Maintenance of adequate dialysis in a patient with peritoneal calcification using tidal peritoneal dialysis.
Farmer CK. Goldsmith DJ. Sharpstone P. Kingswood JC.
Trafford Department of Renal Medicine, Royal Sussex County Hospital, Brighton, UK.
A case report of a 50-year-old woman who has been treated with peritoneal dialysis for 9 years, with a short period off dialysis following transplantation. The patient had long-standing secondary hyperparathyroidism and had declined parathyroidectomy, she had had two episodes of peritonitis in the preceding eight years. She presented with blood-stained dialysate effluent and intermittent abdominal pain. Investigation revealed widespread peritoneal calcification with large plaques of calcium on the visceral peritoneum. She was treated with tidal automated peritoneal dialysis; adequate creatinine clearances have been maintained and the patient has had little further abdominal pain and bleeding. In this report we have illustrated an unusual complication of peritoneal dialysis, peritoneal calcification, and suggest that tidal peritoneal dialysis is a useful therapeutic tool in such cases.
Rapidly progressive glomerulonephritis associated with hepatitis C virus infection.
Usalan C. Erdem Y. Altun B. Nar A. Yasavul U. Turgan C. Caglar S.
Division of Nephrology, Hacettepe University, Ankara, Turkey.
Glomerular disease often accompanies a wide variety of liver diseases, including acute or chronic hepatitis. A striking association between hepatitis B virus and glomerulonephritis particularly membranous glomerulonephritis has been reported by various authors. It is not surprising, therefore, that hepatitis C virus (HCV) infection has been recently associated with the development of various types of glomerulonephritis. The principal type of glomerulonephritis associated with HCV infection is either cryoglobulinemic or non-cryoglobulinemic membranoproliferative glomerulonephritis. However, other types of glomerular lesions were seen in the clinical course of HCV infection. We report a rare case of a 20-year-old woman who developed rapidly progressive glomerulonephritis (RPGN) during the course of the active HCV infection. Whether this case represents a true association or a coincidental association is not known.
Postpartum hemolytic uremic syndrome with a more severe liver involvement.
Mocan H. Mocan MZ.
Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
A 22-year-old woman presented with postpartum hemolytic uremic syndrome with a more severe hepatic involvement. The patient was dialysed and successfully treated with plasma infusion and intravenous immunoglobulin. Two months following discharge her creatinine clearance was 105 ml/min/1.73 m2, 99mTc DTPA scan and brain CT were normal. Here child is also alive and healthy.
Hernia development in CAPD patients and the effect of 2.5 l dialysate volume in selected patients.
Afthentopoulos IE. Panduranga Rao S. Mathews R. Oreopoulos DG.
Toronto Hospital, Canada.
The aim of this study was to estimate the prevalence of hernia formation in CAPD patients and to study the effect of increased dialysate volume (2.5 l) in selected population of patients who could tolerate it. We reviewed the charts of 454 individuals treated with CAPD in our center during a five-year period (September 1991-September 1996). Out of 404 patients who used 2.0 l dialysate exchange volume forty-nine (11%) developed hernia (umbilical 53%, inguinal 33%, incisional 14%) after having been on CAPD for an average of 10 +/- 11 months, while only one of the 50 patients who would tolerate 2.5 l developed a hernia (inguinal 2%), after having been on CAPD for 12 months. All hernias were repaired surgically and most of the patients returned to CAPD after temporary intermittent peritoneal dialysis. Age, sex, nutritional status, polycystic kidneys, and diabetes do not seem to be predisposing factors for hernia formation, while previous operation for aortic abdominal aneurysm repair, or low body weight (< 60 kg) were risk factors. The use of increased dialysate volume (2.5 l) in patients who could tolerate it, did not result in a higher frequency of hernia development. Surprisingly, patients with hernias seem to have a higher mortality than those without.
Pasteurella multocida peritonitis in peritoneal dialysis.
Musio F. Tiu A.
Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Pasteurella multocida infection may occur in multiple sites to include rare involvement of the peritoneal cavity in peritoneal dialysis patients. Six cases of peritonitis associated with this organism have been reported in patients undergoing continuous peritoneal dialysis. A history of close contact with household cats was noted in all cases, with direct trauma to the dialysis tubing frequently seen. In this setting the organism appears to have a short incubation period with florid growth within 24 hours of known contamination. We report a case of Pasteurella multocida peritonitis in a patient treated with continuous cycling peritoneal dialysis and review the literature.
Mesalazine-associated tubulo-interstitial nephritis in inflammatory bowel disease.
Calvino J. Romero R. Pintos E. Losada E. Novoa D. Guimil D. Mardaras J. Sanchez-Guisande D.
Nephrology Unit, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
The 5-aminosalicylic acid (5-ASA) is currently the treatment of choice for patients with inflammatory bowel disease. It can be administered as sulfasalazine (5-ASA + sulfapyridine), mesalazine (5-ASA + resins or gels) and olsalazine (two molecules of 5-ASA). The recent trend has been to use formulations without sulfapyridine since they produce less side-effects although some cases of nephrotoxicity have been described. We report the case of a young female with Crohn's disease treated with mesalazine (400 mg every 8 hours) over a period of 12 months who developed acute interstitial nephritis. The characteristic features of renal function impairment were an insidious onset with non-specific laboratory data and progression towards a chronic state which partially improved with steroid treatment. In summary, it is important to bear this possibility in mind when confronted by any renal impairment which cannot be related to a relapse of inflammatory bowel disease. Renal function should be monitored routinely in patients receiving mesalazine at least during the first year of treatment and annually thereafter.