Unearthing uric acid: an ancient factor with recently found significance in renal and cardiovascular disease.

Uric acid is strongly associated with cardiovascular and renal disease, but is usually not considered to have a causal role. However, recent experimental, epidemiological, and clinical studies provocatively suggest that uric acid may contribute to the development of hypertension, metabolic syndrome, and kidney disease in some patients. Clinical studies are urgently needed to examine this important possibility.

Management of hypophosphatemia induced by high-flux hemodiafiltration for the treatment of vancomycin toxicity: intravenous phosphorus therapy versus use of a phosphorus-enriched dialysate.

Intensive high-flux hemodiafiltration is often used in the management of vancomycin toxicity. We describe two patients who developed hypophosphatemia as a consequence of this form of therapy. The first patient was treated with an intravenous phosphorus infusion. For the second patient, hypophosphatemia was corrected, during hemodiafiltration, with the use of a phosphorus-enriched dialysate. The latter dialysate was prepared by adding sodium phosphate salts to the "base concentrate" of a dual-concentrate, bicarbonate-based dialysate delivery system. This simple method was more efficient than intravenous therapy in ameliorating the hypophosphatemia secondary to aggressive hemodiafiltration treatment.

Amlodipine besylate induced acute interstitial nephritis.

Adverse effects of amlodipine besylate, a widely used antihypertensive medication, include peripheral edema, flushing, headache, pruritus, and rash. An adverse renal effect attributable to the medication has hitherto not been reported in the literature. We herein report a case of amlodipine besylate induced acute interstitial nephritis.

Thalamic hemorrhage following carotid endarterectomy-induced labile blood pressure: controlling the liability with clonidine--a case report.

Carotid endarterectomy can lead to alterations in baroreceptor sensitivity. Impairment of this sensitivity can in turn lead to volatility of blood pressure (baroreflex failure syndrome--BFS). Rapid elevations in blood pressure can cause hypertensive encephalopathy in a patient with BFS. A patient is presented with hypertensive intracerebral hemorrhage associated with BFS.

Effect of chronic peritoneal fluid eosinophilia on peritoneal membrane function.

This study was undertaken to evaluate the effects of long-term persistent peritoneal fluid eosinophilia on the peritoneal membrane as reflected by a change in dialysis function. This was a prospective study undertaken at a community-based peritoneal dialysis unit, where thirty-one patients were enrolled over a 9-month period. Chronic, long-term peritoneal fluid eosinophilia was noted in 12/31 (38.7%) patients. Significant differences were not noted between values of creatinine clearance, D/P urea and Kt/V, compared to their baseline values. This study shows that long-term peritoneal fluid eosinophilia does not significantly affect peritoneal membrane function in patients on maintenance peritoneal dialysis.

Metastatic soft tissue calcification in chronic renal failure detected by radionuclide imaging.

Metastatic calcification has been reported in several disease entities, including chronic renal failure. Various imaging modalities have been shown to be useful in the detection of metastatic soft tissue calcification. Radionuclide imaging may detect metastatic soft tissue calcification more readily than routine diagnostic modalities and be a valuable noninvasive method to establish an early diagnosis in high-risk patients. The authors report a patient with extensive soft tissue metastatic calcification who had a myriad of clinical symptoms. The extensive calcification was detected with a radionuclide imaging.

Use of a phosphorus-enriched dialysis solution to hemodialyze a patient with lithium intoxication.

A normophosphatemic patient suffering from lithium intoxication was hemodialyzed with a phosphorus-enriched, bicarbonate-based dialysis solution. A post-dialysis fall in plasma phosphorus level was prevented.

Hypomagnesemia in continuous ambulatory peritoneal dialysis patients dialyzed with a low-magnesium peritoneal dialysis solution.

OBJECTIVE: Previous studies have shown a decrease in serum magnesium (Mg) concentration when continuous ambulatory peritoneal dialysis (CAPD) patients previously maintained on a 1.0-1.2 mEq/L Mg peritoneal dialysis solution (PDS) were dialyzed with a 0.5 mEq/L Mg PDS. However, the prevalence of hypomagnesemia in CAPD patients dialyzed with low-Mg PDS is unknown. DESIGN: A retrospective study to determine the prevalence of hypomagnesemia and the factors associated with its occurrence in CAPD patients dialyzed using a 0.5 mEq/L Mg PDS. SETTING: A CAPD unit in a large Veterans Affairs Hospital. PATIENTS: All our CAPD patients (33) enrolled over a 52-month period. RESULTS: All patients had serum magnesium levels higher than 1.25 mEq/L prior to use of low-Mg PDS. Hypomagnesemia (serum Mg < 1.25 mEq/L) developed in 21/33 patients (64%) when a 0.5 mEq/L Mg PDS was employed. Hypomagnesemia developed a mean of 8.2 months after beginning treatments. The duration of dialysis and the number of episodes of peritonitis did not differ between patients with and those without hypomagnesemia. Serum albumin levels were significantly lower in patients with hypomagnesemia (2.5 +/- 0.12 g/dL vs 3.2 +/- 0.12, p < 0.01). Magnesium supplements were given to 13 patients; following this therapy, serum magnesium values became normal. CONCLUSIONS: CAPD patients dialyzed with a 0.5 mEq/L Mg PDS may develop a considerable fall in serum magnesium level and may require magnesium supplements in order to restore normal serum values.