Ascites was successfully infused in a patient with intractable ascites after filtration and concentration of the fluid. A 64-year-old female, who had had bilateral nephrectomy for a polycystic kidney 20 years earlier and another for recurrent pyelonephritis 14 years later, had been maintained by hemodialysis. The paracentesis done for marked abdominal distention yielded clear, straw-like fluid, which contained more than 4g/100ml protein and few cell fractions.
Despite frequent paracentesis, the ascitic retention did not decrease, and hypotension, hypoproteinemia and occasional vomiting continued. A large amount of plasma protein fraction was infused without effect.
Ascitic fluid was filtered with a cellulose diacetate hollow fiber 0.2μ pore in diameter and concentrated with a polyacrylonitrile hollow fiber, using an Autoascit II (Asahi Medical Co., Ltd.). A MEDICUT (Argyle Co., Ltd.) 16G side hole needle was chosen for paracentesis. The protein of the fluid was raised to the concentration of 10g/100ml This concentrated fluid was then intravenously infused during ascites drainage or stored at -80°C for later use.
The patient's general feeling of well-being was improved and abdominal distention decreased by this technique. No side effects were noted. Thirteen thousand four hundred ml of ascites were drained by these four infusion procedures, while it had been possible to remove only 6, 800ml of ascites during the six months before infusion. The plasma protein fraction requirement decreased from 3, 250ml to 0ml Systolic blood pressure rose and abdominal girth decreased significantly, but levels of serum protein showed no difference.
Filtration, concentration and infusion of ascites was effective for improving the patient's discomfort and saving the use of plasma protein fraction in a case of intractable ascitic retention.

View full abstract

In a previous report, it was shown that cuprophan membrane induced hemodialysis leukopenia and activated the complement system, while PMMA membrane did not.
In this study, we designed experiments to clarify the correlation between hemodialysis leukopenia and complement activation by EVAL (ethylene vinyl alcohol copolymer) and the effects of heparin, which is known to inhibit complement activation, on leukopenia and complement activation.
EVAL membrane activated the complement system via the alternative pathway, but the ability was about half of that of cuprophan membrane. While cuprophan membrane induced severe leukopenia, EVAL membrane induced only mild leukopenia. There was no significant difference in the degree of leukopenia between heparin hemodialysis and heparin-free hemodialysis with EVAL membrane. When EVAL membrane was incubated with human serum containing various amounts of heparin, the complement activation by the membrane was dose-dependently inhibited, but 1u/ml of heparin was not effective to prevent the complement activation.
These studies suggest that hemodialysis leukopenia is more closely dependent on the ability of the dialyzer membrane to activate the alternative pathway of the complement system and that the amount of heparin used in regular hemodialysis is not effective to prevent complement activation and leukopenia by EVAL membane.

View full abstract

Acute myoglobinuric renal failure developed in two patients after they had received haloperidol. Case 1. A 55-year-old man was hospitalized in August, 1978 for involutional psychosis. On November 1, the patient began receiving haloperidol. This therapy was terminated on December 3 because of malignant syndrome. On December 10, he was admitted to Yokohama City University Hospital and underwent nine sessions of hemodialysis for acute oliguric renal failure. On admission, extreme elevations of CPK and LDH were noted, and urine and blood samples were both positive for myoglobin. Renal function improved after a month. Case 2. A 42-year-old man with a history of chorea began receiving anticonvulsants and haloperidol in 1980. In January 1982, this treatment was discontinued. Extreme involuntary movement appeared. On February 17, he received 5mg of haloperidol by muscle injection. Starting on February 20, he underwent peritoneal dialysis for acute oliguric renal failure and was admitted to Yokohama City University Hospital for hemodialysis on Feburuary 25. Extreme elevations of CPK and LDH were noted, and the blood sample was positive for myoglobin. Renal function subsequently improved. Acute renal failure may be due to rhabdomyolisis, and the relationship between haloperidol and myoglobinuria was mentioned.

View full abstract

Gastrointestinal bleeding is a well-known complication of chronic renal failure. Studies on the metabolism of gastrin suggested that the kidney is a major site of gastrin degradation. To elucidate whether immunoreactive gastrin (IRG) plays any important role in so called “uremic gastropathy, ” IRG concentration was measured by using two kinds of antisera, 2604 by Rehfeld and R2702 by Yanaihara. The former detects four main forms of total IRG (TG) with equimolar potency, and the latter exclusively detects G34 and its N-terminal fragments. In 33 patients with chronic renal failure (24 with, 9 without hemodialysis) and 12 normal subjects, blood samples were taken in the fasting state, before and after dialysis and after test meals.
Basal TG concentration was significantly higher in patients with chronic renal failure, irrespective of whether or not they were on dialysis. TG levels were not correlated with serum creatinine levels. TG levels were decreased by 37%, as a result of hemodialysis, but G34 levels showed no significant change. A small amount of IRG was detected in the dialysate by antiserum 2604. As to the postprandial IRG release, in patients with renal failure, both TG and G34 levels attained their peak values 60 minutes after the test meal, and these high values were more prolonged than those in normal subjects.
The finding that the predominant circulating form of gastrin in chronic renal failure in G34, and the fact that G17 is 6 times more potent than G34 in stimulating gastric acid secretion would suggest that hypergastrinemia has minimal significance in acid secretion.

