Renal Dialysis Patient Research Articles

Acquired perforating dermatosis in renal dialysis and diabetic patient: a case report

Acquired perforating dermatosis (APD) is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. APD affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. We report a new Moroccan case of this rare entity. It’s about a 62-year-old patient, followed for diabetes mellitus and renal failure under dialysis and who presented an extremely itchy rash, made of nodules with a keratotic center and associated with multiple scratching lesions. The skin biopsy showed a perforated epidermis with the removal of material containing keratin and collagen. the outcome was favorable with oral corticosteroids with a follow-up of one year. APD is a rare dermatosis that affect considerably the quality of life of patients. its treatment remains suspensive pending the treatment of the cause.

17980 Severe nodulocystic acne in a renal dialysis patient managed successfully with low-dose isotretinoin

A 31-year-old woman with a background of a previous simultaneous pancreas-kidney (SPK) transplant with failed kidney, on long-term dialysis, was referred to our dermatology service for management of severe nodulocystic acne. She had type 1 diabetes, with secondary retinopathy, nephropathy and gastroparesis. Examination revealed severe nodulocystic acne affecting her face and neck, with evidence of scarring. Previous treatments included conventional topical treatments, as well as oral oxytetracycline. Her regular medications were mycophenolate mofetil, prednisolone, isoniazid, and paroxetine. Six months of low dose isotretinoin treatment (20 mg daily) resulted in complete resolution of her acne and there have been no adverse side effects reported thus far. Nodulocystic acne is not uncommon in renal dialysis patients. The mechanism of this whilst still largely unknown, has previously been postulated to be related to the toxic effect of uraemia. Nodulocystic acne often has a significantly negative impact on a patient’s quality of life and often fails to respond to conventional acne therapy. The use of low dose isotretinoin to treat acne in haemodialysis patients has been scarcely reported with only Lin et al’s prospective study in 1999 showing significant efficacy and minimal side effects. Renal elimination of isotretinoin and its metabolites is known to be negligible, and isotretinoin is protected from haemodialysis removal through its protein binding. Our case adds to the evidence that low-dose isotretinoin can safely and successfully be used to treat severe nodulocystic acne in renal dialysis patients, leading to a significant improvement in patients’ quality of life.

Enhanced Long-term Antithrombogenicity Instigated by Covalently-Attached Surface Modifier on Biomedical Polymers

During a variety of medical procedures such as renal dialysis, bypass surgery, and lung transplantation patient blood is exposed to the surface of a number of polymeric materials such as polycarbonate (PC), poly (vinyl chloride) (PVC) and polysulfone (PS) for a period up to several days. Such exposure may result in undesirable protein-material interactions that can potentially trigger deleterious biological processes including thrombosis, which may be responsible for other complications such as cognitive disability. In order to address this issue, we have further examined the behavior of an ultrathin antifouling and antithrombogenic coating based on monoethylene glycol silane surface chemistry. Samples of polymeric substrates were exposed to blood flow at a shear rate of ~20 s-1 for time periods of 3 and 6 hours, as well as 3 days. No additional anticoagulant chemistry was applied in the experiments. For all time periods, platelet adhesion, aggregation, and thrombus formation on the coated surfaces was inhibited compared to bare substrates (coated PC performing the best, followed by PVC-, and then PS-coated), strongly supporting the results of previous research conducted over far shorter blood contact times.

Methods for Estimating Survival Time of Treatments for Renal Dialysis

This papes discusses the theory and application of statistical methods for describing and analyzing survival times of the renal dialysis patients : a) from the first diagnosis until the time of death, and b) on each mode of given treatment. The paper also tries to predict the variables significantly effecting the survival time of renal dialysis patients. The paper makes use of and focuses on the data sets containing patient hospital records, patients’ identity and hospital code centre. To meet the desired aims, the paper uses two prominent methods of survival analysis including the Kaplan-Meier and Cox Proportional Hazard model. The result shows that survival time on the first treatment depends on mode of treatment and it quite low approximately 18 days for median time on hospital outpatient CAPD. Similarly, survival time on the second treatment is quite low about 24 days for the median time on hospital outpatient CAPD. It was also indicated that the survival time of renal dialysis patient depends on the number of treatments, the number of treatment changes, place of treatment, age and the first treatment

