Patients with renal insufficiency have a risk of radiocontrast nephropathy (RCN). To study whether RCN can be avoided by prophylactic continuous hemodialysis (CHD), 47 patients with serum creatinine level (S-Cr)>1.5 mg/dL who had undergone coronary angiography were evaluated retrospectively. Among these, 9 patients were treated with prophylactic CHD (groupI), while 38 other were not (groupII). Prophylactic CHD was started just before the administration of contrast media and was continued for 2-3 hours after the completion of the angiography. An increase in S-Cr≥25% from the baseline level within 72 hours after the procedure was defined as RCN. Baseline S-Cr was higher in groupI (2.2±0.9 vs. 1.7±0.4 mg/dL, p<0.01). Age, the prevalence of diabetes mellitus, and the volume of contrast media used did not differ between the 2 groups. After coronary angiography, a minimal increase in S-Cr was observed in both groups, but the increase was not significant. The incidence of RCN was 22% in groupI and 18% in groupII, with no significant difference between the 2 groups. Prophylactic CHD, even if started before the administration of contrast media, did not prevent the development of RCN in patients with renal insufficiency.

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We evaluated the indications for long-term vascular catheter (VC), expected for a permanent vascular access (VA). Subjects were 47 renal failure patients (26 males, 21 females) in poor conditions ; 21 had acute renal failure (ARF) and 26 had chronic renal failure (CRF) (16 incident ally and 10 chronic ally dialyzed cases). The mean age was 66±14 years old, the mean serum albumin was 2.37±0.54 g/dL, the mean CRP was 5.14±5.36 mg/dL. We inserted 48 long-term VCs, 44 cases in the right internal jugular vein, three cases in the left internal jugular vein and one cases in the left subclavian vein. The average duration of long-term VCs was 49.5±56 days. The outcomes of long-term VCs were 16 cases of arteriovenous fistula (AVF) creation, 16 deaths (nine from malignant diseases, seven from sepsis), five infective symptoms, four recovery of renal function, two occlusions, two effective use and three other. The patency rate of long-term VCs was 80% after 30 days and 60% after 90 days. Using a long-term VC, hemodialysis therapy could be performed stably over seven weeks. The long-term VC was useful as VA bridging toward AVF creation in CRF patients and for renal replacement therapy until recovery from ARF, excect for permanent VA.

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A female in her forties who had received PD for 7 years followed by HD for 11 years was hospitalized with severe polyarthralgia and gait disturbance in July 2006. She had undergone several parathyroidectomies and percutaneous ethanol injection therapies (PEIT) on residual and autografted enlarged parathyroid glands after total parathyroidectomy (PTX) with an autograft to the right forearm in 2001. The level of PTH was 818 pg/mL, and serum calcium (Ca) was 13.0 mg/dL. An enlarged auto-grafted parathyroid gland measuring around 40 mm in diameter was detected by ultrasonography. ^99mTc-MIBI scintigraphy showed accumulation of a radioactive substance in the right forearm but no accumulation in the cervical areas. An enlarged parathyroid gland measuring (18×15×43 mm) was removed from the muscular tissue of the right forearm. The level of intact PTH and Ca in sera decreased to 22 pg/mL and 9.0 mg/dL, respectively on day 7 after surgery. Her activities of daily living (ADL) improved thereafter. It appears that timely and sufficient examination and PTX of residual and autografted parathyroid gland should be performed in patients with intractable 2°HPT after total PTX with autografts.

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A 74-year-old Japanese female on hemodialysis therapy complained of right lower abdominal pain in January 2008, and was admitted to our hospital. On admission, we treated the patient under a provisional diagnosis of ischemic colitis, but symptoms did not respond. Pathological diagnosis of colon mucosal biopsy samples demonstrated cytomegalovirus (CMV) infection. The patient was then treated with gancyclovir and symptoms quickly improved. When a hemodialysis patient diagnosed with ischemic colitis does not respond as expected, to treatment, CMV colitis should be suspected.

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A 59-year-old man, who had been undergoing hemodialysis for three months, developed recurrent bladder cancer soon thereafter. The patient had undergone left nephroureterectomy for left renal pelvic carcinoma four months before the initiation of hemodialysis. He underwent transurethral resection of the bladder tumor (TURBT) and received intravesical instillations of mitomycin C (MMC) to prevent tumor recurrence. However, he developed severe chronic inflammation and hemorrhagic cystitis following MMC instillations. Thereafter, bladder cancer recurred repeatedly, and the tumor T stage and grade worsened with each recurrence. Total cystectomy was finally carried out in order to control the bladder tumor. One year after total cystectomy, CT scan demonstrated an enhanced tumor in the right lower ureter, which necessitated right nephroureterectomy. However, prior to surgery, the patient developed acute pancreatitis and died from sepsis. Since patients with chronic renal failure trend to have a variety of physiological disorders, such as oliguria, acidosis and immune deficiency, a specific bladder instillation protocol is urgently needed to inhibit recurrence without inducing complications, such as symptomatic hematuria. Early cystectomy combined with total resection of the upper urinary tract might be one of the treatment options for such hemodialysis patients with repeated recurrence of urothelial cancer.

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The patient, a 68-year-old man, had been a 6-year history of hemodialysis (one year on CAPD). His medical history included percutaneous coronary intervention, total parathyroidectomy and autotransplantation. Immediately after the initiation of hemodialysis, pruritus became prominent and an acute itching sensation persisted except for the period immediately after the total parathyroidectomy and autotransplantation and the period when the shift was made to CAPD. Various agents, such as external dermatological medications, skin care preparations and anti-histaminics, were applied to no avail. Recurrent hyperparathyroidism was treated with intravenous vitamin D injections when he reported to our hospital, while the serum calcium level remained high. When this medication was switched to oral cinacalcet, the PTH concentration decreased slightly, while the serum calcium and phosphorus concentrations were reduced to the optimum levels. It is well-known that pruritic symptoms improve dramatically following parathyroidectomy, which can be explained by a reduction in the PTH level together with marked reductions in the serum calcium and phosphorus levels. Marked improvement in pruritic symptoms were attested by a visual analogue score (VAS). The present case illustrated that the PTH, calcium and phosphate levels can be satisfactorily controlled by switching from intravenous vitamin D therapy to oral cinacalcet, with the added effect being the control of pruritus. The case is presented along with a discussion.

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