Journal of Japanese Society for Dialysis Therapy
Online ISSN : 1884-6203
Print ISSN : 0288-7045
ISSN-L : 0288-7045
Current issue
Displaying 1-19 of 19 articles from this issue
  • Yoshio Suzuki, Masahiro Miura, Shigeko Hara, Keihachiro Kuzuhara, Hiro ...
    1985 Volume 18 Issue 3 Pages 237-245
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    In 33 using the ultasonic tomography (Echo) and patients who had undergone hemodialysis for more than 10 years in our hospital, we investigated, by using the ultrasonic tomography (Echo) and CT scan methods, the influence of long-term hemodialysis on the polycystic changes in the kidneys and further studied the possible relationship of the changes to the renin-angiotensin-aldosterone system and to the occurrence of hypotension by means of the angiotensin II infusion test. Polycystic changes in the atrophic kidneys were observed in 31 of the cases (94%) and were classified from the morphological standpoint by Echo into 5 types, I to V.
    In Type I the kidney has a normal length of 8 to 9cm and the whole kidney is replaced by multiple large cysts measuring 1 to 3cm in diameter. In Type II the kidney is shorter (less than 6cm) and is replaced by multiple large cysts 1 to 3cm in diameter. In Type I and II, hardly any normal renal tissue is detected by Echo. The kidney in Type III is less than 6cm in length and only a few cysts measuring less than 1cm in diameter are found. Echo revealed that there is no cyst in Type IV. In Type V, the kidney size and cyst formation differ in the left and right kidneys.
    There was no correlation between laboratory data underlying kidney disease and the morphological classification as Type I through V.
    Predialysis plasma renin activity (PRA) in Group A (n=21), consisting of Types I and II, was statistically significantly higher than that in Group B (n=10), consisting of Types III and IV (p<0.01). The post/predialysis PRA ratio was markedly higher in Group A than in Group B. The renin secretion due to hemodialysis was found to be greater in Group A than in Group B.
    There was no difference in plasma aldosterone concentration in Types I through V.
    There were 7 cases of hypotension defined by the WHO standard. All these 7 patients were hyperreninemic and hyperaldosteronemic. There was no significant difference in predialysis PRA between hypotensive cases and normal and hypotensive cases. However, when the mean postdialysis/mean predialysis PRA ratios were compared, the value in hypotensive cases was found to be significantly greater than that in normal and hypertensive cases, suggesting that the influence of hemodialysis on renin secretion was greater in hypotensive cases.
    Critical doses estimated by the angiotensin II infusion test were more than 30ng/kg/min in all 7 hypotensive cases, seeming to suggest that hyperreninemia is a compensatory mechanism for this low vascular responsiveness. However, as the percentage of hypotensive cases in Group A was nearly equal to that in Group B, further study is necessary to determine if the cyst has a direct role in the compensatory mechanism in renin secretion.
    Download PDF (3282K)
  • Yoshihiro Nakamura, Kenichi Ishibashi, Mitsuo Ogura, Matsuhiko Suenaga ...
    1985 Volume 18 Issue 3 Pages 247-251
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Severe peritonitis developed in two patients on continuous ambulatory peritoneal dialysis (CAPD). Both patients died, and autopsies were performed.
    Case I: A 30-year-old man with chronic renal failure had started CAPD from November, 1980. He had been in good condition until November 27, 1982, when he suffered from abdominal pain and noticed turbidity of the dialysate return. Thus, he was admitted to our hospital.
    On admission, severe tenderness and resistance was observed over the whole abdominal wall. He had a temperature at of 38°C. The peritoneal fluid was turbid, and the fluid culture was positive for pseudomonas aeruginosa.
    After admission, peritoneal dialysis was started with IP. and IV. antibiotics for lavage. But, in spite of the therapy, clinical improvement was not obtained. Peritoneal catheter removal and reinsertion of a new catheter were undertaken, but the peritonitis did not improve.
    The patient gradually developed sepsis and died two weeks later. The autopsy revealed a hen's-egg sized subphrenic abscess.
