Abstract
On April 4, 1978, the first dialysis therapy in Japan for a leprosy patient with renal failure was performed in the dialysis unit of the National Leprosarium, Tama Zenshoen. Since then, during a 12 year 9 month period from April 1978 to the end of 1990, 22 leprosy patients have received dialysis therapy. of these, one had acute renal failure and 21 had chronic renal failure. These 21 cases were investigated with regard to their clinical course, causal disease, blood access, effects of drugs, effect of the therapy, complications, influence of the therapy on the clinical course of leprosy, and autopsy findings.
The results obtained were as follows: 1. Clinical course up to the onset of dialysis therapy was similar to that of usual patients with chronic renal failure. 2. Arterio and arteriolosclerotic nephrosclerosis, chronic proliferative glomerulonephritis, amyloidosis, interstitial nephritis, polycystic kidney, arteriosclerotic renal atrophy, and chronic pyelonephritis were recognized as causal diseases. These causal diseases were not leprosy-specific. Diabetic nephropathy was not found in any of the 21 patients. It seems that the incidence of diabetic nephropathy in leprosy patients is low. 3. Autogenous internal shunts prepared in these cases were used effectively, in some cases for many years. Problems such as closure, edema and low blood flow occurred, but not frequently. 4. Drugs used for usual patients with chronic renal failure, such as antihypertensive drugs (β-blockers, angiotensin-converting enzyme inhibitors and calcium channel blockers), inhibitor of urate biosynthesis, alfacalcidol and recombinant human erythropoietin, showed the expected effects when administered to leprosy patients with chronic renal failure. 5. Dialysis therapy had no influence on the clinical course of leprosy. Relapse did not occur even after many years of dialysis therapy. 6. Hemodialysis, 2-3 times a week 4-5 hours each time, was able to maintain patients in good condition for many years. 7. On autopsy, amyloid deposition in the kidney was detected often.
