RESUMEN
BACKGROUND: Colonic diverticulitis is an important cause of polymicrobial peritonitis, which requires surgical treatment and cessation of peritoneal dialysis (PD). The aim of this study was to examine whether plain abdominal computed tomography (CT) is useful for evaluating colonic diverticulosis in chronic kidney disease (CKD) patients and to explore whether colonic diverticulosis is a risk factor for enteric peritonitis. METHODS: The subjects consisted of 137 consecutive CKD patients (Stage 4 or 5) who were candidates for PD from February 2005 to November 2009. Abdominal CT without contrast media was performed in all PD candidates. RESULTS: Diverticula of the colon were detected by plain CT in 57 cases (41.6%). The number of diverticula tended to increase with age. The most common site of involvement of diverticulosis was the ascending colon. In patients treated with PD, the incidence of peritonitis was higher in patients with diverticulosis than in those without diverticulosis (P = 0.004). However, only one episode of enteric peritonitis was observed among patients with diverticulosis. The presence of diverticulosis did not affect cumulative or technical survival. PD was not selected in four cases due to a high frequency of diverticula with episodes of abdominal pain. Two cases developed severe diverticulitis with peritonitis and underwent resection of the colon. CONCLUSIONS: Our study suggests that plain CT examination is useful for detecting diverticulosis in CKD patients. Silent diverticulosis is not a risk factor for enteric diverticulosis-related peritonitis. PD may be contraindicated in cases having frequent diverticulosis with episodes of lower abdominal pain.
Asunto(s)
Diverticulosis del Colon/complicaciones , Fallo Renal Crónico , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Adulto , Anciano , Anciano de 80 o más Años , Diverticulosis del Colon/diagnóstico por imagen , Diverticulosis del Colon/patología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Peritonitis/epidemiología , Peritonitis/mortalidad , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
We report a case of peritonitis resulting from colon perforation caused by ingestion of a rare foreign body in a patient on peritoneal dialysis (PD). A 72-year-old woman on PD was hospitalized with abdominal pain and cloudy PD fluid (PDF). Although conventional antibiotic therapy was started because of a diagnosis of infectious peritonitis, low-grade fever, abdominal pain and a high number of white blood cells in PDF persisted. On day 3, anaerobic bacteria were recognized on bacterial culture of PDF, suggesting a gastrointestinal etiology. During exploratory laparotomy, sigmoidal perforation by a piece of bamboo, probably resulting from ingestion of contaminated food, was found.
Asunto(s)
Colon Sigmoide/lesiones , Contaminación de Alimentos , Cuerpos Extraños/complicaciones , Perforación Intestinal/etiología , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua , Peritonitis/microbiología , Sasa/efectos adversos , Dolor Abdominal/etiología , Anciano , Antibacterianos/uso terapéutico , Colon Sigmoide/microbiología , Colon Sigmoide/cirugía , Drenaje , Femenino , Cuerpos Extraños/cirugía , Humanos , Perforación Intestinal/cirugía , Lavado Peritoneal , Peritonitis/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 68-year-old man was admitted with acute renal failure caused by cholesterol embolization after undergoing carotid artery stenting. Hemodialysis therapy (HD) was immediately required because of uremia, using nafamostat mesilate as an anticoagulant for HD. However, blue toes and gangrene of the feet worsened. To prevent use of anticoagulants and stabilize BP, HD was changed to peritoneal dialysis (PD). After starting PD, blue toes and gangrene improved markedly. Residual renal function also partially recovered. Although BP was unstable during HD, stability of BP and avoidance of anticoagulants during PD therapy might have contributed to the good results.
