The occurrence of fever during hemodialysis and hemofiltration. A comparative study

The occurrence of fever during various blood purification methods was evaluated in a retrospective study. It could be demonstrated, that patients treated chronically by conventional hemodialysis experience six times more febrile episodes than patients on chronic hemofiltration (4.84% versus 0.81%). Since many of the increased temperatures could not be explained by conventional means, it has to be assumed that the treatment itself caused the fever, possibly activating the monocyte hormone interleukin 1. It is of further note that there was no difference in the magnitude of the temperature due to septicaemia or to no obvious cause. This finding necessitates in our opinion an early antibiotic therapy in those cases where fever develops without clear explanation.

HTLV-III antibodies in hemodialysis patients--a consequence of blood transfusions?

An investigation for HTLV-III antibodies in chronic hemodialysis patients revealed in four out of 276 patients a positive result using the ELISA and western blot techniques. All HTLV-III positive patients had received blood transfusions. As it has been shown that a needle stick could transmit the HTLV-III, it is suggested that hemodialysis patients who have received frequent blood transfusions should be screened.

Hypercalcemia and elevated serum 1,25-dihydroxyvitamin D3 in a patient with Hodgkin's lymphoma

A 74-year-old woman was hospitalized because of decreased appetite, fatigue, and weight loss. The laboratory examination revealed hypercalcemia, a slightly increased serum creatinine level, and a markedly elevated serum level of 1,25-dihydroxyvitamin D3. The most important finding the physical examination revealed was enlarged inguinal lymph nodes. A biopsy disclosed lymphocyte-depleted Hodgkin's disease. After steroids, but not after calcitonin, both the elevated calcitriol concentration and serum calcium normalized. In spite of intensive chemotherapy, a further episode with hypercalcemia occurred and increased 1,25-dihydroxyvitamin D3 serum levels were observed. According to the available evidence it seems probable that the humoral hypercalcemia in this patient resulted from production of 1,25-dihydroxyvitamin D3 in the tumor.

Performance and biocompatibility of a new hemodialysis membrane

Performance studies and investigations of the biocompatibility of a new hemodialysis membrane were conducted in patients being chronically hemodialyzed. The investigated polycarbonate membrane revealed a very satisfying performance with regard to clearance values and the ultrafiltration rate. The biocompatibility studies showed a significant leukopenia and an increase of C5a, platelet factor 4 and granulocyte elastase. Thrombocytes and C3d remained unchanged. Long-term studies have to confirm whether or not the new membrane is more biocompatible, a suggestion which could be advanced, as no febrile episodes were observed during any treatment, a finding which is not typical for Cuprophan hemodialysis.

Effect of long-term administration of 1,25-dihydroxyvitamin D3 and 1 alpha-hydroxyvitamin D3 on the calcium content of the aorta, heart and kidney of normal and uremic rats

Studies in uremic rats were performed to see whether or not the long-term administration of therapeutical doses of 1,25-Dihydroxyvitamin D3 or 1 alpha-hydroxyvitamin D3 would induce histological changes in the aorta or increase the calcium content of the aorta or the heart. In contrast to observations of others, no effect of both vitamin D sterols could be observed on both investigated tissues. However, the remnant kidneys of the rats treated with both vitamin D compounds showed a significantly increased calcium content. According to these results one cannot exclude that the chronic application of active vitamin D metabolites has induced a calcium deposition in the remnant kidney. This finding deserves special attention, although we found, on the other hand, no evidence that an underlying arterial disease is aggravated by this therapy.

Effect of an acute protein load on the creatinine clearance in healthy vegetarians

In normal man an acute protein load increases the glomerular filtration rate (GFR) significantly, which seems to represent a renal functional reserve. Healthy vegetarians are known to have a statistically reduced baseline GFR. We performed three creatinine clearance studies (24-h study design) on each of nine healthy vegetarian subjects. The first clearance was measured as baseline, the second one was done on day 2 after an oral protein load of 100 g vegetarian protein (1.2-2.0 g/kg body wt.), respectively, ingested within half an hour. The third clearance, serving as a control, was done on day 14. All subjects had their normal vegetarian meals during the study. All vegetarians had at all times a normal serum creatinine level. The mean baseline creatinine clearance was 65.4 +/- 33.3 ml/min. 1.73 m2. In five of nine vegetarians we found a significant increase of the creatinine clearance after the protein load of 66.0% (mean) and a decrease to the baseline values, respectively, when the control clearance was measured. The remaining four vegetarians did not increase their creatinine clearance immediately after the protein challenge and their control clearances were found to be significantly reduced (-40.2%) compared to the individual baseline.

Endotoxin-induced acute renal failure in mice. Effects of indomethacin and the thromboxane-synthetase antagonist UK 38.485

Functional acute renal failure (ARF) was induced within 24 h following i.p. injection of 200 micrograms E. coli endotoxins (ET) into C3H/HeHan mice. Pre- and post-treatment with either UK 38.485, a selective thromboxane (TX)-synthetase inhibitor, or with the cyclo-oxigenase inhibitor, indomethacin (IM), does not prevent acute renal failure in these mice. Histologically, only very little fibrin degradation and few microthrombi are present 24 h later in the kidneys, so that disseminated intravascular coagulation (DIC) mechanisms cannot have caused the significant azotemia. Slight histological changes are accentuated in the UK 38.485-treated group. Only the indomethacin group has a significantly increased mortality as compared to all other groups. We conclude from our study that with low dosages of endotoxins functional ARF can be induced in mice without a circulatory shock and early mortality and that both UK 38.485 and IM are of little value in preventing it.

