Two patients were treated for eosinophilic peritonitis in continuous ambulatory peritoneal dialysis (CAPD). Both were males, one 46 years of age the other 39.
Eosinophilia appeared 2 days after CAPD was initiated in the former case and 13 days after in the latter. In both cases, the patients exhibited no symptoms other than cloudiness of the dialysate. Cultures of both patient's dialisates were sterile, and the eosinophil count in both returned to normal spontaneously, in spite of continuing CAPD.
The cause of eosinophilia could not be determined, but an elevated IgE serum level in one patient suggested possible allergy to the peritoneal dialysate system. Eosinophilia was benign in both patients.
It is thus important not to over-react by immediately treating eosinophilic peritonitis with antibiotics or other medications.

View full abstract

A new radioimmunoassay system for erythropoietin (EPO) titers in plasma or serum was established using recombinant human EPO which was raised recently. It has excellent specificity, sensitivity and reproducibility, and can be used for clinical purposes. EPO titers could be directly measured within the range of 3-250mU/ml and the sensitivity was 5mU/ml.
EPO titers were 16.1±8.6mU/ml (m±SD) in 428 patients on maintenance dialysis and 17.1±7.2mU/ml in 86 normal controls. No significant difference was observed between the two groups. EPO titers in the dialysis patients were extremely low compared with their low hematocrit, and no correlation was observed between EPO and hematocrit. EPO titers were similar in patients who had received large blood transfusions and in patients not tranfused, although frequent blood transfusions were required in some patients with severe anemia whose EPO titers were lower. EPO titers tended to increase with age in both groups, though they decreased slightly above 70 years of age in normal controls. No correlation was observed between EPO and the duration of dialysis, though the number of patients with higher hematocrit tended to increase with the duration of dialysis. Among the various etiologies of renal failure, the highest EPO titer was observed in patients with multiple myeloma. Anemia was mild and EPO titer was slightly higher in patients with polycystic kidneys. EPO titers were similar in patients with and without the administration of anabolic steroids or iron preparations. There was no correlation between EPO and reticulocyte count, serum concentration of urea, creatinine, iron or ferritin.

View full abstract

Three patients with bleeding tendency or hyperlipidemia were treated by plasmapheresis using nafamostat mesilate (FUT-175, Torii & Co., Ltd., Japan) as an anticoagulant. Double-filtration plasmapheresis (DFPP) was performed in two patients with bleeding tendency. Another patient with type V hyperlipoproteinemia was treated by centrifugation and filtration plasmapheresis (CFPP), using a centrifuge-type blood cell separator as the plasma separator and hollow fibers as the filter. The celite-activated coagulation time was measured to determine the infusion volume of FUT-175.
In patients with bleeding tendency, when FUT-175 was infused continuously at the rate of 20mg per hour, DFPP could be maintained without coagulation in the circuit and without worsening on the bleeding tendency. On the other hand, in the patient with type V hyperlipoproteinemia, because the extracorporeal circulation time for CFPP was longer than that of DFPP, FUT-175 was to be infused at a rate of at least 50 to 60mg/h. Unlike heparin, FUT-175 did not cause any change in the electrophoretic mobility of β-lipoprotein by agarose gel electrophoresis. The result suggested that FUT-175 did not affect lipid metabolism. No adverse effects were observed with the administration of FUT-175.
In conclusion, FUT-175 was useful and safe as an anticoagulant in the plasmapheresis of patients with bleeding tendency or hyperlipidemia.

View full abstract

The objective of the present study was to elucidate the possible mechanism of uremic neuropathy using an experimental model. Bilateral nephrectomy was performed to induce acute renal failure in rats. Rats given sham operation were used as controls. Forty-eight hours after the operation, measurements were made of motor nerve conduction velocities, axoplasmic electrolyte concentration and cross-sectional area of myelinated fibers in the sciatic nerves. The axoplasmic Na, K and Cl concentrations were measured by electron X-ray microanalysis using freshly freeze-dried thin sections.
The results were as follows: 1) The sciatic motor nerve conduction velocity in uremic rats was significantly decreased compared with that in the controls (29.2±3.1m/sec. vs. 37.1±1.9m/sec., n=20, mean±S. D.; p<0.01). 2) Axoplasmic Na concentration in sciatic nerves from uremic rats was significantly decreased compared with that from the controls (6.0±0.7mmol/kg wet weight vs. 12.7±1.4mmol/kg wet weight, n=10, mean±S. D.; p<0.05). 3 An approximately 16% reduction in the cross-sectional area of myelinated fibers was observed in uremic rats.
These results suggest that impairment of Na permeability and atrophy of the myelinated fibers may play an important role in the decreased motor nerve conduction velocities in acute renal failure.

