Showing papers on "Peritoneal dialysis published in 1979"

Acute oliguric renal failure induced by indomethacin: possible mechanism.

Abstract: A patient with compensated congestive heart failure suffered acute deterioration of her renal function and cardiac status, requiring peritoneal dialysis, in association with indomethacin therapy. Discontinuation of this inhibitor of prostaglandin synthesis led to a prompt improvement in both her renal function and cardiac status. The patient was rechallenged with indomethacin and again developed acute reduction of her glomerular filtration rate and severe volume retention, which were again totally reversed when the drug was stopped. Urinary prostaglandin E was measured by radioimmunoassay in this patient and five additional patients with congestive heart failure and prerenal azotemia. All patients were found to have elevated levels of urinary prostaglandin E. The possible role for renal prostaglandin E as a compensatory mechanism to the vasoconstrictive stimuli present in congestive heart failure is discussed. The potential danger of inhibitors of prostaglandin synthesis in patients with congestive heart failure and prerenal azotemia is emphasized.

Effect of peritoneal dialysis, haemodialysis and kidney transplantation on blood platelet function. I. Platelet aggregation by ADP and epinephrine.

Abstract: Quantitation of the thrombocytopathy of uraemics may be one useful way of evaluating forms of therapy. 24 patients treated by haemodialysis and peritoneal dialysis at two different times had platelet aggregation studies whose parameters were compared with those of 24 normal persons, 5 successful transplants or 13 untreated uraemics. Renal transplantation and peritoneal dialysis improved platelet function. The haemodialysis procedure itself impaired platelet function: this was not due to heparin.

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat

Abstract: Continuous peritoneal dialysis significantly prolonged mean length of survival and reduced lethality rate of taurocholate-induced pancreatitis in the rat. The effect was improved by compensating protein loss due to pancreatitis and dialysis treatment. The beneficial effect of intravenous albumin treatment was enhanced when combined with dialysis treatment. Using hypothermic dialysate or adding aprotinin intraperitoneally had no additional effect.

Acute massive hydrothorax complicating peritoneal dialysis, report of 2 cases and a review of the literature.

Abstract: Acute massive right-sided hydrothorax is a relatively rare but serious complication of peritoneal dialysis and may be responsible for the development of dyspnea during peritoneal dialysis. The pleural fluid appears to arise from the peritoneal dialyzate based on the time of its appearance and its chemical composition. It should be included in the differential diagnosis when a patient becomes dyspneic during peritoneal dialysis along with exaccerbation of congestive heart failure, pneumonia, atelectasis, and purulent bronchitis. Its occurrence is an indication to stop the peritoneal dialysis and contraindicates further use of this form of dialysis. Treatment may be conservative or aggressive (thoracentesis) depending on the clinical condition of the patient. Etiology is poorly understood. In some cases, there may be traumatic diaphragmatic fenestrations, but the majority of cases appear to be due to less well defined communications between the peritoneal and pleural spaces.

Acute renal failure in burns.

Abstract: We present the combined experience of a burns unit and a renal dialysis unit in treating acute renal failure in burn injury patients A total of 28 cases have been treated of whom 4 regained normal renal function We would like to emphasize the following points which may improve the usually very poor prognosis: early diagnosis, early daily haemodialysis, adequate feeding and the early amputation of non viable limbs A search of the literature reveals that only 11 previously reported cases of burns injury patients being successfully dialysed for acute renal failure

Role of dialysis in the treatment of severe hypercalcemia: report of two cases successfully treated with hemodialysis and review of the literature.

Abstract: The role of dialysis in the treatment of patients with severe hypercalcemia is uncertain. The fourteen previously reported cases of hypercalcemia treated with either peritoneal or hemodialysis have been reviewed. Two additional patients treated with hemodialysis are described in this report. Because the use of large volumes of intravenous fluids was contraindicated, each of the patients received a low calcium bath (0-1 mEq calcium per liter) hemodialysis for three and a half hours. After dialysis, the serum calcium fell to normal in both and remained normal thereafter with treatment of the underlying disease (multiple myeloma in one and vitamin D intoxication in the other). Hemodialysis can clear up to 682 mg of calcium per hour as compared to 124 mg per hour for peritoneal dialysis and 82 mg per hour with forced saline diuresis. Low calcium bath hemodialysis is indicated when the presence of renal and/or cardiac failure prevents the administration of large volumes of intravenous fluids to hypercalcemic patients.

Peritoneal Transport of Vancomycin during Peritoneal Dialysis

Abstract: The peritoneal transport of vancomycin during peritoneal dialysis was studied in 11 uremic patients following intravenous and intraperitoneal administration of vancomycin. The half-life of vancomycin

Dialysis and transplantation in young children.

Abstract: patients with severe depressions, and the expectation is that those patients with elevated 2-7 patterns will show more antidepressant responses to lithium than those with lower 2-7 patterns, our findings suggest that obsessional thinking might be as important as depression as a discriminator variable of antidepressant responses to lithium. For example, when scale 7 was used alone, our results approximated the 2-7 hit rate found by House and Martin (74\",, v 8000 respectively) for the responders, suggesting that response to lithium is almost equally dependent on high scores on obsessional thinking almost as much as on depression. These suggestions from several studies seem worthy of further investigation, given the interest being taken in attempts to find patient subgroups and potential responders prior to the weeks of treatment usually required to evaluate response or non-response to psychoactive drugs. EDWARD F DONNELLY DENNIS L MURPHY IVAN N WALDMAN

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat. II. Analysis of its beneficial effect.

