Colchicine myoneuropathy in chronic renal failure patients with gout

Colchicine myoneuropathy is a rare and often underdiagnosed disease. It often presents as painless subacute muscle weakness. We present a case of painful colchicine myoneuropathy in a 76-year-old man with chronic renal failure and gout. Published work about clinical presentations of colchicine myoneuropathy in gouty arthritis patients are reviewed. During the previous year, the patient had a drug regimen of colchicine 0.5 mg three times per day for a 3 day course each month. He developed bilateral lower leg weakness and severe myalgia. His serum creatinine level was 680.7 micromol/L and creatinine kinase was 959 IU/L on admission. Laboratory findings included decreasing amplitude of motor and sensory nerve conduction velocity and an electromyogram showed small amplitude, short duration polyphasic waves over the right biceps. A muscle biopsy disclosed vacuolar changes in the cytoplasm. These results all supported a diagnosis of colchicine myoneuropathy. After cessation of colchicine, the creatinine kinase level decreased approximately 50% in 6 days, myalgia subsided and his muscle weakness improved gradually over the next 2 weeks.     

Alterations in ocular surface and corneal thickness in relation to metabolic control in patients with chronic renal failure

AIM: Ocular surface changes and ocular symptoms may be encountered in patients with chronic renal failure (CRF) undergoing haemodialysis. The ocular surface changes and its relationship with metabolic control in CRF patients were aimed to be emphasized in this study. METHODS: Thirty-eight CRF patients (75 eyes) undergoing haemodialysis were enrolled. Patients underwent a complete ocular examination together with Schirmer, tear break-up time tests, pachymetric measurements and conjunctival impression cytologies. Blood calcium, phosphate levels and total body volume changes after haemodialysis were recorded. RESULTS: The most common findings were conjunctival calcification with red eye (81.3%) and dry eye (62.7%, according to tear break-up time test) in 75 eyes of 38 patients. Impression cytologies were graded as 0 in 57.3% of eyes and 2-3 in 40% of eyes showing positive correlation with the extent of conjunctival calcification (R = 0.486, P = 0.0001). Serum calcium and phosphate levels were also positively correlated with the degree of conjunctival calcification (R = 0.684, P = 0.0001 and R = 0.428, P = 0.0001, respectively) as well as with the grades of impression cytology (R = 0.587, P = 0.0001 and R = 0.385, P = 0.0001, respectively). Furthermore, the mean corneal thickness decreased significantly (9.31 +/- 26.9 mum) following haemodialysis (Paired t-test, P = 0.002). CONCLUSION: Dry eye and irritational symptoms are major ocular symptoms in CRF patients. Serum calcium and phosphate levels seem to have a prognostic importance for the ocular findings and symptoms in patients with CRF.     

Whole body and regional body composition in patients with chronic renal failure

BACKGROUND.: Nutritional state is a powerful prognostic factor in chronicrenal failure (CRF). Techniques for the assessment of nutritionhave limitations which are often most marked in the presenceof renal disease. We have used techniques of body compositionanalysis to assess the nutritional state of groups of patientswith CRF. METHODS.: Body composition was measured in groups of patients with advancedCRF on conservative treatment, peritoneal dialysis, and haemodialysisand the results compared with a healthy control group. The selectioncriteria for the CRF patients ensured that they were ‘stable’with no recent intercurrent illness, and dialysis adequacy wassatisfactory according to currently accepted targets. RESULTS.: Whole body dual energy X-ray absorptiometry (DEXA) found significantreduction in lean tissue in haemodialysis patients and femaleperitoneal dialysis patients. Regional analysis with DEXA showedreduction in limb (especially arm), lean tissue in CRF patients,with arm lean tissue being reduced in all three CRF groups forfemales and both dialysis groups for males. Limb/trunk leantissue ratios were significantly reduced for all CRF groups.Bioelectrical impedance showed reductions of fat-free mass inthe same groups who had reduced whole body lean tissue withDEXA, but skinfold anthropometry failed to detect any significantreduction in fat-free mass. CONCLUSIONS.: We conclude that even in ‘healthy’ groups of CRFpatients receiving adequate dialytic and dietary management,lean tissue depletion is a common problem. Regional analysisby DEXA, with measurement of limb lean tissue mass is a moresensitive method for the detection of lean tissue depletionthan measurement of whole body lean tissue in patients withCRF.     

Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis

Articular cartilage is sensitive to mechanical loading, so increased risk of osteoarthritis in older or obese individuals may be linked to changes in the relationship between cartilage properties and extrinsic joint loads. A positive relationship has been reported between ambulatory loads and cartilage thickness in young individuals, but whether this relationship exists in individuals who are older or obese is unknown. This study examined the relationship between femoral cartilage thickness and load, measured by weight × height and the peak adduction moment, in young normal‐weight (28 subjects, age: 28.0 ± 3.8 years, BMI: 21.9 ± 1.9 kg/m²), middle‐aged normal‐weight (27 subjects, 47.0 ± 6.5 years, 22.7 ± 1.7 kg/m²), young overweight/obese (27 subjects, 28.4 ± 3.6 years, 33.3 ± 4.6 kg/m²), and middle‐aged overweight/obese (27 subjects, 45.8 ± 7.2 years, 31.9 ± 4.4 kg/m²) individuals. On the lateral condyle, cartilage thickness was positively correlated with weight × height for all groups (R² = 0.26–0.20) except the middle‐aged overweight/obese. On the medial condyle, weight × height was significantly correlated only in young normal‐weight subjects (R² = 0.19), as was the case for the correlation between adduction moment and medial–lateral thickness ratio (R² = 0.20). These results suggest that aging and obesity are both associated with a loss of the positive relationship between cartilage thickness and ambulatory loads, and that the relationship is dependent on the compartment and whether the load is generated by body size or subject‐specific gait mechanics. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:394–402, 2014.     

Endothelin in chronic renal failure.

The aims of the present study were to determine plasma endothelin (ET) in chronically uraemic patients, the renal clearance of endogenous ET in normal dog and man, and the effect of acute volaemic expansion on ET. The mean plasma ET concentration in haemodialysis patients was 57.5 +/- 5 pg/ml before haemodialysis and remained unchanged at 52.5 +/- 5 pg/ml after haemodialysis. They were thus significantly elevated both before and after haemodialysis (P less than 0.01) compared with plasma ET in normal subjects of 20.8 +/- 0.8 pg/ml. There was no evidence of ET clearance across the cuprophane membrane of the dialyser. Resting plasma ET values in the 15 non-dialysed uraemic patients ranged between 20 and 52.5 pg/ml (mean 38.2 +/- 2.3 pg/ml), significantly greater than those observed in controls (P less than 0.01). In CAPD patients, plasma ET was also significantly (P less than 0.01), elevated (63 +/- 10 pg/ml) when compared to controls, and similar to those observed in patients before haemodialysis. In dogs, mean ET did not diminish between the aorta and the renal vein (28.1 +/- 1 versus 28.4 +/- 2 pg/ml). In man mean ET did not significantly decline between the renal artery and the renal vein (17 +/- 3 to 13 +/- 0.8 pg/ml). In the seven healthy subjects who received 2000 ml of isotonic saline intravenously ET remained unchanged (24 +/- 2; 23 +/- 1 and 23 +/- 2 pg/ml before and 1 and 2 h after starting hydration respectively). We have thus shown that plasma ET is elevated in patients with chronic renal failure especially those on dialysis and CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of low-dose erythropoietin in predialysis chronic renal failure patients

Recombinant human erythropoietin (rHuEpo) has been shown tobe both effective and usually safe in patients with chronicrenal failure who have not yet reached the stage requiring dialysis.There are, however, disturbing reports on the possibility ofdeterioration of the reserve renal function in association withrHuEpo therapy. Most of the published studies have used rHuEpoin doses of 50–150 U/kg three times weekly subcutaneously.An open-label trial of rHuEpo therapy was conducted on 21 patientswith chronic renal failure treated sequentially at a referralhospital, rHuEpo was used in doses of 50 U/kg twice weekly for4 weeks followed by 25 U/kg twice weekly for 8 weeks subcutaneously,a regimen substantially lower than current recommendations.This was associated with a gentle but significant increase inhaematocrit (P<0.05) and haemoglobin (P<0.05), while theserum creatinine and the reciprocal of the creatinine remainedstable, with a tendency to improve rather than worsen (P=0.06).We conclude that there is no need to aim at a rapid increasein haematocrit and haemoglobin by rHuEpo therapy; rather a gentleincrease using modest doses is both effective and safe.     

