Dosage requirement of erythropoietin can be reduced with more frequent administration

In short-term studies, once weekly and twice weekly dosing regimens of erythropoietin (EPO) have both been shown to be effective in correcting anaemia in dialysis patients. However, the optimal dosing frequency has yet to be determined. The long-term effects of EPO given by more frequent divided doses in 10 stable haemodialysis patients were studied. The patients achieved a stable haemoglobin level for at least 3 months prior to the study. The frequency of administration was altered from 4000 units once weekly to 2000 units twice weekly in seven patients, from 4000 units once every 10 days to 2000 units twice weekly alternating with 2000 units once weekly in two patients, and from 4000 units fortnightly to 2000 units once weekly in one patient. After the conversion, EPO dosage was adjusted in order to maintain the haemoglobin at the preconversion level. At the end of 28 weeks, the mean haemoglobin level remained unchanged. However, the mean dosage requirement of EPO reduced from 3400 units per week to 2500 units per week (P = 0.019). This represents a significant 26% reduction in dosage and cost. It was concluded that subcutaneous administration of frequent small doses of EPO is a more cost-effective way of correcting anaemia in haemodialysis patients.link_to_subscribed_fulltex

Dosage requirement of erythropoietin can be reduced with more frequent administration

In short-term studies, once weekly and twice weekly dosing regimens of erythropoietin (EPO) have both been shown to be effective in correcting anaemia in dialysis patients. However, the optimal dosing frequency has yet to be determined. The long-term effects of EPO given by more frequent divided doses in 10 stable haemodialysis patients were studied. The patients achieved a stable haemoglobin level for at least 3 months prior to the study. The frequency of administration was altered from 4000 units once weekly to 2000 units twice weekly in seven patients, from 4000 units once every 10 days to 2000 units twice weekly alternating with 2000 units once weekly in two patients, and from 4000 units fortnightly to 2000 units once weekly in one patient. After the conversion, EPO dosage was adjusted in order to maintain the haemoglobin at the preconversion level. At the end of 28 weeks, the mean haemoglobin level remained unchanged. However, the mean dosage requirement of EPO reduced from 3400 units per week to 2500 units per week (P = 0.019). This represents a significant 26% reduction in dosage and cost. It was concluded that subcutaneous administration of frequent small doses of EPO is a more cost-effective way of correcting anaemia in haemodialysis patients.link_to_subscribed_fulltex

Association of IgA nephropathy with T cell receptor constant alpha chain gene polymorptism

T-cell receptor (TCR) proteins recognize a complex of an antigen-derived peptide bound to the cell surface products of the major histocompatibility complex (MHC) that could be of importance in the immunopathogenesis of IgA nephropathy (IgAN). Previous studies found no difference on TCR constant β chain gene frequencies in IgAN compared with control. Yet no study on the TCR α gene in IgAN was reported. We studied the TCR Cα gene polymorphisms by restriction fragment length polymorphism (RFLP) in 53 patients with IgAN and in comparison with 67 healthy controls. The patients were also classified into different histopathological grading (I, II, and III with increasing histological severity) and renal functions. The extracted DNA were digested with Taq I enzymes and probed with a full-length TCR-α cDNA clone p1.2α probe. A 7-kb C-α Taq 1 fragment is found in 32 of 53 patients (60.3%) compared with 26 of 67 controls (38.8%) (P < 0.05). There was no association of any polymorphic fragment, including the 7-kb fragment, with either the histological grading or renal function. It is concluded that the TCR C-α gene is associated with IgAN but not with the prognosis of the disease

Autoimmune polyendocrinopathy type II in a Chinese patient

Autoimmune polyendocrinopathy type II is rarely reported in Chinese patients. A 42-year-old Chinese woman with a history of Hashimoto's thyroiditis and hypogonadotropic hypogonadism presented with pneumonia. During hospitalisation, she went into an adrenal crisis and diabetic ketoacidosis. Subsequent dynamic hormonal tests revealed primary and secondary adrenal insufficiency. She also had pernicious anaemia, possible alopecia areata, and myasthenia gravis. This constellation of multiple endocrine and non-endocrine disorders led to the diagnosis of autoimmune polyendocrinopathy type II. As the syndrome can be lethal, it is important to maintain a high index of suspicion, enabling early diagnosis and the appropriate replacement therapy, to ensure a successful outcome.link_to_subscribed_fulltex

Xanthomonas maltophilia peritonitis in uremic patients receiving continuous ambulatory peritoneal dialysis

Xanthomonas maltophilia peritonitis has been only occasionally reported in patients receiving continuous ambulatory peritoneal dialysis. We present a series of six cases of peritonitis caused by such bacteria, accounting for 1.5% of all peritonitis episodes encountered in our renal unit over the past 5 years. Recent bacterial peritonitis treated with broad-spectrum antibiotics was the major risk factor, and the outcome was poor with medical treatment alone. Secondary peritonitis, especially fungal, was common and probably related to the prolonged course of antibiotics. All patients eventually required removal of the catheter, either because the effluent failed to clear up or because of secondary peritonitis. We suggest that X maltophilia peritonitis be treated with double antibiotics as soon as it is diagnosed. To prevent the development of superimposed infection after prolonged administration of antibiotics, the Tenckhoff catheter should be removed if the peritonitis fails to respond to a short course of antibiotics.link_to_subscribed_fulltex

