We examined the association between aortic arch calcification (AAC) area and serum osteoprotegrin (OPG) regulating vascular calcification, and also examined that between serum OPG and factors related to renal osteodystrophy. In forty-eight CKD patients including 14 diabetics, without administration of vitamin D, who were investigated before starting dialysis, the average serum Cr was 4.8±3.9mg/dL. Serum corrected Ca, Pi, calcitriol, intact-PTH, BAP and OPG were also examined. The averaged serum corrected Ca, Pi, calcitriol, intact-PTH and BAP was 8.8mg/dL, 4.4mg/dL, 24.8pg/mL, 160pg/mL and 34.0U/L, respectively. Serum OPG correlated with AAC area (p=0.0326). Stepwise regression analysis demonstrated an independent relationship between serum calcitriol or age, and serum OPG (p<0.0001). Furthermore, serum calcitriol negatively correlated with serum OPG (p<0.0001). These results suggest that decreased serum calcitriol relates to vascular calcification in CKD patient before starting dialysis.

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Percutaneous thrombectomy has become an established treatment for thrombosed hemodialysis access. Thrombuster II^TM, which removes the clot by aspiration, is a new device for percutaneous transluminal thrombectomy. Thrombectomy using Thrombuster II^TM does not need either urokinase or the complicated machinery because of its simple structure. Our study evaluated the usefulness of this device for removing the thrombi from the thrombosed hemodialysis access and determined the clinical success rate. Thrombectomy was performed in 20 thrombosed hemodialysis access routes by using this device. The clinical successful rate of this method was 85.0%; the success rate for grafts was 85.7% and that for native vascular access was 83.3%. The volume of bleeding was 100mL or less in all patients except one (130mL). We concluded that percutaneous transluminal thrombectomy by using Thrombuster II^TM was effective and useful.

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A 59-year-old man was referred to our hospital because of right abdominal pain. He had been maintained on hemodialysis for 10 years and 3 months. Computed tomography (CT) demonstrated bilateral acquired cystic disease of kidney and right retroperitoneal hemorrhage. The patient was treated by transcatheter embolization (TAE) of the right renal artery. On the 13th day after surgery, he had complained of acute right abdominal pain during hemodialysis. CT demonstrated that the right retroperitoneal hemorrhage had enlarged. Right renal arteriography was repeated and it demonstrated that hemorrhage occurred from another renal artery, that had not been detected during the previous TAE. Therefore, we performed the second TAE. The postoperative course was uneventful. Eighteen months after TAE, there has not been any new hemorrhage. This case and the treatment of retroperitoneal hemorrhage are presented with a review of the relevant literature.

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A 35-year-old female was transferred to our hospital by ambulance because of palpitation and general fatigue. She had taken 28, 000mg of sustained-release theophylline preparation for a suicide attempt 5 hours before admission. Blood pressure was 80/50mmHg and heart rate was 180/min. Blood examination demonstrated leukocytosis (10, 100/μL), hypokalemia (2.4mEq/L), hyperglycemia (283mg/dL) and respiratory alkalemia (PaCO₂; 19.4mmHg). Electrocardiogram showed sinus tachycardia but there was no ventricular arrhythmia. A short-term seizure occurred, but was improved by intravenous diazepam injection. Serum theophylline concentration on admission was 169.2μg/mL. We performed stomach lavage and administered 50g of activated charcoal powder. Four hours after admission, hemoperfusion using an activated charcoal column was performed for 3 hours and the serum theophylline concentration decreased to 124.1μg/mL. Then, we performed hemodialysis for 4 hours. At the same time, we injected lactate Ringer solution and furosemide to promote a forced excretion of theophylline. After hemodialysis, the serum theophylline concentration decreased to 29.2mg/μL and electrolyte abnormalities improved on the next day, the serum theophylline concentration further decreased to 5.4μg/mL and consciousness became alert. This patient also demonstrated rhabdomyolysis due to acute theophylline intoxication and the peak level of serum creatinine phosphokinase (CPK) was 108, 470IU/L 24 hours after taking the drug. She improved without developing acute renal failure due to rhabdomyolysis and was ambulatory when discharged on the 15^th hospital day.

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A 71-year-old female who had undergone a Miles procedure for rectal cancer on 26 July 2004 was admitted to our hospital on 8 September with renal failure and elevation of CRP. She was diagnosed with ANCA-associated glomerulonephritis and treated with steroids. She was discharged on 31 October, but was readmitted on 11 November with an elevation of LDH and CRP. Pneumocystis carinii pneumonia was diagnosed by bronchoalveolar lavage, and she recovered after administration of sulfamethoxazole-trimethoprim. Pneumocystis carinii pneumonia is a life-threatening disease, which in this case was successfully treated with a combination of steroids.

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