【Objectives】Urinary tract infection is one of the causes of mortality in hemodialysis patients. It is important to clarify aspects of urinalysis and urinary bacterial culture in such patients. This study was conducted to investigate urinalysis and urinary bacterial culture in patients on maintenance hemodialysis. 【Methods】 The subjects were 33 men and 21 women with a mean duration of dialysis of 46.4±41.1 months and mean age of 65.1±13.4 years. The number of patients with diabetes mellitus was 23. None of the patients had symptoms of urinary tract infection. We evaluated urinalysis, colony forming units and species of bacterium, and sensitivity to antibiotics. 【Results】Pyuria was observed in 20 (37.0%) out of 54 samples. Thirty-eight patients (70.4%) showed bacteria in their urine. More than 10⁴/mL colony forming units were observed in 19 patients (35.2%). Nine of 20 patients with pyuria and 10 of 34 patients without pyuria showed more than 10⁴/mL colony forming units. The difference in the rates of colony forming units of more than 10⁴/mL between patients with and without pyuria was not significant (p=0.256). Fifty-two species of bacteria were detected in 38 patients. Staphyloccous spp. were detected in 12 patients (23.0%). Streptococcus agalactiae and Enterococcus faecalis were each detected in 8 patients (15.4%). Escherichia coli was detected in 5 patients (9.6%). Gram-positive cocci constituted about 70% of the total in both men and women. There were no bacteria showing resistance to carbapenem antibiotics. No multi-drug-resistant bacterial species (e.g., methicillin-resistant Staphylococcus aureus and multi-drug resistant Pseudomonas aeruginosa) were detected. 【Conclusion】A therapeutic strategy for urinary tract infection in patients on hemodialysis should be decided by considering these findings.

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We present a case of a patient with end-stage renal disease maintained on hemodialysis, who was managed successfully by oral levocarnitine treatment. The patient was a 58-year-old male who was started on hemodialysis for end-stage renal disease secondary to diabetic nephropathy in April 2008. Echocardiography revealed systolic and diastolic dysfunction with EF of 48.9% and E/e’ of 19.5 and severe left ventricular hypertrophy (LMVI 151 g/m²). rHuEPO was administered subcutaneously at 9,000 IU/week. Because the ESA resistance index (ERI), calculated as the weekly weight-adjusted dose of EPO divided by the hemoglobin level (rHuEPO doses/kg/g/dL/week), was relatively high (13.5), oral levocarnitine therapy (1,200 mg/day) was started. At 1 year of therapy, echocardiographic parameters improved with EF of 72.7% and LVMI of 107 g/m². NT-proBNP decreased from 12,800 pg/mL to 7,850 pg/mL. The dose of rHuEPO could be reduced from 9,000 U/week to 3,000 U/week and ERI decreased markedly from 13.5 to 3.9. Brachial-ankle pulse wave velocity (baPWV) as an arteriosclerotic indicator decreased from 1,832 cm/sec to 1,545 cm/sec. Arm muscle area (AMA) increased from 32.9 cm² to 39.3 cm². ALT and AST decreased slightly from 12 U/L to 9 U/L and from 14/U to 9 U/L, respectively.

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Cyst infection is a frequent and adverse complication of polycystic kidney disease (PCKD) and sometimes results in a fatal outcome. The diagnosis and treatment of cyst infection are often difficult. We report a PCKD patient with multiple cyst infection treated by bilateral nephrectomy. A 65-year-old male hemodialysis patient with PCKD was transferred to our hospital because of high fever and abdominal pain. The laboratory findings revealed leukocytosis and high CRP level. Contrast-enhanced abdominal CT scan showed multiple hepatic and renal cysts ; however, it could not distinguish infected lesion accurately. Diffusion-weighted magnetic resonance imaging (DWI-MRI) showed high signal intensity and apparent diffusion coefficient map (ADC map) showed low signal intensity in several cysts on both kidneys. Furthermore, fluid-fluid levels were detected in some cysts. Taking the symptoms, laboratory findings, and MRI features together, we diagnosed him with bilateral multiple renal cysts infection. Treatment was started with intravenous levofloxacin administration, but his general condition deteriorated gradually. Bilateral nephrectomy was performed on the seventh hospital day, and his general condition improved thereafter. This case suggests the usefulness of DWI-MRI and ADC map in the diagnosis of cyst infection. Early surgical intervention should be considered in some cases.

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