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Peritoneal dialysis (PD) is one of the established methods for the management of patients with end-stage renal failure. Laparoscopy has been used to assist in the insertion of new catheters as well as for the salvage of malfunctioning peritoneal dialysis catheters (PDC).The purpose of this retrospective study was to review our experience in the utilization of laparoscopy for the management of PDC.We reviewed the charts of all consecutive patients who had undergone either a ap-assisted insertion of a PDC utilizing a modified peritoneoscopic Y-TEC [Medigroup, Inc, Oswego, Ill) technique (YT) under direct laparoscopic vision or laparoscopic-assisted procedures for the salvage of a malfunctioning PD catheter.Twenty nine patients had undergone 43 procedures that included the insertion of a new PD catheter using the modified YT technique, YT with simultaneous adhesiolysis and omentectomy; YT with repair of an epigastric hernia, omentectomy, adhesiolysis and repositioning of PDC; and ravage and repositioning of the obstructed PD catheter in all patients who needed repositioning of the catheter, the PDC was fixed with an intraperitoneal suture to the lower anterior abdominal wall. Postoperatively, malfunction of the catheter was found in one patient due to reclotting of PDC caused by oozing as a result of extensive adhesiolysis. One patient needed emergent laparotomy due to small bowel perforation that was missed during a difficult laparoscopic adhesiolysis.Laparoscopic surgery may be helpfuL for the diagnosis and the management of a malfunctioning PDC. A modified YT technique is safe and may be one of the alternative methods for the placement of a PDC.

The life expectancy of dialysis patients depends, to a large extent, on blood access which provides uninterrupted and efficient treatment. Dialysis access created by a direct anastomosis between artery and vein usually allows normal dialysis for many years. Blood access by a bridge graft between artery and vein functions for a much shorter time and occludes chiefly because of endothelial hyperplasia at the graft vein anastomosis. This type of fistula is created when the veins of the patient are small. During the last few years the dialysis population is increasingly composed of adult and elderly patients suffering from diabetes mellitus, hypertension, dyslipidemias and atheromatous vascular disease so that a relatively large proportion of dialysis accesses are created using a bridge graft. Since we currently do not have the knowledge of how to arrest or delay the processes which lead to access occlusion, attempts are made to implement prophylactic strategies, find stenoses and dilate them before the access fails. Up to date, controlled trials have not succeeded in proving that this method prolongs access use. These trials did not describe the use of stents following dilatation.Between July 2002 and May 2005, 238 angiographies were performed on blood accesses including 179 angioplasties of stenoses. In sixteen patients a stent was deployed during the angioplasty.In ten patients dialysis was performed using the same access up to the end of the study period, an average of 43 months from the creation of the access. Three patients died with a functioning access and in three the access occluded during the period of followup.This study shows that the use of stents following angioplasty of dialysis access stenoses can improve the duration of use of accesses created through grafts.

Henoch-Schonlein purpura (HSP) is a systemic vasculitic disorder involving both arterioles and capillaries. Although mainly a disease of early childhood, it can occur at any age. HSP is typically recognized as a syndrome with four major components: rash, joint manifestations, abdominal symptoms and renal disease. It is usually a mild condition with a tendency to relapses and generally has a good prognosis. Occasionally, however, it takes on an aggressive course. Gastrointestinal involvement is potentially the most serious complication of HSP. It may mimic an abdominal emergency and in its severest form result in small bowel infarction and/or perforation. Renal manifestations range from asymptomatic haematuria and/or proteinuria through a nephrotic syndrome to progressive glomerulonephritis leading to end stage renal failure. Apart from the major components outlined above, HSP may affect almost every other bodily organ. Vasculitis involving the myocard, lungs (pulmonary haemorrhage), ureter (stenosing ureteritis) and nervous system have been reported. We describe a case of HSP in a 50 year old woman which was complicated by the development of necrotizing crescentic glomerulonephritis and a left hemiparesis due to cerebral vasculitis. Interestingly, this patient had first appeared at the age of 9 years with a nephrotic syndrome and had been diagnosed by renal biopsy at the age of 31 as IgA nephropathy (IgAN). On her current admission, steroid and immunosuppressive therapy resulted in an improvement of renal function and an almost complete disappearance of her neurologic deficit.

Diffuse Proliferative Glomerulonephritis (DPGN) is the most ominous form of lupus nephritis. Treatment according to the "NIH Protocol" is considered by many physicians to be the treatment of choice for this form of disease, but this is not accepted exclusively. OUR AIM: To evaluate the outcome of SLE patients with biopsy proven DPGN diagnosed and treated in our department, between the years 1976-1996, and to compare the results achieved by using the "NIH Protocol" as opposed to other forms of treatment.The archive of the Department of Pathology was screened for patients with SLE and DPGN. The specimens were re-examined to confirm the diagnosis and calculate the activity and chronicity scores. The pertinent data was extracted from the patients medical records.Twenty-six patients fulfilled the inclusion criteria, 22 females and 4 males. We followed-up on these patients for an average period of 89 +/- 74 months (range 9-255). More than 80% of the patients achieved remission, about a third experienced at least one relapse. Only one patient died during the follow-up period and 4 others developed end stage renal failure necessitating chronic renal replacement therapy. Sixteen patients were treated according to the NIH protocol, the other 10 were treated with high dose Prednisone, either alone or in combination with oral immunosuppressive drugs. At time of diagnosis there was no statistically significant difference between the two groups regarding the age and gender distribution, blood levels of creatinine and C3 and the level of proteinuria. We were unable to demonstrate any statistically significant difference between the two groups in any of the evaluated parameters, regarding neither patient and kidney survival nor the type and rate of complications.Following treatment, patient and kidney survival is good. The NIH protocol is the treatment of choice, but the use of high dose steroids for six months with or without oral immunosuppressive drugs may yield comparable results in selected cases.