The patient was a 76-year-old male who developed nephrotic syndrome. Idiopathic membranous nephropathy was diagnosed by renal biopsy and clinical findings. The patient had been refractory to predonisolone and cyclosporine A therapies, and overhydration recurred repeatedly during the clinical course. One year after an initial hospitalization, he had to be hospitalized a second time because of overhydration. During the hospitalization, he underwent fluid removal by the extracorporeal ultrafiltration method (ECUM), as his response to diuretics was too weak to permit the control of cardiac insufficiency. The ECUM alleviated his overhydration, but no remission of nephrotic syndrome was achieved. The patient was then discharged temporarily, but overhydration developed again 2 months later. Peritoneal dialysis (PD) using an overnight dwell of a single dose of icodextrin was initiated to obtain stable fluid removal. This promptly alleviated the refractory subcutaneous edema, and type I incomplete remission of nephrotic syndrome was achieved about 2 weeks after the start of PD. The patient could be withdrawn from the PD therapy 4 months later. Subsequently, the urinary volume was maintained and the serum creatinine level was stabilized at about 2 mg/dl. In our patient, the protein leakage into the drainage was small enough to permit remission of the nephrotic syndrome with stable fluid removal. On this basis, we believe that PD using icodextrin is considered as one of the options for the treatment of refractory nephrotic syndrome with poor water control.
In this study, we investigated the clinical effects of long-term administration of the phosphorus (P) binder lanthanum carbonate (LC), which was launched in Japan in 2009. The subjects were 58 dialysis patients who began receiving LC, and we evaluated the clinical effects for up to 36 months after treatment initiation. The average serum P concentration remained low during the 36-month study period, with a significant reduction from 6.25 mg/dL at the start of the study to 4.94 mg/dL after 36 months (P < 0.001). A significant reduction was also observed in the average serum calcium concentration after 36 months (P < 0.05), but not in the serum intact parathyroid hormone concentration. Significant reductions were also observed in the average serum total protein, albumin and potassium concentrations (P < 0.05). The dosages of LC increased by approximately 1.9-fold after 36 months, in contrast, the dosages of concomitantly used sevelamer hydrochloride and Ca carbonate preparations decreased. These results indicate that LC could be used to treat hyperphosphatemia without causing hypercalcemia, and would be useful for long-term treatment with hemodialysis patients.
Purpose : We developed a novel 187-channel signal-averaged vector-projected high-resolution electrocardiograph(SAVP-ECG)for detecting abnormalities in the spatial location of ventricular late potentials (VLP). The Predictor(Corazonix)is a standard system for detecting VLP with a high predictive accuracy in patients with ischemic heart disease. This study was conducted to verify the validity of the criteria for measuring ventricular VLP by SAVP-ECG. Object and method : We consecutively evaluated 615 patients with cardiovascular disease. We examined the VLP index(filtered QRS[f-QRS], RMS40, LAS)determined by the Predictor and SAVP-ECG. We evaluated the correlation of the VLP index with the prior development of lethal ventricular arrhythmia in 135 patients with ischemic heart disease. Result : The VLP index of the two models showed a significant correlation. The positive standard values of the VLP index by SAVP-ECG were f-QRS ≧ 127msec, RMS40 < 16 μV and LAS > 44msec. The predictive values for lethal ventricular arrhythmia by the Predictor and SAVP-ECG were 84.6% and 69.2% for sensitivity, 71.3% and 67.2% for specificity, 23.9% and 18.0% for positive-predictive value, 97.8% and 96.5% for negative-predictive value, and 72.6% and 67.4% for predictive accuracy, respectively. Conclusion : Our study showed that there were significant correlations between the indexes(f-QRS, RMS and LAS)using SAVP-ECG and those using Predictor.
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