Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
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A high proportion of the patients with Salmonella enterica serotype Typhi infection develop severe sepsis. The mortality rate is high despite aggressive antimicrobial therapy in these patients. ⋯ The thrombocytopenia and organ failure had resolved after 3 days of plasma exchange therapy. Plasma exchange is suggested to be a life-saving intervention in a child with TAMOF secondary to S. typhi infection.
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Difficulties in gaining vascular access have become one of the major problems in long-term hemodialysis patients. We report a case with an extreme vascular access problem, which was solved by the placement of a permanent central vein catheter after successful angioplasty to the right subclavian and inominate vein stenosis. A 78-year-old woman with end-stage renal disease due to diabetic nephropathy had been on hemodialysis since 1982. ⋯ In 2004, difficulty was experienced in reinserting a new central venous catheter because of multiple stenotic and occlusive lesions of the central veins. Percutaneous transluminal angioplasty was carried out in the stenotic right subclavian and inominate veins, and after successful angioplasty, a permanent central vein catheter could be placed into the right subclavian vein as a vascular access for hemodialysis. Pretreatment with percutaneous transluminal angioplasty of the stenotic central veins before inserting a permanent catheter may be a useful strategy in patients that experience difficulty in the insertion of a catheter.
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Case Reports
A case report of acute renal failure associated with bee pollen contained in nutritional supplements.
We report a case of renal failure associated with the ingestion of bee pollen containing nutritional supplement. A 49-year-old male patient who had been ingesting a nutritional supplement for more than five months had breathing difficulties, anuria, exceptional weight gain (20 kg) due to systemic edema, and loss of appetite. A renal biopsy confirmed interstitial nephritis with the presence of eosinophils, which is suggestive of drug-induced acute renal failure. ⋯ The patient's condition improved after several hemodialysis sessions, which were then stopped. Current information regarding the adverse effects of bee pollen is not very robust, therefore potential damage should be kept in mind before ingesting nutritional supplements in which it is contained. This report serves as an important reminder to the public as well as healthcare providers of the potential of renal failure related to nutritional supplements.
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Multicenter Study Clinical Trial
One year efficacy and safety of lanthanum carbonate for hyperphosphatemia in Japanese chronic kidney disease patients undergoing hemodialysis.
Lanthanum carbonate is a non-calcium-based phosphate binder for hyperphosphatemia in patients with chronic kidney disease (CKD). The efficacy and safety of lanthanum carbonate (LaC) on hyperphosphatemia in patients has been well documented in clinical trials in Western countries and recent relatively short-term clinical trials in Japan. Evidence supporting its safety and efficacy in Japanese patients for longer-term treatment is now desired for clinical practice. ⋯ There was no clinically relevant change in vital signs, or electrocardiograms for a period. The profiles for parathyroid hormone, bone alkaline phosphates, and osteocalcin were stable in the patients concomitantly treated with vitamin D. This study provides further evidence that the administration of LaC over a period of one year is safe and effective for the reduction of serum phosphate levels in CKD patients undergoing hemodialysis.
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Clinical Trial
Hemoperfusion with an immobilized polymyxin B fiber column decreases macrophage and monocyte activity.
We investigated whether direct hemoperfusion with a polymyxin B column (DHP-PMX) was able to decrease macrophage and monocyte activity in patients with sepsis. Nineteen patients with sepsis were enrolled in the study. They all had signs of systemic inflammatory response syndrome (SIRS) due to infection and a mean arterial blood pressure > or =65 mm Hg (irrespective of the use of catecholamines). ⋯ Serum neopterin was measured four times: before DHP-PMX, and 24, 48, 72 h after it had begun. The serum concentrations of neopterin were 654 +/- 234 nmol/L prior to DHP-PMX vs. 573 +/- 196 nmol/L at 24 h, 452 +/- 161 nmol/L at 48 h, and 372 +/- 139 nmol/L at 72 h, showing a significant decrease from 48 h onwards compared with before treatment. These data suggest that DHP-PMX decreases macrophage and monocyte activity.