Sing-Leung Lui

Castleman’s Disease and Mesangial Proliferative Glomerulonephritis: The Role of Interleukin-6

Renal complications of Castleman’s disease (angiofollicular lymph node hyperplasia) are uncommon. The reported cases are very heterogeneous and their renal pathology ranged from minimal change disease, mesangial proliferative glomerulonephritis, to amyloidosis. We have previously reported two cases of Castleman’s disease with renal complications. We now present two more such cases. In contrast to other reports, all our cases are of the plasma cell type and their renal pathology showed remarkable similarities, namely mesangial proliferation, interstitial plasma cell infiltration and negative immunofluorescence. The level of serum interleukin-6 (IL-6) in both patients was elevated at presentation and came down with immunosuppressive therapy.

PREVALENCE OF COGNITIVE IMPAIRMENT AMONG PERITONEAL DIALYSIS PATIENTS, IMPACT ON PERITONITIS AND ROLE OF ASSISTED DIALYSIS.

♦ Background: Chronic renal failure and aging are suggested as risk factors for cognitive impairment (CI). We studied the prevalence of CI among peritoneal dialysis (PD) patients using Montreal Cognitive Assessment (MoCA), its impact on PD-related peritonitis in the first year, and the potential role of assisted PD. ♦ Methods: One hundred fourteen patients were newly started on PD between February 2011 and July 2013. Montreal Cognitive Assessment was performed in the absence of acute illness. Data on patient characteristics including demographics, comorbidities, blood parameters, dialysis adequacy, presence of helpers, medications, and the number PD-related infections were collected. ♦ Results: The age of studied patients was 59±15.0 years, and 47% were female. The prevalence of CI was 28.9%. Patients older than 65 years old (odds ratio [OR] 4.88, confidence interval [CI] 1.79 – 13.28 p = 0.002) and with an education of primary level or below (OR 4.08, CI 1.30 – 12.81, p = 0.016) were independent risk factors for CI in multivariate analysis. Patients with PD-related peritonitis were significantly older (p < 0.001) and more likely to have CI as defined by MoCA (p = 0.035). After adjustment for age, however, CI was not a significant independent risk factor for PD-related peritonitis among self-care PD patients (OR 2.20, CI 0.65 – 7.44, p = 0.20). When we compared patients with MoCA-defined CI receiving self-care and assisted PD, there were no statistically significant differences between the 2 groups in terms of age, MoCA scores, or comorbidities. There were also no statistically significant differences in 1-year outcome of PD-related peritonitis rates or exit-site infections. ♦ Conclusion: Cognitive impairment is common among local PD patients. Even with CI, peritonitis rate in self-care PD with adequate training is similar to CI patients on assisted PD.

Severe hyperkalemia in a peritoneal dialysis patient after consumption of salt substitute.

for 8 – 10 hours nightly (8,9). Allergy is unlikely, given that no eosinophilia was present and that the increased WBCs developed in most patients after 6 – 10 months of exposure. Intrinsic contamination of the PD solution with endotoxin is a possibility that cannot be excluded, because the endotoxin level in the PD solution was not measured. Contamination of PD solution with endotoxin has been reported as the cause of an outbreak of sterile peritonitis (10). The reason that the increase in WBCs was observed in some children and not in others is unclear. The spontaneous improvement in one child is interesting, but the rise in WBCs was transient.

Detection of microalbuminuria in non-insulin dependent diabetes mellitus (NIDDM) patients without overt proteinuria by a semiquantitative albumin-creatinine urine strips

Abstract Microalbuminuria is the hallmark of the reversible stage of incipient diabetic nephropathy. A cost- effective and convenient bedside screening test is essential to detect this phase. We used Clinitek 50® which is a semiquantitative strip test to check spot urine sample from 81 patients with albustix one plus or less. The incidence of Clinitek 50® microalbuminuria was 17%, 18.2% and 75% in 47, 22 and 12 patients with albustix negative, trace or one plus respectively. Nineteen and 13 of the 21 Clinitek 50® positive patients were checked for spot urine DCA 2000® and two 12-hour urine collection for immunoassay respectively. Around 60% of these samples fell into the microalbuminuria range and 40% into the overt albuminuria range by either technique. There was no false positive of Clinitek 50®. The lowest range of microalbuminuria detected by Clinitek 50® was 27 μg/minute (38 mg/day). We concluded that Clinitek 50® is a useful screening test as it is nonexpensive, easily operated and has a sensitivity close to the lower range of microalbuminuria.

