In the diets for dialysis patients, we examined differences in protein values between those calculated from the Standard Table of Food Composition in Japan (4^th revised edition) (calculated value) and those determined by our experiments (determined value). Based on these experiments, we further analyzed the correlation between the ratio (determined value/calculated value) and the food weight after cooking, and between the ratio and the water contents in each diet. Among card-style recipes on the market for dialysis patients, 36 recipes were randomly chosen, and were prepared as diet samples. Each measured value of protein was calculated by the nitrogen determination using the Kjeldahl method.
The result showed that the average ratio of determined value to calculated value was 0.972±0.157 and the calculated value was not greater than the determined value (p<0.05). However, as the difference between the two was 2.8%, it is not considered significant in terms of evaluating dietary intake.
As a guidance medium for dialysis patients, both the standard table and the food exchange table for renal disease are used in guidance and nutrition control. In this regard, we found that the difference in the protein values calculated from both tables was 4%. Therefore, the difference may not require much consideration.
Taking into account the difference between the determined value after cooking and the calculated value, however, sufficient nutrient intake to prevent malnutrition is needed.
As there have been few reports about the difference in the dietary protein values after cooking compared to the calculated values, our study may be of significance.

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We applied β₂-microglobulin adsorbing Lixelle column of different sizes (Lixelle S-15: 65mL of priming volume, S-35: 177mL of priming volume) to patients (S-15: 28 males and 38 females; S-35: 29 males and 24 females) with dialysis-related amyloidosis (DRA), and compared the incidence of adverse effects, the degree of improvement in clinical symptoms such as joint pain, and β₂-microglobulin adsorbing efficiency between Lixelle S-15 and S-35 columns. The incidence of adverse effects such as hypovolemia or decrease in hematocrit was reduced in Lixelle S-15 (8%) compared to that (25%) in Lixelle S-35. Lixelle S-15 exhibited about 90% (vs S-35) efficiency in adsorption of β₂-microglobulin combined with high-performance membrane dialyzer and the same efficacy as with S-35 in improvement of clinical symptoms. Change from S-15 to S-35 was necessary for some patients due to worsening shoulder pain. Lixelle S-15 was considered useful for patients with DRA to whom Lixelle S-35 is not applicable because of adverse effects.

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To investigate myocardial damage in hemodialysis patients, coronary flow reserve was measured by the flow wire technique, and early diastolic velocity of the mitral annulus by tissue Doppler imaging (TDI) technique. Seven dialysis patients (mean age 64.8 years) were studied. They had no significant coronary artery stenosis and no diabetes mellitus, but clinical symptoms and ischemic changes on electrocardiography indicated that they might have ischemic heart disease.
Coronary blood flow velocity was recorded by the flow wire technique in the left anterior descending artery (LAD seg. 7) and left circumflex artery (CX seg. 13). Baseline average peak velocity (APV) and hyperemic APV were analyzed. Coronary flow reserve was assessed by the ratio of flow velocity change induced by intracoronary nicorandil (2mg). Early diastolic velocity was recorded by the TDI technique from the lateral mitral annulus.
The coronary flow reserve of LAD and CX was lower (LAD: 2.0±5.5, CX: 2.0±0.3) than those in previous studies of normal subjects. The early diastolic velocity was also lower (9.6±2.0cm/s) than that in previous studies of normal subjects.
In conclusion, the results of this study suggest that hemodialysis patients sustain myocardial damage due to persistent microvascular dysfunction.

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An 80-year-old man got multiple stung by wasps near a mountain and was admitted to our hospital. Initially, the patient's main complaints were local pain at sites of stings, but he subsequently developed unconsciousness and multiple organ failure due to rhabdomyolysis complicated. The patient required hemodialysis and finally recovered after 8 sessions of hemodialysis. The pathomechanisms may include acute tubular necrosis due to toxic effect of the insect venom, rhabdomyolysis and intravascular hemolysis.
We describe the clinical course of acute renal failure due to multiple wasp stings, and the effectiveness of blood purification therapy.

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Amantadine hydrochloride is not only widely used to treat Parkinson's disease, it has also been heralded in recent years as effective for treating influenza. However, given the fact that amantadine hydrochloride is eliminated by the kidneys and not dialysable, practitioners should pay attention to this medication for patients with renal failure. We have recently experienced a case of amantadine hydrochloride intoxication in a dialysis patient who demonstrated Parkinson's symptoms. The case was an 82-year-old male who was prescribed 150mg/day of amantadine hydrochloride after exhibiting exacerbated articulation disorder, festination and frozen gait. The patient subsequently presented involuntary movement, uneasiness and delirium and was diagnosed with amantadine hydrochloride intoxication. We performed DHP and HF to eliminate the causative agent and the patient recovered completely. DHP exhibited effective removal capacity, with a 93.5% adsorption rate. While there are no reports of eliminating amantadine hydrochloride by using HF, this technique exhibited a removal rate of 23.5%, suggesting its possible efficacy.

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The patient was a 69-year-old woman who had undergone maintenance hemodialysis (HD) since July 1996. At the end of March 2000, one month after the administration of losartan for the treatment of hypertension, she developed a high fever, loss of appetite, and general fatigue. Physical examination and laboratory findings were unremarkable, but routine chest X-ray showed an infiltration in the bilateral lung, accompanied by an increase in the number of eosinophils in the peripheral blood. She was admitted to our hospital on April 7th for further examination of high fever and abnormal shadow on chest X-ray.
Under the tentative diagnosis of drug-induced pneumonia, losartan was discontinued, and prednisolone was given orally. Bronchoscopy was performed on the 5th hospital day, and disclosed an increase in the percentage of eosinophil in the bronchoalveolar lavage. Her high fever and abnormal findings on chest X-ray resolved following prednisolone therapy. Although a drug-lymphocyte stimulation test (DLST) for losartan was negative, a diagnosis of eosinophilic pneumonia induced by losartan was made.
We report the first case that developed eosinophilic pneumonia associated with losartan treatment. Clinicians must consider the potential adverse effects of angiotensin II recepter blocker (ARB), because treatment with ARB is expected to increase.

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A fifty-six-year-old male on maintenance hemodialysis (HD) from the age of 44 due to chronic glomerulonephritis, was admitted to our hospital because of FUO. In the 5th year after the introduction of HD, he developed high fever (38°C) after each HD session, which later became an almost daily event. Laboratory data showed CRP 4.6mg/dL, WBC 10, 700/μL, eosinophil 36%, and a positive ANA test. Series of examinations excluded the possibilities of dialysers incompatibility, endotoxin, infection, collagen disease, malignancy or drug fever. Myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA were positive. It was highly speculated that fever was due to ANCA-related vasculitis. After daily administration of prednisolone 40mg, CRP and eosinophil decreased to the normal ranges and fever disappeared. To date, many causes of FUO in HD patients have been reported. We conclude that ANCA-related vasculitis should be considered as one of the causes of FUO in HD patients.

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