Bring me home: Renal dialysis in the Kimberley

SUMMARY:   The incidence of end-stage renal failure (ESRF) in the Kimberley region at the top end of Western Australia far exceeds known national rates and trend analysis demonstrates a close parallel to what is occurring in the Northern Territory. Dialysis prevalence in the Kimberley has nearly tripled in the last decade and has increased at a much faster rate than the rest of Western Australia. Almost all of these people with ESRF are Aboriginal Australians living in remote communities.
In January 2004, the Western Australia Country Health Service and Kimberley Aboriginal Medical Services' Council, under the auspices of the Kimberley Aboriginal Health Planning Forum, embarked upon a review of renal disease in the Kimberley funded by the Western Australia Department of Health. The main purpose of the review was to identify the scope of the problem and make projections upon which to base programme and service development over the next 10 years.
This paper outlines the findings of the Review of Renal Disease in the Kimberley and presents, for the first time, regional data analysis and comparisons. In addition, future projections on the impact of ESRF and recommendations for improving current service delivery are discussed. Given the challenges of remoteness and individuals' desire to return home, this review recommends development of locally-based expertise capable of providing training and support to patients and their families, reinvigoration of community-based dialysis modalities, and the initiation of planning for a second satellite service in the Kimberley.     

大鼠腹腔巨噬细胞表达促肾上腺皮质激素释放激素的实验研究

目的 观察促肾上腺皮质激素释放激素(CRH)在大鼠腹腔巨噬细胞的表达变化规律.方法 体外培养大鼠腹腔巨噬细胞,采用RT-PCR及ELISA技术检测正常及脂多糖(LPS)、佛波脂(PMA)刺激后,细胞CRH mRNA转录水平及CRH多肽合成水平.结果 RT-PCR结果显示,正常大鼠腹腔巨噬细胞内有一定水平的CRH mRNA,LPS及PMA刺激后,细胞内CRH mRNA水平均显著增高(P＜0.01).在多肽水平,正常大鼠腹腔巨噬细胞可表达低水平的CRH[约(0.07±0.01)ng/107cells],LPS及PMA促进了CRH多肽的合成(P＜0.01).结论 正常大鼠腹腔巨噬细胞可合成表达CRH,其水平在活化后大鼠腹腔巨噬细胞显著上调.     

Iron-mobilizing properties of the gadolinium-DTPA complex: clinical and experimental observations.

BACKGROUND: Gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investigates a mechanism of severe iron intoxication with life-threatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence of iron overload. We hypothesized that Gd-DTPA may have an iron-mobilizing effect in specific conditions of iron overload combined with prolonged exposure to the agent. METHODS: For the in vitro study, Gd-DTPA was added to mice liver homogenate and iron metabolism parameters were measured after incubation in comparison with the same samples incubated with saline only. For the in vivo study, an experimental model of acute renal failure in iron-overloaded rats was designed. Previously iron-overloaded and normally fed rats underwent bilateral nephrectomy by renal pedicle ligation, followed by Gd-DTPA or saline injection. Iron and iron saturation levels were checked before and 24 h after Gd-DTPA or vehicle administration. RESULTS: Significant mobilization of iron from mice liver tissue homogenate in mixtures with Gd in vitro was seen in the control (saline) and in the experimental (Gd) groups (513+/-99.1 vs 1117.8+/-360.8 microg/dl, respectively; P<0.05). Administration of Gd-DTPA to iron-overloaded rats after renal pedicle ligation caused marked elevation of serum iron from baseline 143+/-3.4 to 570+/-8 microg/dl (P<0.0001). There were no changes of the named parameter, either in iron-overloaded anuric rats after saline injection or in normal diet uraemic animals, following Gd-DTPA administration. CONCLUSIONS: The combination of iron overload and lack of adequate clearance of Gd chelates may cause massive liberation of iron with dangerous elevation of free serum iron. It is highly recommended that after Gd contrast study, end-stage renal disease patients with probable iron overload should undergo prompt and intensive haemodialysis for prevention of this serious complication.     