Abstract: In acute sodium-taurocholate-induced pancreatitis in the rat, peritoneal dialysis reduced serum amylase levels and the amount of fat necrosis, but did not influence the damage to the pancreas itself. Pancreatic ascites obtained in the early course of the disease was found to have a hypotensive effect when given intraperitoneally to healthy rats. This effect vanished in the later course of acute experimental pancreatitis and was reduced by acidification of the ascites or by administration of an antihistaminic drug. Thus the beneficial effect of continuous peritoneal dialysis on survival time and mortality rate seems to be of systemic origin.

Function of the hypothalamo-hypophysial-thyroid axis in chronic renal failure.

Abstract: Hypothalamo-hypophysial-thyroid function has been studied in twenty-five patients with chronic renal failure. Eight were receiving conservative treatment, nine peritoneal dialysis and eight haemodialysis. All were clinically euthyroid. Total thyroxine (T4) and triiodothyronine (T3) levels were reduced but free T4 levels were normal, while free T3 was reduced in patients with the most severe renal failure. It is suggested that the binding of thyroid hormones by the transport proteins is reduced and that peripheral conversion of T4 to T3 is impaired in renal failure. The thyrotrophin response to thyrotrophin-releasing hormone (TRH) is reduced in renal failure but this reduction is probably independent of alterations in thyroid hormone metabolism. Growth hormone was released by TRH in seven of the patients studied, possibly as a result of protein malnutrition.

Hematologic Problems of Dialysis Patients

Abstract: Recently, there have been numerous significant advances in our knowledge about the pathophysiology and management of the anemia of chronic renal failure. Aluminum, which dialysis patients receive as phosphate binders, can interfere with erythropoiesis (1, 2); significant evidence has been presented to suggest that uremic inhibitors play a minor, if any, role in the causation of the anemia (3, 4); an uremic, anemic sheep model corrected the anemia with infusions of plasma-rich sheep erythropoietin (Epo) and no in vivo nor in vitro erythroid marrow inhibition could be demonstrated (5, 6); and finally, recombinant human erythropoietin (rHuEpo) has been reproduced by recombinant genetic technology methods and has been shown in clinical trials to be effective in eliminating the anemia in almost all hemodialysis patients to which it has been given (7, 8). The measurement of Epo in plasma is now easier and more reliable with the use of radioimmunoassays to either human urinary or recombinant human Epo.

Intensive care unit treatment of acute renal failure following snake bite.

Abstract: Twenty-nine patients with acute renal failure following bites by snakes of the genera Crotalus and Bothrops were treated in an Intensive Care Unit (ICU). Eight were given conservative treatment. Peritoneal dialysis was necessary in 21 patients, and hemodialysis in one of these. The main complications occurring while the patients were in the ICU were pulmonary edema (5 cases), respiratory failure (4), cardiac arrest (4), and hypovolemic shock (1 case). Three patients died with respiratory and hemodynamic disturbances while in the ICU, one of them during the polyuric phase. Twenty-four patients were discharged from the hospital with no clinical or laboratory evidence of renal failure. Two patients developed bilateral cortical necrosis of the kidney. One of them died in the general ward after interruption of dialysis and the other was discharged from the hospital with chronic renal failure. It was not possible to perform a kidney transplantation. The importance of the ICU in the recovery of such patients is stressed. Language: en

Peritoneal clearance and total body elimination of vancomycin during chronic intermittent peritoneal dialysis.

Abstract: Vancomycin is a useful antimicrobial agent in patients undergoing chronic hemodialysis treatment; its efficacy in chronic peritoneal dialysis (CPD) has not been established. Serum (VS) and peritoneal fluid (VPF) vancomycin concentrations were measured in two CPD patients with staphylococcal peritonitis. Half-life of VS agreed with the half-life of VPF in each patient, and the VS/VPF ratio was 1.27 in both patients. Distribution volumes were 37.2 and 58.7 l, values approximating total body water in these patients. VS and VPF persisted in the therapeutic range (greater than 5 microgram/ml) for more than 16 days. In one patient, mean peritoneal clearacne was 9.8 ml/min, and overall drug clearance averaged 2.3 ml/min; in the other patient, overall clearance was 2.1 ml/min. These results indicate that therapeutic vancomycin levels can be maintained for more than 16 days with a single 1 g intravenous dose in patients receiving intermittent CPD, as is the case for hemodialysis patients. Because of this, parenteral vancomycin is useful in the treatment of staphylococcal peritonitis in CPD patients.

Renal venous thrombosis.

Abstract: In neonates, thrombosis beginning in small renal veins and progressing to larger veins is best termed renal venous thrombosis (RVT) since the renal vein is not usually concerned. RVT occurs dominantly in the new-born and affects males more often than females (2:1). Hyperosmolality, maternal prediabetes and angiocardiography contribute to the occurrence or RVT. Early signs and symptoms are largely non-specific with the most reliable being the presence of haematuria (49%) or a palpably enlarged and hard kidney (60%). A falling platelet count, raised FDP level of falling plasminogen level support the diagnosis in 90% of cases. Radiology and nephrosonography are very useful in establishing the presence or absence and functional state of the kidneys. Therapy consists of the maintenance of homeostasis, minimization of spread, correction of uraemia and prevention of renal hypertension from a contracted functionless kidney by elective nephrectomy after 4--6 months. Heparin therapy and peritoneal dialysis have greatly improved the outlook in bilateral cases.

Hemodialysis and pregnancy.

Abstract: When severe renal failure requiring hemodialysis complicates pregnancy, there is hesitation to continue the pregnancy. However, successful hemodialysis in pregnancy is being reported with growing frequency. Fetal survival and even conception is possible in patients undergoing dialysis. ( JAMA 241:1811-1812, 1979)