Cardiac function in dialysis patients evaluated by Doppler echocardiography and its relation to intradialytic hypotension: a new index combining systolic and diastolic function.

AIM, PATIENTS AND METHODS: Cardiac function of 40 patients on maintenance dialysis was examined using a new Doppler index combining systolic and diastolic function. Immediately before dialysis, ultrasonic pulsed Doppler was used to measure right and left ventricular inflow and outflow waveforms. The sum of the isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) was calculated by subtracting the ejection time from the interval between the end of an inflow waveform and the start of the next inflow waveform. The new index was obtained by dividing the sum of the two isovolumetric times by the ejection time. Cardiac function was evaluated in dialysis patients and healthy controls using new indices of the right and left heart systems. RESULT: Indices of the right and left heart systems in dialysis patients were significantly higher than those in healthy controls. With respect to hypotension during dialysis, patients were divided into two groups, a group with decreased blood pressure (group A: 27 patients) and a group with normal blood pressure (group B: 13 patients). Only the left heart system index in group A was significantly higher. There were no significant differences in other M-mode Doppler indices between the two groups. CONCLUSION: The new index was a more sensitive evaluator of cardiac function and predictor of hypotension during dialysis compared to standard echocardiographic indices.

[Anti-glomerular basement membrane antibody-mediated glomerulonephritis remarkably improved by pulse therapy with methylprednisolone, plasmapheresis and continuous heparin infusion].

The patient, a 28 year-old-man, was admitted to a hospital because of general fatigue and fever. He was pointed out renal dysfunction and was transferred to Nagasaki University Hospital. The laboratory data on admission showed moderate azotemia (BUN 43 mg/dl, Cr 5.4 mg/dl). A percutaneous renal biopsy on admission revealed a diffuse crescentic glomerulonephritis. A direct immunofluorescence of renal biopsy showed a linear pattern for IgG along the glomerular basement membrane. Radioimmunoassay of his serum for circulating anti-GBM antibody was strongly positive. Aggressive treatment with pulse therapy (methylprednisolone), plasmapheresis, and continuous heparin infusion was performed. He had markedly recovered from renal failure and escaped hemodialysis. The patient is making satisfactory process after 3 years.

[Tuberculosis in patients undergoing hemodialysis].

The incidence of tuberculosis is very high in patients treated by hemodialysis particularly in the early stage of hemodialysis. The diagnosis of tuberculosis in dialysis patients was obscured as symptoms were nonspecific and extrapulmonary involvement was seen frequently. We investigated cell mediated immunity in dialysis patients in relation to the period of dialysis. The data indicate that dialysis patients show the following immunological impairments; 1) lymphopenia, 2) decreased B cell, 3) alteration of T cell subset, 4) decreased reaction of PPD skin test, 5) decreased T cell activity, 6) decreased IL-2 production, 7) decreased PHA induced lymphocyte blastogenesis, 8) decreased NK cell. Decreased immunologic host defence mentioned above may contribute to the high incidence of tuberculosis in the early stage as well as in the maintenance phase of dialysis.