Clin Nephrol
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Randomized Controlled Trial Comparative Study Clinical Trial
Once weekly versus twice weekly subcutaneous administration of recombinant human erythropoietin in patients on continuous ambulatory peritoneal dialysis.
Twice weekly subcutaneous (s.c.) administration of recombinant human erythropoietin (rHuEPO) is effective in reversing renal anemia in CAPD patients. However the optimal frequency of administration has not been established. It would be more convenient to give rHuEPO by once weekly rather than twice weekly injection. ⋯ Subcutaneous administration of low dose rHuEPO is effective in reversing renal anemia. Similar responses were obtained with once weekly and twice weekly regimens. It is therefore acceptable and convenient for patients to receive one weekly s.c. injection of rHuEPO for the treatment of renal anemia.
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Three children with nephropathic cystinosis received cysteamine therapy, mostly in the form of phosphocysteamine, for more than six years. The patients were between two and three years of age at the start of the study. ⋯ When comparing their evolution with data on the natural history of childhood cystinosis, no improvement was observed in terms of growth and glomerular function. It is concluded that cysteamine therapy did not provide clear benefit to the three patients reported here.
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We describe a patient who developed persistant hypokalemia after renal transplantation that was initially attributed to diuretics and/or steroids. However after stopping the diuretic, the patient continued to have urinary losses of potassium (less than 30 mEq/day) at a time when the serum potassium was only 2.4 mEq/l and high urinary chloride (33 mEq/day) suggesting that the diuretics were not responsible for the hypokalemia and the metabolic alkalosis. ⋯ Surgical removal of the adrenal adenoma led to the normalization of the serum potassium and a fall in the total CO2 content in plasma. To our knowledge this is the first report of a case of hypokalemia secondary to primary hyperaldosteronism in a renal transplant recipient.
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Uremic patients manifest delayed elimination of many drugs prolonging the biological half-life, and impaired excretion of the metabolites of biotransformed drugs, some of which are toxic or biologically active. More subtle changes in bioavailability, distribution, metabolism and pharmacodynamics frequently occur, as well, rendering drug dosing hazardous, especially when the margin of safety is narrow. ⋯ Restricting drugs use in uremic patients to unequivocal indications, limiting doses according to guidelines, restricting the duration of treatment, monitoring plasma drug levels, clinical observations and vigilant suspicion of toxicity would eliminate most toxicologic problems. Physicians must not, however, rely blindly on normograms and cookbook guidelines for dosing potentially toxic drugs.
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Fifteen patients with chronic active hepatitis (CAH) were tested in order to ascertain the site of tubular dysfunction in renal tubular acidosis (RTA) associated with CAH. Renal plasma flow and GFR were reduced in the patients compared to controls (P < 0.005). ⋯ A sustained acidification test showed adequate urinary acidification in these three patients. Bicarbonate loading carried out in two of the three patients showed a proximal tubular acidifying defect (Type 2 RTA), Distal RTA (Type 1 RTA) complicating CAH is widely known, but these data suggest that CAH can also involve the proximal convoluted tubule in isolation.