Serum hepatocyte growth factor concentration in patients with various degrees of chronic renal failure

Summary: Serum hepatocyte growth factor (HGF) concentrations were measured in healthy volunteers, chronic renal failure patients without renal replacement therapy and haemodialysis patients. Serum HGF concentrations in healthy volunteers, chronic renal failure patients and haemodialysis patients were 0.18 ± 0.04 (s.d.), 0.28 ± 0.06 and 0.46 ± 0.22 ng/mL, respectively. Serum HGF concentration in chronic renal failure patients was significantly higher than that in healthy volunteers. Serum HGF concentration in haemodialysis patients was significantly higher than those in healthy volunteers and chronic renal failure patients. There was no regression of serum HGF concentration on age, sex, history of haemodialysis, prehaemodialysis serum creatinine concentration, and serum tumour necrosis factor (TNF)-α concentration. We conclude that chronic renal disease and haemodialysis therapy are contributing factors to an increased serum HGF concentration.     

Increased cytosolic free sodium in platelets from patients with early-stage chronic renal failure

Cytosolic free sodium concentration ([Na⁺]i) and sodium transportsystems were measured in intact platelets from 19 patients withearly-stage chronic renal failure and 33 healthy control subjectsusing the novel fluorescent dye sodium-binding-benzofuran-isophthalate.Resting [Na⁺]i was significantly greater in patients with chronicrenal failure compared to control subjects (40.8±3.1mmol/1versus 32.2±2.0 mmol/1, mean±SEM, P<0.05).After inhibition of Na-K-ATPase by 1 mmol/1 ouabain a highernet sodium influx was observed in platelets from patients withchronic renal failure compared to control subjects (49.8±8.7mmol/1 versus 28.5±5.2 mmol/1, P<0.05). The plateletNa-H exchanger was similar in the two groups. Cytosolic freecalcium concentration ([Ca²⁺]i) was measured using fura2 anddid not show significant differences between the two groups.To evaluate whether a circulating factor may be associated withelevated [Na⁺]i, a linked-enzyme Na-K-ATPase assay was included.Compared to control subjects plasma from patients with chronicrenal failure produced a significant inhibition of steady-stateNa-K-ATPase activity by 11.2±3.0% (P<0.01). It isconcluded that early-stage renal failure is associated withsignificant impairment of platelet sodium metabolism.     

Significance of 8-hydroxy-2'-deoxyguanosine levels in patients with chronic renal failure

SUMMARY:     The aim of this study was to determine the significance of 8-hydroxy-2'-deoxyguanosine (8-OHdG), which is known as a marker of oxidative stress in vivo , in patients with chronic renal failure (CRF). Fifty-one non-dialysed CRF patients (29 men and 22 women; mean ± SD age, 57.8 ± 12.8 years) who were under dietary therapy for at least 6 months were enrolled in the study. Both serum and urinary 8-OHdG levels were measured by using high-sensitive enzyme-linked immunosorbent assay (ELISA) kits. We examined the relationship between 8-OHdG levels and clinical indices in patients with CRF. As a result, the serum 8-OHdG level was strongly correlated with serum levels of urea nitrogen (UN; r  = 0.58; P  < 0.0001), creatinine (Cr; r  = 0.53; P  < 0.0001), and β2-microglobulin (β2-MG; r  = 0.54; P  < 0.0001). Furthermore, the serum 8-OHdG level was inversely correlated with creatinine clearance (Ccr; r  = −0.54; P  < 0.0001). In contrast, urinary 8-OHdG level was not correlated with any of the clinical parameters. This is the first report of 8-OHdG level determination in patients with CRF. It is suggested that serum 8-OHdG level is not sufficient as a marker of oxidative damage in patients with CRF, and it should be corrected according to the residual renal function to estimate the accurate degree of oxidative stress.     

Back pain in chronic renal failure.

Back pain in chronic renal failure Patient SK, a 40-yr-old female, resident of Bhagalpur villagein Bihar, India, was operated for gallstones 3 years previously.On pre-operative checkup, mild renal dysfunction was detected.She was asymptomatic for renal disease with serum creatinineof 159 µmol/l (1.8 mg/dl), bland urinary sediment     

Clonidine as an adjuvant for lidocaine in axillary brachial plexus block in patients with chronic renal failure

