Yasubumi Irie

Mode of hepatitis C infection not associated with blood transfusion among chronic hemodialysis patients.

In a retrospective study carried out on about 730 patients with chronic renal failure who underwent ambulatory hemodialysis from January 1991 to June 1994, 49 patients were found to have developed acute hepatitis C, as confirmed by seroconversion for anti-HCV antibodies without blood transfusion in the preceding 6-month period. Epidemiological survey disclosed that two patients undergoing dialysis at consoles separated by one console developed acute hepatitis C in October 1992, and another three patients at adjacent consoles also developed acute hepatitis C within 2 weeks in April/May, 1993. It was found that some negligent nurses could have withdrawn needles from these patients one after another without changing gloves at the termination of the dialysis procedure. After reeducation of the staff members and introduction of a new type of adhesive pad to be placed on the needle wounds at the time of needle withdrawal, no new case of acute hepatitis C occurred for more than 1 year, suggesting nosocomial spread of HCV infection among hemodialysis patients in a mode that is preventable with very strict aseptic precautions.

Interferon treatment for chronic hepatitis C in haemodialysis patients: Suggestions based on a small series

Chronic hepatitis C is endemic among chronic haemodialysis patients. There have been a number of reports on hepatocellular carcinoma developing in such patients in Japan. The present study reports on the treatment of 15 patients who showed elevated ALT levels due to biopsy proven chronic hepatitis C with interferon α‐2a (IFN). The dose schedule was 6 mega units (MU) daily for the first two weeks followed by 3 doses per week for 5.5 months. Side effects were so severe that IFN treatment was discontinued early in one patient, the dosage reduced in 11 and only tolerated in the original schedule by three patients. Excluding one patient who only recently completed the therapy, 13 were able to be evaluated for therapy efficacy by assessment of serum ALT and viral RNA. The overall results showed that IFN was effective in eight of 13 patients, a rate somewhat higher than the reported figures in this country. It is concluded that IFN therapy is indicated in haemodialysis patients with progressive chronic hepatitis C, but the dose administered should be lower and the dose schedule more flexible, perhaps 3 MU three times a week, in order to minimize untoward side effects.

Case–control study of calcification of the hepatic artery in chronic hemodialysis patients: Comparison with the abdominal aorta and splenic artery

Background and Aims: Studies of the hepatic artery are scarce. We have observed that hepatic artery calcification is very uncommon in patients with hyperparathyroidism that expedites calcification.

Superinfection of TT virus and hepatitis C virus among chronic haemodialysis patients

Background : The TT virus (TTV), a new DNA virus found in Japan from a patient with post‐transfusion hepatitis non‐A–non‐G, is frequently positive in the sera of patients with liver disease. It is not established whether this virus causes liver damage. We studied the frequency of superinfection of this virus and hepatitis C virus (HCV) known to be endemic among haemodialysis patients, and the possible deleterious effect of TTV on HCV‐induced chronic liver disease.

Cryoglobulinaemia among maintenance haemodialysis patients and its relation to hepatitis C infection

It has been shown that hepatitis C virus (HCV) infection is closely associated with mixed type cryoglobulinaemia. It is also known that HCV infection is rampant among chronic haemodialysis patients. We studied 531 renal failure patients on maintenance dialysis including 170 with positive HCV antibodies for cryoglobulinaemia, and its incidence was compared with controls which consisted of 242 chronic hepatitis C patients without renal failure and 183 healthy adults. Cryoglobulinaemia was present in 30.6% of dialysis patients with HCV infection, 10.8% of dialysis patients without HCV infection, 29.8% of patients with chronic hepatitis C without renal failure, and 0% of healthy adults. Among the 30 new renal failure patients who were started on dialysis within 6 months, four were positive for HCV antibodies, and one of them had cryoglobulinaemia; of the 26 HCV‐negative patients, four (15%) were cryoglobulinaemic. The cryocrit values among dialysis patients were much lower than those of the control cases and other reports on non‐dialysis cases. Patients with cryoglobulinaemia were generally younger compared with patients negative for this condition. There was no correlation between cryoglobulinaemia and past blood transfusion, underlying disease or length of dialysis. Cryoglobulinaemic patients seem to develop renal failure at relatively young ages and a considerable proportion of cryoglobulinaemic dialysis patients may have already had cryoglobulinaemia at the time of the start of haemodialysis. There was no indication that the presence of cryoglobulin in serum adversely affects the liver disease nor increases serum virus load in HCV‐infected dialysis patients. Thus, it was concluded that although HCV infection has a certain role in the development of cryoglobulinaemia in dialysis patients, they develop cryoglobulinaemia less frequently and produce cryoglobulin to a lesser degree in the presence of HCV infection as compared with non‐dialysis patients.

