Lymphatic absorption in continuous ambulatory peritoneal dialysis (CAPD)
Explore the source record for details and available documents.
Absorption↗
Biomedical subjects
I K Cheng
Publications and source records attributed to I K Cheng.
Clinical experience with pefloxacin in patients with urinary tract infections.
A total of 27 patients, 21 of them females, with a median age of 56 were treated with pefloxacin for urinary tract infections. Some 74% of these infections were associated with upper tract symptoms, and Escherichia coli was the most common causative micro-organism (75% of cases). Fifteen patients had co-existent diseases with/without urological abnormalities. All strains of E coli were sensitive to pefloxacin; Actinobacter and one strain of Klebsiella and Streptococcus faecalis were resistant. Two patients who defaulted and one who had an initial negative bacterial culture were excluded from the analysis of the outcome. The overall bacteriological cure rate at four to eight weeks was 87.5% (21/24). The incidence of possible side-effects was high, occurring in 59% of the patients. Nausea, dizziness and vomiting were the most common. These were mild and did not require termination of treatment. Peripheral neuropathy, which disappeared four weeks after stopping pefloxacin, occurred in one patient.
Adolescent↗
Long-term peritoneal clearances in patients on continuous ambulatory peritoneal dialysis.
Explore the source record for details and available documents.
Female↗
Minimal change glomerulopathy in two patients after thymectomy.
Two myasthenia gravis patients developed nephrotic syndrome due to minimal change glomerulopathy 3 to 14 years after thymectomy for malignant thymoma. Impaired cellular and humoral immunity has been documented in patients with thymoma and persists after thymectomy. The occurrence of minimal change disease lends support to the hypothesis that the glomerulopathy is secondary to T-cell dysfunction, resulting in production of a lymphokine which increases glomerular basement membrane permeability.
Adult↗
Mesangial IgA nephropathy with steroid-responsive nephrotic syndrome: disappearance of mesangial IgA deposits following steroid-induced remission.
This report describes the clinical features and renal biopsy pathology in two patients with immunoglobulin A (IgA) nephropathy and nephrotic syndrome before and after steroid-induced remission. Apart from confirming the frequently relapsing course and mild glomerular changes observed in patients with IgA nephropathy and steroid-responsive nephrotic syndrome (SRNS), we were able to show that mesangial expansion and mesangial IgA deposits disappeared or were greatly reduced in repeat renal biopsies following steroid-induced remission. Because mesangial IgA deposits usually persist in repeat biopsies obtained from patients with typical IgA nephropathy, their resolution in our patients following steroid remission would support the proposal that the association of IgA nephropathy and SRNS may represent a distinct clinical syndrome. It is postulated that the presence of mesangial IgA deposits during nephrotic presentation and their disappearance following steroid-induced remission may result from increased mesangial sequestration of IgA circulating immune complexes (CIC) during the period of enhanced glomerular permeability and that the increased load of IgA CICs may reflect a common defect in mucosal immunity or immunoregulation in these patients.
Adult↗
Hepatitis B infection and renal transplantation: the absence of anti-delta antibodies and the possible beneficial effect of silymarin during acute episodes of hepatic dysfunction.
The incidence of hepatitis B infection among renal transplant recipients was reviewed. Among 90 patients, 13 were HBsAg positive prior to renal transplantation. Episodes of hepatic dysfunction were seen in eight and one died of fulminating hepatitis and disseminated tuberculosis. Silymarin, a herbal extract, appears to confer some benefits in ameliorating hepatic dysfunction. Antibodies to the delta agent were not detected during any of these episodes. One patient contracted hepatitis B after transplantation and rapid reduction in steroid dose was associated with deterioration of liver function. He developed antibodies and cleared the virus. Four HBsAg-negative patients received kidneys from HBsAg positive donors without becoming HBsAg positive.
Adult↗
Tuberculous peritonitis complicating long-term peritoneal dialysis. Report of 5 cases and review of the literature.