    Case II: 55-year-old man with chronic renal failure started CAPD from July, 1982. August 15, 1983, he noticed abdominal pain and turbidity of dialysate return, so he was admitted to our hospital.
    On admission, severe abdominal tenderness was observed, and the peritoneal fluid was turbid. The fluid culture was positive for staphylococcus aureus.
    After admission, peritoneal dialysis with IP. and IV. antibiotics was performed, but clinical improvement was not obtained.
    Even after the catheter removal, the peritonitis lasted for (more than) two months, and the patients died of subarachnoidal hemorrhage on November 12, 1983.
    The autopsy revealed abscess in the hepatic flexure.
    Though both patients had intra-abdominal abscess, neither Ga-scintigraphy nor ultrasonic survey had revealed any abscess.
    Our experiences suggest that we must consider the possibility of intra-abdominal abscess formation whenever peritonitis persists and does not respond to the usual treatment, and, if we can obtain a diagnosis of intra-abdominal abscess, radical procedures, including laparotomy, may be required.
    Download PDF (1738K)
  • Toshiaki Hirabayashi, Yoshiaki Takenaka, Yoshihiko Nishian, Yoko Fujit ...
    1985 Volume 18 Issue 3 Pages 253-258
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Recently the number of patients with renal osteodystrophy due to secondary hyperparathyroidism has been increasing among long-term hemodialysis cases. We performed subtotal parathyroidectomies on 40 patients (15 males, 25 females). Their ages were 24-36 years and their hemodialysis histories were 52-163 months. Scintigraphy of the parathyroid glands was performed on all the patients before and after the operation. The scintigraphy was performed by the computer-assisted sugtraction technique with 201 TI and a radioisotope of I.
    The results were as follows: There were 75 true positives, 7 false positives, 67 false negatives, and 18 true negatives. The sensitivity was 53%, the specificity was 72%, and the predictive value was 91%. In 52 of 76 (68%) excised parathyroid glands weighing more than 500mg, hyperparathyroidism was detected before the operation. In 23 of 66 (35%) excised parathyroid glands weighing less than 500mg, the condition was detected before the operation. One of the false positive findings was a papillary carcinoma of the thyroid glands. Scintigraphy was also useful in the postoperative follow-up study.
    These results suggest that scintigraphy of the parathyroid glands in patients with renal osteodystrophy is valuable for localization, diagnosis of secondary hyperparathyroidism, and postoperative follow-up study.
    Download PDF (713K)
  • Yoichi Okada, Yoshihisa Ushiyama, Kazuhiko Yamada, Kazunori Miyahara, ...
    1985 Volume 18 Issue 3 Pages 259-263
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Pulse wave velocity (PWV) at the common carotid artery was determind non-invasively to assess the degree of atherosclerosis in patients undergoing hemodialysis. Consequently, the PWV values in dialysis patients was greater (8.9+1.7m/sec) than in healthy subjects (5.9+1.5m/sec). It was suggested that atherosclerosis of dialysis patients may be accelerated.
    In addition, the elastic modules (E), compliance (C) and stiffness parameter (β), which were physical indexes of arteriosclerosis indicated a significant difference between dialysis patients and healthy subjects.
    These data are an obvious suggestion that accelerated atherosclerosis does occur in long-term hemodialysis.
    There was no correlation between the duration of hemodialysis therapy and the degree of atherosclerosis in dialysis patients. The mutual relation between hypertension or lipid metabolism as major risk factor of atherosclerosis and the PWV factor was not proven in this study.
    Download PDF (650K)
  • Takahiro Mikami, Tetsuo Yatabe, Hiromu Nagai, Tsutomu Birumachi, Takuy ...
