Haematological toxicity of midodrine in haemodialysis

Comment. In Goodpasture syndrome or anti-GBM nephritis, advanced renal impairment is not generally prevented by current treatments when the patient presents initially with Source Haemodialysis CAPD/ Transplant Total progressive renal insufficiency. Here we used cyclosporin A, IPD which is commonly used in organ transplantation, because of its selective inhibition of immune response. The immuno-Blood transfusion 40 11 16 67 suppressive effect is mediated by the inhibition of calcineurin, Intravenous drugs 4 1 0 5 which impairs the expression of several T-cell activation Sexual contact 0 0 0 0 genes including interleukin-2 and its receptor. This drug has Holiday 6 0 0 0 Renal transplant 0 0 2 2 been used in humans with anti-GBM antibody mediated Not known 43 14 30 87 nephritis, but experiences are limited [4,5]. The growing Total 93 26 48 167 knowledge of immune pathogenesis has led to the concept that cellular immunity also plays a key role in this disease and thus it seems plausible to use a T-cell directed immuno-suppressive therapy. This case illustrates the beneficial use hepatitis C in relation to modality and source of contact is of cyclosporin A in a patient whose kidney function worsened deailed in Table 1. after the initiation of conventional immunosuppressive The six holiday contacts were all haemodialysis from therapy. Furthermore, cyclosporin A seems to be an alternat-Egypt, Pakistan, Bosnia, France, Tenerife and Saudi Arabia. ive treatment option in cytotoxic drug induced leukopenia. Fifty eight per cent of units routinely tested for hepatitis C We conclude that cyclosporin A may be helpful to both following dialysis in non-UK units and 39% of units isolate achieve and maintain remission in rapidly progressive anti-hepatitis C patients from other patients. Forty-eight per cent GBM glomerulonephritis and might be considered as an of units advise holiday dialysis patients of potential risk of alternative approach to conventional immunosuppression. contacting hepatitis C. The clinical results support the idea that T-cells are of major The risk of contracting hepatitis C by holiday dialysis importance in Goodpasture syndrome. seems small, though we would suggest that all units advise holiday patients of potential risk and patients are treated as Kliniken der Stadt Kö ln Frank Merkel possibly infected for 2 months following return. prognosis of anti-basement membrane antibody (anti-BM-Ab) 1. McIntyre PG, McCruden EA, Dow BC et al. Hepatitis C virus mediated disease: report of 35 cases. populations in whole peripheral blood of patients with antibody-Oral …