Robert Smith Pedersen

Prognosis and risk factors in acute, dialysis-requiring renal failure after open-heart surgery.

Of 1988 patients who underwent open-heart surgery from 1980 through 1988, 68 (3.4%) developed postoperative acute renal failure requiring dialysis (2.5% of adult and 8.3% of pediatric patients). Isolated aortocoronary bypass grafting was the operation with lowest incidence of this complication (0.6%). Acute renal failure usually appeared during the first 3 postoperative days. It carried a mortality rate of 63%, with half of the deaths occurring during the first few postoperative days, due to low cardiac output and progressive multiple organ failure. Logistic regression analysis in cases of aortic valve replacement demonstrated that significant independent preoperative risk factors for acute renal failure were renal insufficiency (serum creatinine greater than 110 mumol/l in greater than or equal to 2 samples) and increased cardiothoracic index/left ventricular end-diastolic dimension. Data from the literature indicated no time-related trend towards reduction of acute renal failure incidence or mortality. Prevention of low cardiac output is of major importance in these respects. Operative intervention before development of advanced disease with left ventricular dilatation and secondary kidney failure is advocated.

Prognosis in Septicemia Complicated by Acute Renal Failure Requiring Dialysis

During a 12-year period 419 patients were admitted because of acute renal failure requiring dialysis. Fifty (12%) had septicemia verified by blood culture. In a retrospective study age, sex, focus of infection, blood culture results, kidney function, mode of dialysis treatment, numbers and durations of complicating organ failures, presence of gastrointestinal bleeding, and secondary complicating events of septicemia were recorded for the purpose of establishing a prognostic index based on clinical criteria. Respiratory failure was present in 34 patients, circulatory failure in 31 patients, failure of coagulation system in 25 patients, and hepatic failure in 10 patients. Overall mortality was 46%. Highest death-rates were found during the first days of dialysis. In patients with multiple organ failures, in elderly and in patients suffering from staphylococcus aureus septicemia, a non-significant trend towards higher mortality was found. The mode of dialysis treatment did not influence patient survival. Our intention of establishing a prognostic index based on bedside clinical criteria has not been fulfilled. Even though mortality-rate increases in patients with acute renal failure complicated by failure of one or more vital organs, survival-rate in patients with four or more organ failures was 30%.

Henoch-Schönlein Purpura Associated with Campylobacter Jejuni Enteritis

After an episode of enteritis caused by C. jejuni a 15-year-old boy developed Schönlein-Henoch purpura. Because of continuous proteinuria a renal biopsy was performed. Light microscopy revealed focal proliferative glomerulonephritis. IgA was the dominant immunoglobulin. A causal relationship between enteritis caused by C. jejuni and Schönlein-Henoch purpura complicated with focal proliferative glomerulonephritis is suggested.

Long-Term Prognosis in Idiopathic Membranoproliferative Glomerulonephritis

The following results were obtained in a long-term follow-up investigation including 37 patients who suffered from idiopathic membranoproliferative glomerulonephritis. The mean follow-up period was 51 months (median 32 months). 1) Renal survival was 35% at 5 years and 16% at 10 years. 2) Univariate analysis indicated significant (p < or = 0.10) association between poor prognosis and the two following parameters a) high age b) elevated blood pressure. 3) Using a Cox-analysis including a) gender b) age at kidney biopsy c) square of age (age age) at biopsy d) presence of nephrotic syndrome e) presence of elevated blood pressure, the following p-values were found: 0.56; 0.02; 0.04; 0.50; 0.09. Thus at the 10% level age, the square of age and elevated blood pressure were significant and independently associated with poor prognosis.

Hemodialysis does not always protect against recurrence of wegener's granulomatosis

Hemodialysis may protect against disease activity in Wegeners granulomatosis. We report here a 41-year-old woman with Wegeners granulomatosis, in whom renal transplantation was performed after a 10-month period of hemodialysis during which no signs of disease activity were detected. Recurrence of disease did, however, take place 2 years after renal allograft transplantation despite immunosuppressive therapy with cyclosporine A and prednisone. Reinstitution of hemodialysis and graftectomy did not improve the patients condition but plasmapheresis and treatment with cyclophosphamide and prednisone eliminated all signs of disease within a fortnight. A proposal for better maintenance of these patients is made.

Lead poisoning treated with haemodialysis.

A 27-year-old woman ingested as an abortifacient 40 grams of litharge (PbO). She was treated with EDTA infusion and haemodialysis. The half-life of lead in the blood was 9 hours during combined haemodialysis and EDTA infusion and 96 hours when EDTA was given alone. Signs and symptoms attributable to acute lead intoxication were mild.

Acute Renal Failure Caused by Polymyxin B Containing Ointment

A case is presented in which a 67-year-old man suffering from non-insulin-dependent diabetes mellitus, after being treated with polymyxin B containing ointment for leg ulcers, developed acute renal failure. After a period of 13 days during which the patient was treated with peritoneal dialysis 5 times, renal function returned. At discharge creatinine-clearance was 12 ml/min. Treating large ulcers with polymyxin B may be dangerous.