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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a retrospective analysis of infections in 154 children (114 boys, 40 girls) with nephrotic syndrome who satisfied the International Study of Kidney Disease in Children criteria. Their mean age at onset of symptoms was 6.2 years (range 6 months to 16 years) and the mean duration of follow-up was 32 months (range 6-55 months). One or more infectious complications were observed in 59 of the 154 children (38%), with urinary tract infection being the commonest (13.7%), followed by pulmonary tuberculosis (10.4%), peritonitis (9.1%), skin infections (5.2%), upper respiratory infections (5.2%), lower respiratory tract infections (3.9%) and pyomeningitis (0.6%). There were 3 deaths, the mortality in 2 patients being attributable to infections. There was no significant difference between children who developed infection and those who didn't in terms of age of onset, sex, duration of disease, serum creatinine, blood urea nitrogen and 24-h proteinuria. However, the children who developed infectious complications had significantly higher serum cholesterol levels (P < 0.01) and lower serum albumin levels (P < 0.02). The frequency of infections was higher in children who were frequent relapsers, steroid dependent and subsequent non-responders (28/60) compared with infrequent relapsers and initial non-responders (29/94).
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PMID:Spectrum of infections in Indian children with nephrotic syndrome. 757 3

Adequacy of peritoneal dialysis has been less well studied than that of hemodialysis. Fractional urea removal, total creatinine removal, and various indices have been proposed to reflect or predict patient morbidity and mortality. No prospective study has been published in this regard. To evaluate this area further, in addition to reviewing selected literature, 45 continuous ambulatory peritoneal dialysis (CAPD) patients were recruited in two dialysis centers for a prospective study on treatment adequacy. Patients were well rehabilitated and had no peritonitis or hospitalization in the 6 months before the study. Urea and creatinine kinetics were analyzed, as were dietary intake and fluid balance. The weekly Kt/V, calculated to include peritoneal and residual renal clearance (KprT/V), averaged 1.77 with a Kt/V hemodialysis equivalent of 0.59. Patients with residual renal function (58% of the studied population) had an average residual renal clearance of 3.42 mL/min, and had lower steady-state concentrations of urea nitrogen and creatinine in the plasma than patients with no residual renal function. As a consequence, a lower percent excretion of urea and creatinine in the peritoneal fluid was observed in the former patients compared with the latter, where the peritoneal route was the only one for solute excretion. The concentration profiles in blood appear to be the critical factor in achieving the final target of the treatment, ie, the excretion of the overall amount of waste products derived from protein and other metabolic pathways. The constant blood levels in CAPD explain why such a low Kt/V can be adequate whereas, in hemodialysis, a higher Kt/V is required.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Assessment of adequacy in peritoneal dialysis. 764 Oct 84

The characteristics of two types of intraperitoneal (i.p.) soilage sepsis models, autologous fecal inoculum (FEC) and a pure culture of Escherichia coli (EC), were studied in 26 male Yucatan minipigs (20-30 kg). Early (1-4 h) and late (24-72 h) changes were different between the two groups. The EC group was characterized early by hypotension, low cardiac output, and increased systemic and pulmonary vascular resistances, along with leukopenia, hypoglycemia, lactacidemia, and elevated blood urea nitrogen. Of the pigs in the EC group that survived the early effects, there were few significant differences in physiological parameters, compared to control pigs, that would indicate ongoing pathological processes. In contrast, the FEC group pigs demonstrated early hypotension, but with increased cardiac output and reduced systemic vascular resistance. Other parameter changes were similar to those seen in the EC pigs, but to a lesser degree, with the exception of elevations in serum lactate dehydrogenase. Also in contrast to the EC group, most of the changes in the FEC group persisted in later days, and FEC pigs demonstrated leukocytosis. There were also greater elevations in circulating lipopolysaccharide (LPS) concentrations in the EC group that returned later to baseline levels. In the FEC group, there were persistently elevated LPS concentrations over 72 h. These observations suggest that pigs challenged with intraperitoneal E. coli demonstrated an initial acute peritonitis and damaging physiologic effects of high levels of circulating LPS. Survivors in this group improved and were physiologically stable after 24 h. Pigs that received i.p. autologous feces developed an early acute peritonitis phase with lower levels of circulating LPS, and later developed pronounced peritoneal reaction as demonstrated by multiple abdominal abscesses, pyogenic granuloma formation, and adhesions with physiological evidence of developing sepsis over 72 h. These observations indicate that i.p. EC models evoke a systemic response not unlike intravenous administration of LPS or EC, however, the FEC model produced a systemic response akin to a slower developing septic process.
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PMID:Porcine peritoneal sepsis: modeling for clinical relevance. 773 52

