The long-term effect of combined therapy with steroids and Sai-rei-to on dialysis arthropathy was examined. The study included 7 patients receiving hemodialysis for more than 8 years with chronic arthralgia in more than 3 joints uncontroled with non-steroid anti-inflammatory drugs, except patients with secondary hyperparathyroidism, rheumatoid arthritis or other diseases inducing polyarthralgia. The initial dose of predonine^® ranged from 2.5mg to 10.0mg a day and 6.0g of Sai-rei-to was simultaneously administered. The dose of predonine^® was gradually reduced every one or two weeks. Five weeks after the beginning of therapy, only Sai-rei-to administration was continued if it was sufficient to control arthralgia. The grade of pain was evaluated by each patient in ten steps, with no pain being indicated as 1 and maximum pain as 10. Though the pain score before starting the combined therapy was 8.2±1.6 on average, it was reduced to 2.3±1.7 after therapy, showing adequate analgetic effect in all cases. The effect was observed one week after beginning of the therapy in most cases. One month after stopping administration of steroid, the pain score was only 3.6±2.2, indicating nearly satisfactory pain control. In 5 cases, arthralgia has remained well controlled with Sai-rei-to after stopping steroid administration. In 3 cases, arthralgia has been well controlled for more than two years without steroids. Although 2.5mg of predonine^® administration was not effective for controlling arthralgia, analgesic effect was observed in patients simultaneously dosed with Sai-rei-to. This is thought to show enhancement on the anti-inflammatry effect of steroid by Sai-rei-to. In conclusion, predonine^® and Sai-rei-to combination therapy is very useful in controlling arthralgia due to dialysis arthropathy for many years diminishing the dose of steroid required and thus reducing the side effects of steroids.

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To elucidate the mechanism by which blood pressure (BP) is paradoxically elevated during ultrafiltration in hemodialysis (HD) patients, we investigated factors influencing the range of BP in 128 outpatients who were classified as the increasing BP group, non-increasing BP group and decreasing BP group.
The number of increasing BP patients was 14 (10.9%).
All of plasma renin activity (PRA), plasma aldosterone concentration (PAC) and atrial natriuretic peptide (h-ANP) in the increasing BP group were higher than those in the decreasing BP group, but the differences were not significant.
The mean hematocrit (Ht) before HD in the increasing BP group was significantly less than that in the decreasing BP group.
Moreover, plasma sodium concentration increased after HD in the increasing BP group and was significantly higher than that in the decreasing BP group.
The plasma total protein (TP) after HD was diluted on 6 of 14 increasing BP patients.
The plasma sodium concentration after HD correlated with BP increase and TP dilution, respectively. Furthermore, BP increase was correlated with h-ANP and decreased in Ht, respectively.
The rising plasma sodium concentration may influence BP by increaing intravascular volume.

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A questionnaire survey was used to investigate the disposal methods used for continuous ambulatory peritoneal dialysis (CAPD) waste by 114 patients in Yamagata prefecture. As a whole CAPD bags were discarded as burnable garbage (25%), as nonburnables (40%) or were burned at home (25%) or at hospital (10%). In the suburbs, more patients burned CAPD bags at home (40%) by themselves, as compared with those in urban areas (10%). In case of discarding CAPD waste, 60% of patients wrapped them in an opaque plastic bag. CAPD fluid was discarded in the toilet (70%), in the bathroom or in a field (30%). Patients responded that responsibility for disposal of CAPD waste lies with the patients themselves (57%), the hospital (8%), the local government (20%) and the CAPD company (5%). Ten patients (8.8%) experienced refusal of waste collection by the local government and 6 of them had to change their disposal methods. Despite of patient's request, one district refused to collect CAPD waste. Many patients wanted reduced CAPD waste volume. This survey showed that each patient had a different method and problems regarding disposal of CAPD waste and required an individual remedy.

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We report a case of bilateral renal infarction due to abdominal aortic thrombosis with oliguric acute renal failure (ARF) requiring hemodialysis (HD). A 64-year-old woman, with hypertension and lower limb artery thrombosis, complained of nausea, vomiting, lumbago and oliguria in February 1995. BUN and serum-creatinine were elevated at 63mg/dl and 6.9mg/dl, respectively. She developed ARF, and her CRP, erythrocyte sedimentation rate (ESR) and LDH were also elevated. Enhanced abdominal CT showed low-density areas in both kidneys. Intravenous digital subtraction angiography (DSA) revealed abdominal aortic thrombus, suggesting that ARF was the result of bilateral renal infarction. The patient underwent thrombectomy, but renal function did not recover, resulting in maintainance by hemodialysis treatment. DSA findings were very useful in diagnosing renal infarction.

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We report a case of agranulocytosis and acute progressive renal dysfunction due to hyperuricemia associated with Mizoribine (MZ) administration.
The patient was a 70-year-old woman who had been treated for rheumatoid artritis since 1991. Renal insufficiency was diagnosed in April 1996. Daily oral doses of 50 to 100mg of MZ were added to her regimen in September 1996. Two months later, agranulocytosis and progressive renal dysfunction occurred. She was referred to our hospital because of these problems and admitted on January 16, 1997.
Abnormal laboratory findings were as follows; a WBC 700/μl (granulocyte 21%), BUN 151.9mg/dl, Cr 4.12mg/dl, and UA 25.8mg/dl. Her serum concentration of MZ was 5.97μg/ml (therapeutic levels: 2 to 4μg/ml). MZ was discontinued, and she was treated with G-CSF and hemodialysis. Thereafter, these problems gradually resolved. However, on the 12 day after admission, he suddenly developed dyspnea during a hemodialysis session and died.
MZ is widely used as an immunosuppressive drug with fewer adverse side effects. However, this case suggests that MZ can induce severe side effects when administered to patients with mild to moderate renal dysfunction.

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We report a chronic hemodialysis patient treated with Le Veen shunt implant due to intractable ascites. A 53-year-old male undergoing hemodialysis for chronic glomerulonephritis showed abdominal distension and dyspnea in January 1997.
Abdominal CT revealed considerable ascites, but liver cirrhosis was not detected. Initially, diuretic was not effective and intravenous reinjection of ascitic fluid after filtration was performed seven times. However, ascites increased gradually, so we implanted Le Veen's peritoneo-venous shunt in July 1997. Postoperatively, the patient demonstrated a high grade fever for several weeks. However, ascites decreased and the general condition improved.
Le Veen shunt is a useful surgical treatment for intractable ascites even in patients on maintenance hemodialysis.

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We report a case of chronic renal failure on continuous ambulatory peritoneal dialysis, presenting with macro CK (creatine kinase). The patient, a 57-year-old male, was diagnosed with nephrotic syndrome due to membranous nephropathy by renal biopsy when he was 51 years old. Although he was treated with glucocorticoid hormone, renal function deteriorated and maintenance dialysis was initiated. The patient had shown 331-839u/l of serum CK before maintenance dialysis was initiated. The serum CK level continued to increase and showed 2, 092u/l. At that time, macro CK linked to IgA-κλ was detected. Muscle biopsy was performed but did not reveal any abnormal findings. Macro CK has been detected four times to date and hyper-creatinekinasemia persists. The patient has not complained of myalgic pain, muscle atrophy, skin lesion or fever during this period. Rapid worsening of renal function and prolonged duration of hyper-creatinekinasemia suggest there is an abnormality in the immune responses of this patient.

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