No abstract

Two cases of purulent staphylococcal pericarditis successfully treated in the course of chronic haemodialysis (HD) are reported. Pericardiac fenestration was carried out in both. In the second case the first pericardiac fenestration had yielded a sterile fluid and bacterial pericarditis developed only later. The significance of local therapy, side by side with surgery and chemotherapy, is stressed.

Atrial natriuretic peptide (ANP), a recently discovered cardiac hormone, is an important regulator of body fluid homeostasis. Twenty patients with established chronic renal failure and on maintenance haemodialysis were studied before and after dialysis with capillary dialysers. ANP was determined by RIA after extraction. Mean (+/- SD) pre-dialysis ANP concentration was 146 +/- 51 pg/ml and decreased significantly during dialysis to 68 +/- 38 pg/ml (p less than 0.001). Per cent and absolute changes in plasma ANP level correlated significantly with concomitant changes in body weight (r = 0.764; p less than 0.001 and r = 0.558; p less than 0.01, resp.) but not with changes in serum creatinine, blood pressure or serum electrolytes. The obtained results indicate that ANP levels in patients with chronic renal failure are elevated mainly due to fluid overload, and the rapid fall in ANP concentration observed during haemodialysis is caused by the removal of excess fluid from the body.

In long-term haemodialysis patients suffering from secondary hyperparathyroidism Se iPTH could be suppressed by an intravenous calcitriol therapy. As the Se iPTH level became reduced, lower doses of Rh-EPO were already sufficient for the maintenance of the target haematocrit, while in two patients not requiring Rh-EPO treatment an improvement of their moderate anaemia could be observed. These data corroborate the view that calcitriol is an effective drug in secondary hyperparathyroidism. The results suggest that in the improvement of renal anaemia of dialysed patients the reduction of the Se-PTH level also plays a role.