    1985 Volume 18 Issue 3 Pages 265-268
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Dialysis anticoagulation was performed by Ca-free dialysate and low-dose FOY. The dialyzers used were Toray B2-100 and B2-200. The composition of the Ca-free dialysate was as follows: Na139mEq/l, K2.5mEq/l, Cl103mEq/l, Mg1.5mEq/l, HCO3- 20mEq/l, citrate 20mEq/l, and glucose (200mg/dl). Ionized Ca, total Ca, and Kaolin-activated whole blood clotting time (KCT) were measured. Citrate (20mEq/l) in the dialysate deionizes not only a trace amount of dialysate Ca but also blood Ca, because citrate is transferred from the dialysate to the blood by dialysis. Consequently, ionized Ca was decreased and KCT was considerably prolonged at the outlet of the dialyzer. Decreased ionized Ca and prolonged KCT were corrected by infusion of 2% CaCl2 solution at the end of extracorporeal circulation. Ca-free dialysis with low-dose FOY was performed 20 times on 8 hemodialysis patients. FOY at about 400mg/hr was required to prevent clotting in the arterial drip chamber for 7 patients. Anticoagulation by only Ca-free dialysate was possible in one patient.
    It is concluded that dialysis anticoagulation by Ca-free dialysate in combination with low-dose FOY is useful in patients with a high-risk bleeding tendency.
    Download PDF (448K)
  • Ryo Shoji, Toshiyuki Nakao, Yuichiro Ishida, Sadahiro Nara, Kohzo Ishi ...
    1985 Volume 18 Issue 3 Pages 269-272
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The number of uremic patients with diabetic nephropathy who come to require hemodialysis treatment has been increasing in recent years. However, problems with blood access have been one of the major difficulties in regular hemodialysis treatment for those patients.
    In order to clarify the details of such difficulties in hemodialysis patients with diabetes, we studied the frequency and type of problems in 15 patients with and 15 without diabetic nephropathy on regular hemodialysis treatment in our hospital. We also studied the platelet function, blood viscosity and blood flow rate of arteriovenous fistulas suspected as contributing factors of thrombosis.
    The following results were obtained: (1) The major blood access problem was obstruction due to thrombosis and the frequency of this difficulty was remarkably higher in diabetic than nondiabetic patients. Remedial surgery of blood access was required on every 19.4 months for a diabetic patient and every 113.5 months for a nondiabetic patient. (2) There were no significant differences in the platelet function or blood viscosity between diabetic and nondiabetic patients on hemodialysis. (3) In diabetic patients, the blood flow rate of arteriovenous fistulas was diminished significantly in the post hemodialysis period, particularly when changing from the supine to the sitting position.
    From the above results, it is concluded that reduction of the arteriovenous blood flow rate after HD might be a major cause of blood access problems in diabetic patients.
    Download PDF (519K)
  • Atsuhiro Yoshida, Tadashi Oikawa, Ikuo Shinmura, Kunio Morozumi, Takao ...
    1985 Volume 18 Issue 3 Pages 273-281
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Two interesting cases of hemolytic uremic syndrome (HUS) are reported in this paper.
    The first case was that of a 46-year-old male admitted with nephrotic syndrome and fever elevation in October 1951. A renal biopsy performed on 25 October showed pathological findings of HUS. The serum creatinine (s-Cr) level increased rapidly and progressively.
    Hemodialysis (HD) was started but was discontinued after 3 weeks, because of recovery from uremia. On 1 December laparotomy was performed because of massive GI bleeding from a duodenal ulcer. After the operation, intraperitoneal bleeding of unknown origin and dilatation of the stomach occurred.
    In consequence of severe dehydration, the s-Cr level rose again, and the patient was re-introduced to maintenance HD.
    In this case, we were able to treat the HUS by early introduction to HD, but another factor led the patient to end-stage renal failure.
    The second case was that of a 13-year-old female admitted with chronic glomerulonephritis in July 1983. Renal biopsy revealed focal and segmental glomerulonephritis (FSGN) with a large crescent. This patient received intensive treatment with cyclophosphamide, urokinase and dipyridamole. On 3 September she complained of fever, and subsequent GI bleeding and decreased renal function were observed.
    She was introduced to HD, and after 11HD treatments her renal function was improved. However, gradually S-Cr increased again, and hemodialysis was begun again in November.
    We suggest that the patient with FSGN with a crescent was affected with HUS accidentally. The first, reversible, uremia was due to HUS, and the second, irreversible, uremia resulted from the accelerated course of the FSGN.
