Contemporary Nephrology: Volume 4: 004

Books by Shaul G. Massry
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Animal experiments for inducing tolerance may not have been successful initially but in that process, The impact of unroofing. Unroofi ng is a controversial procedure to avoid catheter removal in the treatment of the chronic exit site and tunnel infection, but is now rarely recommended. Here we aimed to evaluate the effects of the unroofi ng procedure on peritoneal catheter survival. Management of type 2 Diabetes in patients with Chronic Kidney Disease.

Diabetes has been shown to have signifi cantly stronger association with CKD in patients with younger age 2. Case report and Current Status.

Nephrologists Take Fistulas Into Their Own Hands

Encapsulating peritoneal sclerosis EPS , is a rare but devastating complication of long-term peritoneal dialysis PD with a high mortality rate. The incidence is between 0. EPS is defi ned as a clinical syndrome with major signs of gastrointestinal obstruction, infl ammatory parameters, radiological and macroscopic changes. Induction therapy has established itself as an integral component of modern-day renal transplantation.

Carefully selected induction therapy helps not only to avoid early rejection of grafts but also allows grafts with delayed function to recover prior to introduction of potentially nephrotoxic immunosuppressants. Phenazopyridine abuse presenting with acute kidney injury, hemolytic anaemia and jaundice. Phenazopyridine, an azo dye, is commonly used to relieve dysuria caused by bladder irritation or infection.

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But the activity of water channels is dependent and limited by the crystalloid osmotic pressure [ 16 ] which our methodology did not allow to be calculated, being a limitation for characterization of the late stage UFF. In spite of that we were able to document free water transport compromise by the indirect sign of decreased sodium sieving.

More relevant to our study was to highlight that baseline UFF is prevalent but often transitory and not predicted by baseline clinical variables according to previous investigations [ 7 — 12 ]. Many aspects of early stage transport changes and mechanisms indeed remain to be understood. While lymphatic absorption cannot be excluded as a cause of early UFF, the evolution of patients recovering ultrafiltration capacity does not support such etiology.

We can speculate that although no significant changes were documented in small solute transport at baseline between the groups with and without UFF, membrane structural changes induced by uremia per se namely interstitium fibrosis might justify the marginal compromise of sodium sieving. This indeed gives lumped information and is not only dependent on an increase of diffusive mass transport coefficients for small solutes, but also on a decrease of the glucose osmotic conductance number and function of aquaporins, number and diameter of small pores and on reduction of ultrafiltration coefficient of the peritoneal membrane role for the interstitium changes.

Therefore, in some of our patients a transitory fast transport status may explain the inherent UFF. In other patients, the causes of such baseline UFF are not clear, pointing to the complexity of peritoneal membrane time-dependent functional changes.

The risk phase with clinical impact may be documented by the late increasing side of the U-shaped curve, with decreasing mesothelial cell mass as a marker of structural changes that go along with UFF and sodium sieving compromise. Again we highlight the importance of routine membrane monitorization also including an accessible and affordable structural marker—CA effluent appearance rate [ 19 ].

However, our global population presented stability in the transport rates for small molecules and sodium sieving over time. On the other hand, uremia and baseline GFR as its surrogate, is indeed an important bystander not usually taken into account in peritoneal membrane changes investigation.

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Contemporary Nephrology: Volume 4: eBook: Saulo. Klahr Volume 4 of Contemporary Nephrology summarizes major advances in 16 different areas of. with 9 ratings. Shaul G. Massry's most popular book is Nutritional Management of Renal Disease. Contemporary Nephrology: Volume 4: by. Saulo Klahr.

We identified it here as a clinical variable that independently impacts on UFF-free survival. This clue deserves further investigation but suggests that uremia may be crucial to explain acquired peritoneal membrane changes, and although it has not been associated with baseline transport characteristics may modulate membrane time-dependent profile [ 4 — 6 ].

As a limitation of our study, we did not control for a panel of pharmacological agents shown experimentally to modulate membrane structure, namely, renin angiotensine system inhibitors and erythropoiesis stimulating agents [ 22 , 23 ]. However, since the use of these agents is massive in our PD patients, it is not presumed to change our results. In spite of some controversy [ 18 ], our study also showed that the influence of peritonitis on the development of UFF seems to be limited.

Only clusters of peritonitis or peritonitis episodes that occur later in PD have been described as causing a decrease in UF [ 25 ]. Considering the link between comorbidity and peritoneal transport, data is controversial. Some papers document that systemic inflammation associated with comorbid diseases and elevated interleukin- IL- 6 level may induce vasodilation and neoangiogenesis in peritoneal membrane [ 26 ]. We did not find any association between morbidity and higher transport rates, like others [ 27 ], nor comorbidity score was predictive of UFF.

As a structural marker, effluent cancer antigen can be used reflecting mesothelial cell mass and cell turnover in stable, noninfectious PD patients.

International Journal of Nephrology

Its decrease with the duration of PD, described previously [ 28 ], is consistent with the reported cell loss observed in peritoneal biopsies. Such profile of effluent CA appearance rate is therefore more likely a sign of damage to the peritoneum than a causative factor of UF by itself. In conclusion, this paper documents early-stage peritoneal membrane changes with transitory cases of inherent ultrafiltration capacity failure dissociated from small-solute transport, whose mechanisms remain unclear.

By highlighting the importance of previous cumulative RRT time and baseline RRF concerning peritoneal membrane function status these results support a PD-first strategy in the integrated renal replacement treatment plan. MJ Carvalho, and nurse Olivia Santos for patient recruitment and management.

International Journal of Nephrology.

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Indexed in Web of Science. Subscribe to Table of Contents Alerts. Table of Contents Alerts. Introduction Peritoneal membrane ultrafiltration failure UFF is a relevant long-term complication menacing peritoneal dialysis PD [ 1 ]. Time Course of Peritoneal Membrane Function By repeated measurements mixed model analysis, it was shown that small solute, UF, and sodium-sieving parameters remained essentially stable during the followup. Multivariate Cox proportional hazard analysis of variables significantly associated with UFF-free survival.

View at Google Scholar K. Di Paola et al.