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High-flux hemodialysis is the method of choice for the treatment of many life threatening intoxications. Reports on intoxication with pentoxifylline are rare, and although pharmacokinetic properties of the drug suggest a potential role for hemodialysis, there are no published reports on extracorporeal treatment attempts. We report the first case of successful treatment of potentially life-threatening pentoxifylline intoxication by high-flux hemodialysis. Based on this single case, dialysis should be considered, especially in anuric patients with pentoxifylline intoxication.

While newly developed potent immunosuppressive agents have dramatically reduced the incidence of rejection of transplanted organs, they have increased the patients' susceptibility to opportunistic infections and cancer. Here we report a rare skin infection caused by atypical mycobacterium marinum in a 50-year-old female renal transplant recipient. The patient presented with localized skin lesion on the dorsum of her hand, which was misdiagnosed as gout. Only after the lesions spread in a sporotrichoid pattern, a cutaneous infection with atypical mycobacteria was suspected. The diagnosis was based on histopathological analysis as well as mycobacterial culture, both showing infection with atypical mycobacterium. Three months of antimycobacterial treatment led to a marked regression of the lesions. Sporotrichoid lesions in renal transplant patients are rare and a diagnostic challenge for the physician. A thorough history and a low threshold for skin biopsies could prevent painful and unnecessary surgical interventions.

Foreign body aspiration can be a life-threatening emergency requiring immediate intervention. However, unlike in children, clinical presentation of foreign bodies in adults often varies with regard to symptoms and signs and occurs without asphyxia. We here describe the case of a 65-year-old man on maintenance hemodialysis who developed dyspnea and left chest aspiration pneumonia after swallowing one tablet of the phosphate binder sevelamer. This case illustrates that elderly patients with swallowing complaints should be taken serious when they complain about their subsequent frustration of ingestion of their pills.

Background: Increased blood levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) predict cardiovascular mortality in patients with end-stage renal disease. Despite its low molecular weight, available information on the impact of hemodialysis (HD) on ADMA plasma levels is controversial., Methods: We assessed plasma concentrations, dialyzer clearance and total amount of ADMA removed in 30 patients with end-stage renal disease during regular HD. In addition, plasma ADMA levels were assessed in 10 patients with acute renal failure treated with extended HD., Results: Regular HD decreased plasma creatinine (from 774 +/- 42 to 312 +/- 17 micromol/l) and urea (from 24.5 +/- 1.5 to 8.4 +/- 0.5 mmol/l) concentrations significantly (both p < 0.001), whereas plasma ADMA remained unchanged (4.35 +/- 0.19 vs. 4.76 +/- 0.24 micromol/l). ADMA clearance was 92 +/- 6 ml/min, and the total amount removed in the spent dialysate was 37 +/- 4 micromol. The clearances of creatinine (161 +/- 3 ml/min) and of urea (173 +/- 3 ml/min) were significantly higher. Furthermore, even during extended HD, plasma ADMA concentrations did not decrease significantly (1.73 +/- 0.22 vs. 1.63 +/- 0.18 micromol/l)., Conclusion: In conclusion, dialysance of ADMA is markedly lower than expected from its molecular weight because of significant protein binding of the substance. Since markedly increased ADMA blood concentrations have been linked to cardiovascular complications due to atherosclerosis in patients with ESRD, new strategies should be evaluated to remove this putative uremic toxin.

Carbamazepine intoxication is associated with seizures, coma, arrhythmias and death. In acute intoxication, charcoal hemoperfusion is employed for removal of the drug. This can be associated with thrombocytopenia, coagulopathy, hypothermia and hypocalcemia. Alternatively, we used high-efficiency hemodialysis with a batch dialysis system (Genius), lowering not only serum levels of carbamazepine but removing a considerable amount of the drug as measured in the dialysate. This treatment regimen was compared to treatment by hemoperfusion. A 3.5-hour high-flux hemodialysis was as effective as a 2-hour hemoperfusion. We conclude that high-efficiency hemodialysis is a safe and effective alternative for treating life-threatening carbamazepine intoxication.