Hemolytic uremic syndrome in patients with Behçet's disease treated with cyclosporin A: report of 2 cases.

Hemolytic uremic syndrome (HUS) has been reported in patients treated with cyclosporin A (CsA) following bone, hepatic and kidney transplantation. We report two patients with Behçet's disease (BD) under CsA treatment because of severe uveitis, who developed HUS several months after the initiation of treatment. Renal biopsies showed lesions consistent with the diagnosis of the arterial form of thrombotic microangiopathy: vascular thrombosis with extensive glomerular ischemia. Renal failure persisted after withdrawal of CsA: one patient is in chronic renal failure (CRF) with a 4-year follow-up; the other died after refusal of chronic hemodialysis. In our two patients, excessive doses of CsA with high trough levels are likely to have contributed to the development of HUS. A rapid adjustment of CsA doses and an early detection of signs of the microangiopathic process might have prevented this severe complication of CsA treatment.

Idiopathic acute interstitial nephritis associated with anterior uveitis in adults.

Concomitant renal and ocular lesions have been described in a few systemic diseases. The association of acute interstitial nephritis (AIN) and anterior uveitis without determined cause was first described in children. Recently, the same clinical association has been reported in adults. We report 3 cases of this association and present a review of the literature. Including our 3 patients, 7 cases of this association have been reported in adults. All patients were females aged 27-74 years. Initial symptoms were either ocular, or pseudoviral (fever, myalgia and fatigue). Histological renal studies revealed acute interstitial nephritis with tubular lesions. Immunofluorescence and electron microscopy were not contributive. Ocular prognosis was always good. In 5 patients, the evolution of renal function was excellent with complete resolution of acute renal failure within a few weeks. Chronic renal failure developed in two of the four patients who did not receive systemic steroid therapy (with evolution towards terminal renal failure in one patient). Three of the patients received 60 mg per day of prednisone and none of them developed chronic renal failure. Despite the small number of patients reported and the possibility of spontaneous regression, these data suggest a beneficial effect of systemic steroid therapy to prevent or reduce interstitial inflammation and subsequent fibrosis.

Dialysis treatment of insulin dependent diabetic patients: ten years experience.

From January 1973 to March 1983, 108 IDD patients with a mean age of 46 years were accepted to the dialysis program of the Hôpital de la Pitié. Since January 1973, 67 patients have been treated by hemodialysis. Since August 1978, 38 patients have been treated by CAPD. Three patients have been treated by intermittent peritoneal dialysis. Although diabetic patients remain at a higher risk compared to patients of the same age group, very encouraging results are observed including a 75% survival rate at three years among hemodialyzed patients less than 50 years old. Since 1978, CAPD, when home dialysis was possible, was selected as a first choice treatment. Some severe peritoneal complications still jeopardize the advantages of this method. Diabetics with ESRD, even in the older age group, should not be excluded from treatment. They should be offered within an integrated program all dialysis methods and transplantation.

Acute effects of clometacin on renal prostaglandin biosynthesis in healthy subjects.

In 6 healthy subjects the effect of clometacin on renal function, sodium and water excretion, plasma renin activity and urinary excretion of prostaglandins has been studied. After four days of treatment with clometacin, the excretion of urinary prostaglandins E2, F2 alpha and 6 keto F1 alpha and thromboxane B2 were reduced by 61.2, 41.2, 59 and 42%, respectively. 62% reduction in plasma renin activity was also observed. There was no significant change in mean blood pressure, heart rate, body weight, creatinine clearance or urinary excretion of sodium. It is concluded that clometacin is an efficient cyclooxygenase inhibitor in healthy individuals with a normal sodium intake, and that caution is required when giving clometacin to patients at risk of developing renal failure during treatment with a cyclooxygenase inhibitor.

[Peritonitis during continuous ambulatory peritoneal dialysis. Lavage treatment or not? A prospective study]. / Les péritonites au cours de la dialyse péritonéale continue ambulatoire. Traitement par lavage ou non? Etude prospective.

A prospective study. To evaluate the advantages of continuous peritoneal lavage in treating peritonitis occurring during continuous ambulatory peritoneal dialysis a prospective study was planned in one Center during a 5 months period. 32 cases of peritonitis divided in two groups were treated according to 2 different protocols, one with continuous peritoneal lavage, the other one with the standard dialysis technique using the bags. Intraperitoneal administration of antibiotics was similar in both groups. Results show no significant advantages in using peritoneal lavage. Continuous lavage should be restricted to cases whose treatment is started late as well as those with purulent dialysate and fungi infections.

