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Fourteen episodes of peritonitis complicating chronic peritoneal dialysis were treated with intravenous injections of 1 gm of vancomycin weekly for 4 successive weeks. Peak (one hour after completion of injection) and trough (immediately before the next injection) serum and dialysate vancomycin levels were measured. Vancomycin treatment resulted in a cure in 12 episodes (85.7%). Serum vancomycin levels were always above therapeutic range, but did not rise, with subsequent injections, to toxic range. Dialysate vancomycin levels were therapeutic for more than 85% of the measurements. One patient, who failed to respond to vancomycin plus cephalosporins, was cured with intraperitoneal streptokinase plus the same antibiotics. In another patient, a relapse was cured with vancomycin plus oral rifampin. Dialysate vancomycin levels were therapeutic in the last two patients. Peritoneal catheters were not removed. No significant side effects of vancomycin treatment were observed.

We evaluated the diagnostic accuracy of ultrasonic echo-Doppler velocimetry for the noninvasive diagnosis of renal artery stenosis. Renal artery stenosis was diagnosed if one or more of the following four abnormal hemodynamic parameters were found by Doppler velocimetry: (1) peak blood velocity greater than 100 cm . sec-1 in a focal area along the length of a renal artery, (2) absence of blood velocity during diastole, (3) absence of any detectable blood velocity denoting occlusion, or (4) broad-band Doppler frequency spectra due to focal blood velocity disturbances. With these criteria, the presence or absence of renal artery stenosis was blindly evaluated in 26 patients (52 arteries) who underwent standard or digital subtraction angiography. Compared to arteriography (reduction in diameter greater than or equal to 50%), the sensitivity of Doppler method was 89%, while its specificity was 73%. This noninvasive method may be useful in selecting patients for radiographic evaluation of renal artery stenosis and in the long term follow-up of these patients. Furthermore, echo-Doppler velocimetry may have the unique capability of assessing the hemodynamic consequences of renal artery stenosis.

Five patients, one woman and four men, aged 24 to 54 years, developed abnormally high hematocrits between 4 and 22 months after renal transplantation. In four patients, red cell mass was above normal and plasma volume below normal. In one patient, both red cell mass and plasma volume were below normal. The cause of the deranged plasma volume was not evident. Decreased plasma volume may either contribute to or may, in rare instances, be the only cause of apparent erythrocytosis in renal transplant recipients.

Nine of 81 members of two families were found to have renal problems. Three patients in one family had renal-retinal dysplasia with probable recessive inheritance. Of the 6 patients in the second family, one received a kidney transplant from his brother who initially had no detectable renal abnormality but later developed renal failure. In this family, the mode of inheritance seems to be dominant. Hereditary renal-retinal dysplasia differs from medullary cystic disease and nephronophthisis in its pattern of uniformly recessive inheritance and its accompaniment by retinitis pigmentosa. Because genetic considerations have important implications in selection of donors for renal transplant, these entities should be considered distinct despite the similarities in their clinical and pathologic features.

We analyzed causes and clinical associations of hemodialysis performed during the course of CAPD in 71 patients (34 diabetic) on CAPD between 1978 and 1988. Thirty seven patients had at least one hemodialysis during CAPD. Causes (multiple for some patients) included poor compliance with CAPD (20 patients), peritoneal catheter loss from infection (16 patients), and miscellaneous other conditions (18 patients). Hemodialysis rates were similar between diabetic and non-diabetic CAPD patients. Compared to non-hemodialyzed patients, CAPD patients hemodialyzed for poor compliance had higher rates of peritonitis (one episode per 8.3 patient months vs one episode per 23.4 patient months, p less than 0.001) and catheter loss (one loss per 27.7 patient months vs one loss per 112.0 patient months, p less than 0.001), and exhibited a trend towards more deaths (annual mortality 30.9% vs 14.3%, p = 0.067). Hemodialysis performed in CAPD patients because of poor compliance is associated with higher rates of peritonitis and catheter loss, and, probably, with increased mortality.

We measured by affinity chromatography glycosylated hemoglobin levels in the blood of 43 diabetic and nondiabetic patients (139 measurements) on long-term dialysis therapy (continuous ambulatory peritoneal dialysis and hemodialysis) to determine the usefulness of this method of estimating glycemic control in diabetic persons on dialysis therapy. In nondiabetic patients, glycosylated hemoglobin levels were within the normal range (4.0% to 6.8% of total blood hemoglobin levels) for both continuous ambulatory peritoneal dialysis and hemodialysis. Glycosylated hemoglobin values correlated significantly with fasting blood glucose levels, serum urea levels, and serum total carbon dioxide content. By stepwise regression, fasting blood glucose values accounted statistically for .54 of the variability (R2) in glycosylated hemoglobin. The contribution of the other variables to this variability was minimal. In 9 diabetic patients (3 on hemodialysis), glycosylated hemoglobin levels correlated significantly with average daily blood glucose levels. Regression of the fasting blood glucose value on glycosylated hemoglobin was similar between continuous ambulatory peritoneal dialysis and hemodialysis. Measuring glycosylated hemoglobin levels by affinity chromatography is a suitable method for assessing glycemia in dialysis patients.