GB virus-C infection among chronic haemodialysis patients: clinical implications.

It is known that patients on chronic haemodialysis are frequently infected with hepatitis C virus (HCV). It has recently been found that GB virus‐C (GBV‐C) and hepatitis G virus frequently coinfect patients with HCV. This study aimed at elucidating the clinical implications of GBV‐C infection among haemodialysis patients who have and do not have HCV infection. GBV‐C RNA was detected in sera of randomly selected 98 anti‐HCV‐positive and 85 ‐negative patients on dialysis by reverse transcription‐polymerase chain reaction using two sets of amplification primers made from the reported sequences of the non‐structural protein 3 and 5’ untranslated regions. In these patients, liver function tests were carried out at regular intervals. There were six patients who were coinfected with HCV and GBV‐C and three who had only GBV‐C RNA. All had a history of past blood transfusion. The onset of mild hepatitis was identified in three HCV‐negative patients; elevation of alanine aminotransferase (ALT) following blood transfusion was very mild but recognizable, and aspartate aminotransferase (AST) was higher than ALT. In two of six coinfected patients, the onset of liver disease was recognized with a peak ALT of 72 and 90 IU/L, respectively. Two of these six were Amplicore (HCV‐RNA) negative and asymptomatic, two had low‐grade HCV viraemia and two moderate‐grade HCV viraemia. Of the 98 anti‐HCV‐positive cases, 41 were thought to have had nosocomial infection of HCV or non‐A, non‐B virus; none of them had GBV‐C. GBV‐C RNA was negative in nine patients who had chronic non‐A‐E hepatitis. GBV‐C infection was detected in 6.1% of anti‐HCV‐positive and in 3.5% of‐negative dialysis patients. All had blood transfusion in the past, and there was no evidence of patient‐to‐patient spread of GBV‐C in hospital. The liver disease was very mild and self‐limited in GBV‐C infection alone. The natural history of coinfected patients may be similar to that of those with chronic HCV infection, but the liver disease appears to be milder.

Imidapril-Induced Eosinophilic Pleurisy

We describe an unusual case of a patient with eosinophilic pleurisy associated with long-term administration of imidapril, an angiotensin-converting enzyme inhibitor (ACEI). An 81-year-old woman who had been given imidapril for the treatment of essential hypertension was admitted to our hospital for investigation of persistent low-grade fever, dry cough and difficulty in breathing. Left-sided eosinophilic pleurisy was diagnosed based on eosinophilic pleural effusion and peripheral eosinophilia. Soon after administration of imidapril was discontinued, her clinical symptoms subsided, and there was improvement in both diagnostic imaging and laboratory findings. So far, to our knowledge, this is the first reported case in which ACEI induced eosinophilic pleurisy.

A report of successful pregnancy and delivery in a hemodialysis patient, and normal developement in her child

帝王切開後4年5か月経過した現在, 母子ともに健在な血液透析患者の妊娠出産例を経験したので報告する.症例は33歳女性, 原疾患は慢性糸球体腎炎で透析歴は5年であった. 腹部膨隆を自覚し産科を受診したところ妊娠14週と診断された. 33週で帝王切開にて出産し, 新生児は体重1584gでApgar scoreは7であり, 乳児発育に異常は認められなかった.本邦における慢性腎不全患者の出産例は1986年までに15例の報告があり, 本症例は第8例目であった. 合併症として早産, 弛緩出血, 肝障害および羊水過多が多く, 早産防止には羊水過多の管理が重要である.