    Download PDF (3622K)
  • Youichi Okinaga, Chikako Shimano, Kazukiyo Nakao, Yasuo Ohki, Takefumi ...
    1985 Volume 18 Issue 3 Pages 283-287
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Thrombus formation, despite efficient anticoagulation with heparin, takes place on the dialyzer membrane during hemodialysis. Since thrombus formation is associated with a transient fall in platelet count and an elevation of platelet factor 4 (PF4), it is hypothesized that platelet retention on these membranes is an initial step in the process leading to thrombus formation. To determine whether aspirin reduces this thrombus formation on the dialyzer, the platelet counts and PF4 levels and mean platelet volumes (MPV) during hemodialysis with the patient taking 1gm of aspirin daily were compared with the levels during a control period without aspirin. At first, to assess the direct effect of heparin on platelet activation, heparin (5, 000u) was injected in to a normal control intravenously as a bolus.
    A transient fall in platelet count and an elevation of PF4 were seen 15 minutes after the injection and were rapidly cleared by the circulation. One gm of aspirin per os with heparin has been shown to reduce the elevation of PF4 significantly. Similarly during hemodialysis, a transient fall in platelet count and an elevation of PF4 were seen, especially 30 minutes after the beginning, but 1gm of aspirin with heparin could not suppress the elevation of PF4, Therefore it was concluded that the platelet activation during hemodialysis was due not only to the blood-dialyzer surface interaction but also to the direct effect of heparin itself. Furthermore 1gm of aspirin reduced the platelet activation caused by heparin itself but did not reduce the activation during hemodialysis with heparin as an anticoagulant.
    Download PDF (1177K)
  • Tadanobu Goya, Takashi Fujinaga, Tetsuya Abe, Taketo Iwamoto, Haruhiko ...
    1985 Volume 18 Issue 3 Pages 289-293
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Carpal tunnel syndrome (CTS), an entrapment of the median nerve in the carpal tunnel, has been reported with increasing frequency in patients undergoing hemodialysis. During the last 8 months, 21 maintenance hemodialysis patients with CTS visited our hospital. These patients were 10 males and 11 females whose mean age was 56.8. The original disease in all of them was primary glomerulonephropathy. Ten of them had bilateral CTS; therefore 31 involved upper extremities are discussed here. The condition occurred most often in long-term hemodialysis patients. The mean duration of dialysis treatment was 107.2±34.1 months and only 3 out of the 21 patients were on dialysis less than 5 years. Diagnosis of CTS was based on the following symptoms and signs: hand pain, sleep paresthesia, numbness of the hand in a median distribution, positive Phalen test and wasting of the thenar eminence. Prolongation of distal motor latency was revealed in 25 out of 26 tested hands, it was absent in and the mean value in the other 20 was 7.81±3.05msec. 22 of 31 involved upper extremities had an active A-V fistula and 6 had previous surgery. Creation of an A-V fistula was statistically associated with development of CTS (P<0.002). However it seems likely that the increased incidence of CTS in bilateral hands and in long-term hemodialysis patients is due to other pathogenetic mechanisms rather than alteration in hemodynamics at the access site that increases venous pressure or the vascular “steal” phenomenon. Surgery for decompression of the median nerve at the wrist was performed on 18 hands of 16 patients. An S-shaped incision was made over the palm to the anterior aspect of the wrist with wide exposure of the flexor retinaculum. Visible thickening of the flexor retinaculum within the carpal tunnel was present in all 18 hands. They were cut by a sharp scalpel to release bundlelike constriction of the median nerve. In some instances there was venous engorgement within the neurilemmal sheath or serous exudation. After surgery, immediate relief of hand pain was felt in all patients. 6 to 8 weeks after surgery, the two-point discrimination test on the palm was improved, but numbness, wasting of the thenar eminence and prolongation of distal motor latency continued. It is important to make an early diagnosis of CTS and to perform early surgical decompression of the median nerve, because delay in treatment may cause irreversible damage to the entrapped median nerve.
    Download PDF (1499K)
  • Masami Oda, Noboru Kasihara, Kouichi Ikeuchi, Tadashi Yamamoto, Minoru ...
