The effectiveness of oral essential aminoacids and aminoacids containing dialysate in peritoneal dialysis.

BACKGROUND/AIM: Oral essential amino acids (AAs) containing supplements (EAS) and AA containing dialysate (ACD) are frequently used in peritoneal dialysis (PD) patients with malnutrition. The present study was conducted to investigate two strategies and compare their effects on the malnutrition status of PD patients. MATERIALS AND METHODS: A total of 31 EAS, 14 ACD patients were enrolled in this study. Serum albumin levels were lower than 3.5 g/dL in all subjects. EAS group patients took five pills containing AAs three times a day with meals. In the other, 2.000 cc of 1.1% ACD was given to patients daily during the study. Demographic and laboratory parameters were analyzed and compared at baseline and 6th month. RESULTS: Significant increases in BMI, albumin, and protein in both groups. Mean albumin levels increased significantly by 0.54 g/dL in ACD group (p < 0.005) and 0.49 g/dL in EAS group (p < 0.001) following 6 months. Mean albumin and delta albumin levels did not differ between two groups. CONCLUSION: These strategies may play an important role in increasing albumin levels and improving the nutritional status of PD patients.

Anastrozole-associated sclerosing glomerulonephritis in a patient with breast cancer.

OBJECTIVE: Anastrozole is a selective aromatase inhibitor and is used for the hormonal treatment of postmenopausal breast cancer. There are major side effects of anastrozole including decrease in both lumbar spine and total hip bone mineral density, increase in the incidence of all bone fractures (especially fractures of spine, hip and wrist), joint disorders and increase in the cholesterol level. CASE SUMMARY: We report a case of a 73-year-old postmenopausal woman with stage T2N0M0 breast cancer. Adjuvant chemotherapy was not indicated and anastrozole hormonotherapy was started. Diagnosis of sclerosing glomerulonephritis occurred in this patient during anastrozole use, suggesting a newly defined side effect of anastrozole. DISCUSSION: Renal elimination is not a significant pathway of elimination for anastrozole, clearance of anastrozole is unchanged even in severe renal impairment. Dosing adjustment in patients with renal dysfunction is not necessary for anastrozole. We believe that the acute renal failure in our patient was associated with anastrozole. Renal injury due to anastrozole has not been published in the English literature. CONCLUSIONS: Anastrozole may be the causative factor in patients with sclerosing glomerulonephritis.

Intravenous gammaglobulin-induced chronic renal failure in a patient with multiple myeloma.

Although generally well tolerated there have been a number of reports of acute deterioration in renal function with the use of intravenous immune globulin (IVIG). It is of generally limited duration and is self-limiting. We for the first time have described a patient with multiple myeloma and normal renal function who developed chronic renal failure shortly after IVIG treatment in a patient with no pre-existing renal disease. We would therefore recommend the cautious use of IVIG in patients with normal renal function or with pre-existing renal disease. Renal function should also be assessed both prior to and after application of IVIG.