We compared a urokinase-coated catheter and a Shaldon-type double-lumen catheter with respect to complications of blood access. Sixty-five patients (36 males, 29 females, mean age 54.8 yr) with chronic renal failure underwent total of 653 hemodialyses with urokinase-coated catheters (10 Fr, 15cm) placed in the hemoral vein. Each patient received hemodialyses 3-24 times (mean 10 times) over a period of 5-52 days (mean 20.3 days). Complications observed in the 653 hemodialyses were insufficient blood flow (16), fever≥ 38.0°C (3), spontaneous dislodgment of catheters (1), and catheter breakage (2). Massive bleeding and hematoma were not observed. Another 124 patients, with Shaldon-type double-lumen catheters (12 Fr, 20cm) indwelled in the femoral vein, (71 males, 53 females, mean age 52.7 yr) underwent 1474 hemodialyses. Each patient received hemodialysis 2-35 times (mean 11.9 times) over a period of 3-92 days (mean 26.4 days). Complications observed in the 1474 hemodialyses were fever≥38.0°C (27), insufficient blood flow (21), bleeding and hematoma (4), and spontaneous dislodgment of catheters (4). We found that the frequency of complications using urokinase-coated catheters was the same as that using Shaldon-type double-lumen catheters. However, urokinase-coated catheters were associated with a much lower frequency of fever≥38.0°C.
In conclusion, although urokinase-coated catheters did not show decreased catheter-related complications, it has advantages in enabling the patients to be mobile and to maintain a better quality of life.

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Background: No sufficient treatment against dialysis related pruritus has been established.
Cases and method: The subjects were 17 patients who exhibited dialysis related pruritus. They applied an emollient (Camellia oil) every day for 4 weeks and recorded their condition concerning itchiness and skin dryness in a diary.
Result: In 12 cases, the skin dryness was ameliorated. Eight of the 12 cases reported reduced itchiness, and four were relieved from sleeplessness due to pruritus. Itchiness in patients with allergic dermatitis and hyperparathyroidisms did not respond to this procedure.
Conclusion: Daily skin care with Camellia oil may relieve dialysis related pruritus based on skin dryness.

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We developed a continuous albumin purification system (CAPS) and an albumin-containing dialysate regenerating system. We investigated the clinical application of the systems using bilirubin as an index, and investigated the transfer of endotoxin into blood during treatment. Removal of indoxyl sulfate and cisplatin, a protein-binding toxin, by CAPS was also assessed.
Since it was confirmed in these experiments that the dialysate regenerating system was useful and that endotoxin was not transferred into the blood, CAPS appears to be a very safe system in clinical practice. It was also confirmed that indoxyl sulfate could be removed, although cisplatin could not be removed.

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At 15 weeks gestation, a 28-year-old woman (gravida 0, para 0) was first noted to have chronic renal failure with reflux nephropathy. She was immediately admitted and hemodialysis was started at 21 weeks gestation. She delivered a male infant weighing 1790g at 32 weeks (small for date). The infant was in good condition and appeared normal. Hemodialysis treatment was stopped after delivery, but her renal function gradually declined, and regular hemodialysis was started 22 months after delivery. She became pregnant and delivered a female infant weighing 2764g at 3 weeks gestation.
No congenital abnormalities were detected. The two children are developing normally and their mother continues to receive regular hemodialysis without complications.

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We encountered three cases of abdominal and thoracic aortic aneurysms in chronic hemodialysis patients. Case 1 was 48-year-old man who complained of abdominal and back pain. Abdominal CT revealed a DeBakey type IIIb dissecting aneurysm, 10cm in maximal diameter. He underwent graft replacement for the dissecting aneurysm of the infrarenal and thoracic descending aorta. Three months after the surgery, he died due to retroperitoneal abscess following sepsis. Case 2 was a 62-year-old man who complained of abdominal pain and vomiting. Abdominal CT and ultrasonoray revealed an abdominal aortic aneurysm, 5cm in maximal diameter. He underwent graft replacement for infrarenal aortic aneurysm. After surgery, his condition was well maintained but he died from cerebral infarction on the 40th post-operative day. Case 3 was an 81-year-old man who noted an abdominal mass. Abdominal CT revealed an abdominal aneurysm, 5cm in maximal diameter. In this case, conservative treatment was selected because of his high age. The patient is currently well.
Our findings confirmed that early detection and aggressive surgery are necessary for aortic aneurysms in chronic hemodialysis patients, because ruptured aneurysms are critical. Although the surgical treatment for this disease is progressive, it involves some risks. Therefore, careful perioperative management is very important.

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We report here, a case of end stage renal failure due to crossed ectopic pelvic kidney without fusion. A 36-year-old male developed abdominal fullness and nocturnal urinary frequency 10 years and 2 years prior to admission, respectively. Although hypertension was detected 2 months prior to admission, no medical examination was performed. The patient was referred to our hospital due to urinary tract infection with high fever.
On admission, he showed high serum creatinine, metabolic acidosis and anemia. Hemodialysis was started immediately. Abdominal CT and MRI revealed giant cystic masses in his abdomen. To differentiate between hydronephrotis and multi-cystic dysplasia and to preserve renal function, drainage of the masses was erformed. Analysis of the drained fluid revealed that the masses were hydronephrotic kidneys. The final diagnosis of the pelvic kidney of crossed ectopia without fusion was made when the hydronephrotic poorly functioning left kidney was extirpated.
Although this renal malformation is not rare, few cases of end stage renal failure due to hydronephrosis of the crossed renal ectopia without fusion have been reported.

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Peritoneal resting for several months is considered to be useful to improve peritoneal ultrafiltration failure in CAPD patients. Recently, we encountered a patient with end-stage renal failure and a 6-year history of CAPD who frequently used high osmotic dialysate. She was switched to automated peritoneal dialysis (APD). APD with daytime peritoneal resting is effective to improve peritoneal function without interrupting PD therapy. APD may influence the peritoneal function in some patients.

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A case of multiple urothelial cancers associated with chronic renal failure during hemodialysis is reported. A 55-year-old man visited our hospital complaining of macroscopic hematuria. He had been treated with hemodialysis for 4 years because of chronic renal failure caused by diabetes mellitus. Cystoscopic examination revealed two papillary bladder tumors and he received TUR-Bt on December 19, 1995. Pathological diagnosis was transitional cell carcinoma (pTa, grade 3). However, macroscopic hematuria and urinary cytology class V were again noticed and multiple bladder tumors were revealed by cystoscopic examination in August 1996. Simple cystectomy was performed on September 4, 1996. Pathological diagnosis was TCC (pT2, grade 2, INFβ). No postoperative adjuvant therapy was performed.
CT was performed because of right flank pain and high fever in November 1996. CT revealed right pyonephrosis. Right nephrectomy was carried out on November 27, 1996. Pathological diagnosis was TCC (pTa, grade 2) and carcinoma in situ (CIS) of the right renal pelvis and CIS of the stump of the right ureter. We performed right remaining ureterectomy on January 22, 1997. Pathological diagnosis was TCC (pTa, grade 2) and CIS. CT was performed again because of left flank pain and high fever in June 1997. CT revealed left pyonephrosis. Although we tried to perform left nephrectomy on June 25, 1997, nephrectomy did not succeed because of strong adhesion. Percutaneous nephrostomy was performed because of continuous pyonephrosis on October 7, 1997. Although the patient was treated with maintenance hemodialysis, he died on February 11, 1998.
We discuss here, the difficulties of diagnosis and surgery for multiple urothelial cancer during hemodialysis.

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