Subject(s)
Barotrauma/etiology , Fistula/etiology , Hydrothorax/etiology , Peritoneal Dialysis/adverse effects , Peritoneal Diseases/etiology , Peritoneum/injuries , Pleura/injuries , Pleural Diseases/etiology , Drainage , Female , Glucose/analysis , Glycogen Storage Disease Type V/complications , Humans , Hydrothorax/surgery , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/therapy , Middle Aged , Pleural Effusion/etiology , Pleural Effusion/surgery , Rupture/etiologySubject(s)
Antibiotic Prophylaxis , Catheter-Related Infections/prevention & control , Peritoneal Dialysis/adverse effects , Peritonitis/prevention & control , Administration, Topical , Candidiasis/etiology , Candidiasis/prevention & control , Catheter-Related Infections/epidemiology , Catheter-Related Infections/etiology , Catheter-Related Infections/microbiology , Catheters, Indwelling , Device Removal , Gentamicins/administration & dosage , Gentamicins/adverse effects , Gentamicins/therapeutic use , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/etiology , Gram-Negative Bacterial Infections/prevention & control , Humans , Peritoneal Dialysis/instrumentation , Peritonitis/epidemiology , Peritonitis/etiology , Peritonitis/microbiology , Staphylococcal Infections/epidemiology , Staphylococcal Infections/etiology , Staphylococcal Infections/prevention & controlSubject(s)
Edema/etiology , Genital Diseases, Male/etiology , Peritoneal Dialysis/adverse effects , Aged , Humans , MaleABSTRACT
We report a patient in Automatic Peritoneal Dialysis (APD) with tuberculous peritonitis by possible peritoneal infection due to the proximity between fallopian tube and the left ovary, a peritoneal liquid culture was constantly negative. The patient presented a bad clinic evolution. Her only medical history was hypercalcemia six months before developing a peritonitis and occasionally nausea and vomits To confirm the diagnosis it was needed a peritoneal biopsy by means of a laparoscopy with a removal of the peritoneal catheter and left anexectomy. Now, the patient is asintomatic in daily home hemodialysis.
Subject(s)
Peritoneal Dialysis , Peritonitis, Tuberculous/etiology , Adnexal Diseases/diagnosis , Adnexal Diseases/microbiology , Adnexal Diseases/surgery , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Combined Modality Therapy , Drug Therapy, Combination , False Negative Reactions , Female , Humans , Hypercalcemia/etiology , Hypoalbuminemia/etiology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Laparoscopy , Middle Aged , Ovarian Cysts/complications , Ovariectomy , Peritonitis, Tuberculous/diagnosis , Peritonitis, Tuberculous/drug therapy , Peritonitis, Tuberculous/surgery , Pneumoperitoneum/etiology , Tuberculoma/diagnosis , Tuberculoma/surgery , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/surgerySubject(s)
Candidiasis/etiology , Catheter-Related Infections/microbiology , Peritoneal Dialysis/instrumentation , Peritonitis/etiology , Aged , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Catheter-Related Infections/etiology , Device Removal , Fluconazole/therapeutic use , Flucytosine/therapeutic use , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Klebsiella Infections/drug therapy , Klebsiella Infections/etiology , Klebsiella pneumoniae/isolation & purification , Male , Recurrence , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Staphylococcus epidermidis/isolation & purificationSubject(s)
Quality of Life , Renal Dialysis , Sleep , Humans , Peritoneal Dialysis , Surveys and QuestionnairesSubject(s)
Emphysema/etiology , Peritoneal Dialysis/adverse effects , Pyelonephritis/etiology , Aged , Humans , MaleABSTRACT
Prototheca spp exits throughout nature but only infrequently cause infection in humans. Most of the cases of human infection have involved the skin or subcutaneous tissues, but there have been reports of rare cases of protothecosis of the urinary tract, and disseminated disease. The species most commonly isolated is Prototheca wickerhamii. Few cases of peritonitis due to P. wickerhamii in peritoneal dialysis had been reported. We report a successful treatment of Prototheca peritonitis complicating peritoneal dialysis with amphotericin, itraconazole and removal of the catheter.
