Effect of high fiber density ratio polysulfone dialyzer on protein removal.

BACKGROUND/AIMS: A dialyzer (APS-EX) with a higher hollow fiber density ratio was manufactured using the highest performance polysulfone hollow fiber from Asahi-Kasei Medical. METHODS: We compared the performance of this device in comparison with hemodialysis (HD; APS-S) and hemodiafiltration (HDF) conditions (APS-S, 10 l post-HDF) to evaluate its merit as an internal filtration-enhanced dialyzer. RESULTS: With low molecular weight proteins, APS-EX had a reduction ratio of 74.3% for beta(2)-microglobulin (beta(2)-MG), and 31.0% for alpha(1)-MG. APS-EX had a significant higher removal amount of alpha(1)-MG compared to APS-S (HDF). Significant differences were seen in albumin loss, 4.0 g for APS-EX, 3.0 g for APS-S (HDF), and 0.9 g for APS-S (HD). Using HD mode, APS-EX demonstrated a performance which was more than equivalent to approximately 10 l post-HDF. CONCLUSIONS: The results suggested the possibility that HD equivalent to HDF can be performed safely with the ultrapure dialysate when using APS-EX with internal filtration.

Isolated renal tuberculosis following intravesical Bacillus Calmette-Guérin therapy for bladder cancer.

We present a case of isolated renal tuberculosis following bacillus Calmette-Guérin (BCG) therapy for bladder cancer. In the presurgical radiographic examination, we suspected an atypical renal cell carcinoma. According to the diagnosis of renal cell carcinoma, we performed a radical nephrectomy. The histological findings were tuberculosis-specific inflammatory changes and the patient received an antituberculous multiple drug therapy for a year. It is concluded that we should pay attention to the possibility of a renal tuberculosis granuloma in any patient who presented with subacute formed renal masses following BCG treatment before deciding on the strategy of the treatment of the renal masses, especially in patients who had received such a treatment which induced an immunocompromised state.

Blood extracellular superoxide dismutase levels in hemodialysis patients pre- and post-hemodialysis and its association with lipoprotein lipase mass and free fatty acid.

BACKGROUND: Hemodialysis (HD) is a method of chronic therapy for patients with renal failure. Diabetic nephropathy is the most common underlying disease among HD patients in Japan. A characteristic problem associated with this condition is endothelial cell damage. We have been using extracellular superoxide dismutase (EC-SOD) attached to the heparan sulfate on the endothelial cell surface as a marker of vascular damage. METHODS: This study examined the pre- and post-HD levels of lipoprotein lipase (LPL). The increase in free fatty acid (FFA) is affected by a type of cytokine-like substances, which induces insulin resistance and causes abnormal lipid metabolism. RESULTS: Pre-HD blood samples showed highly significant correlations between EC-SOD and LPL mass (r = 0.792) and between EC-SOD and FFA (r = 0.675) (p < 0.0001). EC-SOD, LPL mass, and FFA were remarkably high among the patients who had been placed on HD treatment for over 20 years. CONCLUSION: Because EC-SOD and LPL mass represent heparin-binding proteins, these results were considered to reflect severe vascular damage.