Parathyroid hormone and 1,25-dihydroxyvitamin D3 affect the tissue concentrations of zinc in uremic rats

The tissue concentration of zinc was studied in normal and uremic rats. Differences between the groups only reached significance when either parathyroid hormone or 1,25-dihydroxyvitamin D3 were administered. Uremic rats having obtained these compounds showed a significantly higher concentration of zinc in their liver, whereas their serum content of zinc was decreased.

Effect of diets containing varying concentrations of essential fatty acids and triglycerides on renal function in uremic rats and NZB/NZW F1 mice

Influences of essential fatty acids (EFA) and triglycerides as reasons for the progression of chronic renal failure are still in debate. We studied the outcome of four diets containing different concentrations of triglycerides and EFA in 5/6 nephrectomized rats and in NZB/W mice up to 45 weeks. The results showed no significant differences in the outcome of survival rate, proteinuria, urea, and creatinine levels as well as histological findings in the different groups of both animal models. We conclude that diets containing EFA up to C18:2 or being free of EFA or that triglyceride-enriched diets have no influence on the natural course of the renal disease in these both experimental models.

[Analysis of antibiotic therapy in 500-bed hospital: indications, administration and possibilities of cost reduction]

The introduction of a justification form in a 500-bed acute hospital before starting therapy with antibiotics resulted in a more than 30% decrease of current antibiotics costs. The cost reduction was mainly caused by reduced consumption of very expensive antibiotics. Moreover, analysis of the justification form revealed that more than 20% of diseases such as pneumonia, bronchitis, postsurgical complications, or skin and bone infections were diagnosed and treated without sufficient clinical and bacteriological documentation. The use of a justification form for antibiotics is therefore not only useful for cutting costs, but also for educating physicians in how to administer rational prophylaxis and therapy with antibiotics.

Failure to show a temperature-dependent vascular stability during hemofiltration

The effect of different blood temperatures on the vascular stability during hemofiltration was evaluated in 10 patients being in the regular chronic hemofiltration program. In contrast to recent data, no differences could be observed with regard to the heart rate, systolic blood pressure or mean arterial pressure, when the blood returned to the patient either with a temperature of 34.68 degrees C or 36.22 degrees C. According to these data it is therefore presently not justified to consider differences in the blood temperature as a critical determinant for the vascular stability during HF.

Successful hemodialysis for acute renal failure in late pregnancy

The occurrence of an acute renal failure during pregnancy does not necessarily imply the termination of the gestation. A 21-year-old pregnant woman was successfully dialyzed because of an acute azotemia developing in the 27th week of pregnancy. After repeated hemodialysis treatments the renal function recovered and the patient gave birth to a healthy child at full term. It is suggested that hemodialysis should be performed as often as possible (twice daily) in order to avoid any dramatic changes of the serum chemistry and the fluid content of the body. Furthermore, such a regimen allows the regular intake of calories, which is considered as especially important in such an event.

[Vitamin D 1980--a stocktaking (author's transl)]

Vitamin D3 and its various metabolites have a central position in the regulation of the calcium- and phosphorus metabolism. Of special importance is 1,25-dihydroxyvitamin D3, which is almost exclusively synthesized in the kidney. Its production is dependent upon several hormonal stimuli and of course occurs normally only in intact renal tissue. The multifactorial regulation of its formation implies that a variety of diseases could cause disturbances in the metabolism of vitamin D. 1,25-dihydroxyvitamin D3 exerts its biological effects not only at the intestine, bone and kidney, but as well presumably in organs as the parathyroid glands, hypophysis, pancreas and skin. 24,25-dihydroxyvitamin D3--although its biological value is still in debate--represents possibly a second vitamin D-hormone of importance. Inspite of intensive research work the metabolic fate of vitamin D3 and its full biological significance is not yet entirely understood.

Digoxin-quinidine interaction in patients with renal failure

Investigations were performed in order to study whether or not quinidine would exert similar effects on the serum digoxin concentration in patients with renal failure as in normal subjects. Fourteen out of fifteen patients showed a significant increase of the serum digoxin level after four days of quinidine application. This indicates, that the quinidine effect is not solely caused by a decrease of the renal digoxin clearance, although nine patients, not being hemodialysed, revealed a correlation between their creatinine clearance and the rise of the serum digoxin concentration after quinidine. As however, the patients on hemodialysis did not show higher digoxin levels than those treated conservatively, it is suggested that the degree of the uremic intoxication might be responsible for the observed correlation.

Failure to show a correlation between serum parathyroid hormone, nerve conduction velocity and serum lipids in hemodialysis patients

The proposed role of parathyroid hormone as an important agent for the development of certain uremic complications could not be confirmed in studies correlating, in dialysis patients, the nerve conduction velocity and the serum lipids with four different immunochemically defined forms of circulating parathyroid hormone. To a certain extent the data invalidate suggestions which favor parathyroid hormone as a leading uremic toxin.