Steven F. Gouge

Chemical Peritonitis Secondary to Intraperitoneal Vancomycin

Although previously reported in the literature, the existence of chemical peritonitis due to vancomycin in patients on peritoneal dialysis remains controversial. We report four similar episodes of sterile peritonitis in three patients receiving intraperitoneal (IP) vancomycin. The prior report implicated a change in the brand of vancomycin preparation, from Vancocin to Vancoled, as a contributing factor. We noted the occurrence of such episodes following a switch from Vancocin to a generic preparation from Abbott Laboratories. High-performance liquid chromatographic (HPLC) profiles of the three preparations show Vancocin to have a lower level of impurities than the other two; the presence of certain contaminants in the other brands may be contributing to the clinical difference observed. We conclude that chemical peritonitis due to IP vancomycin administration does occur, and that increased awareness of this entity could allow other cases to be identified.

Analysis of the Quantitative Relationship Between Anemia and Chronic Renal Failure

The authors analyzed data from 106 adults with chronic renal failure [(CRF), serum creatinine (Scr) greater than 132.6 mumol/l (1.5 mg/dl)], to define the precision of, and effects of covariables on, the relationship between anemia and CRF. We excluded dialyzed or patients who had received transplants and those with obvious potential nonrenal causes of anemia. Hct was a linear function of BUN and Scr (r = -0.48, and r = -0.67, respectively), and a curvilinear function of creatinine clearance (r = 0.68), all p less than .0001. Confidence interval analysis revealed a +/- 10 volume percent variation in Hct at any level of renal function. Sex was the only covariable that affected Hct independently of CRF. This study suggests that CRF may have a different effect on Hct in males and females and indicates that the range of Hct possible at a given level of CRF precludes attributing anemia to CRF with assurance.

Hemodialysis-Associated Acute Subdural Hematoma

Subdural hematoma is an infrequent occurrence in association with hemodialysis. Because of its rarity, there is no widely accepted method of continuing dialysis in such patients. We describe a case of

Scleroderma Renal Crisis Prior to Scleroderma

SCLERODERMA renal crisis (SRC) is characterized by rapid onset of severe hypertension and rapid deterioration of renal function. Although this event usually complicates established progressive systemic sclerosis (PSS), occasionally SRC may be the mode of presentation of the illness. 1 We report a case in which renal failure occurred before skin thickening, causing other etiologies of renal failure to be considered. The diagnosis of scleroderma renal involvement was confirmed at autopsy.

Radiocontrast Removal by Dialysis Membranes

To examine the effect of membrane characteristics on radiocontrast mass transfer, we studied in vitro clearances with cuprophane and polyacrylonitrile (PAN) dialyzers and with polysulfone hemofilter. A perfusate of saline at 37 degrees C, with 7.5 mmol/l (45 mg/dl) of urea and either Renografin (molecular weight 723) or Hexabrix (1405), was pumped through the blood path of dialyzers at 200 ml/min for 5 min. Each radiocontrast agent (RCA) and dialyzer was tested at 0, 150, and 250 or 300 mm Hg transmembrane pressure. In experiments with the use of hemofilter, clearances were tested at the perfusate flow of 50, 100 and 150 ml/min. RCAs were measured by fluorescent excitation analysis of iodine. Mean urea clearance was 16% higher in PAN than in cuprophane dialyzers. Clearance of RCAs was 1.5-3 times higher in PAN than cuprophane dialysers. With the latter, increases in transmembrane pressure resulted in a small amount of ultrafiltration (UF) and little increment in RCA clearance. With the former, increases in transmembrane pressure resulted in massive UF and remarkable increases in RCA clearance. Renografin clearance generally exceeded that of Hexabrix, which we attributed to Renografins lower molecular weight. With the hemofilter, sieving coefficients were approximately 0.8 for each RCA. Yet, because of the lack of diffusive transport and a small surface area even at the highest perfusate flow rates, RCA clearance by the hemofilter was 20-50% less than that of cuprophane dialyzers. We conclude that PAN dialyzers are more efficient for RCA removal than cuprophane dialyzers or polysulfone hemofilters.

Inferior vena cava thrombosis due to an indwelling hemodialysis catheter.

Various indwelling venous catheters have been used in hemodialysis patients after failure of traditional angioaccess. Thrombosis of the subclavian vein occurs with these cannulae and is usually asymptomatic. Such thromboses rarely cause significant pulmonary embolism. We describe a thrombus in the inferior vena cava due to an indwelling hemodialysis catheter, a site with potential for fatal pulmonary embolism.