摘要:

Discontinuation of life-sustaining dialysis therapy led to death in 282 of 5,208 patients who started therapy for end-stage renal disease (ESRD) in Michigan during 1980–1985 with a follow-up through 1986. Based on life table estimates at 60 months after initiation of therapy, 9.4% of patients overall died due to termination of dialysis, 11 % of females versus 8 % of males (p = 0.02), 0.1–3.4% for ages 80 years, 12% for white versus 4% for black patients (p < 0.001) and 16% for diabetic ESRD patients (higher than any other group, p < 0.05). The Cox regression model confirms these significant findings for race, diabetes and age, and reveals a significant 60% increase in overall withdrawals for the years 1980–1985 (1.10/year, p < 0.02). A separate analysis of discontinuation of dialysis as the percentage of all 2,564 dialysis deaths in prevalence cases for 1980–1984 revealed an overall ratio of 8.9% with a significant difference for ages ≤ 64 versus ≥ 65 (p < 0.001), race (p < 0.001) but not for prior transplant failure or continuous ambulatory peritoneal dialysis therapy. Whereas the results for age and diabetes were expected, the significant increase of dialysis withdrawal over time and the racial difference are unexplained by information available at the Michigan Kidney Registry and indicate the need for exploration by furt

ISSN:0250-8095    

DOI:10.1159/000167954

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

This report describes two patients in whom essential IgG-IgM mixed cryoglobulinemia (EMC) glomerulonephritis led to end-stage renal disease. Both patients underwent primary hemodialysis, and during the period of uremia clinical and biological manifestations of the disease fully resolved. Transplantation was performed, and in both cases cryoglobulinemia quickly recurred (30 days and 6 months after transplantation, respectively) with clinical renal and extrarenal flare, and reappearance of the biological markers of the disease (decrease in C3 and C4 components of serum complement, detection of rheumatoid activity and of cryoglobulinemia in the serum). The literature on EMC glomerulonephritis leading to end-stage renal disease is reviewed. Factors that may have contributed to extinguishing the disease and to further recurrence following transplantation – consequences of uremic state, alloimmunization and intercurrent infectious disease – are discus

ISSN:0250-8095    

DOI:10.1159/000167955

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The characteristics of 5 patients who developed tuberculous peritonitis while receiving long-term peritoneal dialysis (PD) are presented. There were 2 males and 3 females. 3 patients were on intermittent and 2 were on continuous ambulatory peritoneal dialysis when tuberculous peritonitis was first diagnosed. None of the patients had recently received immunosuppression therapy or were diabetics. The clinical presentations were similar to other forms of peritonitis complicating PD except for a more insidious onset. As extraperitoneal involvement and peritoneal lymphocytosis were rarely present, the diagnosis was mainly dependent on the direct demonstration of Mycobacterium tuberculosis with smear (1 patient) and culture (4 patients). In 1 patient with a pleuroperitoneal communication, the diagnosis was made by pleural biopsy and a positive response to antituberculous therapy. All patients responded to treatment with a combination of three antituberculous drugs which included streptomycin, isoniazid, rifampicin and pyrazinamide. Two patients were transferred to hemodialysis. In 3 patients, peritoneal dialysis was continued. Peritoneal clearance and ultrafiltration capacity were unchanged for up to 16 months after treatment in 2 patients who continued peritoneal dialysis but was reduced by 30 and 50%, respectively, in the remaining patient. Only 1 patient died, but her death was not directly related to tuberculous peritonitis. It was concluded that with a high index of suspicion and early institution of treatment, tuberculous peritonitis complicating PD can be successfully treated with low mortality and without compromising the dialysis capacity of the peritoneal membrane.

ISSN:0250-8095    

DOI:10.1159/000167956

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A case of hypocomplementemic membranoproliferative glomerulonephritis was studied during remission of nephrosis induced by high doses of corticosteroids. Hepatitis B surface antigen (HBsAg) and immune complexes were detected in serum and glomeruli. Anti-hepatitis-B surface antibody, undetectable in serum by conventional radioimmunoassays was identified in circulating immune complexes (CIC). On two occasions, improvement in renal function coincided paradoxically with an extreme increase in serum HBsAg levels as well as with marked elevation of CIC. We suggest that, as previously observed in animal models of glomerulonephritis, extreme antigen excess may inhibit glomerular deposition of immune complexes.

ISSN:0250-8095    

DOI:10.1159/000167957

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167958

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167959

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167960

出版商:S. Karger AG    

年代:1989

数据来源: Karger