View full abstract

We examined 148 parathyroid glands surgically removed because of secondary hyperparathyroidism from 42 patients (29 male, 13 female) with chronic glomerulonephritis on maintenance hemodialysis. Using morphometric analysis, we measured the area occupied by oxyphil cells in a section through the maximum diameter and calculated the ratio to total area (R). We divided the glands and patients into four groups: Group I (R<1%), Group II (1≤R<5%), Group III (5≤R<10%) and Group IV (10%≤R).
1) There were no significant differences between the sexes in age, duration of hemodialysis, serum PTH-C level, or Ca×iP product. 2) The largest number of patients (40.5%) and glands (53.4%) belonged to Group I. 3) Diffuse hyperplasia was dominant in Group I (63.3%), and nodular hyperplasia in Group IV (76.9%). 4) There were no differences in age or serum PTH-C level between the groups of patients. However, patients in Group I, compared with those in Group IV, had a shorter duration of hemodialysis and smaller Ca×iP product. 5) There were positive correlations between total glandular weight and serum PTH-C level, as well as between total weight and total area. No specific tendency was found in the scatter diagram of oxyphil cell area and serum PTH-C level. However, in cases with an oxyphil cell area of more than 10mm² or an R value of more than 5%, serum PTH-C levels were rather low. The results favor the theory that oxyphil cells may not secrete PTH-C. 6) There was no evidence for tertiary hyperparathyroidism in our 42 patients.

View full abstract

When 16 hemodialysis patients were asked by a questionnaire, about the presence or absence of dry mouth, 15 of them answered in the affirmative. In these patients, salivary flow volume and concentrations of salivary components (Na, K, Cl, P, BUN, Cr, osmolarity, amylase and pH) were measured before and after hemodialysis. It was found that salivary flow volume in hemodialysis patients was lower both before and after hemodialysis than that in healthy persons and that their post-dialysis salivary flow volume was significantly larger than that before dialysis. Futher all the salivary components measured were lower or tended to be lower after hemodialysis. Among other things, a positive correlation was observed after hemodialysis between % decrease in salivary osmolarity and % increase in salivary flow rate, a finding suggesting that increased osmolarity might be involved in the dry mouth experienced by hemodialysis patients. Sialography performed in 5 patients demonstrated dilatation of the primary duct and atrophy of glands in 3 of them, indicating the presence of irreversible xerostomia characterized by decreased salivary flow volume.

View full abstract

It has recently been reported that the incidence of malignancy is high in hemodialysis patients. We report a case of continuous ambulatory peritoneal dialysis complicated with IgA myeloma, multiple bone fractures and liver failure. IgA myeloma was treated with cyclophosphamide, and the level of cyclophosphamide in serum was measured during hemodialysis treatment.

View full abstract

A rapid assay for serum indoxyl sulfate was developed using internal-surface reversed-phase high-performance liquid chromatography (ISRP-HPLC). The identification of indoxyl sulfate was confirmed by secondary ion mass spectrometry and UV spectrometry. By using ISRP-HPLC, the serum level of indoxyl sulfate can be directly analyzed from serum samples, without deproteinization.
The serum level of indoxyl sulfate was quantitated in 80 chronic hemodialysis patients. The serum level of indoxyl sulfate before hemodialysis in the hemodialysis patients, 32.6μg/ml, was markedly increased compared with that in healthy subjects, 0.5μg/ml, and showed weak but significant correlation with duration on hemodialysis, serum creatinine, and serum β₂-microglobulin. The serum level of indoxyl sulfate in the hemodialysis patients was 25.7μg/ml after hemodialysis. Protein (albumin) binding of indoxyl sulfate before and after hemodialysis was 89% and 84%, respectively.
Equilibrium dialysis demonstrated that indoxyl sulfate inhibited the albumin binding of salicylate and that 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid inhibited the albumin binding of indoxyl sulfate.
Indoxyl sulfate which was bound to serum albumin, could not be easily removed from blood by hemodialysis, and therfore was markedly accumulated in uremic serum as an inhibitor of drug-binding.

View full abstract