Asunto(s)
Lesión Renal Aguda/terapia , Arterias Carótidas/cirugía , Embolia por Colesterol/terapia , Diálisis Peritoneal , Stents/efectos adversos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Anciano , Arterias Carótidas/patología , Embolia por Colesterol/complicaciones , Embolia por Colesterol/diagnóstico , Humanos , Masculino , Diálisis Peritoneal/métodosRESUMEN
A 54-year-old woman on peritoneal dialysis (PD) was hospitalized with peritonitis with a high body temperature, abdominal pain and cloudy peritoneal fluid. She progressively fell into septic-like shock within only 6 hours after onset. The causative bacteria were Streptococcus mitis (S. mitis), part of the normal flora of oral cavity, intestine, female genial tract and upper respiratory tract. S. mitis shows pathogenicity for diseases such as endocarditis, brain abscesses and sepsis in children with malignancy or transplantation. However, S. mitis rarely shows severe pathogenic responses in adults. We report herein a case of fulminant peritonitis caused by S. mitis in an adult PD patient.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Infecciones Estreptocócicas/etiología , Streptococcus mitis , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Peritonitis/diagnóstico , Peritonitis/tratamiento farmacológico , Peritonitis/microbiología , Choque Séptico/diagnóstico , Choque Séptico/tratamiento farmacológico , Choque Séptico/etiología , Choque Séptico/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus mitis/aislamiento & purificación , Streptococcus mitis/patogenicidadRESUMEN
BACKGROUND: High baseline peritoneal solute transport rate is reportedly associated with reduced patient and technique survival in continuous peritoneal dialysis (PD) patients. However, the determinants of baseline peritoneal solute transport rate remain uncertain. The aim of this study was to investigate the relationship between peritoneal local inflammation, angiogenesis and systemic inflammation and baseline peritoneal permeability. METHODS: Peritoneal biopsy specimens from 42 pre-dialysis uraemic patients and 11 control individuals were investigated. Immunohistochemistry for CD68-positive macrophages, chymase- and tryptase-positive mast cells, interleukin-6 (IL-6)-positive cells, CD3-positive T cells, CD20-positive B cells, neutrophils and CD31- and pathologische anatomie Leiden-endothelium (PAL-E)-positive blood vessels in the peritoneum was performed. Baseline dialysate-to-plasma ratio for creatinine (D/P Cr) was determined within 6 months of PD induction. Clinical and laboratory parameters were measured at the time of peritoneal biopsy. Factors associated with peritoneal permeability were assessed by multiple linear regression analysis. RESULTS: Pre-dialysis uraemic peritoneum showed infiltration by CD68-positive macrophages, and mast cells, as compared with controls. Baseline D/P Cr was correlated with density of CD68-positive macrophages (P < 0.001), IL-6-positive cells (P < 0.001), CD31-positive (P < 0.05) and PAL-E-positive blood vessels (P < 0.05) and serum albumin (P < 0.05). However, baseline peritoneal permeability was not correlated with infiltration by mast cells, B cells, T cells, neutrophils, serum C-reactive protein or other clinical factors. On multiple linear regression analysis, the number of CD68-positive macrophages in peritoneum was an independent predictor for baseline peritoneal permeability (P = 0.009). CONCLUSIONS: Peritoneal macrophage infiltration is predominant in uraemic patients and is an important factor in predicting baseline peritoneal permeability.
Asunto(s)
Soluciones para Diálisis/farmacocinética , Inflamación/fisiopatología , Fallo Renal Crónico/complicaciones , Macrófagos Peritoneales/metabolismo , Macrófagos Peritoneales/patología , Diálisis Peritoneal , Transporte Biológico , Biomarcadores/metabolismo , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Técnicas para Inmunoenzimas , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Distribución TisularRESUMEN
As an extension of research, we have investigated modification of left-hand side (LHS) of biphenyl analogues containing an acylsulfonamide moiety in the development of potent and selective human beta(3)-adrenergic receptor (AR) agonists. Result of structure-activity relationships (SAR) and cassette-dosing evaluation in dogs showed that the hydroxynorephedrine analogue 16 had an excellent balance of in vitro and in vivo potency with pharmacokinetic profiles. In addition, to facilitate structure-based drug design (SBDD), we also have performed a docking study of biphenyl analogues based on the X-ray structure of the beta(2)-adrenergic receptor.