BACKGROUND: Clonidine is often used as an adjuvant for local anaesthetics in regional anaesthesia; however, its effects on axillary block in chronic renal failure patients have not been investigated. These effects were the focus of this study. METHODS: Twenty-eight adult chronic renal failure patients (ASA physical status III) scheduled for arteriovenous fistula construction were studied in a prospective, randomized, double-blind, controlled design. All axillary block procedures were performed by the same anaesthesiologist using the nerve stimulator technique. The control group received 40 ml of lidocaine (10 mg ml(-1)) combined with 1 ml of saline, and the clonidine group received 40 ml of lidocaine (10 mg ml(-1)) mixed with 150 microg of clonidine. Characteristics of the patients and the blocks were recorded, in addition to data on the nerves stimulated, intraoperative haemodynamic parameters, and sedative and analgesic requirements. RESULTS: The onset time for sensory blockade was longer in the clonidine group than in the controls (P = 0.013), and both motor and sensory blocks lasted longer in the clonidine group (P = 0.004, P < 0.001, respectively). In addition, the clonidine group had lower mean arterial pressures, heart rates and higher sedation scores compared to the controls (P < 0.05 for all). CONCLUSION: Use of clonidine (150 microg) as adjuvant for lidocaine in axillary blocks for arteriovenous fistula construction in chronic renal failure patients prolongs blockade, decreases both heart rates and blood pressures and provides sedative effects.     

In-vivo induction of monocyte chemotactic and activating factor in patients with chronic renal failure

BACKGROUND: Monocyte chemotactic and activating factor (MCAF) is a novelinflammatory cytokine belonging to the chemokine superfamilyand stimulates chemotaxis and activation of monocytes. Increasedproduction of inflammatory cytokines has been shown in patientswith end-stage renal disease (ESRD). This study was thus conductedto determine plasma MCAF in patients with ESRD. METHODS: Plasma levels of MCAF were determined by ELISA. Gene expressionof MCAF in PBMC was assessed by RT-PCR followed by southernblot hybridization. RESULTS: Plasma MCAF in 72 patients with long-term haemodialysis (HD)(162.4 ± 58.2 pg/ml) and eight uraemic patients not yetdialysed (167.6 ± 57.7 pg/ml) was found to exceed significantlythe level in 24 normal subjects (86.0±19.4 pg/ml). MCAFbefore HD session in long-term HD patients was the same whetherHD was carried out with either cellulosic (CUP) or synthetic(PMMA) membrane dialysers. Intradialytic increase in plasmaMCAF during a single HD session was observed in both patientgroups dialysed with CUP or PMMA membranes. The results of RT-PCRanalysis indicated that haemodialysis stimulates the gene expressionof MCAF in PBMC in vivo. CONCLUSIONS: The present results indicate that increased levels of plasmaMCAF may promote the activation of monocytes in patients withESRD.     

Consideration of the femoral head cartilage thickness in preoperative planning in bipolar hemiarthroplasty

Purpose  Bipolar hemiarthroplasty (BH) is one of the commonly performed orthopedic procedures for the treatment of displaced fractures of the femoral neck. However, despite the common use of the BH, little has been written on preoperative planning for this operation. The purpose of this study was to assess the neglected subject which is about the cognition of the femoral head cartilage in planning a BH. Methods  We reviewed a group of 62 consecutive patients in whom cemented BH had been performed by one surgeon. A total of 31 patients underwent BH with consideration of the femoral head cartilage thickness in preoperative planning. The anteroposterior radiographs of this group were compared to those of a group of 31 patients who underwent BH without consideration of the femoral head cartilage thickness in preoperative planning. We measured the limb length and offset with reference to the normal contralateral hip and the cartilage thickness of the hip joints postoperatively. Results  There were significant reduction in the limb-length discrepancy (LLD) (mean 0.4 mm lengthening compared with 1.6 mm shortening; P < 0.001) and improvement of the femoral offset ratios of the operated hips to the normal contralateral hips (mean 99.9% compared with 96.8%; P = 0.032) in the group of patients with consideration of the femoral head cartilage thickness in preoperative planning. Conclusions  The femoral head cartilage should be considered when determining the level of femoral neck resection in order to reduce postoperative LLD when planning a bipolar hemiarthroplasty. Accurate and careful preoperative planning can result in balanced hip reconstruction by equalizing limb lengths and restoring the offsets.     

Polymorphonuclear leukocyte rigidity is defective in patients with chronic renal failure.

