Progressive renal failure in surgically treated hyperparathyroidism.

Of 570 patients operated on for hyperparathyroidism, 18 subsequently died (between one day and 12 yr after operation). Pathological findings at necropsy in these patients have been reviewed. Four necropsies on patients with untreated hyperparathyroidism have also been reviewed for comparison. Of these 22 cases, 14 had renal failure at the time of death. This was attributed to the following: nephrocalcinosis 6; chronic glomerulonephritis 4; analgesic nephropathy 1; cystinuria 1; sarcoidosis 1; and polycystic disease 1. Of those with renal failure due to nephrocalcinosis, three had persistent hypercalcaemia after operation; the other three survived only for a short time. There was no evidence of residual nephrocalcinosis producing progressive renal failure if the plasma calcium concentration was corrected. In those with chronic glomerulonephritis, cystinuria, and polycystic disease, the hyperparathyroidism was considered to be tertiary to the renal disease but renal failure was not always present at the time of diagnosis.     

Chronic granulocytic leukaemia in a patient with chronic renal failure on dialysis.

A diagnosis of chronic granulocytic leukaemia was made in a man who had been haemodialysed for three years. The association between leukaemia and chronic renal failure is rare.     

Increase in mean platelet volume in patients with chronic renal failure treated with erythropoietin.

AIMS--To assess whether r-HuEPO (recombinant human erythropoietin) has any effect on thrombopoiesis in patients with chronic renal failure. METHODS--This was a retrospective study of 78 patients with chronic renal failure undergoing either haemodialysis (n = 57) or intraperitoneal dialysis (n = 21). All patients had a full blood count (in EDTA) measured before starting r-HuEPO and at monthly intervals thereafter up to six months. Variables studied were haematocrit, platelet count, mean platelet volume (MPV) and platelet distribution width (PDW). Other groups of control patients were also studied--patients with chronic renal failure receiving dialysis but not r-HuEPO (n = 40) and a group of patients with normal renal function who were receiving aspirin (n = 30). RESULTS--There was a significant increase in mean haematocrit (p < 0.01) and in mean platelet volume (p < 0.001) over the six month period, but no change in either total platelet count or platelet distribution width in the patients with chronic renal failure receiving r-HuEPO. In contrast, both the control groups showed no significant change in MPV. CONCLUSIONS--The results suggest that r-HuEPO affects thrombopoiesis and may be part of a group of humoral factors contributing to megakaryocyte development and maturation. Larger platelets are more reactive and may contribute to the increased risk of thrombosis associated with r-HuEPO.     

Increased prevalence of latex-sensitization among children with chronic renal failure

BACKGROUND: Type-I-allergy to natural rubber latex (NRL) has been shown to be more prevalent among certain groups of patients. Children suffering from chronic renal failure (CRF) could be a suspected risk group because of their intense exposure to latex through catheters, gloves and anesthetic equipment during frequent hospitalizations from early life on. We investigated the prevalence of latex-sensitization among this group of patients and sought to identify risk factors. METHODS: Ninety-three patients (mean age 10.5 years) suffering from CRF were assessed by questionnaire-based history (details on renal disease, number and kind of surgical procedures, family and personal history of atopic diseases, allergic reactions to NRL, and the use of pacifiers) and by measurement of total and latex-specific serum immunoglobulin (Ig)E. RESULTS: Ten of 93 (10.8%) patients showed elevated latex-specific IgE-levels. One of 10 patients reported clinical symptoms to latex-allergen, but no allergic reactions to NRL during medical care were reported. Sensitized patients were significantly more likely to be atopic, reflected by a positive history of other allergies as well as elevated total serum IgE-levels, and had a significantly higher number of urogenital surgeries (P = 0.02 in all cases, Fisher's exact and Wilcoxon test, respectively). CONCLUSION: This study demonstrates that children with CRF are at increased risk of latex-hypersensitivity. Significant associations with atopy and repeated surgeries were observed. Larger studies are required to elucidate whether these children are also at increased risk of anaphylaxis and therefore deserve preventive measures.     

Varicella zoster virus: vaccination and implications in children with renal failure

The varicella zoster virus is associated with significant disease in those with chronic kidney disease, both pre- and postrenal transplantation. With the advent of the varicella vaccine, the opportunity to prevent significant morbidity and mortality exists. Despite the secondary immune defects associated with renal failure, the varicella vaccine has been demonstrated to be immunogenic, safe and efficacious in pediatric patients with kidney disease.     

Results of hormonal studies in 23 adolescents with renal failure treated by chronic dialysis

The hormones regulating growth, growth hormone (hGH), IGF I, sex steroids, thyroxin (T4) and parathormone (PTH) have been measured in 23 adolescents aged from 13.5 to 20 years (14 boys, 9 girls), with chronic renal failure treated with haemodialysis. Growth velocity (GV) was (mean +/- DS) 4 +/- 2.1 cm/year in boys and 1.6 +/- 1.65 in girls, with a bone age of 12.9 +/- 2.4 cm/year. T4 and DHA sulfate (DHAS) differed according to sex (boys: T4 = 70 +/- 4.7 ng/ml; DHAS = 655 +/- 139 ng/ml; girls: T4 = 102 +/- 16.6 ng/ml; DHAS = 118 +/- 35 ng/ml). IGF I, within normal limits, was correlated to bone age and pubertal stage. T4 was negatively correlated to testosterone and SDHA in boys. GV expressed as SD according to bone age was negatively correlated to PTH.hGH deficiency was evidenced in one case, and GV increased under hHG therapy. It is concluded that measuring hormones is necessary in renal failure. Secondary hyperparathyroidism is an inhibiting growth factor. Possible hormonal deficiencies have to be treated.     

Acute renal failure amongst children in a tropical environment

The pathogenetic factors leading to acute renal failure (ARF) in 223 children between the ages of 20 days and 14 years were studied. Diarrhoeal diseases were responsible for ARF in 49.8%, acute glomerulonephritis in 34.1%, drug induced intravascular hemolysis in glucose -6-phosphate dehydrogenase deficiency in 4.5%, snake bite in 4%, hemolytic uremic syndrome in 2.2%, and miscellaneous causes in 5.4%. Dialysis was instituted in 178 children and the others were treated conservatively. Renal histology in 39 out of 76 children who presented with an acute nephritic illness revealed acute endocapillary proliferative glomerulonephritis in 27 and crescentic glomerulonephritis in 12. The histology in 79 out of 147 remaining patients showed acute tubular necrosis in 64, acute cortical necrosis in 13, and acute interstitial nephritis in 2. Overall mortality was 27.4%. This high incidence of ARF due to infective diarrhoeas and dysentery reflects poor socio-economic and hygienic conditions, inadequate facilities in rural areas, delays in seeking medical advice, and lack of knowledge about fluid and electrolyte therapy amongst the staff.