Comparison of peritoneal transport characteristics at the second week and at six months of peritoneal dialysis commencement.

Peritoneal equilibration test (PET) is an important tool for managing peritoneal dialysis (PD) prescription. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines suggest that the first PET be performed 4-8 weeks after PD commencement. The main reason for this delay is because of the peritoneal membrane might change its character once it is exposed to the glucose based dialysate. In this study, we compared PET 2 weeks after PD commencement to PET after 6 months to evaluate the changes in the peritoneal membrane character with time. This study included 126 patients who underwent PD initiation between March 2007 and December 2011. The PET was performed as per the standard protocol at 2(nd) week and 6(th) month after PD initiation. Transport status was categorized as low, low average, high average, and high as per the standard definition. There was no change in transport character in 115 patients (91.2%) between the two PET measurements. When the Early PET at 2(nd) week and 6(th) month PET data were analyzed, no significant changes were observed in measured D/P creatinine (0.59 ± 0.14 vs. 0.62 ± 0.14 respectively P = 0.26) and D/D0 Glucose (0.46 ± 0.12 vs. 0.46 ± 0.11, P = 0.65). Using the Bland-Altman analysis the repeatability coefficients were 0.27 and 0.25 for creatinine and glucose values respectively. In our study, the PET performed at the 2(nd) week are similar to that of the 6(th) month PET in 91.2% of our patients and the test did not significantly change with time. In conclusion, we could do PET early at 2(nd) week to assess the peritoneal membrane character and this would help in proper dialysis prescription to the patients.

Nonfunctioning adrenocorticalcarcinoma.

Clinically inapparent adrenal masses detected through imaging for nonadrenal disease, often referred to as adrenal incidentalomas, were first described approximately 20 years ago. However, their impact on health outcomes is now better appreciated and gaining broader attention. Despite the rarity of primary endocrine cancers of the adrenal, adrenal masses are one of the most prevalent of all human tumors. The prevalence of adrenal incidentaloma approaches 3% in middle age and increases to as much as 10% in the elderly. This report describes the case of a 30-year-old man who presented primarily with complaints of deep vein thrombosis of the left leg secondary to a nonfunctioning adrenocortical carcinoma.