Gene/Protein Disease Symptom Drug Enzyme Compound
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The prevalence of HIV positive patients (HIV pts) with ESRD is likely to increase and many will be going on CAPD. There are, however, factors which cause one to be concerned about a possible increased risk of peritonitis in these patients. These include not only their impaired immune and nutritional status, but often their mental status. We examined the incidence and type of peritonitis among the 184 patients who have been in our program since December 1983 for a total of 4,017 patient months (pt mo). During this time we treated 9 known HIV pts (4 drug users and 5 homosexuals) for a total of 114 pt mos. We also looked at albumin, cholesterol, and creatinine as possible risk markers. We found a greater than two fold incidence of peritonitis in the HIV positive patients and that low albumin was a significant risk factor in the HIV negative patients, but not in the HIV positive patients.
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PMID:Peritonitis and the patient with human immunodeficiency virus (HIV). 136 99

Twenty Saudi children (mean age: 7.7 years) with chronic renal failure who had received several blood transfusions were screened for antibodies to hepatitis C virus (anti-HCV), antibodies to the human immunodeficiency virus (anti-HIV) and antibodies to the various markers of hepatitis B virus (HBV). Prevalence of anti-HCV antibodies was significantly higher in these patients (45%) than in controls (1%) (p less than 0.001). In contrast, the exposure rate to HBV was similar in both groups (15.0% in patients vs 16.8% in controls). These results underscored the high risk of acquiring HCV infection in patients on haemodialysis irrespective of age. Currently, practices such as screening blood for HBsAg and other preventive measures seem to be effective in controlling HBV but not HCV infection in patients on haemodialysis. Perhaps, as with HBV, a stringent policy regarding HCV should be implemented if HCV is to be controlled. None of our patients or controls was anti-HIV positive.
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PMID:Seropositivity to hepatitis C virus (HCV) in Saudi children with chronic renal failure maintained on haemodialysis. 138 99

Investigation of repetitive thrombotic episodes in an HIV-positive patient on maintenance hemodialysis revealed extraordinarily high levels of total (free plus protein bound) protein S antigen but severe reductions in free (interactive) protein S antigen. Patients with the nephrotic syndrome or chronic renal failure have shown elevations of total protein S antigen, associated with increased levels of the specific C4b-binding protein, yet have had normal free protein S antigen levels. Based on the fall in total and free protein S levels during hemodialysis treatments, the presence of normal levels of C4b-binding protein, and the coexistence of a polyclonal gammopathy, the authors infer the presence of a unique protein that binds protein S in this patient and that is not apparent in normal plasma. The anomalous association of protein S with this binding protein resulted in levels of free protein S antigen in the range of those reported in hereditary deficiencies of the anticoagulant.
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PMID:Case report: a novel form of free protein S deficiency in an HIV-positive patient on hemodialysis. 153 66

It is projected that the proportion of black Americans, American Indians, Asian Americans, and Hispanic Americans entering the ESRD program will continue to increase. Despite the increase in the average age of the ESRD population, the minorities entering the ESRD program are much younger. The major risk factors of ESRD--hypertension, diabetes, and glomerulonephritis--are affecting these minorities at a higher rate and in varying combinations. High prevalence and severity of hypertension followed by diabetes mellitus are the major risk factors in blacks, especially black women. Heroin and HIV nephropathies, tied to the epidemic of illicit drug abuse, have a major impact on young black men. The high prevalence of diabetes and the epidemic of glomerulonephritis in certain tribes are the major risk factors in American Indians. Hypertension and diabetes are the risk factors for the rapidly increasing Asian American population, especially for the elderly segment of this population. Diabetes predominates as the risk factor for the rapidly growing Hispanic American population, a group that needs to be identified separately within the ESRD program. Diabetes and hypertension are treatable, and adequate control can prevent progression of renal failure. However, with minority groups, it is difficult to fully implement the measures necessary to achieve this control. Outreach programs are necessary not only to provide medical treatment but to include instruction in socioeconomic and educational strategies. Programs that will seek out these patients and treat them should also educate them about their diet, about the detrimental effects of alcohol and smoking, and about the danger of substance abuse. Ultimately, these programs may be much cheaper than supporting a rapidly increasing ESRD program.
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PMID:End stage renal disease in minorities. 192 May 1

There is controversy on whether or not patients with End Stage Renal Disease (ESRD) on chronic hemodialysis (HD) should be routinely tested for the presence of HIV-antibody (HIV-Ab) in their blood. Several reports have appeared in the literature reporting incidence from 0 to 11%. A total of 227 patients receiving chronic HD; at the University and San Juan City Hospital, from January to December 1987 were screened for the presence of HIV-Ab by the ELISA method. Those reported as positive were confirmed by the Western Blot method. HIV-Ab presence was reported and confirmed in 9 patients (4%). Five of these patients (2%) were IV drug abusers, 2 (0.9%) homosexual, 1 (0.4%) had history of sexual promiscuity and 1 (0.4%) had been exposed to multiple blood transfusion (MBT) prior to HIV testing of blood. Our prevalence was 7%. However when risk factors other than MBT were excluded the prevalence was 0.4%. The incidence and prevalence of HIV positive cases in our hemodialysis population is comparable to that previously reported.
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PMID:Incidence and prevalence of HIV-positive patients on chronic hemodialysis at the University and San Juan City Hospital. 203 77