A woman with mild chronic renal insufficiency was being treated with glucocorticoids for a presumed chronic inflammatory disease. She developed peritonitis arising from a pelvic abscess, which was drained without complications. Unexpectedly, she became obtunded, and eventually, the neurologic dysfunction was linked to hyperammonemia in spite of normal liver function tests. Hyperammonemia was only transiently controlled in spite of protein restriction, repeated hemodialysis, and the use of biochemical means to reduce ammonia. A recurrent pelvic abscess was drained, and hyperammonemia disappeared. A review of ammonia and nitrogen metabolism indicates that bypassing the liver with shunting of ammonia into the systemic circulation should be added to the causes of symptomatic hyperammonemia. Treatment requires the elimination of the bacteria.
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PMID:Unexpected encephalopathy in chronic renal failure: hyperammonemia complicating acute peritonitis. 784 45

Male Fischer 344 rats were orally fed one of four diets (Osmolite HN, Alitraq, Impact, and Purina rodent chow). After 6 days, jejunal mucosal nitrogen content and thickness were normal in all groups. After 7 days, challenge with Escherichia coli intraperitoneally demonstrated no difference in survival for any dietary group. In a second study, acute protein-calorie malnutrition was induced by administering 5% dextrose orally for 10 days. Animals were refed for 7 days with one of the four diets. Serum albumin concentrations and intestinal mucosal nitrogen content and thickness returned to normal with each refeeding program. Challenge with E. coli after 7 days of refeeding, however, again demonstrated no difference in survival for any dietary group. Specialized enteral feeding products, containing additional amounts of arginine, glutamine, glutamate, RNA, and omega-3 fatty acids, are no more effective than a standard enteral feeding product or rat chow in maintaining intestinal anatomy or restoring anatomy following fasting. Furthermore, we found no survival advantage for the specialized products following E. coli peritonitis.
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PMID:Effects of enteral feeding products on survival from Escherichia coli peritonitis. 796 75

Although spontaneous bacterial peritonitis is considered a precipitating factor of renal impairment in cirrhosis, no study specifically addressing this problem has been reported. This study was aimed at assessing the incidence, clinical course, predictive factors and prognosis of renal impairment in cirrhotic patients with peritonitis. Therefore, 252 consecutive episodes of spontaneous bacterial peritonitis in 197 patients were analyzed. Clinical and laboratory data obtained before and after diagnosis of peritonitis were considered as possible predictors of renal impairment and hospital mortality. Renal impairment occurred in 83 (33%) episodes, and in every instance it fulfilled the criteria of functional kidney failure. Renal impairment was progressive in 35 episodes, steady in 27 and transient in 21. Blood urea nitrogen and serum sodium concentration before peritonitis and band neutrophils count in blood at diagnosis were independent predictors for the development of renal impairment. Renal impairment was the strongest independent predictor of mortality during hospitalization. Other independent prognostic factors were blood urea nitrogen level before peritonitis, age, positive ascitic fluid culture and serum bilirubin level during infection. These results indicate that renal impairment is a frequent event in cirrhotic patients with spontaneous bacterial peritonitis that occurs mainly in patients with kidney failure before infection. Renal impairment is the most important predictor of hospital mortality in cirrhotic patients with spontaneous bacterial peritonitis.
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PMID:Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. 798 50

