Effectiveness of calcium acetate as a phosphate binder in patients undergoing continuous ambulatory peritoneal dialysis

We compared the effectiveness of calcium acetate as a phosphate binder with that of calcium carbonate by substituting one for the other in patients undergoing continuous ambulatory peritoneal dialysis. Twenty patients who had been receiving calcium carbonate as a phosphate binder were instead given calcium acetate, initially with two thirds of the previous dose of elemental calcium. The calcium acetate dose was adjusted to achieve adequate calcium-phosphate balance; 65.6% of the previous dose of elemental calcium in calcium carbonate was required. Eighteen of the 20 patients completed the 3-month study. There were no significant differences in the pre-study and study levels of serum phosphate (1.81Ը?0.04 [SEM] versus 1.89Ը?0.06 mmol/L), corrected serum calcium (2.54Ը?0.04 versus 2.57Ը?0.03 mmol/L), calcium phosphate product (4.60Ը?0.15 versus 4.87Ը?0.18), serum alkaline phosphatase (64.75Ը?4.17 versus 69.94Ը?3.77 U/L), and serum parathyroid hormone (122Ը?31 versus 124Ը?27 ng/L). Three patients developed a total of five episodes of hypercalcaemia (corrected calcium level >/=2.85 mmol/L) and four other patients developed gastrointestinal upset. Calcium acetate can thus achieve similar phosphate control to calcium carbonate, using 65.6% of the dose of elemental calcium in calcium carbonate; however, its clinical superiority was not demonstrated in this study.published_or_final_versio

Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review

OBJECTIVE. To examine the prevalence of glomerular disease in Hong Kong. DESIGN. Prospective review. SETTING. University teaching hospital, Hong Kong. PATIENTS. All patients who presented with suspected glomerular disease from 1993 through 1997. MAIN OUTCOME MEASURES. Histopathological diagnosis from biopsy examination and clinical features of presentation. RESULTS. A total of 1629 consecutive percutaneous renal biopsies of native kidneys showed glomerular disease in 1413 cases. The most common clinical indication for renal biopsy was persistent proteinuria (n=735; 52.0%), while the most frequently found glomerular lesion was immunoglobulin A nephropathy (n=338; 23.9%). Minimal-change nephrotic syndrome (n=125; 8.8%) and immunoglobulin M nephropathy (n=11; 0.8%), were the most common glomerular diseases that presented with nephrotic syndrome. The male to female ratio for lupus nephritis was 1:14 (n=290), whereas for minimal-change nephrotic syndrome, the ratio was 1.8:1 (n=125). Immunoglobulin A nephropathy and membranous glomerulonephritis (n=117) affected approximately equal numbers of male and female patients. Familial fibrillary glomerulonephritis, a disease hitherto unknown in Hong Kong, was diagnosed in two siblings. CONCLUSION. Immunoglobulin A nephropathy was the most common glomerular disease in this survey and represents an important cause of end-stage renal failure in the Hong Kong population.published_or_final_versio

Reversible acute renal failure in a patient with IgA nephropathy

Reversible acute renal failure is a rare complication of IgA nephropathy. We report a patient with IgA nephropathy who developed acute renal failure after an episode of gross haematuria. Renal biopsy revealed extensive acute tubular damage and red blood cell casts. His renal failure recovered spontaneously without specific treatment. The clinical and pathological features of this IgA nephropathy complication are discussed.published_or_final_versio

Genetic linkage study of family members of a patient with adult polycystic kidney disease

OBJECTIVE. To study the feasibility of making an early diagnosis of adult polycystic kidney disease by using genetic linkage analysis in Hong Kong. DESIGN. Genetic linkage study. SETTING. University teaching hospital, Hong Kong. PARTICIPANTS. Six members of a Chinese family with a history of adult polycystic kidney disease. MAIN OUTCOME MEASURES. The inheritance pattern of adult polycystic kidney disease, as detected by polyacrylamide gel electrophoresis of polymerase chain reaction products using radioactively labelled primers specific to six microsatellite DNA markers that are closely linked to the PKD1 gene on chromosome 16. RESULTS. Four of the six members of the family studied were shown to be positive for disease-linked markers, and the inheritance of adult polycystic kidney disease could be traced in this family with a higher degree of precision (93.7%) using genetic linkage analysis, than could be predicted otherwise. CONCLUSION. The success of genetic linkage analysis in providing an early diagnosis of adult polycystic kidney disease is dependent on having a sufficient number of family members whose disease status has been established by imaging methods to allow the disease-linked marker haplotype to be determined. The establishment of a genetic data bank for families with adult polycystic kidney disease should be considered to maximise the effectiveness of this diagnostic approach.published_or_final_versio

Fibrillary glomerulonephritis: a case report

Fibrillary glomerulonephritis is a recently recognised condition. The usual presentation is heavy proteinuria. The diagnosis is established by demonstration of the characteristic Congo-red negative, randomly arranged microfibrils in the glomeruli by electron microscopy. At present, there is no proven effective treatment for this condition and the prognosis is generally poor. The first case of fibrillary glomerulonephritis diagnosed in Hong Kong is reported here in a 38-year-old woman.published_or_final_versio

