[A 'lucky' patient]. / Un caso 'fortunato'

A 72-year-old male diabetic patient admitted to our operative unit of nephrology and dialysis underwent hemodialytic treatment because of rapidly progressive renal failure. A moderate hypertensive state was associated to nephrotic proteinuria and microematuria. Renal angiography showed a severe stenosis of the right renal artery and a smaller left kidney. Right renal artery stenting induced a significant reduction in serum creatinine (Cr) and the patient discontinued with the dialytic treatment.

Nephrotic syndrome from 5-ASA for ulcerative colitis? Complicated by carcinoma of the colon and sclerosing cholangitis.

A patient with nephrotic syndrome had been treated with mesalazine for ulcerative colitis, and also had a carcinoma of the colon and sclerosing cholangitis. This seemingly unrelated series of complications gives us the opportunity to review the problem of nephropathy in ulcerative colitis.

Role of ageing, chronic renal failure and dialysis in the calcification of mitral annulus.

Mitral annulus calcification, a common lesion of the elderly (over age 60 years), has been detected with increased frequency and at younger ages in patients with uraemia. To date a pathogenic role for dialysis and secondary hyperparathyroidism has been suggested only on the basis of older dialytic age and increased serum iPTH observed in the affected individuals. Because this is a potentially dangerous lesion we deemed it useful to evaluate more completely the respective roles of possible pathogenetic factors in uraemic individuals. Evaluation included echocardiography, ECG, limb radiography, and serum assays. A total of 225 dialysis (HD) patients, 67 chronic renal failure (CRF) patients on conservative treatment and 67 normal subjects were studied. Mitral annulus calcification was detected in 87 of 225 (38.6%) HD patients, 11 of 67 (16.4%) CRF and six of 67 (8.9%) normals. In HD, patients with calcification were older and on longer-term renal replacement therapy compared to those without calcification. They also had greater values of iPTH, BGP, AP, and Rx score of secondary hyperparathyroidism. Mitral annulus calcification was associated more frequently (chi 2 = 14.8; P < 0.0001) with rhythm and cardiac conduction defects, but not with ectopic calcifications. Multiple stepwise regression analysis, with mitral annulus calcification score as dependent variable, selected dialysis duration, age, and iPTH (rm = 0.368) as the most predictive parameters, with the first two carrying most of the information. The stratification of patients according with these two parameters showed a progressive increase in the frequency of calcification both with HD duration and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Intradialytic changes of the oxyhaemoglobin dissociation curve during acetate and bicarbonate haemodialysis. Possible interactions with haemodialysis-associated hypoxaemia.

In nine chronic haemodialysis patients, treated alternately with acetate and bicarbonate, the main critical factors in oxygen supply to the tissues were evaluated: Hb values, blood gas parameters, red cell 2-3 diphosphoglycerate (2-3 DPG), phosphataemia and P50 in vivo. Predialytic P50 was higher than in normal controls. During dialysis, arterial pO2 and pCO2 significantly decreased in acetate dialysis, whereas they were stable in bicarbonate dialysis. Rising alkalinisation was accompanied, both in acetate dialysis and in bicarbonate dialysis, by reduction of P50, while 2-3 DPG did not change. The acute increase in Hb-O2 affinity adversely affected peripheral oxygen release. In acetate dialysis this mechanism might magnify the effects of dialysis-induced hypoxaemia, affecting the clinical tolerance.

Hemorheology in biofiltration and acetate dialysis (preliminary results).

Hemorheological measurements were made in 8 stable chronic haemodialysis patients observed in conventional acetate dialysis (AD) with Cuprophan membrane and then in biofiltration (BF) with PAN AN69S membrane. Blood viscosity diminished at the beginning, both during BF and AD, reaching pre-dialytic values again at the end of treatment. Blood and erythrocyte filtration increased after 20 min in AD and throughout the session in BF. Preliminary results suggest an improvement of hemorheological parameters during dialytic treatment, more notable in BF than in AD.

Carpal tunnel syndrome. Comparative study between normal and dialyzed patients.

The various theories of carpal tunnel syndrome (CTS) are reviewed. The clinical and other features are compared and the results of surgical decompression and neurolysis reported in two groups of patients; 65 operations in "classical" CTS and 11 operations in patients on renal dialysis ("dialytic CTS"). Relief of pain and recovery of normal sensation was achieved in a high percentage of cases in both groups. Recovery of motor function was markedly better and quicker in the "dialytic" group, probably because deterioration was more rapid and therefore surgical intervention was carried out earlier. The pathological anatomy showed no significant overall difference between the two groups, except that in two of the renal dialysis patients granular deposits of myeloid substances were observed in the flexor tendon sheaths and on the walls of the carpal tunnel.

Study of the influence of haemodialysis on the beta-methyl digoxin levels in uraemic patients.

This study was undertaken to establish the plasma pharmacokinetics of beta-methyl-digoxin (betamd) in 8 normal subjects (group 1) and 17 uraemic patients (group 2, not undergoing dialysis; group 3, undergoing dialysis). Blood samples were collected serially up to 5 hrs after an initial stimulus of 0.2 ng betamd i.v. betamd was determined both in serum and in dialysate by digoxin radioimmunoassay after having verified the following parameters: the immunological similarity between digoxin and betamd; the possibility of evaluating betamd in dialysate; the quantitative recovery of betamd both in serum and in dialysate. At 15 min after stimulus, the following betamd peaks occurred: 5.82, 3.70 and 6.00 ng/ml for groups 1,2 and 3, respectively, with a significant difference (p less than 0.02) between groups 1 and 2 and between groups 2 and 3 (p less than 0.02) up to 1 h after stimulus. For each group the rapid, mean and slow betamd half-times (T1/2) were calculated. The three T1/2 values differing from each other but being related to the different initial betamd concentrations, the angular coefficients of the disappearance regression lines (taken as parameters related to the betamd disappearance rates, dr) were plotted against the betamd concentrations expressed as % of their highest value corresponding to the respective rapid T1/2. From this approach, it can be deduced that the dr of group 1 is much higher than the dr of groups 2 and 3 which are similar. This finding, together with the consideration that we never found betamd in dialysate, permits the conclusion that the distribution rate of betamd to the tissues is significatively higher in normal than in uraemic patients and that it does not change during dialysis treatment.