BMC of lumbar vertebrae (L2-L4) was measured by QCT and DXA in 21 HD patients.
The effect of sex, aging, HD duration, postmenopausal years and various blood parameters of bone metabolism on BMC was assessed statistically.
1) BMC showed a good positive correlation not only with DXA and QCT (trabecular and cortical bone), but with QCT (trabecuiar bone) and QCT (cortical bone). 2) A significant age-related decrease in BMC, particularly by QCT (trabecular bone), was found in both sexes. 3) BMC measured by QCT (trabecular bone) increased with the duration of HD in male patients. 4) A negative relationship between postmenopausal years and BMC measured by QCT (trabecular and cortical bone) was prominent. 5) BMC was not found to be correlaed with various blood parameters of bone metabolism.
Thus, measurement of BMC (L2-L4) by QCT has the advantage of allowing more precise examination of changes in cortical and trabecular bone.

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We have studied the mechanism of hypoglycemia during hemodialysis by measuring pre- and post-dialyzer glucose concentrations. In patients with blood sugar (BS) levels over 200mg/dl, it decresed from 217.3±5.4 to 116.5±6.7mg/dl. In patients with BS levels of 200 to 100mg/dl, it decreased from 152.3±7.6 to 88.0±3.6mg/dl, and in 80% of patients BS decreased below the glucose concentration of the dialysate. In patients with BS levegs below 100mg/dl, it further decreased from 83.4±3.7 to 71.0±1.2mg/dl, We perfused artificial solution containing 100mg/dl of glucose through the dialyzer under in vitro conditbns. Although BS decreased from 105.6±4.3 to 74.3±4.1mg/dl in vivo, it did not change in vitro. The estimated amount of glucose removed from serum is higher than the estimated influx into the dialysate. We concluded that the mechanism of hypoglycemia could be explained by glucose uptake into red blood cells.

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The number of patients in Japan who are maintained on chronic hemodialysis (HD) has risen to more than 140, 000. Since these patients have a considerable risk of renal cancer, periodic screening by computed tomography (CT) is widely performed. We report a case of adrenal tumor that was incidentally discovered by CT screening in a 44-year-old woman who had been maintained on HD for more than 20 years. Endocrine studies revealed marked elevations of plasma renin activity (PRA) and the plasma aldosterone concentration (PAC). The basal levels of plasma adrenocorticotropic hormone (ACTH) and cortisol were within normal ranges. En bloc resection of the left kidney and tumor was performed and the tumor was shown to be a cortical adenoma associated with hemorrhage. Levels of PRA and PAC decreased markedly, but did not normalize postoperatively. Contents of mineralocorticoids (MC) such as aldosterone and 18-hydroxycorticosterone were extremely high in the adenoma, while that of cortisol was low. On the other hand, while the contents of MC in adjacent tissues were also excessive, the cortisol level was higher than in the adenoma. Both the serial changes in postoperative plasma levels of aldosterone and PRA and the findings regarding corticoid contents suggest that this adenoma did not reflect primary aldosteronism, but rather was an adenoma arising from the adrenal cortex with secondary aldosteronism. As to the patient not being hypertensive throughout her clinical course, it is possible that there was almost no aldosterone target tissue in the atrophic kidneys and that the direct effect of aldosterone on extrarenal target tissues might not be strongly related to blood pressure elevation.

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We report the case of a metastatic squamous cell carcinoma patient with acute renal failure undergoing hemodialysis who was successfully treated with combination chemotherapy consisting of carboplatin plus etoposide. A 67-year-old man was admitted because of systemic lymphadenopathy and left lower extremity edema. Histological examination of the lymph nodes showed metastatic squamous cell carcinoma, and Bowen carcinoma of his right hip was identified as the primary lesion. On admission, left hydronephrosis was diagnosed, and the left kidney was found to be almost non-functional. Acute renal failure occurred as a result of obstruction of the right ureter by intra-abdominal lymphadenopathy. The patient was treated with combination chemotherapy consisting of carboplatin, 240mg/m², and etoposide, 80mg/m², while undergoing hemodialysis. Carboplatin was injected intravenously for 2 hours before hemodialysis. The pharmacokinetics of carboplatin were determined. The Cmax of total and free platinum was 7.8 and 5.4μg/ml, respectively, and the AUC was 4.1 and 2.5mg/ml×min, respectively. After chemotherapy, the systemic lymphadenopathy diminished, and the patient's renal function became normal as his right hydronephrosis improved. Severe thrombocytopenia and other critical side effects were not observed. After 6 cycles of chemotherapy the patient was discharged in complete remission. In conclusion, patients with malignant disease and acute renal failure can be effectively treated by considering the pharmacokinetics and dialysis efficacy of the anticancer agents.

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A case of acute renal failure associated with mannitol infusion is reported. A 49-year-old man with a past history of hypertension whose serum creatinine level was 1.93mg/dl, underwent graft replacement for dissecting aortic aneurysm (DeBakey I). He was not oliguric urine volume: (60-70ml/h) immediately after the operation, but urine volume gradually decreased to about 20ml/h by 12 hours. At that time, blood chemistry findings were: urea nitrogen 35.3mg/dl, creatinine 3.67mg/dl and sodium 125.6mEq/l. Diuresis was not induced by increasing doses of the diuretics given during and after the operation (furosemide, mannitol and bumetanide). Azotemia progressed and pulmonary edema developed, and hemodialysis (HD) was performed on postoperative day 2. Urine volume rapidly increased soon after HD, and there was improvement of renal function. HD was no longer required. The close temporal relationship between mannitol infusion and acute deterioration of renal function in the absence of other recognizable causes, such as shock or graft failure, and the reversal of renal function following a single HD session implies that mannitol was the proximate cause of the acute renal failure in this patient. This case suggests that mannitol should be carefully administered during and after operations, especially in patients with renal impairment.

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Beriberi has almost completely disappeared from Japan as nutritional status has improved, but sporadic cases have occurred, especially in Western Japan, over about the past 20 years.
A patient with acute renal failure and peripheral neuritis associated with high-output heart failure is reported. A diagnosis of cardiac beriberi, was made, because the heart failure markedly improved when vitamin B₁ was given. The acute renal failure appeared to have been caused by direct drug toxicity combined with indirect damage due to rhabdomyolysis. Hemofiltration and hemodialysis were performed, and the renal failure improved together with the cardiac beriberi.
The symptoms, diagnosis, and treatment of this patient are reported with a discussion of the relevant literature.

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