It is well known that end stage renal failure is accompanied by hyperlipidemia, and that the type of treatment utilizel has significant effects on various serum lipid levels. In the present study, we have endeavored to evaluate the effects of hemodialysis (HD), chronic ambulatory peritoneal dialysis (CAPD), and Kidney transplantation on hyperlipidemia in the patients with end stage renal failure.
Fasting blood samples were taken from out-patiens, who were being managed at our clinics. Calories, carbohydrate, fat, protein, and fiber intakes were calculated on the basis of weekly patient records. Patients receiving hemodialysis were divided to two groups, diabetic (HD-DM) and non-diabetic (HD).
HDL-cholesterol levels in the transplantation group were significantly higher than those in the HD group. CAPD patients had significantly higher triglyceride concentrations than those in the other three groups. Among various apolipoproteins, A-I in the transplantation group was significantly higher than that in the other three groups, whereas B in the CAPD group showed a significant increase as compared with the other three groups. Total cholesterol/HDL-cholesterol and apolipoprotein A-I/B ratios were calculated as atherogenic indexes. CAPD groups showed the most unfavorable values for both rations, whereas the transplantation group showed the best values for both indexes. The food record analysis did not reveal any significant differences in calorie, fat, and carbohydrate intakes among the four groups. Fiber intakes in the CAPD and transplantation groups were significantly higher than those in the two HD groups. From these results, we conclude that CAPD patients have the highest risk for atherosclerosis, and that this is probably not attributable to differences in diet among the four groups.

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Psychological problems were investigated in 27 patients (19 males and 8 females) with chronic renal failure in adolescence (group F) by comparing them to 33 controls admitted for more than 6 months due to chronic renal disease (group D). In group F, the mean age of disease onset (6.4±4.2 years) was significantly younger than that in group D (9.2±3.8 years). and 70% of patients had been hospitalized for more than 3 years. Moreover, their growth were markedly retarded and 44% of them had received corticosteroid therapy before. Based on assessments made by each physician in charge, physical strength frequently declined in group F (89%) as compared to group D (45%), while the percentages of patients in low spirits, with delay in school work, with problems in friend or family relationships or who had poor self-control were almost equal to those in group D. On the Y-G Personality Test, Group F showed a tendency towards emotional instability and social maladjustment. Among the five profiles, the Director type was smaller in proportion to both the Black list and Eccentric types. A similar tendency was also recognized in group D.
By MAS (Manifest Anxiety Scale), 32% of group F were judged as having high anxiety, and the patients on dialysis for less than two years tended to have high scores.
The analysis of the Twenty Statement Test indicated that the proportions of statement contents were similar to those of healthy senior high school students, and that descriptions of body image or illness increased instead of identity or life feelings. Although they described fewer positive life feelings, their wishes and dreams for the future were more positive.
Though the psychological and personality trends of group F were also common to group D, the conditions of more long term history, restrictions in living conditions, marked growth retardation, reduced physical strength and dialysis treatment had apparently increased such deviation.

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We conducted a study of six rhabdomyolysis (RML) cases encountered at our center during the 3-year period from 1988 through 1990. The patients were all males and ranged in age from 32 to 67 years (mean age: 45±12 years). The cause of RML was external trauma in 3 cases. The other 3 cases had no history of external trauma. All cases were complicated by renal failure, 1 patient suffered an acute aggravation of chronic renal failure, and the other 5 had acute renal failure.
Two patients improved with conservative treatment, but the other 4 required blood purification (hemodialysis: HD and/or hemodiafiltration: HDF). Although the elimination rate of serum myoglobin (Mb) during blood purification was only 6.3% on HD, it ranged from 22.2-50.0% on HDF with a mean rate of 31.9%.
Four of the six patients svrvived. The courses of the two patients who died were complicated by multiple organ failure (MOF).

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We measured the concentrations of serum C1q, SAP, C1q·β₂-MG, and C1q·SAP in maintenance hemodialysis (HD) patients. These concentrations in HD patients with carpal tunnel syndrome (CTS(+)) were compared with those in HD patients without CTS (CTS(-)). The results were as follows. I, Serum SAP levels in CTS (-) patients were significantly higher than those in CTS (+) patients and healthy control subjects. 2, Serum C1q·β₂-MG levels in CTS (-) patients were significantly higher than those in healthy control subjects, and C1q·β₂-MG levels in CTS (+) patients were significantly higher than those in CTS (-) patients. 3, Serum C1q·SAP levels in CTS (+) patients were significantly lower than those in CTS (-) patients. The above results suggest that C1q·β₂-MG is in some way related to CTS.