Peri-operative administration of rectal diclofenac sodium. The effect on renal function in patients undergoing minor orthopaedic surgery

In a randomized, double-blind study, we administered placebo and diclofenac sodium 100 mg suppositories 1 h pre-operatively and on the first post-operative morning to 22 adult patients undergoing minor orthopaedic surgery. A standardized post-operative intravenous fluid regimen was instituted until oral fluids were tolerated. Renal function was assessed pre-operatively, and on the first and second post-operative days by the measurement of urine output, creatinine, urea, sodium, potassium and NAG (N-acetyl-b-D-glucosaminidase) levels and serum creatinine, urea, sodium and potassium concentrations. On the first postoperative day, the diclofenac group demonstrated a reduced urinary sodium excretion. On the second postoperative day, a reduced urinary NAG/creatinine ratio was observed in the diclofenac group when compared to placebo. We conclude that peri-operative administration of diclofenac causes changes in renal function consistent with prostaglandin inhibition on the first post-operative day but had no lasting adverse effects in this group of patients. Our results reinforce the need for caution when administering this drug in the context of pre-existing renal impairment.published_or_final_versio

Comparison of the outcome of living related donor and cadaveric renal transplantation in Queen Mary Hospital - a single centre experience

Living related donors (LRD) have been the main source of donor kidneys in Hong Kong. In recent years, there has been an increase in the proportion of cadaveric (CAD) kidneys transplantation. This review examines the results of renal transplantation in. Queen Mary Hospital (QMH) in order to assess the continuing need for LRD kidney transplantation. The records of 159 of 165 transplant cases between 1983 and 1991 were analyzed. The mean age of recipients was 35.6 years (range 11 to 57), with a male predominance in the LED recipients (p = 0.03). The waiting time for the LRD recipients was significantly less than the CAD recipients (p < 0.001). There was no difference in the distribution of different primary renal diseases causing end stage renal failure between the LRD and CAD groups. The cumulative graft survival at five years was 82.5% and 65.8% for LRD and CAD respectively (p = 0.02), Graft function was also significantly better in LRD recipients (p < 0,01), Early surgical complications were more common after CAD transplantation (14% vs 29%, p = 0.02). While the transplant centres and the Hong Kong Government continue to promote cadaveric organ donation, the LRD transplant programme should be equally encouraged because of superior graft outcome.published_or_final_versio

A prospective study on anti-endothelial cell antibodies in patients with systemic lupus erythematosus

IgG anti-endothelial cell antibodies (AECA) were detected in 48.5% of patients with active systemic lupus erythematosus (SLE) and in 7% of patients during remission and were associated with the development of diffuse proliferative lupus nephritis. Sixteen AECA-positive patients were prospectively studied for 25.2 ± 2.9 months. Serial AECA levels correlated with disease activity in 10 (62.5%) patients. Seven (43.8%) of 16 patients remained AECA positive during clinical remission, Among four episodes of disease exacerbation and 16 instances of clinical improvement, 85% (17 episodes) were accompanied by corresponding changes in the level of AECA, while corresponding changes in C3, anti-nuclear antibodies, and anti-double-stranded DNA antibodies were noted in 60, 60, and 80% of cases, respectively (p = not significant). AECA served as the only serologic marker of altered disease activity in five episodes, when C3, ANA, and anti-double-stranded DNA levels remained unaltered. We conclude that the level of AECA can serve as a marker of disease activity in SLE and that serial monitoring of AECA can complement other serologic parameters in the management of patients.link_to_subscribed_fulltex

Identification of endothelial cell membrane proteins that bind anti- DNA antibodies from patients with systemic lupus erythematosus by direct or indirect mechanisms

A subgroup of murine monoclonal anti-DNA antibodies bind to vascular endothelial cells either directly as a result of cross-reactivity, or indirectly through immunoglobulin-bound DNA and DNA-binding proteins on the endothelial cell membrane. To determine whether these mechanisms apply in human systemic lupus erythematosus (SLE), and to identify endothelial cell membrane protein(s) that bind human anti-DNA antibodies, we examined, by Western blotting, the binding of human polyclonal anti-DNA antibodies (PoAb) isolated from eight patients with SLE to human umbilical vein endothelial cell membrane proteins. PoAbs bind to endothelial membrane proteins With M(r) 84,000 and 46,000, which correspond to the DNA-binding proteins previously reported. Such binding is diminished after removal of DNA by DNase treatment. In addition, PoAbs bind to membrane proteins with M(r) 180,000, 110,000, 68,000, 44,000, and 35,000-30,000. Such binding is unaffected by alterations in DNA concentration. Anti-dsDNA and anti-ssDNA PoAbs from individual patients exhibit identical binding patterns, as are PoAbs isolated during active disease or remission. The results show that human anti-DNA antibodies can bind to endothelial cells both indirectly via immunoglobulin-bound DNA, and directly due to cross-reactivity. These mechanisms of cellular binding by anti-DNA antibodies may depict pathogenetic steps in human SLE.link_to_subscribed_fulltex