    1985 Volume 18 Issue 3 Pages 295-299
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Single needle dialysis (SND) was developed in the 1960's. Although this method has appreciable advantages over the double needle dialysis (DND) used so far, it has not reached routine clinical application. Moreover, there has been little experimental research on the increase of dialysis efficiency in SND in Japan. The aim of this study, was therefore, to investigate the effects of 4 parameters on dialysis efficiency in SND. These parameters were shunt flow, extracorporeal circulation flow, blood return pressure, and blood return time.
    Material and Methods: A water tank filled with a 100mg/ml urea solution was used as the model of intracorporeal circulation, and was connected with the SND system. After 30 minutes simulation circulation, experiments were performed under various conditions of the 4 parameters, and the results were analyzed to find the optimal conditions for maximum dialysis efficiency in SND.
    The results were as follows:
    With increase in shunt flow from 100 to 300ml/min, the urea extraction rate was significantly increased. Under a shunt flow of less than 200ml/min, the urea extraction rate was not affected by the extracorporeal circulation flow, whereas the rate increased with increase in the extracorporeal circulation flow under a shunt flow of more than 300ml/min, Blood return time did not significantly affect the urea extraction rate irrespective of the shunt flow. The urea extraction rate went up together with blood return pressure. At a low shunt flow (below 200ml/min) there was no significant difference between DND and SND. However there was a significant difference between DND and SND when the shunt flow was over 300ml/min.
    Download PDF (593K)
  • Nobuaki Hirayama, Sachi Osanai, Waka Uematsu, Tadashi Suzuki, Tomihisa ...
    1985 Volume 18 Issue 3 Pages 301-308
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Because of a desire to provide the most suitable treatment for hemodialysis patients, psychological, physical and social problems influencing the mental state of the patients were studied. One hundred in-hospital hemodialysis patients were divided into groups according to age, presence of family problems, occupation, physical complications and character, and compared.
    The mental state was most favorable between 3 and 12 months after the introduction of hemodialysis, whereas in patients with hemodialysis for other lengths of time, depression was noticed in more than half of the subjects. In most of the patients, irritation and anger, and loss of brightness or sympathy were observed during the first 3 months or later than 12 months after introduction of the therapy respectively. As for the relationship between age and mental state most of the patients between 26 and 40 years of age showed depression, irritation, anger, pessimism, despair, fear of death and aggression.
    Regarding family problems, psychopathology including loss of brightness or sympathy, pessimism, despair, anger and aggression was common in divorced, persons and those having children younger than 18 years. As to occupation, most of the salaried workers showed depression, irritaion and anger, whereas most of the unemployed patients presented despair, pessimism and loss of brightness or sympathy. The patients with physical complications other than chronic renal failure showed various psychic problems including a suicidal tendency.
    Analysis of the character tendency by the Yatabe and Gilford test revealed that B-type character was associated with an increased probability of showing depression, pessimism, anger and aggression. A person of E-type character was likely to show despair and a suicidal tendency and C-type despair and fear of death, whereas a D-type person was most unlikely to experience psychic problems.
    The patients were treated mainly with psychotrophic drugs such as antidepressants and/or minor tranquilizers together with psychiatric interviews. Some of the patients, however, needed to have the necessity of hemodialysis explained repeatedly and/or required consecutive psychotherapy. Psychotherapy clearly diminished the psychological or psychiatric symptoms in some of them.
    The present study suggested that a poor outcome of a psychological condition after the introduction of hemodialysis is indicated by 1) a spouse who cannot cope, 2) symptoms of physical origin, 3) the absence of full-time work, 4) having one or young children, 5) being in the prime of life, 6) B and E types of character and 7) long duration of therapy. The study emphasizes the importance of psychological and social care in the overall management of patients under hemodialysis therapy.
    Download PDF (1248K)
  • Keiji Ono, Yohko Hisasue
    1985 Volume 18 Issue 3 Pages 309-313
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    In order to clarity the potential toxic effects of an excess of vitamin A (VA) in regular dialysis patients, plasma VA, retinol binding protein (RBP) and prealbumin (PA) were measured and the relationhsip between plasma VA levels and clinical or biochemical abnormalities was delemined in 47 regular dialysis patients.