[Acute renal failure following intravenous urography. 4 cases (author's transl)]. / Insuffisance rénale aiguië après urographie par voie veineuse. 4 observations.

The authors report on 4 cases of acute oligo-anuric renal failure that followed intravenous urography (IVU) independently from myeloma or cardiovascular collapse. Eighty other cases can be found in the literature. Post-IVU renal failure only occurs in patients already presenting with chronic renal insufficiency, those with diabetic or geriatric arterial disease being particularly at risk. It is reversible in only one out of two cases when serum creatinine levels exceed 440 mumol/l. The various triiodide contrast media with a high osmolality are equally nephrotoxic. The pathophysiology and prevention of this complication of IVU are discussed.

Is continuous ambulatory peritoneal dialysis the best dialysis choice for insulin dependent diabetics?

In the last eight years 100 insulin dependent diabetics (IDD) have been dialysed at the Hôpital de la Pitié. Since August 1978 31 have been started on continuous ambulatory peritoneal dialysis (CAPD). Cumulative duration of treatment was 336 patient months, with an average time of 10.8 months. The actuarial technique success rate was 82 per cent at one year and 65 per cent at 18 months. Causes of drop out were seven deaths and six transfers to haemodialysis. The peritonitis rate was one episode every year. For some IDD patients and within the period of observation, CAPD offers a unique opportunity to be dialysed at home with excellent clinical and biological results.

[Continuous ambulatory peritoneal dialysis (CAPD). 3 years' therapeutic experience in 100 patients]. / Kontinuierliche ambulante Peritonealdialyse (CAPD). 3jährige Behandlungserfahrungen an 100 Patienten.

The pros and cons of CAPD are weighed up on the basis of a 3-year study on 100 patients with renal insufficiency (61 men, 36 women and 3 children). If equal groups are compared, the survival rate corresponds to that of haemodialysis. Continuous detoxication and dehydration lead to a good uraemic metabolic situation (creatinine 960 mumol/l, urea 24 mmol/l, haemoglobin 98 g/l, albumin 31 g/l. The serum electrolytes are well-balanced, anorganic phosphate is normal. The rise in cholesterol and triglycerides observed is a possible negative influence with regard to arterial sclerosis. The functioning of the kidneys is not affected by CAPD. The main risks of this method of therapy are peritonitis and loss of protein via the peritoneal dialysate, which can be favourably influenced by strictly antiseptic handling when changing the dialysate bag and a sufficient protein supply in the diet. In France 10-15% of all patients with terminal renal insufficiency will be treated with CAPD in future.

[Optimization of enoxaparin dose in the prevention of coagulation in the circuits of hemodialysis: results of a multicenter study]. / Optimisation de la dose d'énoxaparine (Lovenox) dans la prévention de la coagulation des circuits d'hémodialyse: résultats d'une étude multicentrique.

In order to define the optimal dosage of a low molecular weight enoxaparine (Lovenox) in the prevention of clotting in extracorporeal circulation during hemodialysis, a multicentre trial was conducted in 72 patients dialysed in seven hemodialysis units. During three weeks, these patients received as antithrombic treatment a single injection of enoxaparine at the beginning of the session. The initial dose fixed by previous data concerning dialysis with high hemorrhagic risks patients was 0.5 mg/kg (50 U1 Anti-Xa/kg). According to the evaluation of thrombotic manifestations during a 4 hour dialysis, the dosage was progressively increased if necessary for each patient. For 41% patients, the initial dose of 0.5 mg/kg was maintained along the whole study; 59% patients needed higher dose, between 0.6 and 0.9 mg/kg. The mean dose for the whole patient population at the end of the study was 0.62 +/- 0.16 mg/kg. No complication nor side effect was noted. The influence of blood flow, nature of dialysis membrane, level of hematocrit was studied. In conclusion, 0.5 mg/kg of enoxaparine can prevent thrombotic manifestations in almost half of chronic hemodialysed patients with good results. Further studies could precise the place of personal or technical parameters in the choice of the optimal dose for each patient.