Factors associated with recovery of renal function in patients with multiple myeloma who were treated with hemodialysis.

BACKGROUND: The presence of renal failure in patients with multiple myeloma (MM) has been considered an ominous prognostic factor associated with a significantly decreased life expectancy. The prognostic factors have seldom been analyzed to predict discontinuation of hemodialysis (HD) therapy in MM patients with renal failure after HD initiation. It is clinically very important to predict whether HD can be discontinued after introducing HD in such patients. METHODS: All medical and HD records were reviewed in MM patients who underwent HD in the National Center for Global Health and Medicine Hospital between January 1995 and May 2009. Thirty-two patients with MM had undergone HD. The clinical features and the factors that might be associated with recovery of renal function leading to discontinuation of HD in MM patients with severe renal failure were examined. RESULTS: The factors associated with recovery of renal function and discontinuation of HD were: low International Staging System (ISS) score (p = 0.0034); high response to chemotherapy (p = 0.036); low serum Ca (p = 0.006); low Cr (p = 0.019), and low serum ß2-microglobulin (sß2M) (p = 0.002). On multivariate analysis, low serum Ca and sß2M were significantly associated with HD discontinuation. Moreover, discontinuing HD was the significant factor associated with improved overall survival in MM patients who required HD at least once. CONCLUSION: sß2M and Ca were the laboratory parameters that were significant, independent prognostic factors for predicting the probability of recovery from severe renal failure and discontinuation of HD in MM patients who needed HD at least once.

Antiepoetin antibody-related pure red cell aplasia: successful remission with cessation of recombinant erythropoietin alone.

An elderly patient with pure red cell aplasia (PRCA) with antierythropoietin (anti-EPO) antibodies is described. PRCA due to alloimmunization is a rare and severe complication of recombinant human erythropoietin (rHu-EPO) therapy. Most reported patients with PRCA were cured primarily by immunosuppressive drug therapy. The patient in this case, however, did not want to receive any immunosuppressive drugs. Therefore, rHu-EPO injection was simply discontinued, the severe anemia gradually improved, and the hemoglobin approached normal range. This case is very rare and significant in that there have been few such elderly patients with rHu-EPO-induced PRCA in whom PRCA remission was achieved, with decreasing antibody titers, after cessation of rHu-EPO alone. Further cases are needed to assess how PRCA should be treated in patients with anti-EPO antibodies.

The value of QuantiFERON TB-Gold in the diagnosis of tuberculosis among dialysis patients.

BACKGROUND: It is difficult to diagnose tuberculosis (TB) in dialysis patients because of the high rate of extrapulmonary TB in these patients compared with the general population. Recently, a new diagnostic test called QuantiFERON (QFT) has been developed and shown promise as a diagnostic tool for active TB diseases and latent TB infection. METHODS: We examined 162 dialysis patients admitted to a single institute, including 8 patients with active TB, and evaluated the utility of this test in dialysis patients. RESULTS: Among 162 dialysis patients, positive QFT results occurred in 28 (17.3%), negative QFT results occurred in 95 (58.6%) and indeterminate QFT results occurred in 39 (24.1%). All eight active TB patients had positive QFT results, and none of the 95 patients with negative results had active TB. Among 23 patients with a history of active TB, 10 (43.5%) had positive results. Although the indeterminate rate was relatively high, no patient with an indeterminate result had active TB. Factors such as shorter duration of dialysis, lower lymphocyte count and higher white blood cell count were associated with indeterminate results. Among 105 cases after excluding the patients with previous TB or indeterminate results, the sensitivity of the QFT is 100% (8 of 8) and the specificity is 89.7% (87 of 97 cases). CONCLUSIONS: Our data suggest that the QFT test is a useful supplementary tool for the diagnosis of active TB even in dialysis patients. Negative and indeterminate results on this test may be used to exclude the presence of active TB.

Abnormal Movements of Japanese Infants following Treatment with Midazolam in a Neonatal Intensive Care Unit: Incidence and Risk Factors.

Background. This study was conducted to investigate the incidence of, and factors associated with, myoclonus-like abnormal movements of Japanese infants following treatment with midazolam in a neonatal intensive care unit (NICU). Methods. We retrospectively investigated abnormal movements and associated risk factors in Japanese infants (less than 1 year old) who received continuous intravenous midazolam treatment in the NICU of the Neonatal Medical Center, Kumamoto City Hospital, Japan, between April 2007 and March 2009. Results. The study included 94 infants who received 119 sessions of midazolam treatment in total. Nine infants (9.6%) developed abnormal movements attributable to midazolam. These nine patients had a significantly lower gestational age at birth, a significantly lower number of weeks after conception at the start of midazolam treatment, and significantly lower body weight compared with patients free of abnormal movements. Logistic regression analysis revealed neonatal asphyxia as a factor associated with an elevated risk of abnormal movements (P = 0.03). Conclusion. The incidence of abnormal movements after midazolam treatment was about 9.6% among the Japanese NICU infants. This result suggests that neonatal asphyxia may be involved in the onset of abnormal movements in infants treated with midazolam.

Thrombotic microangiopathy associated with tuberculous infection.

A 32-year-old man was diagnosed as having thrombotic microangiopathy (TMA) and treated by plasma exchange (PE). During the course of admission, he was also newly diagnosed with pulmonary tuberculosis, tuberculous peritonitis and pleuritis, which was thought to be the cause of the TMA. There are only a few previous reports on TMA associated with tuberculous infection. Although its pathogenetic mechanism is not well understood, it would be valuable to recognize that this worldwide infectious disease could cause TMA.