The characteristics of 5 patients who developed tuberculous peritonitis while receiving long-term peritoneal dialysis (PD) are presented. There were 2 males and 3 females. 3 patients were on intermittent and 2 were on continuous ambulatory peritoneal dialysis when tuberculous peritonitis was first diagnosed. None of the patients had recently received immunosuppression therapy or were diabetics. The clinical presentations were similar to other forms of peritonitis complicating PD except for a more insidious onset. As extraperitoneal involvement and peritoneal lymphocytosis were rarely present, the diagnosis was mainly dependent on the direct demonstration of Mycobacterium tuberculosis with smear (1 patient) and culture (4 patients). In 1 patient with a pleuroperitoneal communication, the diagnosis was made by pleural biopsy and a positive response to antituberculous therapy. All patients responded to treatment with a combination of three antituberculous drugs which included streptomycin, isoniazid, rifampicin and pyrazinamide. Two patients were transferred to hemodialysis. In 3 patients, peritoneal dialysis was continued. Peritoneal clearance and ultrafiltration capacity were unchanged for up to 16 months after treatment in 2 patients who continued peritoneal dialysis but was reduced by 30 and 50%, respectively, in the remaining patient. Only 1 patient died, but her death was not directly related to tuberculous peritonitis. It was concluded that with a high index of suspicion and early institution of treatment, tuberculous peritonitis complicating PD can be successfully treated with low mortality and without compromising the dialysis capacity of the peritoneal membrane.
Adult↗
Cryptococcal infection of the lumbar spine.
Explore the source record for details and available documents.
Adult↗
Fungal peritonitis complicating peritoneal dialysis: report of 27 cases and review of treatment.
The clinical features, treatment and outcome of 27 cases of fungal peritonitis were studied. Twenty-one cases occurred in patients receiving CAPD and six in patients on intermittent peritoneal dialysis. Twenty-five cases were due to Candida spp., one was due to Trichosporon spp. and in one, both Candida and Trichosporon and an unidentified acid-fast bacillus were isolated. Clinical features of fungal peritonitis and bacterial peritonitis were the same. A direct comparison with patients without fungal peritonitis failed to reveal an increased incidence of diabetes mellitus. However, a history of recent bacterial peritonitis and antibiotic treatment was frequently obtained. We found that the combination of oral ketoconazole and intraperitoneal miconazole is successful in treating fungal peritonitis complicating peritoneal dialysis but catheter removal and replacement is often necessary. Analysis of the relationship between clinical outcome and various treatment strategies in cases reported in the literature and in our own showed that an initial trial of antifungal drugs consisting of oral ketoconazole and i.p. 5-fluorocytosine or miconazole is warranted in most cases before contemplating catheter removal.
Adolescent↗
Adult-onset mesangiocapillary glomerulonephritis: a disease with a poor prognosis.
A retrospective analysis of the records of 46 patients with adult-onset mesangiocapillary glomerulonephritis seen over a period of 15 years is reported. There were 28 males and 18 females with a mean age of 34 years. Mean observation period was 60 months. All patients had renal biopsies and characteristic changes, but no dense deposit variant was seen. HBsAg was positive in 20 per cent of the patients tested whereas in the general population it was about 10 per cent. Nephrotic syndrome was the commonest presentation. There was a mean delay of 8.5 months between the onset of symptoms and renal biopsy. Nineteen patients were given steroid/immunosuppressive therapy while 27 received no specific treatment. At the time of review, renal function was stable in 13 patients but progressively deteriorating in 33. In the latter, the slope of the graph of reciprocal of creatinine versus time could be accurately determined. Steroid/immunosuppressive therapy did not influence the rate of progression of renal failure but appeared to hasten and induce more partial remissions of the nephrotic state. There was no difference in cumulative renal survival between treated and untreated patients, and between HBsAg-positive and negative patients. Overall, 23 patients required dialysis/renal transplantation and an additional four had died of end-stage renal failure at the time of this review.
Adolescent↗
Lupus nephritis patients on maintenance dialysis in Hong Kong.
Eleven patients with lupus nephritis required maintenance dialysis. Two were on haemodialysis (HD), 9 on continuous ambulatory peritoneal dialysis (CAPD). One was subsequently transplanted and recurrence of lupus nephritis occurred at 9 months posttransplant. One discontinued CAPD after 6 months; 4 died and the remaining 7 were fully rehabilitated. There was marked regression of extra-renal lupus activity post-dialysis.
Adult↗
A double-blind controlled trial of norfloxacin versus cotrimoxazole in the treatment of urinary tract infections.
A double-blind controlled trial of norfloxacin versus cotrimoxazole in the treatment of urinary tract infections was conducted. Eighty-eight patients were recruited but data from 80 patients were analysed. Norfloxacin cured 93 per cent of the infections while the cure rate achieved by cotrimoxazole was only 70 per cent (p = 0.03, Fisher's exact test). The difference was attributable to a higher incidence of resistance to cotrimoxazole among the bacterial isolates. Escheria coli was the commonest pathogen and together with klebsiella accounted for 78 per cent of all isolates. Fifteen per cent of E coli and 15 per cent of klebsiella isolates were resistant to cotrimoxazole while all were sensitive to norfloxacin. Side effects were minimal and consisted mainly of nausea and non-specific dizziness.