Auto-anti-Leb in the serum of a renal dialysis patient

Clinical & Laboratory HaematologyVolume 1, Issue 3 p. 239-242 Auto-anti-Leb in the serum of a renal dialysis patient CAROLYN M. GILES, Corresponding Author CAROLYN M. GILES Blood Group Reference Laboratory, London* Correspondence: Dr C. M. Giles, Blood Group Reference Laboratory, Gatliff Road, off Ebury Bridge Road, London SWIW 8QJSearch for more papers by this authorJOYCE POOLE, JOYCE POOLE Blood Group Reference Laboratory, LondonSearch for more papers by this author CAROLYN M. GILES, Corresponding Author CAROLYN M. GILES Blood Group Reference Laboratory, London* Correspondence: Dr C. M. Giles, Blood Group Reference Laboratory, Gatliff Road, off Ebury Bridge Road, London SWIW 8QJSearch for more papers by this authorJOYCE POOLE, JOYCE POOLE Blood Group Reference Laboratory, LondonSearch for more papers by this author First published: September 1979 https://doi.org/10.1111/j.1365-2257.1979.tb00472.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume1, Issue3September 1979Pages 239-242 RelatedInformation

Requirements and Pathology in Humans: Discussion of Session 4

Requirements and Pathology in Humans: Discussion of Session 4

Parathyroid carcinoma: a report of two cases and a concise review and update of the literature

Parathyroid carcinoma is very rare and when diagnosed can be difficult to treat as more than 50 per cent have persistent or recurrent disease. Patients generally present with profound symptoms of hypercalcaemia and a palpable neck mass. We describe a case of parathyroid carcinoma in primary hyperparathyroidism and a case in tertiary hyperparathyroidism in a renal dialysis patient. Most studies in the literature are retrospective but recent trends in presentation, treatment options and complications have been reviewed and are summarized in this paper.

Forum of the End-Stage Renal Disease Networks' Role in Implementing the National Kidney Foundation-Dialysis Outcomes Quality Initiative Clinical Practice Guidelines

The development and release of the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines marks an important step in the on-going process of improving the renal dialysis patient's outcomes. The Forum of End-Stage Renal Disease (ESRD) Networks' role in this process should be considered within the context of its mission and the ESRD Networks' Congressional mandate. In addition, facilitating the implementation of the NKF-DOQI Guidelines is one component of the Forum's current quality-related agenda. Environmental trends and current research indicate a variety of factors critical to the successful implementation of the NKF-DOQI Guidelines. The Forum's plan encompasses each of the following key elements: defining and evaluating the Guidelines and clinical performance measures (CPMs); prioritizing and locally disseminating NKF-DOQI Guidelines; converting NKF-DOQI Guidelines into CPMs; expanding the information infrastructure; and conducting quality activities and engaging local physicians. Keeping in mind the broader national agenda for quality improvement in the renal community, including continuing medical education programs focused on quality measurement and improvement tools and techniques, developing decision support tools and increasing on-line access to evidence-based reports and literature is important as well. Carrying out the Forum's plan for implementing the NKF-DOQI Guidelines, in collaboration with national nephrology professional and patient organizations, will facilitate Guideline adoption and use across the renal community.

Evaluation and Management of the Renal Failure and Dialysis Patient

The patient with renal failure presents many potential concerns during the perioperative period. A thorough history and physical examination, evaluation of laboratory parameters, and the knowledge of end-organ damage aid in safe management of these patients.