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Iliac bone biopsy specimens obtained from 33 patients with chronic renal insufficiency being managed conservatively were stained with alkaline Congo red, aluminum stains and Berlin blue in order to study deposition of amyloid, aluminum and iron. The degrees of the staining reactions for amyloid, aluminum and iron were classified into 3 stages, and their related serum β₂-microglobulin, aluminum and ferritin levels were also determined. Amyloid precipitation was positive in 12 (63%) of the 19 patients whose serum creatinine levels were 4.0mg/dl or more, showing that the amyloid staining reaction increased proportionately as the serum β₂-microglobulin level increased Aluminum precipitaion was positive in 18 (55%) of the 33 patients with any compensatory stage of chronic renal insufficiency, and iron was also positive in 18 (55%) of the 33 patients. Aluminum and iron precipitated in the calcification front, and were partly positive on the cement line as well. There was no correlation between aluminum staining and serum aluminum level, or between iron staining reaction and serum ferritin level.
These results suggest that amyloid-related, alminum-related and iron-related bone disease may be present in non-dialyzed patients without clinical symptoms.

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The traditional course of treatment for resistant peritonitis is removal of the peritoneal catheter to eradicate the organism, followed by insertion of a new catheter several weeks later. In the present study, we report the results of treatment of resistant peritonitis by exchanging catheters in a single operation. Catheter exchange was performed in 4 patients with persistent peritonitis and 7 with recurrent peritonitis, of whom 5 were children and 6 were adults. Dialysate culture yielded Staphylococcus aureus in 7 cases, Staphylococcus epidermidis in one case, and Klebsiella, Pseudomonas and Bacillus species in one case each. Intraperitoneal antibiotics (cefalotin or vancomycin and gentamicin or isepamicin) were given. The catheter was exchanged using the same peritoneal insertion site, and a subcutaneous tunnel and exit site were created on the opposite side to the previous one in 9 cases. The new catheter was inserted into the opposite side of the abdomen in 2 cases with tunnel infection. Clinical and laboratory resolution were obtained within 48 hours of operation in 4 patients with persistent peritonitis and in 2 with recurrent peritonitis who had signs and symptoms of peritonitis prior to operation. Peritonitis recurred in one case, in which bacteria was found not to have been eradicated at the time of operation, within 2 weeks. Bacterial examination indicated that the removed catheter of 6 of the 10 patients was positive for an organism, although in only 2 cases was the peritoneal effluent positive for an organism 4-7 days prior to operation. In conclusion, replacement of the catheter in single operation diminishes the risk and inconvenience to patients with resistant peritonitis. Sufficient and approprliate antibiotics would seem to be essential prior to the operation.

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We analyzed CAPD-related tunnel infections (TI) that occurred during a recent 5-year period in our dialysis center.
Forty-two patients (24-65 years old, 15 females and 27 males, 37 non-diabetics and 5 diabetics) were started on CAPD between January 1987 and December 1990, and continued until December 1991. A double-cuffed Tenckhoff catheter (swan neck type) was implanted in all patients.
Fifty-three episodes of TI occurred during the total observation period of 1559 paatient-months (0.41 times/year), and the affected period of these episodes was 323 patient-months (21% of the total observation period).
Forty-five episodes in which the outcome was determined by December 1991 were analyzed. The results were as follows: (1) Twenty-one episodes (47%) required surgical treatment (“unroofing” or catheter removal). Sixty-seven percert of TI coused by Staphylococcus aureus and 100% caused by Pseudomonas aeruginosa required surgical treatment. (2) The mean affected period of TI was 6.4 months. Seventy-six percert of the prolonged cases (over 6 months) required surgical treatment, whereas only 29% of cases under 6 mosths required this. (3) We defined advanced TI on the basis of local features such as necrotic tissue, overt abscess, fistula, cuff extrusion, or tissue deficit due to necrosis. Twenty-four episodes (53%) were advanced TI, and 88% of these required surgical treatment.
Our results indicate that TI episodes caused by S. aureus or P. aeruginosa, prolonged TI episodes of over 6 months, and advanced TI, should all be treated surgically as early as possible.

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In order to evaluate the effect of high-performance membrane (HPM) on the occurrence of carpal tunnel syndrome (CTS), the incidence of CTS was compared between 59 patients treated with HPM and 59 patients treated with Cuprophan (Cu). Most of the patients treated with HPM had been dialysed with Cu and suffered from arthralgia of had high serum β₂-microglobulin (β₂-MG) levels before the study.
After 4 years of therapy, the serum β₂-MG level of the HPM group significantly decreased from 60.3±19mg/l (mean±SD) to 35±10mg/l. The serum β₂-MG level of the Cu group did not change significantly.
There was no significant difference between the incidence of CTS in the HPM group (7 cases per 1, 757 patient-months) and in the Cu group (3 cases per 1, 737 patient-months).
In addition, the duration of hemodialysis until the decompression operation tended to be shorter in older patients in both groups.
In conclusion, changing the membrane to HPM did not prevent the occurrence of CTS in longterm patients. Futher investigation, not only of membranes but of other methods of blood purifi cation, are required.

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Heparan sulfate proteoglycan (HS-PG), which forms the charge barrier of the glomerular basement membrane (GBM), is considered to play an important role in maintaining the effective filtration of solutes since it preserves the hydrophilic character of the GBM. It does this by promoting water retention among the sulfonate groups and preventing clogging of the GBM under physiological conditions. Therefore, we studied the relation between negative electric charge and adsorption by determining the adsorptivity of a dialysis membrane, with an applied sulfonate group, for various proteins.
We found that the negatively charged membrane adsorbed positively charged proteins whose isoelectric points were more than 9.0. Furthermore, the negatively charged membrane achieved greater adsorption of proteins with higher positive charges. The degrees of such adsorption were therefore considered to be largely dependent upon the isoelectric points of proteins in cases in which the molecular weights of the proteins were nearly the same.

