Search

Estudiamos en 10 pacientes en hemodiálisis con hiperparatiroidismo secundario severo (PTH > 50 pmol/L y calcio iónico > 4.4 mg/dl) el efecto inhibidor directo, sobre la función paratiroidea, de incrementos secuenciales de calcitriol intravenoso (2,4 y 6 μg post-hemodiálisis mantenidos 3,2 y 2, meses respectivamente). En segundo lugar analizamos el indice de fracaso terapéutico (necesidad de paratiroidectomía) después de 18 meses de seguimiento. Se utilizó un dializado de 2,5 mEq/l de calcio y como quelante del fósforo geles de hidróxido de aluminio para disminuir el riesgo de hipercalcemia. Valoramos la función paratiroidea después de los períodos de tratamiento con 2 y 6 μg mediante la construcción de la curva sigmoidal Ca-PTH. Consideramos que existía efecto inhibidor directo, no mediado por el calcio, cuando el descenso de los niveles de PTH intacta tras la máxima estimulación era superior al 20 % de sus valores antes del tratamiento. Cuatro pacientes respondieron a 2 μg. En 3 de los 6 pacientes no respondedores el producto Ca P no permitió incrementar la dosis. De los 3 pacientes restantes que alcanzaron la dosis de 6 μg se obtuvo respuesta en sólo 2. A los 18 meses de seguimiento el tratamiento con calcitriol intravenoso había fracasado en el 50 % de los pacientes y el resto continuaba tratamiento con dosis de mantenimiento inferiores a las iniciales. En conclusión, el tratamiento con calci triol intravenoso a dosis elevadas: 1) ejerce un efecto inhibidor directo dosis-dependiente sobre los niveles de PTH; 2) permite a largo plazo dosis de mantenimiento inferiores a las que indujeron la respuesta, lo que sugiere un efecto «sensibilizador» sobre las células paratiroideas, y 3) fracasa en un elevado porcentaje de pacientes (50 %) con hiperparatiroidismo secundario severo.

Peritoneal dialysis patients may need solute permeability transport evaluation during acute peritonitis. The aim of this study was to assess if the simplified mass transfer coefficient (MTCS) or the peritoneal equilibration test (PET) was equivalent to the complex MTC (MTCX) in solute transport evaluation during acute peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We studied 15 episodes of peritonitis (PTIS). Results were compared to a baseline patient study (PRE) and a control study done 30 days after diagnosis of peritonitis (POST). All peritoneal evaluation methods showed a significant increase in solute transport during acute peritonitis compared to baseline and control studies. There was an acceptable correlation between MTCX and simplified methods including the PET in the baseline and control studies. However, correlation between MTCX and simplified methods decreased during acute peritonitis. Likewise, the PET showed a better correlation with MTCX than MTCS. We conclude that the PET has an acceptable agreement with MTCX even during acute peritonitis, so the PET can be a useful tool in evaluating peritonitis-induced peritoneal permeability changes.

Three cases of acquired cystic renal disease (ACRE) are reported in patients treated with periodical hemodialysis (HD) who developed neoplastic degeneration. In the first patient, diagnosis was a chance finding of nephrectomy during renal transplantation. The second patient was discovered following hematuria, and in the third patient disseminated metastases were the presenting feature of the disease. The finding of renal tumours associated with ACRE is a well known fact; however, metastatic disease has been infrequently reported. Generally, the denomination "adenoma" is adopted for tumours with a maximal diameter shorter than 3 cm, as they seldom develop metastases. However, the third patient had an adenocarcinoma measuring 2 cm in diameter. One of the parameters that best correlates the occurrence of ACRE and tumour development is the duration of HD; therefore, it is suggested that those patients who have received substitution therapy for longer than 3 years should undergo radiological studies for the early identification of these complications.

We report 5 cases of acute visual and auditory neurotoxicity in patients with end-stage renal disease receiving desferrioxamine. Four patients complained of visual toxicity characterized by a decrease in visual acuity, loss of color vision and night blindness. In these patients there was a decrease in visual acuity, and the Farnsworth's test revealed a tritanopy (yellow-blue axis impairment); 1 patient also showed retinal pigmentary changes. A fifth patient complained of bilateral and severe neurosensorial deafness. Patients improved clinically upon drug-withdrawal. We recommend careful monitoring of audiovisual toxicity in patients with end-stage renal disease receiving this drug.