Aims: The clinical features, treatment and outcome of fungal peritonitis (FP) in continuous ambulatory peritoneal dialysis (CAPD) patients were examined. Methods: Dialysis records of all 303 end-stage renal disease (ESRD) patients initiated on CAPD treatment between January 1998 and February 2008 were reviewed retrospectively. Results: In the 303 patients dialysed between January 1998 and February 2008, a total of 137 bacterial peritonitis and 43 FP episodes were recorded. The incidence rate of FP was 0.67/100 patient months or 1/148.67 months. It accounted for 23.88% of all peritonitis episodes. Three factors appeared to predict mortality: the presence of non-Candida species, the catheter being left in situ and a serum albumin level <3 g/dl. Multivariate analysis yielded only the latter 2 as predictors of mortality. The use of intraperitoneal antibiotics in the 3 months before infection and low serum albumin have been identified as risk factors for contracting FP. Conclusion: Risk factors for contracting FP and for mortality due to FP have been identified.

Proliferative lupus nephritis deserves aggressive therapy and cyclophosphamide plays a pivotal role. Thirty nine patients with proliferative lupus nephritis (Class III-7 patients and Class IV- 32 patients) with a median follow up of 38 months were considered for this observational study. All the patients received induction therapy with intravenous methylprednisolone. Cyclophosphamide was given intravenously initially in monthly pulses for six months and later quarterly pulses until remission was achieved or until the target dose (200 mg/kg) was reached. The treatment with intravenous methylprednisolone was repeated in the event of a nephritic flare. Later the corticosteroid was reduced to a minimum effective dose and cyclophosphamide was changed to either azathioprine or mycophenolate mofetil. At the time of the last follow up, 82.05% of the patients were in remission (complete remission 51.28% and partial remission 30.77%). The median interval to achieve remission in responders was 15 months. Early diagnosis (P=0.04), a higher creatinine clearance at presentation (P=0.02), and concurrent use of an ACEI or an ARB (P=007) significantly favored attaining remission. Five patients experienced a doubling of serum creatinine and one of them became dialysis dependent. Risk of doubling of serum creatinine correlated with a low Ccr (P=0.03) at presentation, occurrence of renal flares (P=0.034) and failure to achieve remission (P=0.0001). The parameters like serum creatinine, serum C3, serum C4, activity and chronicity indices on renal biopsy, hypertension were not statistically significant. Therapy with cyclophosphamide, if initiated early, helps in inducing remission and hence can retard the progression to CKD.

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Selecting the correct method for routine analysis by 'method evaluation' is an important component of quality assurance. It is a step-wise procedure that evaluates various analytical parameters like accuracy, precision etc of the given method. Finally reference intervals are established for selected population, we evaluated an enzymatic method for serum creatinine. The results show that it is an acceptable method based on the above mentioned criteria.

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