The drug therapies for hypercalcemia of malignancy have been known to be associated with either limited efficacy or cumulative toxicity in patients with advanced renal failure. To establish the guidelines for the use of dialysis and to determine its optimal prescription for hypercalcemia, calcium-free hemodialysis was performed in 6 hypercalcemic patients with renal failure not responding enough to forced saline diuresis. Calcium-free dialysate contained sodium 135, potassium 2.5, chloride 108, magnesium 0.75, bicarbonate 30 mmol/l. Mean hemodialysis time was 160 ± 27 min and mean Kt/V urea was 0.75 ± 0.2. Plasma calcium concentrations fell from a mean value of 2.92 ± 0.21 mmol/l (range 2.55-3.25) to 2.58 ± 0.16 mmol/l at 1 h of hemodialysis and to 2.16 ± 0.33 mmol/l (range 1.63-2.53) following 2-3 h of hemodialysis. The ionized calcium (n = 4) decreased from 1.44 ± 0.14 mmol/l to 0.99 ± 0.2 mmol/l. No patient showed any hypocalcemic symptoms and signs during hemodialysis. The rate of decrease in plasma calcium did not appear to produce adverse effects in any of the patients. There was a significant positive correlation between the decrease in plasma calcium concentration and the Kt/ V urea (y = 1.4x – 0.29, r = 0.92, p < 0.01). We conclude that calcium-free hemodialysis is indicated when the presence of severe renal failure prevents the administration of large volumes of intravenous fluids to hypercalcemic patients. The amount of dialysis (Kt/V urea) can be used to predict the decrease in plasma calcium concentration during calcium-free hemodialysis.

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Plasma angiotensin-converting enzyme activity was measured by spectrophotometer in normal subjects and in patients with end stage renal failure, serially during a routine hemodialysis. Patients on maintenance hemodialysis tended to be associated with elevated plasma angiotensin-converting enzyme activity versus normal subjects. Plasma angiotensin-converting enzyme activity was significantly elevated in patients with chronic renal failure after 5 hours of hemodialysis(p<.001). Plasma angiotensin-converting enzyme activity corrected for hemoconcentration was also significantly increased(p<.05). There was a significant correlation between the increase in plasma angiotensin-converting enzyme activity after 5 hours of hemodialysis and the decrease in white blood cell count at one hour of hemodialysis (r = 0.51, p<.05). It is suggested that plasma angiotensin-converting enzyme analysis may prove to be a method for assessing transient pulmonary dysfunction during hemodialysis.

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Using urinary microalbumin radioimmunoassay, we evaluated the clinical utility of microalbumin excretion in nephrotic syndrome with complete remission, isolated microscopic hematuria and kidney donors in reanl transplantation. The highest value in normal controls was 10.86 μg/min, and the upper normal level was set to 15 μg/min.The range of microalbuminuria in patients with nephrotic syndrome with complete remission was 1.67 μg/min to 32.5 μg/min. There was no significant correlation between the recurrence rate and microlbuminuria level in nephrotic syndrome with complete remission. The range of microalbuminuria levels in isolated microscopic hematuric patients was between 2.37μg/min and 103.2 μg/min.There was no singificant correlation between the amount of the red blood cells in urine and the level of microalbuminuria in the isolated microscopic hematuric patients. Most renal transplantation donors showed a normal range of microalbuminuria after nephrectomy. The aim of this study was to evaluate the clinical utility of urinary microalbuminuria in diseases other than diabetes. We concluded that further extensive and specific study will be required to determine the clinical utility of microalbuminuria.