Minority Economic Development: The Problem of Business Failures

Inflammatory pseudotumour is a rare condition that can affect various organs. The clinical and histologic appearance of the pseudotumour may mimic haematological, lymphoproliferative, paraneoplastic or malignant processes. A previously healthy 39-year-old man presented with nephrotic syndrome. He had a history of headaches, nausea and swollen ankles. Computed tomography of the abdomen revealed a 6-cm mass in the spleen. Following a renal biopsy, a diagnosis of membranoproliferative glomerulonephritis (MPGN) type I was made. Splenectomy was performed and the examination revealed a mixed population of lymphocytes with predominantly T-cells, B-cells and lymphoplasmacytoid cells. Immunostaining confirmed that the small cells were mostly T-cells positive for all T-cell markers including CD2, CD3, CD4, CD5, CD7 and CD8. A diagnosis of inflammatory pseudotumour was established. The removal of the spleen was followed by remission of glomerulonephritis, but it was complicated by a subphrenic abscess and pneumonia. This association between an inflammatory pseudotumour of the spleen and MPGN has not been previously described. Abnormal immune response due to the inflammation leading to secondary glomerulonephritis might be the main pathogenic mechanism

Polycystic kidney disease in patients on the renal transplant waiting list: trends in hematocrit and survival

BACKGROUND: The patient characteristics and mortality associated with autosomal dominant polycystic kidney disease (PKD) have not been characterized for a national sample of end stage renal disease (ESRD) patients on the renal transplant waiting list. METHODS: 40,493 patients in the United States Renal Data System who were initiated on ESRD therapy between 1 April 1995 and 29 June 1999 and later enrolled on the renal transplant waiting list were analyzed in an historical cohort study of the relationship between hematocrit at the time of presentation to ESRD and survival (using Cox Regression) in patients with PKD as a cause of ESRD. RESULTS: Hematocrit levels at presentation to ESRD increased significantly over more recent years of the study. Hematocrit rose in parallel in patients with and without PKD, but patients with PKD had consistently higher hemoglobin. PKD was independently associated with higher hematocrit in multiple linear regression analysis (p < 0.0001). In logistic regression, higher hematocrit was independently associated with PKD. In Cox Regression analysis, PKD was associated with statistically significant improved survival both in comparison with diabetic (hazard ratio, 0.64, 95% CI 0.53–0.77, p < 0.001) and non-diabetic (HR 0.68, 95% CI 0.56–0.82, p = 0.001) ESRD patients, adjusted for all other factors. CONCLUSIONS: Hematocrit at presentation to ESRD was significantly higher in patients with PKD compared with patients with other causes of ESRD. The survival advantage of PKD in ESRD persisted even adjusted for differences in hematocrit and in comparison with patients on the renal transplant waiting list

Biocompatibility and tolerability of a purely bicarbonate-buffered peritoneal dialysis solution.

Contains fulltext : 80497.pdf (publisher's version ) (Open Access)BACKGROUND: Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo. METHODS: This study was an open label, prospective, crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution (bicPDF) by measuring biocompatibility parameters such as cancer antigen 125 (CA125) in peritoneal effluent. 55 patients were enrolled in the study. After a 2-week run-in phase, 53 patients could be randomized into 2 groups, starting with either standard lactate-buffered peritoneal dialysis fluid (SPDF) for 12 weeks (phase 1) and then switching to bicPDF for 12 weeks (phase 2), or vice versa. Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125, hyaluronic acid, vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), interferon gamma (IFNgamma), and transforming growth factor-beta(1) (TGF-beta1). Total ultrafiltration and residual renal function were also assessed. At the end of the study, pain during fluid exchange and dwell was evaluated using special questionnaires. RESULTS: 34 patients completed the study; 27 of them provided data for analysis of the biocompatibility parameters. CA125 levels in overnight effluent were significantly higher with bicPDF (61.9 +/- 33.2 U/L) than with SPDF (18.6 +/- 18.2 U/L, p < 0.001). Hyaluronic acid levels were significantly lower after the use of bicPDF (185.0 +/- 119.6 ng/mL) than after SPDF (257.4 +/- 174.0 ng/mL, p = 0.013). Both TNF-alpha and TGF-beta1 showed higher levels with the use of bicPDF than with SPDF. No differences were observed for IL-6, VEGF, or IFNgamma levels. We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss. Pain scores could be analyzed in 23 patients: there was no difference between the solutions. CONCLUSIONS: The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured, suggesting an improvement in peritoneal membrane integrity. Additionally, it seems to have a positive effect on residual renal function

