[Purpose] Evaluating blood flow (FV or RI) using ultrasonography is a useful method for quantifying the blood flow dynamics of vascular access points (VA); however, it can only be applied to one blood vessel at a time. Therefore, the accuracy of such blood flow evaluations is expected to decrease if a branching blood vessel is located in front of a stenotic lesion. In this study, we examined the dynamics of FV and RI in cases in which branched vessels were located in front of stenotic lesions. [Subjects] The subjects were divided into the following 3 groups: the normal group (normal), stenosis or obstruction group (stenosis), and the stenosis or obstruction and branching blood vessel in front of the lesion group (stenosis+branch). [Methods] The proportion of cases involving lesions that were assigned to the stenosis+branch group was calculated. The mean FV and RI values of the 3 groups were compared. The discriminatory abilities of FV and RI to detect stenotic lesions were analyzed in the stenosis group and stenosis+branch group via ROC curve analysis. [Results & Discussion] The results showed that FV and RI were extremely useful for detecting lesions in the stenosis group, as reported previously. In the stenosis+branch group, the reliability of FV was extremely low. This study indicated that detecting stenotic lesions based on FV is difficult in cases in which a branching blood vessel is located in front of the lesion. In addition, it demonstrated that it is important to simultaneously acquire physical findings when evaluating VA with ultrasonography. We conclude that the results of this study should be considered when evaluating VA, in order to improve the accuracy of VA lesion detection.
The aim of this study was to clarify the degree of awareness about polycystic kidney disease and its complications among patients that were on maintenance hemodialysis due to polycystic kidney disease and whether the patients notified their relatives about this disease. Seventy hemodialysis patients were enrolled from 20 hospitals/dialysis clinics, which participated in the Lake Biwa Clinical Dialysis Meeting in Shiga. According to the subjects’ medical records, the prevalence of cerebral hemorrhaging, cerebral aneurysms, and valvular heart disease was 11.4%, 17.1%, and 21.4%, respectively. A survey on awareness about polycystic kidney disease showed that 70% of patients recognized at least one complication of polycystic kidney disease (cerebral hemorrhaging: 31.4%, cerebral aneurysm: 41.4%, and valvular heart disease: 8.6%). Although 94% of patients had informed their relatives of their disease, only 57.1% had recommended their relatives visit a hospital/clinic to have a medical check-up for polycystic kidney disease. In addition, only 51.4% knew that a new medicine for this disease, tolvaptan, is commercially available. These results indicate that most patients on hemodialysis due to polycystic kidney disease do not recognize the complications of their condition, which have a marked influence on their prognosis, very well. In addition, about 50% do not strongly encourage their relatives to have medical check-ups for polycystic kidney disease and are not given up-to-date medical information about the disease. To improve the prognosis of hemodialysis patients with polycystic kidney disease and their relatives, we need to give them appropriate information about the disease and access to medical services.
We evaluated the primary disease, age at the initiation of peritoneal dialysis (PD), and outcomes of 70 patients who were started on PD at our center. The major primary diseases were congenital abnormalities of the kidneys and urinary tract (38.6%), Denys-Drash syndrome (12.9%), congenital nephrotic syndrome (10.0%), juvenile nephronophthisis (5.7%), and polycystic kidney disease (5.7%). However, focal segmental glomerulosclerosis (FSGS) was only seen in one patient (1.4%). The frequencies of Denys-Drash syndrome, congenital nephrotic syndrome, and juvenile nephronophthisis were increasing. In total, 41.4% of patients were <1 year old when they started on PD. After 2008, 54.2% of patients were <1 year old when they started on PD. Regarding outcomes, 34.3% underwent kidney transplantation, 31.4% continued with PD, and 9 (13%) died. The tendency towards a younger age at the initiation of PD might have been caused a reduction in the number of older patients due to increases in the frequency of preemptive transplantation and the numbers of patients with Denys-Drash syndrome and congenital nephrotic syndrome. FSGS was not a major cause of childhood end-stage kidney disease. This study’s results might have been influenced by center bias; therefore, we need to evaluate these issues using a nationwide registry.
This case involved a 57-year-old male with a history of chronic hepatitis C and chronic glomerulonephritis. He had undergone hemodialysis for 42 years and peritoneal dialysis for 5 months for end-stage renal failure caused by chronic glomerulonephritis. During maintenance hemodialysis at a nearby clinic, he developed intestinal obstruction. Computed tomography (CT) revealed gallstones, pancreatic duct dilation, and ascites, and blood tests showed high levels of trypsin and pancreatic phospholipase A2. However, a close examination performed at the Department of Gastroenterology of another hospital excluded pancreatitis, and he was referred to our hospital for further scrutiny and treatment. An emergency laparotomy was performed because an abdominal abscess and free air were found on CT. However, as septic shock occurred during the operation, the cause of the abdominal abscess was not investigated. Instead, intraperitoneal irrigation was performed, and the operation was completed. Despite intensive care, involving mechanical ventilation and continuous hemodiafiltration, metabolic acidosis and disseminated intravascular coagulation progressed, and the patient died on the 13th postoperative day. A histopathological examination led to a diagnosis of dialysis-related amyloidosis of the gastrointestinal tract, liver, pancreas, and heart; encapsulating peritoneal sclerosis; and a peritoneal abscess.