Search

Multiple Myeloma (MM) causes a wide range of serious clinical, alterations, including acute renal failure (ARF) often present and contributing to the global mortality of this neoplasm. ARF usually occurs well after MM is diagnosed. We describe a case of ARF in a 42 years old male patient requiring urgent hemodialysis that subsequently proved to have MM. The singularity of this case lead us to review cases of ARF admitted to the Nephrology Department between 1978 and 1990. We describe 7 patients (4 male) with ARF as presenting form of MM. Their mean +/- SD age was 60.0 +/- 10.6 (range 42-73). ARF with conserved diuresis was the presenting form in 6, 5 has systemic infection, and none was hypertensive. Replacement therapy with hemodialysis was needed in 6 patients and plasmapheresis was performed in 3. 4 patients died while admitted, 2 were discharged on chronic hemodialysis and there was recovery of renal function in 1 patient.

End-stage chronic renal failure (CRF) is often associated with platelet' disfunction and therefore with impaired hemostasis. Several investigators have reported that rHu Epo, used in the treatment of CRF anaemia, is able to activate a broad spectrum of hematopoietic stem cells, and therefore is able to increase the number of platelets and to induce correction of platelet disfunction. In order to investigate hemostasis changes associated with rHu Epo we studied 8 dialysis patients before and 12 weeks after rHu Epo. RHu Epo did not induce any change in the number of platelets (187710 +/- 52690 vs 204430 +/- 68710; p = NS), but seemed to improve its function (MI% of aggregation with ADP: 46.3 +/- 4.4% vs 49.1 +/- 5.3%; p less than 0.05). There was an improvement in PT (79.0 +/- 3.0% vs 87.5 +/- 8.9%; p less than 0.02) and aPTT (33.3 +/- 5.9" vs 29.3 +/- 2.1"; p less than 0.05) suggesting an improvement in platelet coagulant activities. These preliminary results indicate that rHu Epo does not increase the number of platelets but can induce a correction of platelet disfunction.

In this study we analyse the effects of the administration of recombinant human erythropoietin (rHuEpo) during 12 months to correct the anaemia in a group of 17 patients (9 men and 8 women; mean age 52.7 +/- 13.7; range 23 to 68 years) with end-stage renal disease (ESRD) on chronic haemodialysis (HD) for a range of 14 to 126 months (mean 43.1 +/- 29.6). In the correction period the rHuEpo was started at 50 U/Kg i.v. 3 times a week, immediately after each HD. This dose was maintained during 4 weeks and then increased in 25 U/Kg steps until haemoglobin (Hb) levels of 12 g/dl or a maximum dose of 100 U/Kg were reached. During the long-term maintenance period the individual rHuEpo dose was adjusted to keep the Hb constant at the target level of 10-12 g/dl. Baseline blood tests were done before the beginning of the treatment and every months afterwards. The levels of Hb increased significantly in week 4 and at the end of the first 3 month only 4 patients had no answer to rHuEpo. These patients had baseline serum ferritin levels below 100 ng/ml and responded well when this defficiency was corrected with oral iron. When levels of 30-35 vol% haematocrit (Hct) were reached the dose of rHuEpo could be reduced (150 to 200 U/Kg/week). The serum ferritin levels decreased 51% from a mean baseline level of 247.8 +/- 196 to 121.1 +/- 154.9 ng/ml with the onset of the maintenance phase (p less than 0.05).

A group of 50 patients (26 men and 24 women, mean age 50 +/- 19 years and range 21 to 67) on chronic hemodialysis (HD) and with basal levels of hemoglobin (Hb) less than or equal to 8 g/dl was treated with recombinant human erythropoietin (r-HuEpo) during 3 months. r-HuEpo was started at 50 U/kg I.V. 3 times a week, immediately after each session of HD, for 4 weeks, and this dose was increased in steps of 25 U/kg until a Hb level of 12 g/dl or a maximum dose of 100 U/kg were reached. Complete blood counts and biochemical profile were performed before the first dose of r-HuEpo and once weekly and monthly respectively during the period of treatment. In 8 patients the red-cell life span was studied with cromium 51 labelled erythrocytes just before and after treatment. One patient had a grand mal seizure and the r-HuEpo was discontinued. In 44 patients the mean hematocrit increased from 21.8% to 32.1% and in the other 5 there were no response because of iron deficiency. There were no changes in leucocytes and platelets counts and consistent decreases in iron and ferritin serum concentrations were observed despite oral supplementation of iron. In the 8 patients studied the shortened erythrocyte survival did not suffer any significant variation with r-HuEpo. Predialysis creatinine, urea and phosphorus blood levels increased significantly at 3th month of treatment but there was no increase in potassium. In 32.6% of previously normotensive and hypertensive patients an increase in blood pressure was founded. Thrombosis of arteriovenous fistulas and other severe clinical side effects were not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

We describe a case of advanced chronic renal failure with persisting hypokalemia. The clinical study revealed the simultaneous presence of a salt and potassium loosing nephropathy associated with aldosterone-producing adenoma. This late pathology was revealed as electrolytic changes characteristic of primary hyperaldosteronism became evident as the renal function progressively deteriorated.

29 pregnancies in 27 renal patients were reviewed. The etiology of renal disease was mainly glomerular (14 patients). At the beginning of pregnancy 11 patients had renal failure and 14 patients had a high blood pressure. Only two patients had pregnancy related worsening of the renal function (the two patients had a normal renal function before pregnancy). Maternal morbidity was infrequent with no mortality. Fetal loss was 21.5% related to prematurity. There were no congenital anomalies. Renal failure at the beginning of pregnancy caused an obstetric risk factor. (greater fetal prematurity and mortality).