Between January 1965 and June 1987, we encountered 170 patients who were treated for acute renal failure by hemopurification. They were divided into four groups in chronological order to investigate changes in their survival rates and organ failure.
Patients in the early periods mainly had medical and gynecologic diseases, and for the most part had one to three failed organs. Patients with more than four failed organs were aged and suffering from surgical diseases, and they increased after 1980. Hemopurification consisted of peritoneal dialysis and hemodialysis in the early periods and changed to hemodialysis plus hemoadsorption in 1980 with a resultant improvement in survival rate from 53% to 76%. However, the survival rate decreased to 68% after 1983, in spite of additional treatment by continuous hemofiltration and plasmapheresis, because of an increase in patients with uncontrolled serious Infections. Futhermore, only 17% of the patients who had multiple organ failure, including kidney, lung and liver, survived in that late period.
As a result, the outcome of our treatment of acute renal failure has chronological improvement as a result of advances in hemopurification and the treatment of shock, and subsequent organ failure. Cooperation among those performing surgery, hemopurification and intensive care in treatment, management and research is necessary to improve survival rates in acute renal failure and background organ failure with uncontrolled serious infection.

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The effect of body fat on body dry weight was assessed on the basis of the body fat ratio calculated using the formula: Body Total Fat (BTF)-2000 (kett)
The body fat ratio of 29 subjects undergoing hemodialysis (11 males and 18 females) was measured, and they were grouped into 14 with a normal fat ratio (N) and 15 with a high fat ratio (H), setting the upper limit of normal at 20% in males and 24% in females. Cardio-thoracic (CT) ratio and blood pressure, two routine major determinants of dry weight, were compared in the two groups, along with the results of a questionnaire administered to determine the degree of dry weight consciousness.
The CT ratio tended to be lower in Group H. Comparison of average blood pressures before and after dialysis showed a significant reduction after dialysis in Group H (p<0.01). The questionnaire revealed that whereas only 4 subjects (57%) in Group N had desire to increase dry weight, 7 (70%) in Group H did.
The normal value for dry weight may be set lower than it should be in subjects who have a propensity to gain weight, when analyzed on the basis of body fat ratio, and therefore the body fat ratio ought to be considered in setting dry weight.

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A 53-year-old man had been on CAPD for eight years. Two episodes of peritonitis were successfully treated conservatively with antibiotics and peritoneal irrigation. On this occasion he had cloudy bags again and the patient was treated conservatively. No fever, leukocytosis or positive peritoneal culture was observed, but the cloudy bags persisted for the following seven days. The peritoneal catheter was removed under local anesthesia, and he was then treated by hemodialysis in the absence of any dinical signs or symptoms. On the 9th day after removal of the peritoneal catheter, he complained of severe abdominal pain. The patient was febrile and had abdominal tenderness, guarding and rebound. Leukocytosis was also observed. A laparotomy was performed under the dignosis of pan-peritonitis. The patient's intestines were adherent to each other and covered with a white purulent coating. His appendix had given rise to an ileocecal abscess and was almost compretely necrotic. Appendectomy and drainage were performed. He recovered gradually and was discharged. The symptoms of panperitonitis due to perforation of intra-abdominal organs were modified by irrigation, and it must be borne in mind that such intra-abdominal pathology can arise during CAPD.

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A 34-year-old woman suffering from renal dysfunction for several years was admitted to our hospital because of an exacerbation. Neurological findings suggested that she was suffering from uremic encephalopathy (UE). After hemodialysis, her neurological findings improved remarkably. Brain magnetic resonance imaging (MRI) and computed tomography (CT) were performed before and after hemodialysis. Before treatment, the T₂-weighted MRI image revealed high intensity and the T₁-weighted image showed strong low intensity bilaterally around the globus pallidus, internal capsule, and corona radiata. Low density was observed in the same areas on a CT scan. The T₂-weighted MRI image alone also showed abnormally high intensity in the brain stem area. After the 4th hemodialysis, abnormal MRI and CT images were still observed, but the intensity of abnormalities had decreased and the patient showed improvement in her neurological symptoms. After the 16th hemodialysis, the abnormal images disappeared on both the MRI and CT scans. Although the detailed pathophysiology of UE is still unknown, the MRI and clinical changes observed in this patient suggest that diffuse edematous brain damage is one of the characteristic features of UE.

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