Anti-Glomerular Basement Membrane and Anti-Neutrophil Cytoplasm Antibody-Positive Vasculitis Presenting with Peripheral Neuropathy and Acute Renal Failure

This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, Small vessel vasculitis associated with anti-neutrophil cytoplasm antibodies (ANCA) and anti-glomerular basement membrane (anti-GBM) disease are both uncommon but severe diseases, with similar clinical manifestations including rapidly progressive glomerulonephritis (RPGN) and pulmonary haemorrhage. Despite the similarities in immunosuppressive therapy for these conditions, their response to therapy differs. We present a patient with both autoantibodies, who presented with peripheral neuropathy and acute renal failure. A 71-year-old female with good past health presented with bilateral distal upper and lower limb weakness and paraesthesia. Nerve conduction velocity and sensoryevoked potential studies confirmed the clinical diagnosis of peripheral neuropathy and a mixed sensorimotor neuropathy of predominant axonal degeneration. Her presenting serum creatinine and urea levels were 180 Ìmol/l (2.0 mg/dl) and 10.4 mmol/l (62.4 mg/dl) respectively. Serum creatinine increased to 300 Ìmol/l (3.35 mg/dl) within 2 weeks. Urinalysis: RBC ! 30/Ìl; WBC ! 3/Ìl; no abnormal casts; urinary protein: 0.77 g/day; creatinine clearance: 26 ml/min. Ultrasonography showed normal-sized kidneys. Autoimmune markers were negative. Complement and immunoglobulin levels were normal. ESR was 95 mm in the first hour and CRP was 14 mg/dl (N ! 0.3). Renal biopsy showed fibrocellular crescents in 4 of 8 glomeruli (fig. 1), with linear IgG and C3 staining pattern along the glomerular capillaries and mesangial C3 staining; C1q and IgM were focally and segmentally positive (fig. 2). By this time, anti-GBM titre came

Risk of death in dialysis patients taking cisapride

Abstract Background Cisapride is a prokinetic agent that is useful to relieve gastrointestinal symptoms that often occur in dialysis patients. However, sudden death has been reported and alarmed the use of cisapride in dialysis patients. This study was performed to identify whether the use of cisapride increases the risk of death. Methods We retrospectively analyzed all records of dialysis patients followed during the period November 1997 to March 2000. Cisapride dosage and risk factors associated with increased risk of sudden death such as cardiovascular disease, hypokalemia, and possible interacting drugs were recorded. Results Of 364 dialysis patients, 85 had been prescribed with cisapride (group A) whereas 279 had not (group B). Group A patients were older, with more female patients and longer duration of dialysis. There was no significant difference in mortality or causes of death between the two groups after adjusting for the baseline demographic differences. For group A, eight patients (9.41%) died while still on cisapride and 19 (22.4%) died after cisapride had been stopped. The causes of death were peritonitis (n = 2), infection (n = 2), ischemic heart disease (n = 1), malignancy (n = 1), sudden death (n = 1), and unknown (n = 1). Low serum albumin (p=0.013) and hypokalemia (p=0.066) were potential predictors of death while taking cisapride, but the presence of diabetes mellitus, maximum dosage of cisapride, and underlying cardiovascular disease were not. There was no drug interaction leading to cisapride toxicity. Conclusions Patients who were given cisapride were older, more often women, and had a longer duration of dialysis. Low serum albumin and hypokalemia were significant predictors of death in patients given cisapride. Although no excessive risk of death was documented, the use of cisapride in dialysis patients should still be cautious and potential drug interactions and electrolyte disturbances should be avoided.