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SummaryPatients received 2,000 ml of dialysate intraperitoneally with five exchanges per day during continuous peritoneal dialysis (CAPD) for the treatment of terminal renal insufficiency. During a dwell time of 4 h the dialysate reached a total protein concentration up to 100 mg/dl by mass transfer of intravascular proteins. The composition is dependent on the molecular weight of the proteins. This results in an intraperitoneal hemostatic system of low concentration and different composition.We found an intraperitoneal fibrinogen cleavage and thrombin- antithrombin Ill-complex formation leading to increased levels of fibrinopeptide A (FPA: 33.3 ± 7.0 ng/ml) and thrombin-antithrombin Ill-complex (TAT: 4.7 ± 0.4 ng/ml) in plasma by mass transfer from dialysate to plasma. t-PA (tissue plasminogen activator) and PAI-1 (plasminogen activator inhibitor type 1) concentrations in plasma were within the normal range. The dialysate concentrations indicated a low local secretion. The fibrinolytic fibrin fragment D-dimer and the fibrinogen degradation product concentrations in plasma were greater than in dialysate. But the relations of the proteins between plasma and dialysate refer to a local intraperitoneal production as well.The results show that intraperitoneal coagulation predominates over fibrinolysis which is accompanied by an intravascular fibrinolysis in patients undergoing CAPD. Neoantigens produced in dialysate and diffused to plasma are comparable to changes seen in disseminated intravascular coagulation.

Women patients on permanent dialysis treatment or after transplants display on the whole an increased rate of malignomas; however, it has so far not been possible to assess the relevant incidence in a uniform manner. Hence, regular gynaecological examination should be the rule in order to detect and treat carcinoma risk changes in the genital region. Within the framework of a special gynaecological consultation for renal patients we found in 81 women patients under dialysis treatment one patient with carcinoma of the cervix and one patient with corpus carcinoma. In two cases a cystic ovarial tumour was operated on. To date the 21 patients who had undergone renal transplant surgery did not show any malignant change in the genital region. Choice of contraceptives should rule out the intrauterine device because of the increased hazard of infection under immunosuppressive treatment. Ovulation inhibitors with higher oestrogen doses represent an additional hypertensive risk. Treatment with low-dosage gestagens should produce the lowest rate of side effects.

Uraemic patients are in general infertile. Ovarian function is, however, restored after successful renal transplantation, thus making conception possible. We followed up 14 patients after renal transplantation involving 16 pregnancies. Two patients became pregnant twice, one with twins and the other following renal and pancreatic transplantation--the first recorded in the world. Caesarean section was performed in all patients due to increasing serum creatinin levels, avoid pre-eclampsia or premature rupture of membranes. Both, mother and child in all cases progressed without complications, although these pregnancies are associated with high risk for both. Therefore, a close co-operation between the mother, the nephrologist, the transplantation centre, the gynaecologist and the paediatrician is a prerequisite for a possible favourable course.