Recently, the number of patients being treated by continuous ambulatory peritoneal dialysis (CAPD) has been gradually increasing. The most common and important complication of CAPD is infection, ...e.g., acute bacterial peritonitis and subcutaneous pericatheter infection. We experienced a case complicated by massive pleural effusion in the initial phase of institution. Although pleural effusion is a rare complication of the CAPD, this condition is extremely important because continuation of treatment is relatively ineffective. According to the literature, 43 patients with the same complication have been reported. Almost half of the cases complicated by pleural effusion were switched to chronic hemodialysis due to the difficulty of treatment. On the other hand, 8 cases were able to continue on CAPD after conservative treatment alone, such as decreasing dialysate volume or temporary discontinuation of CAPD. These facts indicate that the etiology of the massive pleural effusion during CAPD was not single. CAPD is a very useful system for managing end-stage renal failure, and pleural effusion cannot be detected before the institution of CAPD. Therefore, cases complicated by pleural effusion must be examined to determine whether CAPD can be continued or not.
Of 195 dialysis (HD) patients (pts), 115 qualified for a study to investigate clinical correlations between duration of HD and bone mineral content, renal osteodystrophy (ROD), pain grade score and ...biochemistry. On the basis of duration of HD, the pts were divided into 4 groups. Group 1 consisted of 34 pts who had been on HD less than 5 years (yrs), group 2 of 37 pts on HD between 5 and 9 yrs, group 3 of 33 pts on HD between 10 and 14 yrs and group 4 of 11 pts on HD for 15 yrs or longer. Bone mineral density (BMD) of the metacarpals was measured by microdensitometry, and BMDS of the metacarpals, lumbar spine and femoral head were measured by DEXA. Significant differences between the 4 groups were seen only in the metacarpals. There was a significant decrease in BMD in male pts who had been on HD for 10 or more years, whereas this decrease was already detected on female pts who had been on HD for less than 10 yrs. A positive correlation was noted between BMD of metacarpals and the ROD pain grade score in the 4 groups. According to the evaluation of BMD by DEXA in the previously mentioned bones, BMD of the metacarpals correlated most closely with ROD pain grade score, followed by duration of HD and age of the pts. Similary, lumbar spine correlated more with C-PTH than age of the pts. BMD of the femoral heads correlated, in decreasing order, with C-PTH, age of the pts, Ca and P product and calcitonin. Significant correlations were seen between BMD of metacarpals and duration of HD and ROD pain grade score. Our data support earlier statements on the clinical importance of the use of microdensitometry and BMD of metacarpals by DEXA in evaluating ROD in HD. Study of the BMD of the lumbar spine by DEXA may indicate the effectiveness of HD therapy in long-term care for ROD.
Pyuria and bacteriuria in hemodialysis patients Ishihara, Satoshi; Kobayashi, Satoru; Maeda, Shinichi ...
Journal of Japanese Society for Dialysis Therapy,
1991/09/28, Volume:
24, Issue:
9
Journal Article
Open access
We report the presence of pyuria and bacteriuria in hemodialysis patients with end stage renal failure. The voided specimens were obtained from the patients without any signs or symptoms of acute ...urinary tract infection. Of centrifuged specimens, 59.7% had 5 or more white blood cells per high-power field, and 43.5% had 10 or more. Also of these specimens, 29.8% yielded bacteria of 104 CFUs/ml or more, and 21.0% yielded 105 CFUs/ml or more. The analysis showed that neither the factors of sex nor diabetes mellitus caused significant differences in the presence of pyuria or bacteriuria. But it showed that sufferers of polycystic kidney disease tend to have both severe pyuria and bacteriuria. We conclude through statistical analysis, that the ordinary diagnostic criteria of urinary tract infection should not be adopted for patients with oliguria of less than 400ml of daily urine output volume.
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