Serologic study of immunoglobulin A-fibronectin aggregates in immunoglobulin A nephropathy

The immunoglobulin A (IgA)-fibronectin aggregates, detected by enzyme- linked immunosorbent assay using either antifibronectin or collagen I as binding protein, were previously found to be raised in the circulation of patients with IgA nephropathy (IgAN). It has been suggested that IgA- fibronectin aggregates are involved in the pathogenesis and that the plasma IgA-fibronectin level may even be of diagnostic value in IgAN. Nevertheless, a recent report has questioned the specificity of these assays as plasma IgA may interact with immobilized IgG and these assays detect not only IgA- fibronectin, but also total plasma IgA. These doubts render the interpretation of raised IgA-fibronectin aggregates in IgAN impossible. We isolated total IgA 1 in plasma by jacalin-agarose. Monomeric and polymeric IgA 1 were distinctly separated by fast protein liquid chromatography. When the fast protein liquid chromatography fractions were analyzed for IgA- fibronectin using the antifibronectin capture assay, increased optical density values were predominantly observed in polymeric IgA but not in monomeric IgA. Similar findings were found when the fast protein liquid chromatography fractions were studied using a novel gelatin-anti-IgA assay that avoided nonspecific interaction between plasma IgA and immobilized IgG used as the capture antibody in antifibronectin capture assay. Using our gelatin-anti-IgA assay, we failed to demonstrate a diagnostic increase in IgA-fibronectin aggregates in polymeric IgA from patients with IgAN compared with controls. Our finding of circulating IgA-fibronectin aggregates in patients with IgAN comparable to those of healthy controls did not support the notion that these aggregates may have a pathogenetic role or diagnostic value in IgAN.link_to_subscribed_fulltex

A simple assessment of peritoneal transport in stable continuous ambulatory peritoneal dialysis patients

We studied the peritoneal transport properties in 175 stable continuous ambulatory peritoneal dialysis (CAPD) patients seeking a simple and handy assessment of peritoneal permeability to small solutes. Measurement of creatinine in biological fluid was known to suffer from interference by high glucose concentration in the sample. Furthermore, the interference is also affected by the creatinine concentration of the specimen. Peritoneal transport properties were studied by determining the dialysate to plasma ratio of creatinine concentration (D/P) at the fourth hour of the peritoneal equilibration test, and the mass transfer area coefficient of creatinine (MTACCr) or glucose (MTACGlu). The ratio of glucose concentration in peritoneal dialysate effluent (PDE) at 4 and 0 h (G4/G0) was examined and compared with various peritoneal parameters. There were significant logarithmic correlations between D/P or G4/G0 with MTACCr (r = 0.96 and 0.79, respectively, p < 0.0001). The correlation between G4/G0 and D/P was linear (r = -0.82, p < 0.0001). A fairly good agreement was present between G4/G0 and D/P by Bland and Altman's method. The bias was -0.93% with 95% confidence interval -23.29% to 21.43% of the measured value. Systematic error was found when D/P or G4/G0 were compared with MTACCr. D/P under estimated MTACCr in the high range. The reverse happened for G4/G0. Net ultrafiltration (NUF) also correlated with MTACCr, D/P and G4/G0 (r = -0.32, p < 0.001; -0.26, p < 0.01; and 0.16, p < 0.05, respectively. In conclusion, the use of G4/G0 as a measure of peritoneal transport in CAPD is an acceptable alternative to D/P. It is highly reproducible and avoids correction of interference when creatinine transport parameters are measured. Because of the logarithmic relations of G4/G0 (or D/P) with MTACCr, the former should not be directly converted to MTACCr. Such a simple measure of peritoneal permeability is, however, most convenient for serial monitoring and can be useful to detect early loss of ultrafiltration or solute clearance.link_to_subscribed_fulltex

Distal Extension Denture &ndash; Case Report and Overview [Corrigendum]

Yeung C, Leung KCM, Yu OY, Lam WYH, Wong AWY, Chu CH. Clin Cosmet Investig Dent. 2020;12:493&mdash;503. &nbsp; Details of the same case report were previously reported by the authors in Yeung C, Leung KCM, Yu OY, Lam WYH, Wong AWY, Chu CH. Prosthodontic Rehabilitation and Follow-Up Using Maxillary Complete Conventional Immediate Denture. Clin Cosmet Investig Dent. 2020;12:437&ndash;445. Figures 1-5, 11 and 12-14 on pages 494, 496 and 497, respectively, should have included the following note: Note: Copyright &copy;2020. Dove Medical Press. Reproduced from Yeung C, Leung KCM, Yu OY, Lam WYH, Wong AWY, Chu CH. Prosthodontic Rehabilitation and Follow-Up Using Maxillary Complete Conventional Immediate Denture. Clin Cosmet Investig Dent. 2020;12:437&ndash;445. &nbsp; Read the original articl