View full abstract

We succeeded in helping a 32-year-old hemodialysis patient, who had found his rehabilitation difficult due to the lack of self-confidence about his physical ability, by giving him physical exercise therapy. However, the patient showed mental disorder a year later.
The reasons were considered to be as follows: the patient was immature in his mental development, and his family had no intention of supporting him in his rehabilitation.
We tried to explain the patient's psychological condition to his family, and at the same time, make them realize how important rehabilitation is for a dialysis patient.
After that, both the medical staff and his family tried to approach the patient with a supporting attitude. This has resulted in the patient's leading such a positive life that he was able to take a high school correspondence course.
From this case, we have learned that, for the nursing and guidance of a dialysis patient, it is important to understand both his mental development process and the relationships among the family members.

View full abstract

The concentration of tocopherol, triglyceride, cholesterol and phospholipids in serum and these levels with the addition of apoprotein A in the HDL fraction were determined in chronic renal failure and hemodialysis patients. The values were compared with the data from normal subjects. In chronic renal failure, the serum tocopherol level increased significantly as compared with normal subjects, but there was no difference between hemodialysis patients and normal subjects. However, the serum tocopherol level in hemodialysis patients tended to decrease with the prolongation of hemodialysis. The tocopherol levels in the HDL fraction in both chronic renal failure and hemodialysis patients were markedly reduced below normal levels. In normal as well as chronic renal failure subjects, HDL-tocopherol was significantly correlated with both HDL-cholesterol and HDL-phospholipids, but these relationships disappeared in hemodialysis patients. The reason for this phenomenon was due to the reduction of the ratio of HDL-tocopherol to total HDL including cholesterol, phospholipids, triglyceride, and apoprotein A in hemodialysis patients according to the prolongation of hemodialysis.
These results suggest that the tocopherol in HDL fraction was reduced in chronic renal failure and hemodialysis patients, the reduction having been enhanced by hemodialysis itself. It is also suggested that the decreased tocopherol in the HDL fraction may be an atherogenic factor along with decreased HDL-cholesterol.

View full abstract

Serum cholesterol binding reserve (SCBR) was measured in uremics from the viewpoint of complications and of hemodialysis treatment in comparison with control subjects (GFR of more than 50ml/min.). The correlation between SCBR and serum lipids was investigated in each group. Further more, the influence of uremic toxins (uremic small and middle molecules) on the SCBR value in vivo, was also studied in an animal experiment. SCBR was determined by a modification of Hsia's method. The subjects studied were 32 uremics (dialyzed, 16) 14 uremics with diabetes (dialyzed, 7) 35 subjects control (nondiabetic nephropathy, 12; diabetic nephropathy, 23). SCBR was significantly low in uremics with and without diabetes and not influenced by hemodialysis. Among the hemodialysis patients with a constantly low SCBR., the rate of uremics with diabetes predominated. A slightly positive correlation was observed between SCBR and LCAT and apoprotein A, but not between SCBR and TG, cholesterol and HDL-cholesterol. In the animal experiment using wistar albino rats, SCBR was slightly suppressed by the administration of uremic toxins in vivo, expecially M. M. obtained from uremics without diabetes.
These results suggest that SCBR as the function of cholesterol transport was partly influenced by uremic toxins, but further studies must be made in order to elucidate other related factors in uremia. These low SCBR levels may play a role in the acceleration of atherogenicity in uremics.

View full abstract

There are many kinds of anti-hypertensive drugs for the treatment of hypertension in chronic renal failure patients. In the treatment of patients treated by hemodialysis, it is necessary to know the accumulation, removal ratio and dialysance of these drugs.
The purpose of this study was to determine the removal rate and dialysance of Nicardipine HCl, a new calcium antagonistic vasodilator, by hemodialysis in vitro.
In this experiment, beef blood was used instead of human blood. The removal ratio and the dialysance of the drug were mesured by using this experimental circiut.
The removal ratio of the drug was 15.8±1.8% at 120 minutes after begining of hemodialysis, and the dialysance of the drug was 4.5±1.3ml/min. The half-life period of this agent was 456±81 minutes. The results show that Nicardipine HCl was slightly removed by hemodialyzer.
Two patients with hypertension who were on long-term maintenance hemodialysis were given 40-60mg of this agent orally every day. Fourteen days after the begining of drug administration, the concentration of the drug in the blood of these two patients was measured before their hemodialysis treatment. The results show that the agent does not accumulate in the blood and that the level of the drug in the blood was little changed by homodialysis treatment.

View full abstract