, Min A Park, Myung Jae Park, So Young Park, Seung Hyeun Lee Uremic pleuritis is a fibrinous pleuritis of unknown pathogenesis in patients with chronic kidney disease. Although it responds to regular dialysis or repeated thoracentesis, cases that are refractory to those therapies have been reported. We report a case of uremic pleuritis which showed marked improvement following corticosteroid therapy. The effusion was exudate, and negative in cytology and microbiology. Pleural biopsy revealed chronic inflammation with fibrosis. The pleural effusion did not respond to chest tube drainage and continuance of hemodialysis. With a diagnosis of refractory uremic pleuritis, we started methylprednisolone. The pleural effusion responded to the treatment and resolved without complication.
Citations
, Sun Seob Park, Eun Jeong Ko, Si Won Lee, Mihong Choi, Kiwon Kim Small cell lung cancer is primarily treated with chemotherapy. For patients with end-stage renal disease (ESRD), systemic chemotherapy is often challenging since renal excretion of chemotherapeutic agents might be decreased due to impaired renal function, leading to increased toxicity. No consensus is made so far regarding appropriate dosage and combination of chemotherapeutic agents for patients on hemodialysis. We report two cases of chemotherapy without significant toxicity in small cell lung cancer patients who were on hemodialysis for ESRD.
Patients receiving hemodialysis have been shown to be carnitine deficient due to many causes. Tissues, especially the skeletal muscle and myocardium, require carnitine for the production of energy. This study was performed to find out the effects of L-carnitine supplementation on muscular symptoms and cardiac functions in dialysis patients.
Among 72 hemodialysis patients, 40 patients who showed decreased free carnitine levels were selected to receive L-carnitine intravenously after each hemodialysis session for 6 months. Before and after supplementation, echocardiography, various neurologic examinations and questionnaires were obtained.
After carnitine treatment for 6 months (1~1.5 g per every hemodialysis session), the blood level of carnitine was increased more than 10 times (19.04±7.12 µmol/L
Regular L-carnitine supplementation on hemodialysis patients can improve their left ventricular ejection fraction and some parts of functionality.
, Ki Sook Hong Cardiac troponin T(cTnT) levels are elevated in patients with chronic renal fail-ure(CRF) with dialysis which represent myocardial damage. But the cut-off levels were different in laboratories and clinical physicians. We conducted a study to find out the cut-off levels of acute myocardial infarction(AMI), ischemic heart disease(IHD), and cardiovascular disease (CVD) in CRF patients with dialysis and prognostic aspect according to cTnT levels.
Cardiac troponin T(cTnT) of total 98 patients(men 43, women 55, mean age 60.4±13.0 years) was reviewed the diagnosis and progress for 3 years by the medical records. Serum cTnT by Elecsys 2010(Roche diagnostics, Germany), the 4th generation assay was performed.
Mean cTnT level of total 98 patients was 0.26ng/mL and the patients with CVD were 59(60.2%) and their cTnT level was 0.41 ng/mL. The mean levels of cTnT in AMI, IHD, and CVD were 1.10, 0.52, and 0.41 ng/mL, respectively. cTnT, CK, CK-MB, and glucose were increased according to severity of cardiovascular disease. The cut-off levels of cTnT in AMI, IHD, and CVD was 0.10, 0.07 and 0.06 ng/mL. The sensitivity and specificity of AMI, IHD, and CVD in each cut-off level were 88.2/71.6%, 76.2/71.4%, and 81.4/71.8%, respectively. The survival rate above cTnT 0.1 ng/mL during 3 years was significantly decreased(p<0.001) than less than 0.1 ng/mL.
The degree of cTnT elevation in CRF patients with dialysis represents severity of cardiovascular disease and poor survival rate.
, Duk Hee Kang, Gyu Bok Choi, Kyun Ill Yoon Patients undergoing maintenance hemodialysis(HD) potentially have an increased risk of exposure to viral hepatitis. The reported prevalence of antiHCV in hemodialysis patients varied widely form 7.6-54% according to dialysis center and there were there were many reports that showed the correlation between the prevalence of antiHCV and duration of HD or transfusion amount.
Fifty-four patients on regular hemodialysis at our hospital were evaluated for the presence of hepatitic C antibody(antiHCV) with the comparison of various parameters such as duration of HD, amount of transfusion, past history of hepatitis, serologic markers of hepatitis B and current liver function. AntiHCV using second-generation enzyme linked immunosorbant assay were found in six of 54HD patients(11.1%). Among six antiHCV(+) percent four patients were found to have HCV-RNA in their plasma detected by PCR. The percent of male patients were significantly higher in antiHCV(+) group(66.7 vs 31.3%, p<0.05). The positivity of antiHCV did not correlated with the duration of HD and amount of transfusion(p>0.05), but prevalence increased over 2 years (5.9% in 1991, 11.1% in 1993) and HBsAg prevalence remained unchanged(9.8% in 1991, 9.3% in 1993).
Therefore, regular follow-up of liver function test and use of separate machine for antiHCV positive patients may be needed to prevent the transmission of the hepatitis C virus during the hemodialysis process itself.
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