Renal and extrarenal signs of autosomal dominant polycystic kidney disease

The aim of the study was to evaluate the clinical impact of renal and extrarenal manifestations of ADPKD (Autosomal Dominant Polycystic Kidney Disease). For this purpose, prospective and retrospective analyses of patients with ADPKD in different populations were performed.Records of 26 patients CAPD (Continous Ambulatory Peritoneal Dialysis) treatment in 1988-1996 were reviewed and dialysis efficacy and complications were evalated in comparison with 26 contemporary controls. The incidence of peritonitis and herniations or the properties of the peritoneal membranes were not different.The post-transplant course was recorded in 114 kidney transplant patients with ADPKD and 114 control patients matched for sex, age and donor type. Specific features of the ADPKD patients were enlarged kidneys, however relevant only before transplantation, requirement of more phlebotomies due to erythrocytosis, and diverticulitis in four patients versus none of the controls, with perforation occurring in two.Thirty patients with ADPKD who had undergone coronary angiography on clinical indication were identified. Control patients with other renal diagnoses investigated by coronary angio-graphy, were matched for age, sex and relation to transplantation. The angiograms were reviewed. The prevalence of coronary aneurysms and minor dilatations was increased and three ADPKD patients but no controls died of aortic aneurysms. The the receiving vein of arterio-venous fistulas created for hemodialysis in 19 ADPKD patients and matched control patients were measured by ultrasound. The maximum diameter of the fistulas in ADPKD patients was significantly wider.An echocardiographic investigation of 21 renal transplant patients with ADPKD was performed and compared with that of a control group of 21 transplant patients with other diagnoses, matched for sex and time after transplantation. Valvular anomalies were infrequent. Aneurysmal formation in the aorta or signs of dilated cardiomyopathy were not observed. Conclusion: The studies suggest that patients with ADPKD have a limited risk of specific complications to CAPD or transplantation related to original disease, but the wider veins of the arterio-venous fistulas and the increased number of dilatations of coronary arteries emphasize the systemic nature of the disease, particularly with respect to vessel involvement

Sixteen Gauge biopsy needles are better and safer than 18 Gauge in native and transplant kidney biopsies

Background Kidney biopsies are essential for optimal diagnosis and treatment. Purpose To examine if quality and safety aspects differ between types and sizes of biopsy needles in native and transplant kidneys. Material and Methods A total of 1299 consecutive biopsies (1039 native and 260 transplant kidneys) were included. Diagnostic quality, needle size and type, clinical data and complications were registered. Eight-three percent of the data were prospective. Results In native kidney biopsies, 16 Gauge (G) needles compared to 18 G showed more glomeruli per pass (11 vs. 8, P &lt;  0.001) with less complications. Sub-analysis in native kidney biopsies revealed that 18 G 19-mm side-notch needles resulted in more major (11.3% vs. 3%; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.4–12.3) and overall complications (12.4% vs. 4.8%; OR, 2.8; 95% CI, 1.1–7.1) in women than in men. If the physician had performed less compared to more than four native kidney biopsies per year, minor (3.5% vs. 1.4%; OR, 2.6; 95% CI, 1.1–6.2) and overall complications (11.5% vs. 7.4%; OR, 1.6; 95% CI, 1.1–2.5) were more common. In transplant kidney biopsies, 16 G needles compared to 18 G resulted in more glomeruli per pass (12 vs. 8, P &lt;  0.001). No differences existed in frequency of biopsy complications. The localization of performing biopsies was not a risk factor to develop complications. Conclusion Kidney biopsies taken by 16 G needles result in better histological quality and lower frequency of complications compared to 18 G. For native kidney biopsies the performer of the biopsy should do at least four biopsies per year. </jats:sec