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Recombinant granulocyte-colony stimulating factor (rhG-CSF) was administrered to a patient with granulocytopenia which developed during treatment for CAPD (continuous ambulatory peritoneal dialysis) peritonitis and good results were obtained. The patient was a 42-year-old female, who complained of abdominal pain, fever, and cloudy dialysate. She was emergently hospitalized with a diagnosis of peritonitis. Transient improvement was achieved by administration of vancomycin and heparin in the CAPD bag and intravenous administration of PIPC. However, the dosage of the intravenous antibacterial agent had to be increased because of a recurrence of inflammatory findings.
Thereafter, the WBC fell to 870/mm³. We suspected that bone marrow suppression, secondary to the increased antibiotic dose, and the seriousness of her peritonitis were the causes of leucocytopenia. Therefore, we stopped the antibiotic administration. Acinetobacter was detected in blood cultures. Symptoms of ileus then appeared and IVH (intravenous hyperalimentation) was started, while CAPD was changed to HD (hemodialysis). However, no increase in her WBC was achieved. When rhG-CSF (75μg/day) was administered subcutaneously, a marked increase in the WBC was found. On the 12th day following rhG-CSF administration, a peak of 138, 000/mm³ was observed. Administration of the antibacterial agent was resumed and the patient's inflammatory findings improved. The ileus resolved, her general condition improved, and she was discharged after 3 months of hospitalization. RhG-CSF was considered to be very useful in the treatment of granulocytopenia associated with CAPD peritonitis.

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A 73-year-old woman, who had been undergoing maintenance hemodialysis since October 1988 because of nephrosclerosis with hypertension, was hospitalized for treatment of general fatigue, fever and epigastralgia. Multiple abscesses were detected in the left of the liver by abdominal US and CT scan. US guided percutaneous abscess drainage was performed and antibiotics were administered intravenously, A drainage tube was also placed. IPM/CS was effective for improving the symptoms and abscesses. Bacterial examination was negative and we could not determine the origin of the infection. Intrahepatic hematoma, probably due to drainage, was found during the course. We changed the anticoagulant from heparin to nafamostat mesilate, which resulted in improvement.
Only 6 cases of liver abscess with hemodialysis have been reported, 5 of which were in Japan, in the international literature. This case was successfully managed and we report here in the clinical course and present a brief discussion of the problems encountered in treatment.

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Two nurses with type C hepatitis transmitted by needlestick accident at hemodialysis units are reported. Each nurse suffered a puncture wound of her palm caused by a needle contaminated with blood from a hemodialysis patient. The two hemodialysis patients were positve for anti-HCV, negative for HBsAg, and had no liver dysfunction. One nurse developed general fatigue and liver dysfunction one month after her needlestick accident. Anti-HCV turned positive about 6 months after the accident. The other nurse developed asymptomatic liver dysfunction 4 months after her needlestick accident. Anti-HCV developed 6 months after the accident. Pathological findings of liver specimens from both nurses, who were biopsied 9 and 15 months after their accident respectively, revealed chronic persistent hepatitis. Liver dysfunction in both nurses resolved completely with administration of β-interferon.

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A 49-year-old female presented with multiple bone and joint pain in spring 1989, but a diagnosis of hyperparathyroidism was not made. Hemodialysis was started in May 1991 for chronic renal failure due to chronic glomerulonephritis. At the beginning of dialysis, marked bone resorption in x-ray pictures and high serum alkaline phosphatase and parathyroid hormone (PTH) were noted. CT examination revealed a huge right lower parathyroid gland confirmed by scintigraphy. Preoperative examination revealed intact-PTH of 1, 199pg/ml (normal range: 15-50pg/ml), C-PTH of 34.2ng/ml (normal less than 0.5ng/ml), and Al-P of 443IU/l. Intact-PTH was not suppressed by hypercalcemia (s-Ca 12.7mg/dl) during hemodialysis (intact-PTH 810→800pg/ml), suggesting automatism of parathyroid function. After subtotal parathyroidectomy removing 5.65g of parathyroid gland, serum PTH fell rapidly. On histological examination, the right lower parathyroid gland revealed a carcinoma consisting mainly of extended fibrous trabeclae and cells with large nuclei and multiple nucleoli.

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Transcatheter oily chemoembolization (TOCE) with 40mg of adriamycin (ADM) was perfomed a 59-year-old man diagnosed as having hepatocellular carcinoma. At the same time, hemodialysis and direct hemoperfusion were carried out to rapidly remove ADM and thereby decrease its adverse effects. As a result, the ADM concentration in blood decreased remarkably after the passage of direct hemoperfusion. No obvious side effects, such as moderate to severe leukocytopenia or cardiotoxicity, were observed.

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