Systemic streptokinase infusion for declotting of hemodialysis arteriovenous fistulas.

In 17 out of 29 hospitalized patients (58.6%) with internal arteriovenous fistula (AVF) thrombosis a systemic streptokinase infusion was used as an alternative to urgent surgical declotting. In the remaining 12 patients (41.4%) fibrinolytic treatment was contraindicated due to the necessity for immediate dialysis, uncontrolled hypertension, active peptic ulcer, known multilevel stenoses of the fistula, or operation 8 days prior to the thrombosis. The systemic streptokinase therapy alone was successful in 9 of 17 patients treated (52.9%), 5 of 17 patients (29.4%) needed the combined therapy (streptokinase plus surgery) and in 3 of 17 patients (17.6%) the fibrinolytic therapy was unsuccessful. No serious complications attributable to the streptokinase infusion were observed. Systemic streptokinase treatment for acute AVF declotting followed by the radiological evaluation of the vessels can be a reasonable alternative to 'blind' surgical emergency reconstruction. The method makes it possible to identify those underlying anatomic abnormalities of the draining vein which may be localized at some distance from the anastomosis and so overlooked during surgery.

[Pulsed dose intravenous steroid treatment in the therapy of acute lupus nephritis with renal failure]. / Wlewy dozylne uderzeniowych dawek sterydów w leczeniu ostrej fazy nefropatii toczniowej przebiegajacej z niewydolnoscia nerek.

The effectiveness of pulse-dose intravenous steroid treatment was studied in acute phase of lupus nephritis with renal failure rapidly progressive despite conventional therapy. On 5-6 consecutive days 1g of prednisolone or methylprednisolone was given intravenously to 33 patients with a mean initial serum creatinine 5.9 +/- 4.1 mg/dl (521.6 +/- 362.4 mumol/l); then the patients were placed on conventional therapy. Immediate remission (group I), lasting at least 6 months, was achieved in 23 patients (69.7%), with a significant decrease of serum creatinine from 4.5 +/- 3.2 mg/dl (397.8 +/- 282.9 mumol/l) to 1.3 +/- 0.7 mg/dl (114.9 +/- 61.9 mumol/l) (p < 0.001) within 3 months. In 19 patients the remission lasted more than a year; till now the longest one is 13 years. In 10 patients (group II), the therapy brought no improvement and they went quickly into terminal renal failure. In this group the initial serum creatinine was 8.9 +/- 3.6 mg/dl (786.8 +/- 318.2 mumol/l), which was much higher than in the I group. All those patients were admitted to chronic dialysis programme; however, 5 of them died during the first 3 months of the treatment. The most frequent complications of the therapy were infections; all but one (a generalized zoster being a cause of death) caused no therapeutic difficulties. Pulse-dose intravenous steroid treatment makes achieving rapid clinical remission possible even in cases of advanced renal failure due to acute phase of lupus nephritis, refractory to conventional therapy.

Intradialytic erythrocyte volume changes.

Haemodialysis (HD) should affect the erythrocytes, which constitute more than 99% of blood cells. The aim of this study was to reinvestigate the intradialytic changes in erythrocyte water content (MCV). MCV was measured during 81 HD (47 uncomplicated, 34 with hypotension), and 16 isolated ultrafiltrations (UF) performed in stable, haemodialysed adults (12 males and 8 females). The MCV following uncomplicated HD (n = 32) did not differ from the predialysis value. Significant MCV increase accompanied the HD initiation (4.9 +/- 9.0 fl, P less than 0.001), UF (2.99 +/- 1.49 fl, P less than 0.001) and hypotension (1.8 +/- 3.1 fl, P less than 0.01). This was independent of sodium and potassium within the cells and plasma. Erythrocyte oedema occurred in situations known to accompany both bioincompatibility reactions and blood volume decrease. Intradialytic MCV increase may reflect a response to these events, possibly hormonal, and needs further investigation.

[Mannitol for the prevention of decompensation symptoms in hydrated patients undergoing long-term hemodialysis]. / Mannitol w zapobieganiu objawom zespolu niewyrównania u chorych przewodnionych, dlugotrwale dializowanych.

Symptoms of decompensation syndrome were frequently noted during sequential ultrafiltration/hemodialysis. In 9 adult patients chronically dialysed 101 cases of overhydration were seen. Mannitol was administered in a 20% solution (250 ml) in a continuous intravenous infusion during 49 dialyses. Changes in body weight were measured, arterial blood pressure, pulse rate, hematocrit, total plasma protein levels, urea, creatinine, sodium and potassium were determined as well as plasma osmolality. Mannitol significantly decreased muscular contractions during dialysis, weakness after dialysis, and incidence of various symptoms of decompensation. The values of analysed clinical parameters and laboratory tests did not differ from those determined without mannitol. Plasma creatinine, total plasma protein levels and hematocrit were significantly lower after several hours after the end of ultrafiltration/hemodialysis. We suggest that mannitol decreases the incidence of the symptoms of decompensation syndrome and is safe. Beneficial effect of mannitol is most probably produced by the changes in body fluids distribution.