Questionnaires were sent to 2, 796 dialysis units in February 1998 to determine the present states of renal cell carcinoma in chronic hemodialysis patients. The response rate was 71.9%. Screening for detecting renal cell carcinoma was performed in 1, 364 of 2, 009 dialysis centers and periodic screening in 956 dialysis centers, resulting in once year in 754, two times and more per year in 175, and once every other year in 7 centers. The method of screening was sonographic examination in 42%, CT scan in 23%, and both modalities in 21%. Renal cell carcinomas were detected in 353 dialysis patients (285 males and 68 females) between March 1996 and February 1998. The mean age of these patients was 55.1±11.3 (mean±SD) years, and the mean duration of dialysis was 131.5±87.9 months. The clinical diagnosis was based on the screening in 88.4%, and only 27 cases (7.6%) were symptomatic. Acquired renal cystic disease was found in 293 of 345 renal cell carcinoma patients (84.9%). Renal cell carcinoma accompanied with acquired renal cystic disease on long-term hemodialysis tended to develop into granular or mixed-cell subtypes and tubular or papillary structural patterns. Forty-five of 273 patients had metastasis. The incidence of renal cell carcinoma in dialysis patients was 146 renal cell carcinomas per 100, 000 dialysis patients per year. In conclusion, periodic screening for detecting renal cell carcinoma was performed at a high frequency in Japan. Fifty-four percent of 353 renal cell carcinomas were detected in patients who had undergone by dialysis for more than 1 years.

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Purpose: The mean age of induction for hemodialysis is increasing in Japan. We therefore examined the clinical characteristics of elderly patients for induction of hemodialysis in our hospital over the 10 years from 1989 to 1998. Method: Sevenhundredninteen patients were divided into 2 groups, under 65 years old (younger group, 517 patients) and those over 66 years old (elderly group, 202 patients), and were compared with each other. Induction for hemodialysis was decided by the criteria of an ad hoc committee sponsored by the Japanese Ministry of Health and Welfare. Results: The induction for hemodialysis of the elderly group was 19% in 1989, but it had increased to 41% in 1998. In the elderly group, nephrosclerosis was frequent (5% vs. 15%, younger group vs. elderly group), but chronic glomerulonephritis (CGN) was less frequent (41% vs. 31%, younger group vs. elderly group). The rate of diabetic nephropathy (DN) increased in both groups (from 30% to 48% in the younger; from 20% to 31% in the elderly) from 1989, 90 to 1997, 98. The clinical symptoms of fluid overload and cardiomegaly in chest X-rays were frequently observed in the elderly group. Gastrointestinal abnormalities were frequent and serum level of creatinine was higher in the younger group. We also compared the clinical characteristics of DN and CGN in each group. In the younger group, DN had lower mean arterial blood pressure, serum BUN and Cr levels, and larger cardiac size compared to CGN. However, in the elderly group, DN had only lower serum Cr level. Conclusion: The induction for hemodialysis in the elderly group was increasing in our hospital. Clinicians should be aware of the characteristics of elderly patients.

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Removal of iomeprol, a nonionic radiocontrast agent, by hemodialysis with various high performance membrane (HPM) dialyzers was evaluated in vitro and in patients with end-stage renal failure. Reduction rates of iomeprol in vitro were 99.9% with a cellulose dicetate (CDA) membrane dialyzer (MELTRA FLUX150), 99.7% with an ethylene vinylalcohol (EVAL) membrane dialyzer (KF20C) and 99.2% with polymethylmethacrylate (PMMA) membrane dialyzer (BK1.6F). Adsorption rates in vitro were 16.7%, 35.7% and 49.4%, respectively. In vivo study in 8 hemodialysis patients showed reduction rates of 81.8%, 73.7% and 89.4% with the CDA dialyzer (MELTRA FLU110 and MELTRA FLUX150), 84.5% with the EVAL dialyzer (KF20C), 80.5% and 77.3% with the PMMA dialyzer (BK1.6F), and 84.8% with the cellulose tricetate (CTA) membrane dialyzer (FB210U) after 4 hours of hemodialysis, and 89.9% with the CTA dialyzer (FB210) in hemodiafiltration. Hemodialysis with each HPM dialyzer performed soon after radiological examinations removed iomeprol efficiently and no adverse effects of iomeprol were observed.
It was concluded that iomeprol could be removed efficiently by hemodialysis with the HPM dialyzer and that it could be used safely even in patients with end-stage renal failure.

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A sixty-five-year-old woman with chronic renal failure (original kidney disease unknown) experienced acute oropharyngolaryngitis followed by myocarditis and pericarditis, and ultimately, congestive heart failure (CHF). Hypotension then occurred repeatedly during the latter half of hemodialysis (HD), and temporary erythrocytosis was observed. To eliminate pericardial fluid, post-dilutional hemodifiltration (HDF) with a high performance membrane and small amount of replacement solution (4L) was conducted. The elevation of hematocrit (Ht) progressed and reached maximum level of 60.1% during the course of uncontrollable CHF. Serum erythropoietin (Epo) was 32.6mU/ml, and the circulating erythrocyte level was 32.2ml/kg. In association with the reduction of pericardial effusion with HDF, further progression of erythrocytosis was noticed. Erythrocytois in this case was considered to have been due to a secondary mechanism of the increased production of Epo from multiple renal cysts with ischemic stimulation during CHF. HDF, even with a small amount of replacement solution, might inhibit the progression of erythrocytosis by eliminating Epo.

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This report concerns a case of a complication of extradural hematoma at the spinal cord in the course of maintenance dialysis. The patient, a male aged 63 years, had been undergoing hemoialysis 3 times a week because of diabetic nephroathy. He had complained of stiff shoulders and pain at the posterior neck about 10 days previously, and was hospitalized because of suspicion of angina pectoris. After the admission, pain of the posterior neck intensified, followed the rapid on set of limb paralysis. Sensory capability was fully lost at levels below C4. MRI revealed a mass of T1-low intensity and T2-iso-to high-intensity at around C2 to C5 outside the dura mater of the cervical cord. After diagnosis of extradural hematoma of the cervical cord was made, a surgical operation was started 30 hours after the onset of total limb paralysis to remove the hematoma and to provide orthopedic treatment of the vertebral arches. The operation improved the neurological symptoms of the upper limbs, but failed to bring further improvement, and the patient died. A though extradural hematoms at the spinal cord rarely occur in the course of dialysis, and the prognosis of cerebral vascular disorder is rather poor, it seems that a surgical operation should carried out as soon as possible if any symptomatic improvement can be expected.

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Here in report hemodialysis patient with primary progressive aphasia and severe left cerebral atrophy. The patient was 67-year-old man who had undergone hemodialysis for 7 years. He was admitted to our hospital because of speech disturbance. On first admission, he could repeat and understand what we said, but mild impairment of confrontation in naming and alexia with agraphia were noted. Seven months later, he was readmitted to our hospital because of progressive aphasia. Neuropsychological examinations revealed severe impairment of confrontation in naming and understanding. Severe alexia with agraphia was also noted, but dementia was not apparent. He was diagnosed as having transcortical sensory aphasia. A computed tomographic scan and magnetic resonance imaging of the brain revealed severe atrophy of the frontal and temporal lobes around the sinus of Sylvius. Positron emission tomography revealed a decrease of cerebral blood flow and cerebral oxygen metabolism in these regions of interest. Based on these findings, primary progressive aphasia due to severe left cerebral atrophy, following a degenerative process, was diagnosed.

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