BACKGROUND: The purpose of the study was to investigate the rigidity of polymorphonuclear leukocytes (PMNs) in non-dialysed chronic renal failure (CRF) and haemodialysis (HD) patients. METHODS: PMN rigidity as well as tumour necrosis factor alpha (TNF-alpha) and interleukin 1beta (IL-1beta) plasma levels were assessed in 10 early-stage CRF, 10 late-stage non-HD, and 10 HD patients, before and during dialysis. In HD patients both cellulose acetate and polysulphone membranes were used. Ten healthy subjects served as controls. Rigidity was tested by counting the deformability in morphologically passive PMNs by the micropipette method. Cytokine levels were measured by enzyme-linked immunosorbent assay. RESULTS: PMN rigidity was significantly increased in end-stage CRF patients regardless of HD but not in early-stage CRF. In HD patients PMN rigidity increased significantly 60 min after initiation of HD. There was an increase of TNF-alpha and IL-1beta levels in end-stage non-HD and HD patients and a further increase at 60 min after initiation of HD. The percentage of morphologically activated PMNs was increased only during dialysis. The nature of the HD membrane had no influence on rigidity, PMN activation, or cytokine production. CONCLUSIONS: The results indicate that PMN rigidity is defective in end-stage chronic CRF patients and is further increased 60 min after initiation of HD, regardless of the nature of the HD membrane used. PMN activation, increased TNF-alpha and IL-1beta levels, or a direct PMN impairment may cause the observed cell rigidity.     

慢性肾功能衰竭患者的高同型半胱氨酸血症

目的 研究慢性肾功能衰竭（ＣＲＦ）患者血浆同型半胱氨酸（Ｈｃｙ）水平、影响因素以及与心、脑血管疾病的关系。方法 采用荧光偏振免疫分析法测定１６０例ＣＲＦ患者血浆总同型半胱氨酸（ｔＨｃｙ）水平，以３１例冠心病患者和４５例正常人为对照。结果 以正常组血浆ｔＨｃｙｘ±２ｓ为９５％可信度上限，ＣＲＦ患者高同型半胱氨酸血症的发生率为８２．５０％，明显高于冠心病组（２２．５８％）（Ｐ＜０．０１）；血液透析（ＨＤ）组血浆ｔＨｅｙ水平［（２４．１３±１２．６８）μｍｏｌ／Ｌ，ｎ＝７３］明显高于持续性非卧床腹膜透析（ＣＡＰＤ）组［（１６．４３ ±５．５８）μｍｏｌ／Ｌ，ｎ＝１９］、冠心病组［（１１．１３±４．９７）μｍｏｌ／Ｌ，ｎ＝３１］以及正常组（７．９７±２．６５）μｍｏｌ／Ｌ，ｎ＝４５，Ｐ均＜０．０１。９２例透析治疗的ＣＲＦ患者中有明确心、脑血管病者的血浆ｔＨｃｙ水平［（２７．１２±１５．９４）μｍｏｌ／Ｌ，ｎ＝３０］明显高于无此类病史的患者［（２０．１７±８．７１）μｍｏｌ／Ｌ，ｎ＝６２］。未经透析的 ＣＲＦ患者血浆 ｔＨｃｙ水平与内生肌酐清除率呈负相关（ｒ＝－０．３７４，Ｐ＜０．０１），与患者年龄、血葡萄糖、血脂及血浆白     

High incidence of renal failure in patients with aortic aneurysms.

BACKGROUND: Renal failure (RF) is a well-recognized complication of aortic aneurysms (AA) although its incidence has been poorly documented previously. The purpose of this study is to examine the incidence of RF in patients with AA and prognosis of AA patients with RF. METHODS: Renal function, complications and prognosis of AA patients with RF were retrospectively reviewed in 350 AA patients (median age 69.8+/-10.7 years) in the International Medical Center of Japan from 1989 to 1999. RESULTS: Among 350 patients with AA, 90 patients (25.7%) had chronic renal failure (CRF) at the initiation of follow-up. The number of CRF patients increased to 117 (33.4%) at 30 months of follow-up. Forty-four out of 160 patients (27.5%) who had aortic surgery developed postoperative acute renal failure (ARF). Stepwise logistic regression analysis revealed that age (>or=65 years), hypertension and multiple aneurysms were independent risk factors for CRF, whereas dissecting aneurysms, preoperative serum creatinine (sCr) levels and duration of surgery were independent risk factors for postoperative ARF in AA patients. In the 5-year follow-up of AA patients with CRF, the mean slopes of 1/serum-creatinine did not significantly differ between conservative treatment and surgical treatment. The survival rates were 49.5% in the conservative treatment group and 67.3% in the surgical treatment group. CONCLUSION: Our data suggest that the management of renal function including blood pressure from an early stage in AA patients is important since CRF is highly prevalent in AA patients and affects their prognosis and mortality.