[Xerostomia and Xerophthalmia in haemodialysis patients]. / Xerostomia e Xeroftalmia nei pazienti in dialisi.

BACKGROUND: A reduction in salivary and lachrymal secretion has been described in many pathologies; however, such alterations have not been described in patients with renal failure. This study was designed to estimate the frequency of alterations in salivary and lachrymal secretion in haemodialysed patients. PATIENTS ABD METHODS: We studied 63 haemodialysed patients and 23 healthy control subjects. In all of them we tested salivary secretion (Saxon test), lachrymal secretion (Shirmer test) as well as the presence of symptoms of xerostomia and xerophthalmia. In a subgroup of patients We investigated any evidence of ocular lesions and tissue damage of salivary glands (histopathology). We also tested the correlation between salivary and lachrymal secretion and autonomic nervous system function. Furthermore, we also studied the association between xerostomia and xerophthalmia and serum auto antibodies (anti nuclear, anti-Ro (SS-A), anti-La (SS-B)) and anti HCV antibodies. RESULTS: On average salivary and the lachrymal secretion was markedly reduced in uraemic patients compared with healthy controls. We found the alterations in salivary glands function to be strongly related to salivary glands fibrosis and atrophy and independent of amyloid accumulation. On the other hand, we observed that xerostomia and xerophthalmia were unrelated to autonomic dysfunction as well as to HCV infection and circulating auto antibodies. Moreover, xerophthalmia was frequently associated with evidence of corneal damage. CONCLUSIONS: Reduced salivary and lachrymal secretion is frequent in uraemic patients. Such alterations are often asymptomatic and could be an expression of the accelerated age-dependent decline in glandular function and the attendant fibrosis and atrophy.

The value of ultrasound as a screening procedure for urological disorders in renal failure.

Renal ultrasound was evaluated as a screening procedure for urological conditions (hydronephrosis or space-occupying lesions) in 175 patients (316 kidneys) with renal failure. The final diagnosis of renal disease was based on excretory urography, ascending or translumbar pyelography, open surgical findings, clinical and laboratory test results or renal biopsies. Ultrasonic images suggestive of renal disease requiring surgery were obtained in 83 kidneys and subsequently confirmed in 67. There were 16 falsely positive and 2 falsely negative results. Assuming a 22 per cent prevalence of renal disease requiring surgery in the azotemic population, Bayes' theorem predicts that an abnormal ultrasonic test will increase the probability of surgery in a patient with renal failure from 0.22 to 0.81, while a negative test will reduce the probability from 0.22 to 0.013. Renal ultrasound is a highly effective method to screen for patients with renal failure who require contrast studies. With this means the risks and cost of contrast investigations can be reduced markedly.