Renal and extrarenal signs of autosomal dominant polycystic kidney disease

The aim of the study was to evaluate the clinical impact of renal and extrarenal manifestations of ADPKD (Autosomal Dominant Polycystic Kidney Disease). For this purpose, prospective and retrospective analyses of patients with ADPKD in different populations were performed.Records of 26 patients CAPD (Continous Ambulatory Peritoneal Dialysis) treatment in 1988-1996 were reviewed and dialysis efficacy and complications were evalated in comparison with 26 contemporary controls. The incidence of peritonitis and herniations or the properties of the peritoneal membranes were not different.The post-transplant course was recorded in 114 kidney transplant patients with ADPKD and 114 control patients matched for sex, age and donor type. Specific features of the ADPKD patients were enlarged kidneys, however relevant only before transplantation, requirement of more phlebotomies due to erythrocytosis, and diverticulitis in four patients versus none of the controls, with perforation occurring in two.Thirty patients with ADPKD who had undergone coronary angiography on clinical indication were identified. Control patients with other renal diagnoses investigated by coronary angio-graphy, were matched for age, sex and relation to transplantation. The angiograms were reviewed. The prevalence of coronary aneurysms and minor dilatations was increased and three ADPKD patients but no controls died of aortic aneurysms. The the receiving vein of arterio-venous fistulas created for hemodialysis in 19 ADPKD patients and matched control patients were measured by ultrasound. The maximum diameter of the fistulas in ADPKD patients was significantly wider.An echocardiographic investigation of 21 renal transplant patients with ADPKD was performed and compared with that of a control group of 21 transplant patients with other diagnoses, matched for sex and time after transplantation. Valvular anomalies were infrequent. Aneurysmal formation in the aorta or signs of dilated cardiomyopathy were not observed. Conclusion: The studies suggest that patients with ADPKD have a limited risk of specific complications to CAPD or transplantation related to original disease, but the wider veins of the arterio-venous fistulas and the increased number of dilatations of coronary arteries emphasize the systemic nature of the disease, particularly with respect to vessel involvement

High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis

BACKGROUND: A native AV-fistula (AVF) for access in hemodialysis (HD) is preferable. Stenosis, a major hurdle, is associated with older age and diabetes mellitus. PURPOSE: This case-control study aimed to clarify if any medical and/or laboratory factors, that can be altered, could be associated to AVF stenosis. METHODS: 33 patients with a patent AVF without need of intervention during a two year period (Controls) were matched by diagnosis and age with 33 patients (Cases), that had at least one radiological invasive examination/intervention due to suspected AVF malfunction (case-control mode 2:1). RESULTS: Cases had higher weekly doses of Erythropoietin-Stimulating Agent (ESA) than Controls both before intervention (mean 8312 +/- 7119 U/w versus 4348 +/- 3790, p = 0.005) and after the intervention (7656 +/- 6795, versus 4477 +/- 3895, p = 0.018). Before intervention serum phosphate was higher in Cases while there was no significant difference in blood hemoglobin, weekly standard Kt/V, parathyroid hormone, calcium, albumin, C-reactive protein, smoking habits, BMI or other medication. CONCLUSION: Higher doses of ESA were administered in patients with AVF stenosis. Since ESA may cause local hypertrophic effects on the vascular endothelium, we should prescribe lower doses of ESA in patients at risk. Further studies should clarify such connection

Membranoproliferative Glomerulonephritis and Inflammatory Pseudotumour of the Spleen

Inflammatory pseudotumour is a rare condition that can affect various organs. The clinical and histologic appearance of the pseudotumour may mimic haematological, lymphoproliferative, paraneoplastic or malignant processes. A previously healthy 39-year-old man presented with nephrotic syndrome. He had a history of headaches, nausea and swollen ankles. Computed tomography of the abdomen revealed a 6-cm mass in the spleen. Following a renal biopsy, a diagnosis of membranoproliferative glomerulonephritis (MPGN) type I was made. Splenectomy was performed and the examination revealed a mixed population of lymphocytes with predominantly T-cells, B-cells and lymphoplasmacytoid cells. Immunostaining confirmed that the small cells were mostly T-cells positive for all T-cell markers including CD2, CD3, CD4, CD5, CD7 and CD8. A diagnosis of inflammatory pseudotumour was established. The removal of the spleen was followed by remission of glomerulonephritis, but it was complicated by a subphrenic abscess and pneumonia. This association between an inflammatory pseudotumour of the spleen and MPGN has not been previously described. Abnormal immune response due to the inflammation leading to secondary glomerulonephritis might be the main pathogenic mechanism