The frequency of infection by methicillin-resistant Staphylococcus aureus (MRSA) is high in Japan and control of such strains is urgently needed. Arbekacin (ABK), a semisynthetic aminoglycoside, has potent activity against S. aureus, including resistant strains, and against Gram-negative bacteria as well. For this reason, in surgical infections (which are often caused by more than one bacterium), this drug might be particularly effective. We calculated the MIC and the decrease in the MIC when cultures of 59 resistant strains of S. aureus isolated in our wards at Osaka City University Hospital, contained arbekacin in the medium. We also used the drug to treat 12 infections caused by resistant strains of S. aureus. The MICs of vancomycin had a single peak at 0.5 microgram/ml, and those for ABK had double peaks at 0.5 and 4.0 micrograms/ml. The effect of arbekacin in lowering the MIC of minocycline (MINO) was slight because of the low MIC of MINO. Effects on fosfomycin (FOM), ampicillin, clavulanic acid/ticarcillin, cefotiam, cefuzonam, flomoxef, and imipenem/cilastatin were strong; the peaks were lowered by 1/2(7)-1/2(11). When 1.0 micrograms/ml ABK was present in the medium, the efficacy of FOM was increased enough that, by prediction from the pharmacokinetics of FOM (blood level when given at the usual dose), all but one (2%) of the 47 resistant strains would be eradicated clinically. If 2.0 micrograms/ml ABK were in the medium, all strain would be eradicated, by our calculations. We treated 11 infections and one colonization by resistant strains of S. aureus with ABK and evaluated the response in these cases of infection. Four infections were treated with FOM as well. The clinical efficacy was good in four infections (three patients), fair in four, and poor in three, for an efficacy rate of 36%. All presumed causative bacteria were eradicated in two (18%) of the 11 infections and S. aureus strains were eradicated in three (27%) of the 11 infections. No symptoms of side effects were reported, but blood urea nitrogen and creatinine rose in a 72-year-old woman with duodenal perforation and peritonitis. The MIC levels of ABK were satisfactory, but clinical efficacy for staphylococcal infections caused by resistant strains was unsatisfactory.
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PMID:[Treatment with arbekacin of surgical infections by resistant strains of Staphylococcus aureus. Arbekacin Study Group]. 807 93

Erythropoietin (EPO) given subcutaneously (SC) once per week has been successful in the treatment of anemia in continuous ambulatory peritoneal dialysis (CAPD) patients. We have identified a population of CAPD patients that requires EPO administration once per week or less often. To determine if specific variables could be identified that would predict which CAPD patients would require infrequent EPO dosing, we reviewed the charts of all our CAPD patients who were receiving EPO as of 1 June 1992. Patients had to have been on CAPD for 3 months and EPO for 3 months to be considered for analysis. We identified 12 patients who required EPO once per week or less frequently (infrequent EPO) and 9 patients who required EPO more than once per week (frequent EPO). Parameters that were analyzed included age, gender, race, time on CAPD, history of gastrointestinal bleeding, exit-site infection or peritonitis in the last 60 days, diabetes, amount of dialysate instilled per day, and the number of exchanges per day. Laboratory data that were analyzed included hemoglobin, hematocrit, serum iron, total iron-binding capacity, ferritin, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, albumin, total protein, parathyroid hormone, and aluminum. Categorical data were analyzed via chi-square, and numerical data were analyzed via the t-test. The infrequent EPO group required only 35% as much EPO as the frequent group to maintain hemoglobin and hematocrit, which were significantly greater. The only parameter that was different between the two groups was age (infrequent EPO 42 +/- 13.2 vs frequent EPO 55.8 +/- 11.9 years, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infrequent dosing of subcutaneous erythropoietin for the treatment of anemia in patients on CAPD. 810 57

