SUMMARY Haemodynamic studies were performed at rest and during exercise in five chronic haemodialysis patients at two different states of hydration, called "normal hydration" and "overhydration" (mean change in body weight 2.9 kg).Apart from an increase in mean aortic pressure and cardiac index there were no signs of cardiac dysfunction at rest at normal hydration. On exercise the mean pulmonary artery and wedge pressure increased significantly while cardiac output doubled.Overhydration caused considerable increases in right and left sided heart pressures at rest, without any increase in cardiac index. These changes became more pronounced during exercise.Anaemia and arteriovenous shunting make dialysis patients very sensitive to volume load. Extreme anaemia should be avoided, and keeping dialysis patients in a state of low volume load should be given high priority.The cardiovascular system of patients on chronic haemodialysis is subject to various stresses. These include anaemia, episodic hypotension, rapid change in electrolyte concentration and blood osmolality, and arteriovenous shunting. Frequently hypertension, pericardial effusion, and secondary hyperparathyroidism add to these stresses.12 The possibility of specific cardiotoxic substances in uraemia is unresolved.34Volume overload resulting from overhydration is perhaps the most important factor which influences the cardiovascular system of these patients. Several reports have dealt with the haemodynamic effects of volume load in dialysis patientss-8 but only the effects of rapid loss during dialysis have been studied.9 12 We have recorded the haemodynamic status of chronic dialysis patients at two different states of hydration: "normal hydration" and "overhydration" when the patients had been at these levels of hydration for long enough to obtain a relatively stable state. Patients and methodsThe five patients studied had advanced uraemia caused by chronic glomerulonephritis, hereditary nephritis, or medullary cystic kidneys. The mean age was 35-2 years (SD 7-5) and the mean time on haemodialysis was 12-0 months (SD 12-5). None of Accepted for publication 11 November 1982 the patients had any evidence of valvular or coronary heart disease. Apart from slight signs of left ventricular hypertrophy in two patients, their electrocardiograms were normal. Pericardial effusions were not present on echocardiography in the state of normal hydration. At overhydration, a moderate posterior pericardial effusion was present in three patients. Apart from moderate and occasional acidosis, hyperkalaemia, and hyperphosphataemia, there were no derangements in electrolyte or acid/base balance.Dialysis was performed on an out-patient basis. Forearm arteriovenous fistulae were used in all patients. Ultrafiltration was controlled volumetrically with dialysis fluid in single pass. Dialysis was given for nine to 10 hours each week in three treatments. Blood urea will be high on this regimen but control of fluid and electrolyte balance is good provided that potassium binding r...

A case is described in which the ingestion of 20 g quinidine produced lethargy, respiratory distress, hypotension, anuria, loss of P waves in ECG and broadening of QRS complex. The highest serum quinidine concentration was 13.5 mg/l. Vasopressor drugs were not effective in restoring BP, and hemodialysis with low concentration of potassium in dialysis fluid was done with impressive effect on the clinical state.

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Fluorescent microscopy examination of up to 4 consecutive renal biopsies has been performed during combined therapy with azathioprine and prednisone in each of 7 patients with SLE and glomerulonephritis. The changes in the immunopathological picture after treatment showed good correlation to the changes in renal function. In 2 cases a progression of immunofluorescent changes corresponded well to a progression of renal insufficiency. The pattern of immunofluorescence microscopy and renal function was unchanged in 2 other cases. In 2 cases an improvement in the immunopathological findings corresponded with an improvement in renal function. One patient died shortly after the commencement of the treatment. Progression was seen particularly in the cases in whom the initial immunofluorescence pattern was very lumpy. In contrast, the immunosuppressive therapy had the best effect in the cases with focal or diffuse granular immunofluorescence patterns.

Abstract. Thirty‐one patients with focal glomerular changes in the renal biopsy are reported. Focal glomerular lesions have been seen in the following diseases: benign recurrent hematuria (19 patients), systemic lupus erythematosus (7 patients), nephrotic syndrome (2 patients), Henoch‐Schönlein's purpura (1 patient), sarcoidosis (1 patient), systemic disease with myocarditis (1 patient). Focal glomerulonephritis is a pathological diagnosis and should be avoided in clinical classification. To retain this term in the histologic classification of renal diseases is in our opinion debatable, due to the fact that the term might convey the impression that focal glomerulonephritis is a specific disease entity. To discuss common etiological factors for this group of diseases seems irrelevant. The task for the pathologist is to demonstrate differential findings in the biopsies that might be of value for the clinical differentiation of the diseases that can show focal glomerular changes on light microscopy of the renal biopsy.