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Man, 60 years old, in two weekly haemodialysis from 2009. From 2007 in treatment with once-daily telmisartan 40 mg for hypertension. From 2008 showed recurrent pharingitys. In June 2011 bacterial cystitis showed at the same time. The telmisartan was discontinued and both problems solved.

SUMMARY Twenty-five patients with diffuse proliferative lupus nephritis were treated with three consecutive Intravenous injections of 1 g methylprednisolone pulses followed by small doses of prednisone. These patients were followed for at least three months. Major side-effects were observed only in one patient. After steroid administration, extrarenal symptoms rapidly disappeared in all patients. Except for four patients with diffuse glomerular sclerosis a significant improvement of serum creatinine was observed after one month and the improvement was more sustained after three months. No deterioration was observed in patients with normal functioning kidneys. Proteinuria decreased significantly over three months. When tested, anti-dsDNA binding capacity and serum complement components became normal within four weeks. Seventeen patients were then followed for 12–93 months. Ten patients received only small doses of oral prednisone and seven were also treated with cytotoxic agents. Eight ‘flare-ups’ of disease occurred in these patients over a cumulative period of 688 months. Additional steroid pulses were administered during the ‘flare-ups’, with subsequent improvement of symptoms and renal function in all but one patient, who had diffuse glomerular sclerosis at biopsy. At present the mean values of serum creatinine are lower than baseline values. One patient has renal failure and another one has moderate renal insufficiency. No patient has the nephrotic syndrome and six patients are free from proteinuria. We suggest that aggressive treatment based on short-term intravenous methylprednisolone during relapse followed by a low-dose maintenance regimen may be a safe and effective way to manage most patients with diffuse lupus nephris.

This paper describes invasion of an indwelling peritoneal catheter by a fungus. This colonization by Penicillium pinophilum, whose identity was proved by isolation, mycological characterization and in situ examination by scanning electron microscopy, did not cause peritonitis. We have discussed possible causes of contamination and implications of the findings. Fungi rarely are responsible for primary peritonitis in CAPD patients, though increasingly they are recognized as secondary agents (1). Mycetes so far isolated belong to the following genera: Aspergillus, Candida. Drechslera, Fusarium, Mucar, Rhodotorula and Trichosparan (2–10). Recently Pearson et al (II) described Penicillium peritonitis which appeared to have been induced by prolonged antibiotic therapy, following repeated episodes of bacterial peritonitis. A similar sequence was encountered after intestinal perforation (3). In CAPD patients peritonitis caused by fungi does not differ from the more common bacterial peritonitis (3), though at first the clinical symptoms may be attenuated and effluent solution may be clear (6, 11). In some cases however such peritonitis can be particularly severe and persistent (12). In these circumstances the catheter should ∼ removed (2, 13, 14), because then the infection clears without specific antifungal therapy. Colonization of the in -dwelling device is associated with a poor prognosis (15). This report describes a patient with massive colonization of the exposed tract of the Tenckhoff peritoneal catheter with Penicillium without clinical symptoms of peritonitis or changes in the dialysate effluent.