Asunto(s)
Agonistas Adrenérgicos/química , Agonistas de Receptores Adrenérgicos beta 3 , Receptores Adrenérgicos beta 2/química , Sulfonamidas/química , Agonistas Adrenérgicos/síntesis química , Agonistas Adrenérgicos/farmacocinética , Animales , Sitios de Unión , Simulación por Computador , Cristalografía por Rayos X , Perros , Descubrimiento de Drogas , Humanos , Modelos Químicos , Receptores Adrenérgicos beta 3/metabolismo , Relación Estructura-Actividad , Sulfonamidas/síntesis química , Sulfonamidas/farmacocinéticaRESUMEN
As an extension of research conducted on beta(3)-adrenergic receptor agonists as potential drugs for treating overactive bladder (OAB), novel series containing an acylsulfonamide moiety instead of the carboxylic acid moiety were evaluated. These compounds have been identified as potent and selective human beta(3)-AR agonists with improved oral bioavailability compared to the previous series. Results of structure-activity relationship (SAR) studies and cassette dosing evaluation in dogs showed several analogues (namely, 6h, 6j, 6o, 7e, and 9e) to have an excellent balance of in vitro potency and selectivity, pharmacokinetic (PK) profile, and an in vivo OAB model. Here we examined the relaxation response in dog detrusor muscle strips to a KCl induced tonic concentration. Results showed that the potency of in vitro relaxation response was not mirrored in the potency of the cAMP accumulation in CHO cell lines. Surprisingly, the EC(50) values of 6e and 7e found to induce relaxation of isolated bladder strips were over 50-fold higher than the cAMP accumulation in cell line. In general, increased lipophilicity led to decreased potency for the bladder relaxation compared with cAMP accumulation in CHO cell lines, indicating that lipophilicity is crucial for OAB drug candidates to improve beta(3) activity.
Asunto(s)
Agonistas de Receptores Adrenérgicos beta 3 , Descubrimiento de Drogas , Sulfonamidas/química , Sulfonamidas/farmacología , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Animales , Células CHO , Cricetinae , Cricetulus , AMP Cíclico/biosíntesis , Femenino , Humanos , Microsomas Hepáticos/efectos de los fármacos , Microsomas Hepáticos/metabolismo , Receptores Adrenérgicos beta 3/metabolismo , Estereoisomerismo , Relación Estructura-Actividad , Especificidad por Sustrato , Sulfonamidas/farmacocinética , Sulfonamidas/uso terapéuticoRESUMEN
BACKGROUND: Acute humoral rejection (AHR) is the most important risk factor for early graft loss in ABO-incompatible (ABO-i) kidney transplantation (RTx). The pathogenesis and diagnostic criteria for AHR after ABO-i RTx remain unclear. Complement fragment C4d deposition in peritubular capillaries (PTC), which is a sensitive indicator for activation of the classical complement pathway, was studied to establish the pathologic diagnostic indicator of AHR. METHODS: Forty-four graft biopsy specimens from 19 patients with ABO-i living donors were analyzed within 90 days after RTx. Nineteen biopsy specimens with acute rejection after ABO-compatible (ABO-c) living-related RTx were used as controls. Diffuse and bright C4d deposition in PTC was considered significantly positive. RESULTS: All of 8 recipients with AHR showed significantly positive C4d in PTC in the ABO-i group, but 9 of 11 recipients without AHR were negative. In the ABO-c RTx group, 16 of 19 recipients were negative for C4d in PTC. The prevalence of C4d in PTC was significantly higher in ABO-i RTx (P<0.05). CONCLUSIONS: C4d deposition is valuable as a specific and sensitive indicator for AHR, even of mild severity, in ABO-i RTx.