RESUMO
Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 mumol/l and Group II comprised patients with serum creatinine concentration of 600 mumol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years; (p < 0.01) patients, and the mean total creatinine clearance for Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-à-vis solute transfer are in progress.
Assuntos
Nitrogênio da Ureia Sanguínea , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Adulto , Índice de Massa Corporal , Creatinina/sangue , Feminino , Humanos , Falência Renal Crônica/sangue , Testes de Função Renal , Cinética , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indies (UHWI), Kingston, Jamaica and Nottingham City Hospital (NCH), England. At UHWI, the referral population was significantly younger, 89% being less than 60 years of age compared to 40% at NCH (p < 0.05). The leading cause of acute renal failure (ARF) at UHWI was systemic lupus erythematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage renal disease (ESRD) at both centres, followed by SLE and hypertension at UHWI and renovascular disease and chronic pyelonephritis at NCH. Nephrotic syndrome occurred more frequently at UHWI than at NCH but the numbers were small (p < 0.05). Mortality rates were similar among patients with ARF and nephrotic syndrome at both centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p < 0.05). Continuous ambulatory peritoneal dialysis (CAPD) was a frequent mode of renal replacement therapy at NCH (76% v 19% on haemodialysis). At UHWI, CAPD was not available and 45% of patients with ESRD were not offered maintenance dialysis because of inadequate facilities. The major difference in management and outcome between the two centres occurred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was available.
Assuntos
Falência Renal Crônica/terapia , Adulto , Idoso , Diabetes Mellitus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica , Diálise Peritoneal Ambulatorial Contínua , Estudos Prospectivos , Encaminhamento e Consulta , Diálise Renal , Terapia de Substituição RenalRESUMO
Three case reports of Cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropositive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortality. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection.
Assuntos
Infecção Hospitalar/transmissão , Infecções por Citomegalovirus/transmissão , Transplante de Rim/efeitos adversos , Adolescente , Adulto , Infecção Hospitalar/sangue , Infecção Hospitalar/tratamento farmacológico , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Ganciclovir/uso terapêutico , Humanos , MasculinoRESUMO
Clinical, laboratory and renal biopsy data on 50 adult patients investigated in Jamaica because of proteinuria of more than 1 g/day were reviewed. Primary glomerular disease was present in 23 cases and the most common histological pattern was mesangial proliferation. Proteinuria was part of a systemic disease in 27 patients of whom 19 had systemic lupus erythematosus (SLE). Urinary protein excretion was less in patients with systemic diseases than in those with primary glomerulonephritis, but hypoalbuminemia, renal function and presence of edema were not helpful in distinguishing types and causes of renal disease. By comparison with other countries SLE and mesangial proliferative glomerulonephritis are common causes of proteinuria and nephrotic syndrome in Jamaica whereas idiopathic membranous glomerulonephropathy appears to be rare.
Assuntos
Glomerulonefrite/complicações , Proteinúria/etiologia , Adolescente , Adulto , Idoso , Feminino , Glomerulonefrite/epidemiologia , Humanos , Jamaica , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/complicações , Nefrose Lipoide/epidemiologia , Proteinúria/epidemiologiaRESUMO
In a survey of 407 patients with homozygous sickle cell disease in Jamaica, 50 had proteinuria of '+' or more on dipstick testing and 231 had had leg ulcers. Both proteinuria and ulcers began to occur mainly in the second decade of life and their prevalence increased with age thereafter. When allowance was made for this there was no significant association between the two, and it is therefore likely that they result from independent effects of the haemoglobinopathy on the kidneys and skin. Though asymptomatic and relatively common, proteinuria in sickle cell disease is not a benign finding since it is associated with renal failure in patients over 40 years old.