Ten years' experience with continuous ambulatory peritoneal dialysis.

Up to January 1989, 171 patients were trained at our center on continuous ambulatory peritoneal dialysis (CAPD), and 17 on continuous cyclic peritoneal dialysis (CCPD). Over 10 years, we have gained 5,068 patient-months experience. Patient survival was 60% and 31% at 5 and 10 years, respectively. In contrast, diabetics had a survival of 32% at 5 years. Major complications included 499 new episodes of peritonitis, 304 exit-site infections, 22 hernias, five bowel perforations, one hydrothorax, and three episodes of sclerosing encapsulating peritonitis. Our technique survival has been 62% and 40% at 5 and 10 years, respectively. We believe that CAPD is a viable dialysis technique for long-term treatment of chronic renal failure and it should be offered as an option to intermittent hemodialysis.

Sclerosing encapsulating peritonitis in rats induced by long-term intraperitoneal administration of antiseptics.

Continuous ambulatory peritoneal dialysis (CAPD) is an effective long-term treatment for renal failure. Sclerosing encapsulating peritonitis (SEP) is a rare but devastating complication of CAPD and may be caused by long-term peritoneal antiseptic exposure. We examined the peritoneal injury resulting from daily inoculations of moderately high concentrations of the following antiseptics: povidone-iodine, Dakin's solution, Amuchina, and Ampercide. After 4, 8, and 12 weeks of daily intraperitoneal injections in rats, a 10% solution of povidone-iodine in dialysis fluid caused a condition that mirrors human SEP. Animals had poor early weight gain, and gross necropsy examination revealed intestinal adhesions and a mesothelium that was sclerotically thickened. From 4 to 8 weeks the 10% povidone-iodine-injected animals showed progressive conditions and the prevalence of multiple encapsulating adhesions increased from 0/6 to 4/4, p = 0.005. Marked visceral mesothelial thickening in the 10% povidone-iodine-injected animals was quantitated after 4, 8, and 12 weeks at 92.0 +/- 11.6, 151.5 +/- 28.8, and 206.0 +/- 36.2 micron, respectively. Rats injected with dialysis fluid (controls) had normal-appearing mesothelial surfaces measured at 1.8 +/- 0.2, 2.4 +/- 0.2, and 2.2 +/- 0.2 micron after 4, 8, and 12 weeks, respectively. The marked thickening of the mesothelium in the 10% povidone-iodine group compared with the controls was highly significant, p less than 10(-8). We conclude that povidone-iodine, the most commonly used antiseptic in CAPD, caused severe tissue injury, whereas other antiseptic solutions, Dakin's, Amuchina, and Ampercide, at the similar dilution did not appear to cause mesothelial injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Nephrotoxicity of cis-diamminedichloroplatinum(II) as measured by urinary beta-glucuronidase.

Urinary beta-glucuronidase activity as a measure of renal tubular damage was studied in 23 patients receiving 43 courses of cis-diamminedichloroplatinum(II) therapy. A 250% increase in urinary beta-glucuronidase activity was noted after therapy, compared with values before therapy. There were no patients who sustained renal insufficiency as evidenced by more commonly used and coarser parameters of renal function. This marked rise in urinary beta-glucuronidase activity was felt to indicate tubular toxicity due to the cis-diamminedichloroplatinum(II) not measured by the usual parameters of renal function.

Nail-patella syndrome.

Three cases with collagenation of glomerular basement membrane are presented. The ages of the patients are 8, 13, and 27 years. An 8-year-old boy presented with nephrotic syndrome; a 13-year-old girl presented with recurrent urinary tract infections, proteinuria, and edema; and a 27-year-old woman was noted during the evaluation of a cardiac murmur to have proteinuria and renal insufficiency. The changes on electron microscopy were identical to those observed in nail-patella syndrome, a rare hereditary disease with ectodermal and mesodermal involvement, manifested as bony and nail abnormalities. Nephropathy is now a well established part of this syndrome. Our cases did not have the typical bony and nail changes. We feel these three cases represent a partial gene penetrance or manifestation of only a portion of gene complex involved in this syndrome.

Fibrosing uremic pleuritis during hemodialysis.

Fibrosing pleuritis with pulmonary restriction occurred in a well-dialyzed patient. Surgical decortication produced clinical improvement.

Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).

Alport's syndrome representing as crescentic glomerulonephritis: a report of two siblings.

Hereditary nephritis is a disease presenting with hematuria, proteinuria, and systemic findings including ocular lesions and deafness. Renal failure frequently occurs in males who have the disease at a young age. We report the case of a female with hereditary nephritis who presented with the classic clinical and pathologic features of crescentic glomerulonephritis post-pregnancy. A sibling also had a comparable course. It is proposed that crescentic glomerulonephritis may be a heretofore unreported presentation of hereditary nephritis with terminal renal failure.