    Mean levels of VA (418±24mcg/dl), RBP (417±19mcg/ml) and PA (582±20mcg/ml) were significantly elevated. There was a significant linear negative relationship between plasma VA levels and the hematocrit (HCT) (r=-0.499). The RBP/VA ratio also was correlated with the HCT (r=0.613) and was inversely related to plasma i-PTH (r=-0.608) and very low density lipoprotein (r=-0.324). Theme was on correlation between plasma VA and serum Ca, P, or triglycerides.
    These results suggest that significantly elevated plasma levels of VA can contribute to anemia in regular dialysis patients and that hypervitaminosis A is severe in patients with a low RBP/VA ratio. This suggests that the potential membranolytic effect of VA is apparent only when VA is bound to lipoprotein, not to RBP. These findings suggest that VA preparations should not be given to patients on regular dialysis treatment
    Download PDF (1152K)
  • Hirofumi Hashimoto, Nobuhiro Tsutsui, Akio Imagawa
    1985 Volume 18 Issue 3 Pages 315-318
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Because the secretion of PTH is controlled when the serum magnesium level is high, generally a dialysate magnesium concentration of 1.5mEq/l is prescribed. However, since hypermagnesemia is also a cause of peripheral nerve damage, pruritus etc., as far as possible magnesium at normal levels is advisable. Recently a preparation of 1α(OH)D3 was used and with an easy compensation for hypocalcemia in dialysis patients the efficacy of low dialysate magnesium (magnesium concentration 0.5mEq/l) was examined.
    Low dialysate magnesium was used for a period of 3 months for 40 regular hemodialysis patients and studies were carried out on the changes in serum magnesium, calcium, phosphate, and c-PTH levels. With the use of low dialysate magnesium the serum magnesium level fell significantly from 2.59±0.53mEq/l to 2.00±0.33mEq/l (p<0.01). There was no significant difference in the serum calcium and phosphate levels before and after the use of low dialysate magnesium. However, with the use of low dialysate magnesium the serum c-PTH level rose significantly from 2.06±1.16ng/ml to 2.75±1.86ng/ml (p<0.02). In addition, with the use of low dialysate magnesium, a negative correlation was obtained between the serum magnesium level and the serum c-PTH level.
    In the future, in order to use low dialysate magnesium concentration over a long term, it will be necessary to examine the fluctuation of serum c-PTH levels obtained from the closely corrected serum calcium level, and to suppress PTH secretion by some other method.
    Download PDF (481K)
  • Kanji Shishido, Ken Takahashi, Tadao Akizawa, Tateki Kitaoka, Shozo Ko ...
    1985 Volume 18 Issue 3 Pages 319-322
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 36-year-old female hemodialysis patient with chronic renal failure due to chronic glomerulonephritis was admitted to our hospital. Since the predialysis period, she had suffered from severe renal anemia which did not respond to anabolic steroid or protein permeable hemodiafiltration.
    In November 1983, her serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels rose to 64 and 53 KU respectively, and continued to rise during the next three weeks, when she was admitted. On admission, the tests for hepatitis B surface antigen and hepatitis A antibody were negative, and no elevation of other viral titers was noted. The tests for hepatitis B surface antibody had been consistently positive since 1981. Drug-induced hepatic injury could be ruled out. Based on these findings, she was diagnosed as having non-A, non-B hepatitis induced by a blood transfusion which had been performed in September because of genital bleeding.
    Her hepatic enzyme levels increased gradually and reached peak values (SGOT 224KU, SGPT 223KU) four weeks after admission. The levels of these enzymes returned to normal eight weeks later. Her hematocrit value, which had been around 16% before the onset of acute hepatitis, showed a rise associated with the liver damage and reached 30% at the peak of the liver enzyme abnormalities. Then her hematocrit value decreased slowly with the improvement in liver function, and was down to 21% sixteen weeks later. The circulating erythropoietin (Ep) level and reticulocyte count increased with the deterioration of the liver damage, and returned to the initial levels after normalization of the hepatic enzyme.
