Phosphate binders do not compromise the copper status of adult renal disease patients on hemodialysis.

The effects of phosphate binder therapies (calcium carbonate, calcium acetate, or aluminum hydroxide) on copper status were assessed in 88 adult patients with end-stage renal disease on hemodialysis. Subjects were divided into two groups based on binder therapy compliance as specified by medical criteria established by the Health Care Financing Administration. Binder compliant subjects (n = 62), aged 59.7+/-12.2 yr, maintained serum phosphorus concentrations of 3.5-6.0 mg/dL. Noncompliant subjects (n = 26), aged 54.2+/-13.8 yr, had serum phosphorus concentrations > 6.0 mg/dL. Mean plasma and red blood cell (RBC) copper, serum ceruloplasmin, and erythrocyte superoxide dismutase activity did not differ between binder compliant and noncompliant subjects. Mean RBC copper, plasma copper, and serum ceruloplasmin concentrations of hemodialysis subjects were within normal limits, despite copper intakes of less than two-thirds of the lower limit of the Estimated Safe and Adequate Daily Dietary Intakes for copper. The phosphate binder therapies (calcium carbonate, calcium acetate, and/or aluminum hydroxide) had no effect on the copper status of patients with end-stage renal disease on hemodialysis.

Acute human immunodeficiency virus infection temporally associated with rhabdomyolysis, acute renal failure, and nephrosis.

A previously healthy 29-year-old homosexual man presented with a 4-day history of fever, malaise, sore throat, and bleeding gums. Rhabdomyolysis, acute renal failure, and nephrotic range proteinuria were also present. The patient was found to have acute human immunodeficiency virus (HIV) infection confirmed by the presence of HIV antigen in his serum and subsequent evolution of an HIV antibody profile typical of acute seroconversion. A kidney biopsy revealed acute tubular necrosis and mesangioproliferative glomerulonephritis, with tubuloreticular inclusions. In the presence of otherwise unexplained acute renal failure, rhabdomyolysis, or new onset nephrotic syndrome, acute HIV infection should be considered in the differential diagnosis.

Pulmonary embolism in end stage renal disease.

Clinically significant pulmonary embolism is considered to be rare in patients with end stage renal disease. Two cases with long standing renal disease on dialysis, are reported where pulmonary embolism contributed significantly to morbidity and mortality. One patient had hypotension during dialysis. The differential diagnosis of sustained hypotension during dialysis or in the ICU should include pulmonary embolism. Establishing the diagnosis may require pulmonary angiography.

The origins of ceramic technology at dolni vecaronstonice, czechoslovakia.

A typology was established for more than 5000 ceramic artifacts at Dolni Vestonice, Czechoslovakia. Conjectured methods of manufacture were confirmed by radiography. The compositions and mineralogy of the artifacts were identical to those of the local soil, loess. A firing temperature range of 500 degrees to 800 degrees C was measured and compared with those of hearths and kilns. The mechanism of sintering was impurity-initiated, liquid-phase sintering. Many fracture sections show evidence of thermal shock, although thermal expansion of the loess is low. The making, firing, and sometimes exploding of the figurines may have been the prime function of the ceramics at this site rather than being manufactured as permanent, portable objects.

Protein S and C antigen levels in proteinuric patients: dependence on type of glomerular pathology.

The cause of the thrombotic tendency in nephrotic patients is unknown. Recent reports of thrombotic complications in patients with deficiencies of protein C or protein S (natural inhibitors of coagulation) have raised the possibility that decreased levels of these proteins may play a role in the hypercoagulable state of nephrotic patients. We measured the levels of protein C, total protein S, and free protein S antigens in 42 patients (21 nephrotic and 21 non-nephrotic) with one of four types of glomerular pathology: diabetic nephropathy (DM), focal glomerular sclerosis (FGS), membranous glomerulonephritis (MGN), and chronic renal failure due to hypertension (CRF). Protein C and total protein S antigen levels were significantly higher in FGS and MGN than they were in DM or CRF. Free protein S levels were lower in DM than they were in MGN. Protein C, total protein S, and free protein S levels did not significantly correlate with either serum albumin or degree of proteinuria. The mean levels of the three proteins did not differ between nephrotic and non-nephrotic patients. Free protein S and protein C were, however, significantly correlated (P less than .005 and P less than .002, respectively) with the type of glomerular pathology, independent of differences in age, sex, serum albumin, or degree of proteinuria. These data suggest that abnormalities of free protein S and protein C are related to the nature of the underlying renal disease, rather than to the degree of proteinuria.

Acquired renal cystic disease in end-stage renal disease: an autopsy study of 155 cases.

