretion by the kidney. This chapter deals only with the effects of calcium, by direct or indirect means, to induce changes in inorganic phosphate excretion by the kidney independent of changes in phosphate metabolism by other organs.

Reversible Uremia due to Bilateral Ureteral Obstruction from Tuberculosis

An El Salvadoran man with reversible uremia secondary to genitourinary tuberculosis is described. The literature of genitourinary tuberculosis is also reviewed with emphasis on the pathology and infrequency of renal failure in this setting. Although the total number of cases of tuberculosis and pulmonary disease in particular is declining, the prevalence of extrapulmonary TB is not. In addition, the incidence of TB in recent immigrants to the United States is extremely high. Thus, the finding of tuberculosis should prompt investigation to rule out genitourinary disease which can be clinically silent in a large percentage of the cases.

1,25-Dihydroxycholecalciferol (Calcitriol): Effect on Phosphate (PO4) Absorption by Isolated Pars Recta

Phosphate handling by the kidney is influenced by a number of factors including extracellular fluid volume, plasma calcium concentration, bicarbonate administration, parathyroid hormone, and dietary phosphate balance. Vitamin D metabolites have also been demonstrated to augment renal phosphate absorption in the presence and absence of PTH (1–6). Bonjour, Preston and Fleisch have demonstrated that calcitriol increases phosphate excretion in the thyropara-thyroidectomized rat (7), and Gloor, Bonjour, Caverzasio and Fleisch demonstrated that calcitriol prevents the renal resistance to the Phosphaturic response to PTH during phosphate depletion (8). These investigators localized the site of action of calcitriol to the proximal convoluted tubule and beyond the point of micropuncture in the distal tubule in the rat (9).

Renal Excretion of Calcium and Magnesium during Acetazolamide or Parathyroid Hormone Administration in Dogs with Distal Blockade

Renal absorption of calcium and magnesium occurs in the proximal tubule, and at unknown site(s) beyond this segment. In the presence of blockade of Henle’s loop by ethacrynic acid, the excretion of ca