Peritonitis caused by Monilia sitophila in a patient undergoing peritoneal dialysis.

Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and "nonpathogenic" fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.

Dialysate protein losses with bleach processed polysulphone dialyzers.

We measured dialysate protein losses from polysulphone dialyzers undergoing repetitive processing with bleach and formaldehyde. The entire dialysate was collected during the first, fifth and tenth use of F-80 dialyzers. Dialysate protein concentration was 1.5 +/- 0.4 mg/dl N = 11 +/- SEM) during the first use, 2.1 +/- 0.3 mg/dl during the fifth use and 3.6 +/- 0.5 mg/dl (N = 10) during the tenth use. In a follow-up study, dialyzers were evaluated for up to 25 uses. After 12 to 15 uses dialysate protein was 7.9 +/- 0.8 mg/dl (N = 13), after 16 to 20 uses; 12.0 +/- 1.2 mg/dl (N = 13) and after 23 to 25 uses; 19.9 +/- 2.1 mg/dl (N = 5). Mean dialysate volume was 83.9 +/- 1.1 liters (N = 63) yielding total protein losses of up to 20.7 grams per treatment. Dialysate albumin losses, which were unmeasurable during the first use of the dialyzers, revealed a similar increase with reuse resulting in a mean value of 14.4 +/- 3.2 mg/dl after 23 to 25 reuses (N = 5). Dialysate beta-2 microglobulin (beta 2m) levels were 1.05 +/- 0.13 mg/l for dialyzers bleached < 10 times (N = 32) versus 1.54 +/- 0.15 mg/liter for dialyzers bleached > 10 times (N = 31, P < 0.02 vs. < 10 reuses). A random sampling of dialyzers processed without bleach for 8, 14, 15, 24 and 25 reuses revealed minimal protein losses, ranging from 1.4 to 2.7 mg/dl with no relation to reuse number and no measureable albumin.(ABSTRACT TRUNCATED AT 250 WORDS)

Mesangial proliferative glomerulonephritis with IgM deposits. Clinicopathologic analysis and evidence for morphologic transitions.

To determine the natural history of mesangial proliferative glomerulonephritis (MesPGN) with IgM deposits and its relationship to minimal change disease (MC) and focal segmental glomerulosclerosis (FGS), we studied the clinical characteristics and outcome in 20 patients with MesPGN, 8 with MC, and 10 with FGS. IgM deposits were present in glomeruli of all MesPGN patients. Progression to FGS was documented in 2 patients with MesPGN, 1 of whom developed renal failure. Transition from MC to MesPGN occurred in 1 patient. 2 MC patients developed FGS, with decline in renal function in 1 of them. These data suggest the possibility of histologic transition from MC to FGS directly or through the stage of MesPGN.

Metoprolol and alopecia.

Beta-adrenoceptor antagonists are very popular agents in the treatment of hypertension. Reversible alopecia of the telogen effluvium variety has been described with propranolol (inderal). We describe a case of reversible alopecia with metoprolol (Lopressor) which also was associated with a telogen effluvium on scalp biopsy, suggesting a similar mechanism for the alopecia associated with these agents.