    The clinical course of this patient strongly suggests a relationship between acute hepatitis and improvement in the anemia. The presumed mechanism of the improvement is that hepatic erythropoietic factor (HEF) produced by the liver damage stimulated hepatic Ep production, which increased erythropoiesis in the bone marrow. Furthermore the elimination, by protein permeable hemodiafiltration, of renal inhibitory factor and accumulated uremic substances, which inhibit HEF and erythropoiesis in the bone marrow, may have contributed to the marked improvement in her anemia.
    Download PDF (506K)
  • effectiveness of HF on diabetic patients
    Shigeko Hara, Masahiro Miura, Keihachiro Kuzuhara, Yoshio Suzuki, Hiro ...
    1985 Volume 18 Issue 3 Pages 323-329
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The outcome for diabetic patients on dialysis has been poor. Early death (within one year) occurs frequently. Therefore we studied the relationship between the effects of dialysis on the prognosis and the clinical findings prior to the treatment.
    Age, sex, types of diabetes mellitus, clinical and laboratory findings of uremia, and glucose and lipid metabolism were analyzed in 45 cases. Moreover, the effect of different modes of dialysis (hemofiltration [HF], and hemodialysis [HD]) on glucose and lipid metabolism were examined in 9 cases.
    (1) Laboratory and clinical findings at the commencement of dialysis vs. prognosis:
    The first group, consisting of 10 cases (survival for less than 1 year), showed significantly high BUN levels (145±48mg/dl, p<0.05) low creatinine levels (10.9±2.5mg/dl, p<0.05) compared with the second group that consisted of 35 cases (survival for more 1 year). Fasting blood sugar levels of the first group were significantly higher (251±219mg/dl, p<0.02) than those of the second group. Serum triglyceride levels were significantly high (239±78mg/dl, p<0.01) in the first group. In the first group, cardio and cerebrovascular complications were observed in 50% and 80% respectively, and were significantly higher than in the second group. Vascular death occurred in 77% of the first group and in 22.2% of the second group.
    Factors influencing the prognosis were a high triglyceride level, abnormal glucose metabolism, and the complication of macroangiopathy.
    (2) Effects of HD and HF:
    There was no difference in the insulinogenic index at 30 nin of Oral-GTT between the two groups. ∑IRI/∑BS was 42.0±21.5μu/mg on HF and 29.8±23.4μu/mg on HD. A significant (p<0.05) increase in insulin secretion was observed on HF. Further study detected somatostatin substance, a kind of antagonist for insulin secretion, in the HF filtrate. HF was somewhat better than HD in lowering the triglyceride level.
    This study suggests that HF is probably more effective than HD in regard to glucose and lipid metabolism of diabetic patients on dialysis.
    Download PDF (1492K)
  • Takakuni Tanizawa, Morimasa Tani, Susumu Inaba, Daisuke Mase, Hiroki M ...
    1985 Volume 18 Issue 3 Pages 331-338
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    PD or CAPD can be the first choice of treatment for infants with CRF and weighing less than 10kg because the construction and maintenance of the blood access are very difficult in such cases.
    We reported a five month-old boy with CRF due to congenital hypoplastic kidney. He was admitted to our hospital with failure to thrive and tetany. Soon after admission he was introduced to PD and thereafter to CAPD. At 10 months of age, he was treated with HD using Brescia-Cimino's fistula becase of incurable peritonitis and the infection of Tenkoff's catheter outlet. At the age of one year, single needle maintenance HD with the a double pump via subclavian vein catheterization was started for the purpose of preserving blood vessels and waiting for the maturation of the internal A-V fistula. The subclavian vein catheter was exchanged at intervals of six to eight weeks without any troublesome infections. One year and one month after the maintenance of HD, transplantation with his mother's left kidney was performed successfully.
    These results indicate that the subclavian vein cannulation for vascular access in infants with GRF is a clinically useful procedure not only in emergency HD, but also in prolonged HD.
    Download PDF (1671K)
  • Masami Kozaki, Shigeto Hataya, Akinori Soejima, Yasuko Hirose, Katsuhi ...