Antibodies to human immune deficiency (HIV) virus were studied in 2000 individuals including cases of non-Hodgkin's lymphoma, systemic lupus erythematosus (SLE), leprosy, chronic renal failure on haemodialysis and patients attending STD clinics. A group of blood donors was also screened, ELISA kits provided by Wellcome Diagnostics were used. Results indicate that the ELISA values were far above the cut off figure in all except in a couple where the husband who had stayed in Uganda for several years, and had features of full blown AIDS died 4 months after the diagnosis. The spouse contacted AIDS within a relatively short incubation period and died within 6 months of diagnosis. The North Indian population thus appears to be free of this virus so far. This observation will be an important lead mark in the future epidemiology of HIV infection in India.
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PMID:HIV-I antibodies in health and disease. 209

One hundred and twenty eight British and Irish nephrologists were questioned about their policy for HIV testing of patients with end stage renal failure being considered for renal replacement therapy. A total of 101 (79%) replied. In the case of candidates for dialysis roughly one third of respondents tested only people they considered at risk of infection with HIV and nearly one fifth considered testing unnecessary. In the case of candidates for transplantation routine HIV testing was carried out by 68 of 100 nephrologists; 22 tested only patients "at risk" and 10 did not test. A positive HIV test result was considered by most but not all respondents (63/86) to exclude patients from transplantation. Twenty four of 88 nephrologists considered that HIV positivity should exclude patients from haemodialysis, but only seven of 87 would exclude such patients from peritoneal dialysis. Similar attitudes pertained for patients with end stage renal failure who refused HIV testing. Testing with the patient's knowledge and consent was the policy of two thirds of nephrologists, but a patient's signature was obtained by only 24 of 88. There should be a consensus on practice for HIV testing of patients with end stage renal failure.
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PMID:HIV testing in patients with end stage renal disease. 210 1

The AIDS epidemic is growing worldwide, and projections for the next decade indicate that over 6 million people will develop clinical AIDS, an increase of 10-30 times the number that has been reported to date. AIDS is spreading rapidly among intravenous drug abusers, which is the risk group that is at highest risk for the development of HIV associated nephropathy (HIVAN). This will result in an increase in the number of patients who develop end stage renal disease (ESRD) and require dialysis treatment during the next decade. Survival time for patients with AIDS is improving as new therapies are implemented; the prognosis for patients with AIDS and ESRD also appears to be slightly better, but the natural course of HIV infection in the ESRD patient remains to be defined.
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PMID:Renal disease and HIV infection: clinical course, treatment outcome, and infection control. 231 3

This paper summarises the information given on the 1986 EDTA Registry centre questionnaire which was returned by 82% of the 2,065 known dialysis and transplant centres in 33 European countries. Information is given on the number of patients alive on haemodialysis according to the type of dialysis facilities available where the patient was receiving dialysis and the number of patients receiving special types of dialysis. The centre questionnaire also included questions on testing for HIV infection, serological evidence or symptoms of AIDS and the diagnosis of hepatitis B in patients and staff. The data given in response to these questions are presented together with data on the involvement of dietitians and social workers in the treatment of patients with end stage renal failure. Finally, information on transplant activity in Europe and the treatment policies of transplanting centres is provided.
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PMID:EDTA Registry centre survey, 1986. Report from the European Dialysis and Transplant Association Registry. 249 73

The existence of an HIV-related nephropathy as a distinct disease entity is controversial. We observed a high incidence of renal disease in our AIDS patients. Of 182 patients, 59 patients (32.4%) were found to have heavy proteinuria (greater than 2 g/24 h). Of these, 24 patients had slow progression of renal insufficiency and 2 patients had rapid deterioration to end stage renal disease. There was a notable absence of hypertension in these cases. The incidence of proteinuria was similar in blacks and hispanics; however 22.8% of blacks had renal insufficiency as compared to 6.9% of hispanics. There was no difference in the incidence of heavy proteinuria between intravenous drug abusers (32.3%) and nonabusers (33.3%). Renal morphology when examined showed characteristic changes, including cytomembranous structures and virus-like particles. These changes were similar in patients with heavy or light proteinuria, though they were less severe in the latter. We conclude that a HIV-related nephropathy exist and the presence of cytomembranous structures and virus-like particles in the renal tissue raises the possibility of a viral etiology for this disorder.
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PMID:Evidence for an HIV-related nephropathy: a clinico-pathological study. 291 6


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