Autopsy reports on 155 successive end-stage renal disease (ESRD) patients and 147 control patients without ESRD, matched for age, race and gender, were collected. Cystic transformation of the kidneys was noted in 58% of the ESRD patients and 13.6% of the control patients. There were 25 ESRD patients with renal adenoma and 3 with renal cell carcinoma. The single best predictor of cystic transformation or tumorous degeneration was patient's age. A statistically significant association between cystic transformation and gender, as well as the cause of ESRD, was also found. In contrast to previous reports we were unable to document a strong association between the incidence of either cystic transformation or tumorous degeneration with the duration of dialysis, nor did these two parameters correlate with mode of dialysis. We suggest that cystic transformation of the kidneys in ESRD is related to age and renal failure per se, is not strongly associated with duration of dialysis and is independent of mode of dialysis. Concomitant tumorous degeneration was frequent, but this was usually an incidental autopsy finding. Renal malignancy was uncommon and metastases were absent.

CT findings in complications of acquired renal cystic disease.

A 42-year-old man with end-stage renal disease developed acquired renal cystic disease. The left kidney underwent tumorous degeneration necessitating nephrectomy. Eight months later acute hemorrhagic renal cyst rupture culminated in right nephrectomy.

Light chain cast nephropathy and acute renal failure associated with rifampin therapy. Renal disease akin to myeloma kidney.

Acute renal failure developed in a patient with a normal serum creatinine level, after treatment with rifampin was begun for tuberculosis. Renal biopsy revealed an obstructive nephropathy due to tubular casts. Immunoperoxidase and immunofluorescence studies demonstrated the presence of heterogeneous light chains within these casts. This unique drug-induced renal disease is discussed with reference to the literature and to possible analogies with myeloma kidney.

Creatine phosphokinase in long-term dialysis patients.

Of 90 patients undergoing regular dialysis, 42% had elevated levels of creatine phosphokinase (CPK). The BB isoenzyme was not detected, and only one patient had CPK MB. The elevation of CPK MM level did not correlate with values for calcium, phosphorus, calcium times phosphorus product, dry weight, or parathyroid hormone. Elevated levels of the enzyme correlated directly with muscle weakness in male patients and with hypothyroidism (depressed free thyroxin index) and inversely with treatment with vitamin D, supplements. We conclude that high CPK levels in uremia are secondary to skeletal muscle abnormalities and that hypothyroidism and vitamin D, deficiency may contribute to so-called uremic myopathy.

Sexual dysfunction in chronic renal failure.

Sexual dysfunction in end-stage renal disease is a troublesome, multifactorial disorder. Abnormality of the hypothalamo-pituitary-gonadal axis is but one of the causes leading to the impotence and infertility commonly encountered in chronic renal failure. Short of kidney transplantation, no therapy is available. Though infertility is the rule in end-stage renal disease, successful fatherhood and deliveries have occurred on rare occasions.

Clinical hyperthyroidism in a patient receiving long-term hemodialysis.

A variety of metabolic and endocrine abnormalities are encountered in chronic renal failure. Nontoxic goiter and laboratory results suggesting hypothyroidism are known. Less well known are thyroid function tests suggesting hyperthyroidism in clinically euthyroid patients. To our knowledge, ours is the first documented case of a patient who experienced both clinical and biochemical hyperthyroidism after four years of long-term hemodialysis therapy.

Thyroid function in hemodialysis.

The relevance of the biochemical evidence of hypothyroidism in patients on regular hemodialysis is debatable. Several indexes of thyroid function were assessed in 46 patients undergoing chronic hemodialysis for 2 to 45 months. Low serum levels of thyroxine were found in 69.5% of the patients studied and of triiodothyronine (T3) in 46.5%. Low values of T3-Sephadex binding were noted in 17.3%, of free thyroxine index (FTI) in 26.3% and of radioiodine uptake in 19.3% of the patients; 13.0% had high levels of thyroid-stimulating hormone (TSH). The overall incidence of hypothyroidism, based on FTI and TSH, was 34.8%. We concluded that the diagnosis of hypothyroidism should be based on FTI and TSH levels, and that chronically hemodialyzed patients tend to exhibit biochemical rather than clinical hypothyroidism.

Intraoperative hemodialysis during cardiopulmonary bypass in chronic renal failure.

This report describes the features and the course of a patient on maintenance hemodialysis in whom infective endocarditis of the aortic valve ensued. The subsequent development of intractable congestive heart failure necessitated aortic valve replacement. Use of intraoperative hemodialysis, facilitating the intraoperative and postoperative management of the patient, is described. Following valve replacement the patient did well with no evidence of congestive heart failure.