RESEARCH ON A REAL-TIME CONTROL SYSTEM OF LOW POWER DISSIPATION FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS(CCPD) CYCLER

FOREWORDPeritonealdialysisrepresentssoluteandfluidexchangemainlybetweenperitonealcapillarybloodanddialysissolutionintheperitonealcavity'CombinedwithhemodialySisandrenaltransplantation,peritonealdialysisisusedmainlyforthetreatmentofrenalfailure,particularlyforchronicfailure'In1976,Prof'Popovichdevelopedcontinuousambulatoryperitonealdialysis(CAPD)basingontheconceptofcontinuousequilibrationdialysis('1'Fromthenon,peritonealdialysisfounditsclinicaluse'Continuouscyclicperitonealdialysis(CCPD…     

心血管外科术后急性肾功能衰竭的处理

目的：总结两组心血管外科术后急性肾功能衰竭病例的治疗经验，提出心血管外科术后急性肾功能衰竭的特点、早期诊断标准及处理原则。方法：１７例心血管外科术后急性肾功能衰竭病例，以入院先后分为两组。第１组８例，第２组９例。回顾第１组病例的急性肾功能衰竭的治疗经验，总结腹膜透析、血液透析和血液滤过的优缺点。在第２组病例治疗中，以急性肾功能衰竭的早期诊断为前题，早期开始腹膜透析。同时，强调综合治疗的重要性。结果：第１组病例均死亡。第２组病例，７例存活（７８％）。结论：心血管外科术后急性肾功能衰竭的早期诊断和早期肾功能替代疗法，是治疗成败的关键。腹膜透析简便易行，在急性肾功能衰竭的早期开始腹膜透析，可以收到良好效果，并以此作为心血管外科术后急性肾功能衰竭的首选肾功能替代疗法。     

Plasma kinetics of 125I-labelled amyloid P component in {beta}2M amyloidosis: A possible approach to quantitate disease activity

Dialysis amyloidosis is one of the most incapacitating complicationsof long-term dialysis treatment. Quantitative assessment ofamyloid deposition using radiolabelled tracers has been recentlyproposed but convincing evidence of its validity in uraemicpatients remains to be provided. We studied the plasma kineticsof i.v. administered ¹²⁵I-labelled serum amyloid P component(¹²⁵I-SAP) in 20 chronic haemodialysis patients compared withthose of nine healthy volunteers and three non-dialysed patientswith systemic amyloidosis. Plasma clearance of the tracer wasabnormal in 17 of 20 dialysis patients in whom plasma radioactivitydeclined in a bi-exponential mode, in contrast to the single-exponentialslope observed in all healthy controls. ¹²⁵I-SAP plasma half-lifeof the second component, probably reflecting metabolic clearance,was significantly prolonged in these dialysis patients comparedwith the healthy controls (35.3 versus 24.6 h, P<0.001).Among the long-term haemodialysis patients the calculated extravasculardistribution of ¹²⁵I-SAP was significantly greater in thosewith severe arthropathy than in asymptomatic patients. Thesefindings demonstrate for the first time that SAP clearance isdisturbed in haemodialysis patients due to both failing renalelimination and retention in extravascular sites. The extravasculardiffusion is greatly enhanced in patients with clinical evidenceof amyloidosis. Therefore the study of plasma ¹²⁵I-SAP kineticspromises to be a valuable tool to quantitate the extent of amyloidosis.     

