Epidural morphine for ischaemic rest pain.

Six patients, aged from 16 to 56 with various types of glomerulonephritis and deteriorating renal function underwent a total of four to six 2!-litre plasma exchanges using the Haemonectics-30 intermittent flow separator at 4-7 day intervals. The replacement fluid consisted of 2 litres of either plasma protein fraction or polygeline with 500 ml of normal saline containing 5000 units of heparin as anticoagulant. A loading dose of 2000-5000 units of hepa-rin was given before exchange. Samples were taken for full blood count, and to measure blood concentrations of urea, electrolytes, proteins, immunoglobulins, complement, and coagulation factors before and at one and 15 hours after completion of exchange. Creatinine clearances were measured between exchanges. Blood pressure was monitored throughout the exchange and for 24 hours after its completion. In each case plasma protein fraction was used for one exchange and poly-geline for all subsequent exchanges. Concurrent immunosuppression using a combination of prednisolone, azathioprine, and cyclophosphamide was given to all patients. In all patients blood pressure and pulse remained stable throughout the procedure and for 24 hours afterwards. Renal function between plasma exchanges, as measured by serum urea and creatinine concentrations together with serial 24-hour urine creatinine clearance measurements , did not deteriorate. Plasma treatment combined with immuno-suppression either stabiliscd or improved renal function in our patients. The effect on serum protein concentrations is shown in the table. Afte'