Peritoneal dialysis is associated with several metabolic and nutritional abnormalities, some of which are related to the use of glucose-based solutions. Furthermore, the catabolic effects of uremia per se, protein and amino acid losses into the dialysate, peritonitis and poor appetite contribute to amino acid abnormalities, negative nitrogen balance and a high prevalence of malnutrition in peritoneal dialysis patients. To overcome these problems the use of amino acid instead of glucose as an osmotic agent has been proposed. Short-term studies have shown that amino acid-based solutions in peritoneal dialysis may supplement in excess the daily losses of amino acids during dialysis with glucose-based solutions. The amino acid solutions produce similar ultrafiltration and solute transport as the standard glucose solutions although the period of effective ultrafiltration is rather short. However, it should be noted that some studies have reported that the transport of small and large solutes may increase in patients using amino acid solutions. During the early 1980s several investigators have developed and tested different amino acid solutions for peritoneal dialysis. The initial clinical experience from Toronto with amino acid solutions containing large amounts of non-essential amino acids and inadequate amount of buffer were in general discouraging. The patients, who were not always malnourished and tended to have a low energy intake, developed increased BUN levels, acidosis, no improvement in nutritional status or amino acid abnormalities and, in some cases, anorexia. In 1985 a new 1% amino acid solution, containing an increased buffer amount and amino acids (mainly essential) in proportions which take the amino acid abnormalities in uremic patients into account, became available. The use of this solution resulted in some improvement in amino acid pattern and nutritional parameters, but acidosis and increased BUN levels remained problems. The experiences from these and previous studies showed that: (1) the improvement of the composition of amino acid solutions was beneficial; (2) a further increase of the buffer amount was needed; (3) patients included should have signs of protein malnutrition combined with low dietary protein intake to benefit from intraperitoneal amino acid supply, and (4) energy intake should be sufficient to prevent amino acids to end up as energy source. For this purpose a new improved 1.1% amino acid solution has been developed containing a further increase of some essential amino acids and an increased amount of lactate (40 mmol/l). This solution has been tested in malnourished patients eating 0.8 g protein/kg/day and 25-30 kcal/kg/day.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Supplemented dialysis: amino acid-based solutions in peritoneal dialysis. 835 59

This study was designed to determine if the serum albumin is a marker for morbidity or mortality in peritoneal dialysis (PD) patients. The impact of a low serum albumin on the risk of hospitalization, peritonitis, or death was examined in 71 patients. Blood urea nitrogen (BUN), cholesterol, age, and the presence or absence of diabetes were also examined. In independent analyses, the serum albumin was lower (32.7 +/- 5.6 v 36.3 +/- 4.3 g/L, P < 0.01), the diagnosis of diabetes was more frequent (41% v 7%, P < 0.01), and the number of episodes of peritonitis were greater (2.0 +/- 1.6 v 0.7 +/- 1.3, P < 0.01) in the group of patients hospitalized compared with those not hospitalized. When diabetics were excluded from analysis, the serum albumin remained significantly lower in hospitalized patients. Stepwise logistic regression analysis, excluding the 10 patients hospitalized only for treatment of peritonitis, confirmed that only a low serum albumin and the diagnosis of diabetes were independent predictors of increased morbidity as evident by the increased frequency of hospitalization. Every 10 g/L decrease in the serum albumin increased the odds ratio for hospitalization by 5.2. The diagnosis of diabetes resulted in a 10-fold increase in the odds ratio. We conclude that a low serum albumin serves as a marker of morbidity in PD patients, primarily as a marker of increased risk for hospitalization. The diagnosis of diabetes also greatly increases the likelihood of hospitalization. Peritonitis is a cause for hospitalization, but not an independent risk factor.
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PMID:Serum albumin: a marker for morbidity in peritoneal dialysis patients. 841 22


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