Adult↗
Climatic factors and peritonitis in CAPD patients.
From March 1983 to December 1987 the relation of the occurrence of all episodes of peritonitis in CAPD patients to climatic factors, such as temperature and relative humidity was examined. Altogether 389 episodes were recorded in 239 patients. Peritonitis due to Staphylococcus epidermidis, Gram-negative organisms and culture-negative episodes was most frequent during the hot months of the year, June to October. The occurrence of peritonitis due to Staphylococcus aureus was uniformly distributed throughout the year. Relative humidity did not seem to affect the frequency of peritonitis.
Climate↗
FSGS and mosaic Turner's syndrome.
Explore the source record for details and available documents.
Adolescent↗
The role of soluble immune response suppressor lymphokine in the prediction of steroid responsiveness in idiopathic nephrotic syndrome.
The role of serum soluble immune response suppressor (SIRS) lymphokine in the prediction of steroid responsiveness in idiopathic nephrotic syndrome was investigated. Serum SIRS was detected by its capacity to suppress the induction of plaque forming cells in pokeweed mitogen-stimulated in vitro lymphocyte culture in a dose dependent manner, and specificity was determined by the ability of monoclonal anti-SIRS coated beads to specifically absorb the suppressor activity. Serum SIRS was present in 7 of 18 patients with steroid responsive nephrotic syndrome and in 1 of 6 patients with nephrotic syndrome who were resistant to steroid treatment. It was also found in 2 of 4 patients with nephrotic syndrome which would be expected to be resistant to steroid treatment, in 2 of 10 patients with steroid responsive nephrotic syndrome in remission and in 2 of 8 normal healthy controls but was absent in 8 patients with non-nephrotic proteinuria secondary to a variety of renal disease. It was concluded that, although serum SIRS was present more often in patients with steroid responsive nephrotic syndrome, it is not a sensitive enough assay for predicting the response to treatment.
Humans↗
Glomerulonephropathy of Laurence-Moon-Biedl syndrome.
A patient with Laurence-Moon-Biedl syndrome and nephrotic range proteinuria is presented. Radiological investigation of the urinary tract revealed clubbed calyces but no evidence of obstruction or vesicoureteric reflux. Renal biopsy revealed occasional sclerotic glomeruli, extensive foot-process fusion and segmental glomerular basement membrane abnormalities with negative immunofluorescence for immunoglobulins and complement. Nephrotic proteinuria responded to steroid therapy but mild proteinuria persisted. The findings were consistent with minimal change nephropathy superimposed on the glomerular lesions of Lawrence-Moon-Biedl syndrome.
Adult↗
Living-related renal transplantation in a patient with nail-patella syndrome.
Living-related renal transplantation was performed successfully in a patient with nail-patella syndrome. Graft biopsy 18 months post-transplantation showed normal glomerular basement membrane by electron microscopy. Dystrophic nails of both index fingers had also regrown, suggesting the donor kidney might replenish deficient factors.
Child↗
The regulation of autoantibody production in Heymann's nephritis by T lymphocyte subsets.
The role of T lymphocyte subsets in the regulation of the autoantibody response to renal tubular antigen and the development of Heymann's nephritis (HN) in different rat strains was investigated in the present study. WF rats were highly susceptible to HN induction, PVG rats were moderately susceptible, whereas DA and BN were resistant. The induction of an autoantibody response to renal tubular antigen and HN in PVG rats was T cell-dependent as they were abrogated by neonatal thymectomy and T cell depletion after adult thymectomy, whole body irradiation and bone marrow reconstitution. Reconstitution of neonatal thymectomized and adult thymectomized whole body irradiated and bone marrow reconstitution of PVG rats with different T lymphocyte subsets revealed that the induction of an autoantibody response to renal tubular antigen in these animals required help from a long lived, W3/25+ T cell subset and was down regulated by a MRC OX8+ T cell subset. Adoptive transfer experiments demonstrated that the suppressor T cells involved were short lived and were probably generated by the interaction between a W3/25+ inducer and a MRC OX8+ precursor subpopulation. The suppressor precursor T cells were recently derived from the thymus as the suppressor T cell response was abrogated by adult thymectomy, an effect which could only be fully restored by thymic grafting or injection of adult thymocytes but not by the injection of normal spleen or lymph node cells. As adult thymectomy had less effect on the autoantibody response and HN development in the highly susceptible WF rats, the difference in disease susceptibility between the WF and PVG rats may be the result of different suppressor T cell recruitment from the adult thymus. Since adult thymectomy did not affect disease development in the DA and BN rats, the recently thymus-derived suppressor T cells did not contribute to innate disease resistance in these rat strains.
Animals↗