Rapid Development of Bilateral Internal Carotid Artery Aneurysm from Sphenoid Sinus Aspergillosis

The purpose of this case report is to familiarize the sinus surgeon with the possibility of the rapid development of internal carotid artery aneuryams from fungal infections of the sphenoid sinuses. A renal dialysis patient with progressive loss of vision was treated with high doses of steroids for the presumed diagnosis of temporal arteritis. Subsequent work-up included a magnetic resonance arteriogram (MRA) and computed tomography (CT) with contrast that failed to demonstrate aneurysmal changes of the carotid arteries but suggested the presence of a mycotic infection of the sphenoid sinuses. During a sphenoidotomy two days later, in addition to the anticipated aspergillus infection of the sinuses, an aneurysm extending from the left internal carotid artery into the sphenoid sinus was encountered. An emergency arteriogram immediately following the surgery revealed a second newly developed large mycotic aneurysm of the right internal carotid artery filling the right sphenoid sinus as well. This case report documents the rapidity with which mycotic aneurysms can develop from a sphenoid sinus infection secondary to aspergillosis in an immunocompromised host.

Tumoral Calcinosis-Like Metastatic Calcification in a Patient With Renal Osteodystrophy CT and Scintigraphic Appearances

Hyperparathyroidism and renal osteodystrophy are the disorders usually associated with metastatic calcifications, including tumoral-calcinosis-like calcification in soft tissue in dialysis patients. Tumoral calcinosis is a hard, juxta-articular mass comprised of septal, thick connective tissue and cavities filled with a dense milky substance. The authors report plain radiographic, CT, and scintigraphic findings of a large tumoral-calcinosis-like metastatic calcification accompanying renal osteodystrophy in a renal dialysis patient. This rare form of metastatic calcification and renal osteodystrophy as a background condition were demonstrated on bone imaging.

HUMAN LYMPHOCYTOTOXIC MONOCLONAL AUTOANTIBODIES FROM A HIGHLY SENSITIZED RENAL DIALYSIS PATIENT

A panel of 5 human monoclonal autolymphocytotoxic antibodies (IRM-3, IRM-4, IRM-7, IRM-8, and IRM-10) of the IgM class was established from a highly sensitized renal dialysis patient (IRM), by the generation of mouse-human heterohybridomas. This panel was screened for reactivity against foreign and autoantigens by ELISA, and for reactivity against different tissue sections and HEp-2 slide preparations by indirect immunofluorescence. Cytotoxicity screening of heterohybridoma supernatants gave broad panel reactivity profiles, being cytotoxic against B cells from patient IRM and also against most B cells tested and less reactive with chronic lymphocytic leukemia B cells; T cells were the least sensitive target. Immunoblotting showed that monoclonal IRM displayed some heterogeneity in their binding profiles, although all of them recognized a cellular structure of 26 kDa. None of the heterohybridoma cell lines exhibited cytoplasmic nor surface staining with an anti-CD5 mAb. Results obtained showed that all the autolymphocytotoxic mAbs generated were also able to react against certain nuclear and cytoplasmic self-structures as well as foreign compounds. Monoclonal antibody IRM-7 and, to a lesser degree, IRM-10 exhibited multispecific properties similar to those observed for polyreactive or natural antibodies.

Synergistic necrotizing cellulitis in the hand of a renal dialysis patient: A case report

Synergistic necrotizing cellulitis in the hand of a renal dialysis patient: A case report

Tumoral calcinosis causing bone erosion in a renal dialysis patient

Tumoral calcinosis is a rare disorder manifest by large calcific periarticular masses. Associated bone destruction has been described previously only once. The radiographic and computed tomographic (CT) findings of bone erosion in a case of tumoral calcinosis in a renal dialysis patient are presented. Although the presence of bone destruction may suggest a neoplasm, it does not exclude the diagnosis of tumoral calcinosis

