Seinosuke Nakagawa

Ten Years’ Survey of Dialysis-Associated Tuberculosis

Tuberculosis associated with dialysis was studied at the Renal Unit of the Tokyo Medical and Dental University and Yokosuka Mutual Aid Hospital Kidney Center, in both of which the treatments of chronic renal failure are the same. There are 12 tuberculosis patients out of 367 patients on maintenance hemodialysis from January 1967 to December 1976, an incidence of 3.3%. This was 6-16 times greater than that in the general population of this country according to yearly statistics. The characteristics of dialysis-associated tuberculosis include a high incidence of miliary tuberculosis, especially in aged patients and difficulty in establishing the diagnosis before death. Clinical features which are helpful in the early diagnosis are intermittent high fever of unknown origin, weight loss, anorexia, abnormalities of the central nervous system, erythrocyte sedimentation rate over 100 mm/h, leukocytosis and high value of the C-reactive protein. With the increasing number of dialysis patients, an increase of dialysis-associated tuberculosis is expected and this will be one of the major problems of dialysis patients in future.

Progressive multifocal leukoencephalopathy associated with prolonged hemodialysis treatment

The association of progressive multifocal leukoencephalopathy (PML) with prolonged hemodialysis treatment (PHT), not previously reported, was observed in a 56-year-old Japanese man who received PHT for 11 years. He suffered from recurrent bouts of fever and progressive neurological signs, such as irritability, speech disturbance, gait disturbance and dysphagia for seven months, and finally fell into a deep coma and died. Clinical signs and symptoms were highly suggestive of progressive dialysis encephalopathy. Necropsy revealed that the PML mainly involved the brainstem and cerebellar white matter. The aluminium content of the brain tissue was lower than that of controls. Possibly the virus causing PML is one of the causes of progressive dialysis encephalopathy, since clinically PML is not easily distinguished from progressive dialysis encephalopathy. It is essential to differentiate PML of viral etiology from progressive dialysis encephalopathy of unknown cause.

Uremic Galactorrhea: an Endocrine Profile

Abnormal lactation (galactorrhea) was observed in 5 female patients with renal failure. This appeared in association with amenorrhea in the terminal stage of renal failure. Lactation gradually decreas

Modified leucocytopenic response and activated complement system during hemodialysis (HD) with dialyzer re-use

目的: 再使用ダイアライザーによる透析中の白血球・補体系の経時的変化を観察し, 初回使用時との比較を通じて, 白血球減少への補体系の関与と, それに対する膜表面の血液成分による被覆の効果を検討した.対象と方法: 6名の透析患者を対象とし, セルロース膜を用いたダイアライザーによる連続する2回の透析において, 初回を新しいダイアライザー, 次回を再使用として, この連続する2回の透析を1クールとし, 計7クールを行なった. 再使用の手技は初回透析後4u/mlヘパリン化生理食塩液2000mlにて洗浄, 冷蔵保存とし, 次回透析に使用した. 各透析ごとにヘマトクリット, 白血球数, CH 50, C 3, C 4を測定した.結果: 白血球減少は初回では最初の15分で65.9±8.9 (M±SD)%と高度の低下をみたが, 再使用時は47.7±16.6%の低下にとどまり, 減少率の差はクリアランス変化を用いた面積補正を行なっても有意であった. 補体系は, 初回では, 最初の15分にCH 50, C 3に有意の低下を認めたが, 再使用では有意の低下はみられなかった. 白血球減少率と補体各成分の減少率の間には, 初回および再使用を通じ, 有意の相関は認められなかった.考察とまとめ: ダイアライザーの再使用により, 白血球減少と補体活性化の程度を軽減させることが可能であった. 血液成分による膜面の被覆が, 血液・透析膜間の相互作用に変化を与えたものと考えられた. セルロース膜を人工臓器材料として用いる場合の生体適合性の示標と考えられているこれら2つの反応は, 適切な膜面処理により防止しうるものと考えられた. また, 補体活性化は白血球減少の一部であることを示唆する.