Assessment was made of the serum protein binding of cefpiramide (CPM), a cephem of very large protein binding capacity, using sera from healthy subjects (HS) and patients with chronic renal failure (CRF), applying equilibrium dialysis in vitro. The protein binding capacity of CPM in patients with CRF [hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), conservative treatment (ND)] was significantly less than that in HS and was found to be directly correlated with the serum albumin concentration. While examining the protein binding of CPM in patients with HD, binding capacity immediately following the start and completion of dialysis was found to decrease significantly compared to that of pre-dialysis patients and to be correlated inversely with a change in the non-esterified fatty acid (NEFA) content. Log nK, for expressing protein binding affinity, decreased slightly in pre-HD, CAPD, and ND patients. This decrease was particularly prominent in patients during and after HD in contrast to HS. The addition of palmitic acid (PA), a common NEFA, to pooled sera from HS caused the binding capacity of CPM to decrease, accompanied by an increase in PA concentration. The addition of warfarin was noted to have the same effect, while diazepam and digitoxin caused no change. It follows from these findings that the changes in the binding capacity of CPM during and after HD may possibly result from the increment of NEFA through heparin-induced lipase activation, with consequent competitive displacement of CPM from in and around site I (warfarin-site) on the albumin molecule or an allosteric effect on the albumin binding capacity. In conclusion, changes in the protein binding capacity of CPM in CRF patients should be taken into consideration when attempting to avoid possible side effects.

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We measured the plasma α-human atrial natriuretic peptide (α-hANP) levels in hemodialysis (HD) patients to assess the usefulness of this index for setting the dry weight (DW) in comparison with other indices, such as body weight, mean atrial pressure and cardio-thoracic ratio. We also investigated the clinical implications of plasma α-hANP levels in chronic HD patients with various types of cardiac disease or hypertension. The subjects were 102 chronic HD patients without diabetes mellitus (59 males and 43 females, mean age: 57.2 years, mean duration of HD: 89.7 months).
Results: 1. plasma α-hANP levels were a useful index for setting the DW, and a level not exceeding 70.0pg/ml appeared to be appropriate as the target post-HD α-hANP level. 2. In HD patients complicated by atrial fibrillation (Af) alone, the pre-HD α-hANP level was significantly higher than that in HD patients without any complications or with other types of cardiac disease. In HD patients with mitral regurgitation plus Af, both the pre-HD and post-HD α-hANP levels were significantly higher than that in the patients without any complications. 3. There was no significant difference in the α-hANP level between HD patients with hypertension and those without this complication.

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We report the results of a trial of the analgesic effects of aqueous gel containing 10% lidocaine with 3% glycyrrhetinic acid mono 3-0 hemiphatalate sodium as an absorption promotor to relieve the pain of venepuncture in hemodialysis patients. A square sponge (20mm in length and 1mm in thickness) filled with approximately 0.3g of gel was applied to the surface of the forearm and kept covered with an adhesive plastic film (Tegaderm®) for 60min, which was the time it took for the maximum analgesic effect to be attained, sixty min application of the gel produced a painscore under “slightly painful” 94 times in 11 cases (original disease; CGN). During the trial, no signs or symptoms were observed in the skin and A-V fistula under the covering. These results suggest that this gel can provide effective local anesthesia for venepuncture in chronic hemodialysis patients.

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Spleen cells of mice immunized with E. Coli J-5 and myeloma cells (Ag8×63) were fused using 50% polyethyleneglycol. Consequently, three different monoclonal antibodies (MoAb) were obtained. These MoAb crossreacted with other gram negative rods such as pseudomonas and salmonella minnesota R595, and a positive reaction was found against lipid A in Dot blot analysis. 10ng/ml to 10μg/ml of E. Coli J-5 was found to be accurately measurable by the competition ELISA using these MoAb against lipid A. The %CV for each point on the standard curve using the competition ELISA ranged from 4.3 to 8.3% with an average of 6.2%. The recovery rate of E. Coli J-5 from urine samples was excellent. Using the competition ELISA, E. Coli J-5 could be measured without any interference from inhibitors and potentiators. We measured the E. Coli J-5 concentration of the plasma from a patient who died from sepsis, the urine sample of a patient with acute pyelonephritis and the dialysate at the inlet of the dialyzer during hemodialysis. The concentration was 540ng/ml, 40ng/ml and less than 10ng/ml, respectively.

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We had a peritoneal dialysis patient who suffered from itching. He was diagnosed as having parasite delusion because of his speech and his behavior, but after about 5 months' ineffective treatment for delusion, scabies was diagnosed by microscopical examination of the eruption. In this case treatment for scabies led to the disappearance of both the itching and the parasite delusion. It is important to first detect parasites and eggs and then administer the proper drugs.

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This case had idiopathic hypothyroidism associated with hypokalemic myopathy, non-traumatic rhabdomyolysis and acute renal failure due to glycyrrhizine and trichlormethiazide.
A 65-year-old female, was admitted to our hospital through the emergency department for disturbance of consciousness and respiratory distress. Laboratory data on admission were as follows: GOT 617KU, GPT 80KU, LDH 2, 833WU, CPK 7, 440IU/l, serum myoglobin 19, 000ng/ml, BUN 54.6mg/dl, Cr 4.2mg/dl, serum K 1.5mEq/l. It was decided to stop the administration of glycyrrhizine and trichlormethiazide. For severe hypokalemia, the patient was given an intravenous drip infusion of KCI solution (150-200mEq/day) for a period of 3 days while monitoring the EKG. Correction of the serum K improved the paralysis of her extremities, respiratory failure and ileus. However, in spite of conservative therapy, acute renal failure progressed, and the patient was put on hemodialysis treatment. She subsequently recovered and is presently in good health without recurrence.

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