Sonographic evaluation of suspected pediatric vascular diseases

Sonographic studies on 52 children with suspected peripheral vascular disease examined between January 1988 and December 1989 were retrospectively reviewed. A technique for examining the jugular, subclavian veins, and superior vena cava (SVC) was developed and is described. The technique for examining the extremities in the child is similar to the adult except higher frequency transducers are used. Twenty-six patients had normal examinations. Twenty-six examinations were abnormal with arterial or venous thrombosis in patients with central lines [10 patients], deep venous thrombosis in patients with painful swollen extremities [9], arterial pseudoaneurysm as a complication of vascular punctures [1], arteriovenous fistula in a renal dialysis patient [1], dilated vessel presenting as a mass [1], compression of a vessel by a mass resulting in extremity swelling [2]. Two patients had other etiologies causing their symptoms and diagnosed on sonography including an infected hematoma and a hip effusion. The advantages of sonography include no contrast material necessary, nonionizing radiation, qualitative and quantitative characterization of vascular flow is possible with Doppler, and the examination can be performed portably. Color Doppler aided in localizing the vessel, visualizing the thrombus, as well as decreasing exam time. Doppler sonography usually answered the clinical question and made further invasive procedures such as venograms and arteriograms unnecessary.

Production and characterization of human monoclonal lymphocytotoxic autoantibodies from a renal dialysis patient

We have produced human monoclonal lymphocytotoxic autoantibodies from a renal dialysis patient by the generation of a mouse/human heterohybridoma. The antibodies are of the IgM class and react with the patient's autologous cells, the B-lymphoblastoid cell line producing the antibody, normal T and B lymphocytes, B cells from chronic lymphatic leukemia patients (CLL cells), and the autoantibody-sensitive cell line K562. Screening of the monoclonal antibodies (mAb) against panels of normal T and B cells and CLL cells demonstrated that different reactivity profiles could be generated at different dilutions of the mAb. These profiles were identical to those seen with autoantibodies from different renal patients and this suggests that these profiles do not imply different antibody specificities but differing target cell sensitivity. Reactivity profiles seen in the fluorescence binding assays suggest that the target cell sensitivity is dictated not by antigen density alone but also by antibody/antigen affinity. The results from studies of enzyme treatment of target cells and lectin inhibition of the molecular specificity suggest that the autoantibodies are polyreactive, capable of binding sialic acid-dependent epitopes and other negatively-charged cell surface molecules.

腎透析患者におけるｂｅｔａ‐ｍｅｔｈｙｌｄｉｇｏｘｉｎの薬物動態

腎透析患者におけるｂｅｔａ‐ｍｅｔｈｙｌｄｉｇｏｘｉｎの薬物動態

Morphological irregularities in Dane particle cores.

Electron microscopy of hepatitis B antigen has revealed Dane particles with abnormal morphology. These aberrant Dane particles contain incomplete cores. They were seen in large numbers in the serum of an HBsAg-carrying renal dialysis patient and were less numerous but invariably present in other Dane particle-containing sera --12 from asymptomatic carriers, 2 chronic hepatitis patients and 1 patient with acute hepatitis. All 16 sera were shown to contain HBeAg.

Isolation of a human B lymphocyte membrane protein with Ia-like properties.

A rapid method for isolation of a major surface membrane glycoprotein from whole, unfractionated cultured human B lymphoblasts is described. After detergent solubilization the method uses gel filtration followed by affinity chromatography on Sepharose Con A and then alkaline acrylamide gel electrophoresis. Specific high-titre, rabbit antisera to the isolated protein reacted with cultured and normal peripheral blood B lymphocytes, as well as peritoneal macrophages from a renal dialysis patient. The antisera selectively inhibited the mixed lymphocyte reaction at high dilution. The protein reacted with a heterologous antiserum to HL-B antigens and contained subunits of MW 33 000 and 27 000. Resolution of the subunits, however, required a discontinuous SDS gel system. These properties indicate its similarity to murine Ia antigens. The protein was not associated with beta 2 microglobulin and showed no structural or antigenic similarity to the major erythocyte glycoprotein, glycophorin. Antisera to the protein failed to precipitate surface-radiodinated components from similarily treated extracts of cultured human T lymphoblasts. This method now makes available a reference membrane glycoprotein from a differentiated, nucleated human cell in sufficient purity and quantity for kinetic and biosynthetic studies.