    1985 Volume 18 Issue 3 Pages 339-344
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Cadaver donor kidney transplantation is often necessary for semiemergency juroery and differs from living donor kidney transplantation. Therefore, preoperative hemodialysis is also necessary for semiemergency operations in many cases, and there are also many patients in whom hemodialysis in necessary due to ATN after the operation. In the present study, we experienced 39 cases of cadaver donor kidney transplantation and obtained the following conclusions concerning hemodialysis for patients with cadaver donor kidney transplantation.
    1) We paid attention to the following points for preoperative hemodialysis.
    a) The coagulation time was ditermined, and heparin volume was made as small as possible.
    b) Ht 30-35% was as a target transfused during the dialysis.
    c) Predonine was administered after the finish of or two hours before the dialysis.
    d) Sufficient conversations between nurses and patients were carried on during the dialysis so that the preoperative nursing could be conducted smoothly.
    2) We paid attention to the following points for postoperative dialysis.
    a) The dialysis was performed more than 24 hours after the operation, and the supplemental solution amount in the meantime was urinary amount plus 30ml/hr. Ion exchange resins and glucose insulin therapies were made against hypercalcemia.
    b) The coagulation time was measured as a short and frequent dialysis in the early stage after the operation.
    c) Predonine was administered after the finish of or two hours before the dialysis.
    d) Scintiscan using 99Tc-DTPA was conducted twice a week in order to discover acute rejection during ATN early on.
    e) In particular, no isolated dialysis was carried out.
    3) Complications due to the dialysis were not particularly noted, 34 out of 39 cases (87.2%) with cadaver donor kidney transplantation could teammate the dialysis, and the maximal dialytic period was 42 days.
    Download PDF (1446K)
  • Kazuo Tsuzuki, Shigeru Minowa, Shigemisu Itoh, Yutaka Inagaki, Izumi A ...
    1985 Volume 18 Issue 3 Pages 345-348
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We placed silicone rubber catheters in the subclavian veins of children by Seldinger's vascular puncture method for emergency blood purification. The size of the catheters was modified to be suitable for children. The vascular access was sufficient to purify their blood for a long period and was not associated with serious complications. When blood purification was not being performed, the catheter was connected to a portable microinfusion pump and heparin was infused continuously. Therefore the children were able to move quite freely, for the long period when the catheters were in place. Monitoring of the central venous pressure was also possible through this access route. Although some training is needed for the success of this vascular access, the technique will become more widely used for emergency vascular access for children.
    Download PDF (1374K)
  • Yuki Yamashiro, Tadayasu Shono, Shinya Hashimoto, Ippei Iwatani, Nobor ...
    1985 Volume 18 Issue 3 Pages 349-354
    Published: June 30, 1985
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Changes of plasma Apo A1, A2, and E, HDL-ch and LCAT activity and serum cholesterol binding reserve (SCBR) were determined during a sigle hemodialysis treatment in uremics with and without complications. Plasma levels of Apo A1 and A2 decreased in hemodialyzed patients. In uremics without complications, plasma Apo A1 and A2 increased after a single hemodialysis treatment. In addition, the value corrected by serum protein concentration still showed an increase in Apo A1 and A2.
    In uremics with diabetes mellitus and liver cirrhosis, no significant changes were observed in Apo A1 or A2 during a single hemodialysis.
    The correlations between Apo A1 and A2, HDL-ch, LCAT activity, SCBR examined respectively during a single treatment of hemodialysis. A positive correlation was observed, especially significantly positive between Apo A1 and A2 and HDL-ch (r=0.833, r=0.641).
    Changes of Apo E were not so marked after a single hemodialysis treatment, but decreased significantly in the value corrected by serum protein concentration.
    Furthermore, heparin loading was carried out to examine the effect of heparin on Apo A1, A2 and E, SCBR, and HDL-ch in uremics, but no significant changes were observed.
    From the above results, it was concluded that the improvement of Apo A1, and A2, HDL-ch in the four after a single treatment of hemodialysis resulted to a great extent from uremic toxins during hemodialysis.
    Download PDF (677K)
feedback
Top