Subject(s)
Infections , Peritoneal Dialysis , Peritonitis/etiology , Prototheca , Adult , Humans , Infections/drug therapy , Male , Peritonitis/drug therapyABSTRACT
Vascular access failure is an important cause of morbidity and mortality for patients on haemodialysis. We have prospectively studied, with a 5 years follow up, a monitoring protocol of native vascular accesses, using the available methods in every haemodialysis unit. All the native vascular accesses, created from 1- 1998 to XII-2001, with a posterior follow up until XII-2002, were monitored. Monitoring was based on physical examination, dificulty for blood flow greater than 300 ml/min, and in a monthly basis: dynamic venous pressure, urea recirculation and urea kinetic model. Abnormalities suggestive of fistulogram were a priori defined. During the recruitment period, a total of 164 accesses were created in 144 patients. Of these only 3 were grafts, 28 native vascular accesses were never functioning (primary failure rate 17. 1%), and 127 native accesses created in 113 patients (age 63.3 +/- 12.4 years; 18 % diabetics), were monitored (83% cephalic vein). Monitoring findings indicated realization of fistulogram in 35% and percutaneus angioplasty in 25% of the accesses. In order to maintain patency, the surgical intervention rate was 0.03 procedures/patient/year, the radiological 0.10 and the total 0.13. During the 5 years of the study occurred 41 thrombosis episodes in 40 accesses (0.07 thrombosis/patient/year), with percutaneus repermeabilization in 30%. Primary (unassisted) survival was 30.3 months (Confidence Interval 95% 25.6, 35.0) and secondary (assisted) survival 42.8 months (Confidence Interval 95%: 38.7, 46.9). Logistic regression analysis showed that presence of a central catheter at the time of creating the vascular access posses a greater risk for thrombosis (Relative Risk 5.6 if in subclavian vein), whereas age, diabetes, time to canulation, number of previous accesses and anatomic type do not increase that risk. In conclusion, in an old haemodialysis population, with an important diabetes prevalence, it is possible to create functioning native vascular accesses in most of them. The monitoring protocol allowed the detection and posterior correction of stenosis in a great number of accesses. The main risk of thrombosis is the presence of a central catheter at the time of creating a vascular access.
Subject(s)
Catheters, Indwelling , Kidney Failure, Chronic/therapy , Renal Dialysis , Follow-Up Studies , Humans , Middle Aged , Monitoring, Physiologic , Prospective StudiesSubject(s)
Kidney Transplantation , Losartan/pharmacology , Postoperative Complications/drug therapy , Receptors, Angiotensin/drug effects , Uric Acid/blood , Adult , Cyclosporine/adverse effects , Cyclosporine/pharmacology , Drug Evaluation , Erythroid Precursor Cells/drug effects , Erythropoietin/metabolism , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/pharmacology , Kidney Tubules/drug effects , Kidney Tubules/physiopathology , Losartan/therapeutic use , Middle Aged , Polycythemia/etiology , Postoperative Complications/blood , Postoperative Complications/chemically induced , Receptor, Angiotensin, Type 1 , Receptors, Angiotensin/physiology , Renal Circulation/drug effects , Treatment OutcomeABSTRACT
UNLABELLED: Hyperhomocysteinemia is an independent risk factor for cardiovascular mortality in ESRD, but about 80% of total homocysteine (tHcy) is bound to albumin (alb). We have tried, prospectively, to reduce tHcy levels by using folic acid (f.a.) and vitamin B6 (P.P.) supplementation. All patients on HD, not receiving f.a. or P.P. and all new patients, after their third month on HD, were supplemented with f.a. 5 mg/48 hours p.o and P.P. 40 mg/week. We determined folate, P.P. (RIA), vit. B12, KTV, residual renal function (KRU), PCRn, alb and tHcy levels (HPLC). 80 patients, age 62.6 +/- 13.6 years, time on HD 16.2 +/- 25.1 months, all dialysed with AN69 or PPMA, and bicarbonate, were included. The prevalence of hyperhomocysteinemia was 84.4%, and P.P. deficit was present in 32%, with folate in the low normal range. At the beginning of the study, before supplementation, tHcy was negatively correlating only with folate (r = -0.336) (p = 0.01), and not with P.P., vitamin B12, age, albumin, KTV, KRU or PCRn. 58 patients received six months of supplementation, with normalization of P.P. levels, a significant increase of folate (7.25; I.C = 95% confidence intervals: 6.45, 8.05 vs 61.29; I.C.: 44.47, 78.11) (p < 0.001), and decrease of tHcy (24.1; IC: 21.5, 26.3 vs 19.9; I.C: 17.5, 22.4) (p < 0.05). 33 patients have received 12 months of supplementation, but in spite of a continued increase of folate (100.78; I.C: 74.81, 126.74) (p < 0.001), only 3 have normal levels of tHcy; correlating directly tHcy with albumin (r = 0.56) (p = 0.001), that had increased compared to the beginning of the study (3.39; I.C. 3.29, 3.49 vs 3.50; I.C: 3.37, 3.63) (p < 0.05). CONCLUSION: After f.a. and P.P. supplementation, though initially tHcy is reduced, this response is short lived, and tHcy directly correlates with albumin levels. Good nutrition associated with HD adequacy, in absence of B vitamin deficits, seems to be the best determinant of tHcy levels rather than its removal by dialysis tHcy levels should be interpreted taking into account the serum albumin.