Aspergillus peritonitis in peritoneal dialysis: case report and a review of the literature

Aspergillus peritonitis is a rare complication of continuousambulatory peritoneal dialysis. The case is described of a 68-year-oldman in whom Aspergillus fumigatus was isolated from the peritonealdialysate after recurrent peritonitis with Gram-negative rodsin association with diverticulosis. Treatment consisting ofremoval of the catheter and intravenous administration of amphotericinB followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertaintiesregarding diagnostic awareness, culture diagnosis, and therapeuticmanagement. Next to institution of appropriate antifungal therapy,early removal the peritoneal dialysis catheter is recommended,as delayed removal of the catheter appears to be associatedwith increased mortality and morbidity.     

Management of abdominal sepsis

Introduction: Today the management of the different forms of peritonitis is generally standardised. The classification of primary and secondary peritonitis is well accepted. From a pathophysiological point of view, postoperative and post-traumatic peritonitis should be considered as independent entities. The bacteriological isolates from the inflamed peritoneal cavity do not correlate with the clinical course, and the occurrence of enterococci and bacteroides may be slightly related to ongoing infectious complications. Classification: Valuable scoring systems mainly rely on systemic signs of the septic disease and seem to better differentiate the prognosis of the disease than more surgically oriented scores do. Although the scoring systems did not allow any clinical decision, they should be used to help better compare patients treated in different institutions. The observation of the minor relevance of bacteriology and the superiority of general sepsis scores agrees with the fact that pre-existing septic organ dysfunction and pre-existing comorbidity are the main determinants of mortality. Treatment: Surgical therapy focuses on the control of the source of infection because it has been clearly shown that, without resolving the source of infection, the prognosis remains poor. Adjuvant surgical measures aim at the further reduction of the bacterial load in the peritoneal cavity. Planned relaparotomy, relaparotomy on demand, and continuous closed peritoneal lavage are used. Results: Clinical results proved these methods to be equally effective although pathophysiological considerations favour closed peritoneal lavage. Conclusion: Summarising the available data, we need a more sophisticated understanding of the pathophysiology of the peritonitis, and well-designed clinical studies are necessary to define the optimal surgical treatment modalities. Received: 27 November 1997     

Peritoneal Desmoplastic Small Round Cell Tumors with Divergent Differentiation: A Review

Peritoneal desmoplastic small round cell tumors with divergent differentiation are recently described highly aggressive neoplasms with characteristic clinical, morphologic, and immunohistochemical features. This review covers 38 cases that have been reported in the literature. The average age of patients is 18.4 years, and males are affected twice as frequently as females. Tumors generally present as multiple peritoneal nodules without obvious organ involvement. Histology shows islands of small cells set in dense desmoplastic stroma. Immunohistochemical stains are usually positive for cytokeratins, epithelial membrane antigen, desmin, and vimentin. Many cases also stain for neuron-specific enolase but rarely for other neuroepithelial markers. Ultrastructural appearances range from undifferentiated small cells to larger epithelial elements. Paranuclear aggregates of intermediate filaments are characteristic. Dense-core granules and other neuroendocrine features have been described in a minority of cases. Some tumors respond to chemotherapy, but most patients die within months to a few years. The histogenesis of these tumors is uncertain.     

新型阳离子(苯乙烯—丙烯酰胺)共聚物的研究 Ⅱ.阳离子(苯乙烯——丙烯酰胺)共聚物与染料的相互作用

以P(St-Am·MG)对染料活性艳红(X-3B)溶液进行絮凝试验,考察了高聚物剂量及外加盐对絮凝效果的影响,并与无疏水基团的阳离子聚丙烯酰胺PAm·MG的絮凝能力进行了比较。发现絮凝体系无外加盐时,高聚物与染料的作用主要是通过静电力;有外加盐时,高聚物的电荷受到屏蔽,高分子链卷曲,PAm·MG的絮凝效果受到较大影响。而P(St-Am·MG)与X-3B之间存在疏水相互作用,受影响较小,此时P(St-Am·MG)的絮凝性能优于PAm·MG。用平衡渗析法研究了不同温度时甲醇和脲存在下P(St-Am·MG)与X-3B相互作用的热力学。证明了它们之间确实存在疏水相互作用。