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Tse KC, Capsi-Morales P, Castaneda TS, Piazza C. Exploring Muscle Synergies for Performance Enhancement and Learning in Myoelectric Control Maps. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941204 DOI: 10.1109/icorr58425.2023.10304809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This work proposes two myoelectric control maps based on a DoF-wise synergy algorithm, inspired by human motor control studies. One map, called intuitive, matches control outputs with body movement directions. The second one, named non-intuitive, takes advantage of different synergies contribution to each DoF, without specific correlation to body movement directions. The effectiveness and learning process for the two maps is evaluated through performance metrics in ten able-bodied individuals. The analysis was conducted using a 2-DoFs center-reach-out task and a survey. Results showed equivalent performance and perception for both mappings. However, learning is only visible in subjects that performed better in non-intuitive mapping, that required some familiarization to then exploit its features. Most of the myoelectric control designs use intuitive mappings. Nevertheless, non-intuitive mapping could provide more design flexibility, which can be especially interesting for patients with motor disabilities.
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Chow YF, Cheng BCP, Cheng HK, Ho B, Lee CK, Ng SK, So R, Tse KC, Tsui C, Wan R, Wong S. Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management. Hong Kong Med J 2020; 26:331-338. [PMID: 32807736 DOI: 10.12809/hkmj208397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient blood management (PBM) is a patient-centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an effort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. The multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely affecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products.
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Affiliation(s)
- Y F Chow
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
| | - B C P Cheng
- Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong
| | - H K Cheng
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - B Ho
- Department of Anaesthesiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - S K Ng
- Private Practice, Hong Kong
| | - R So
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong
| | - K C Tse
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - C Tsui
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - R Wan
- Private Practice, Hong Kong
| | - S Wong
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
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Abstract
♦ Objectives To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). ♦ Design Single-center retrospective case review of patients on CAPD over a 10-year period. ♦ Setting Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. ♦ Patients 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. ♦ Main Outcome Measures Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D4/D0) with standard 2-L 2.5% glucose dialysate were assessed. ♦ Results There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24 – 76 years) and mean duration of dialysis was 61.6 months (range 2 – 166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2 – 12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1 – 37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes ( p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes ( p = 0.91) or survival ( p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. ♦ Conclusions Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.
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Affiliation(s)
- Kai-Chung Tse
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Pok-Siu Yip
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Man-Fei Lam
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Fu-Keung Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Bo-Ying Choy
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tak-Mao Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar-Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lo WK, Lui SL, Li FK, Choy BY, Lam MF, Tse KC, Yip TP, Ng FS, Lam SC, Chu WL, Cheng SW. A Prospective Randomized Study on Three Different Peritoneal Dialysis Catheters. Perit Dial Int 2020. [DOI: 10.1177/089686080302302s26] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveWe compared outcomes for catheters with different configurations: conventional straight, swan-neck straight tip, and swan-neck curled tip.DesignThe study was conducted as a prospective randomized controlled trial in the continuous ambulatory peritoneal dialysis (CAPD) unit of a university center.Patients and MethodsWe randomized 93 new regular CAPD patients without prior peritoneal dialysis (PD) catheter insertion to receive a conventional straight, double-cuffed catheter (CS), a swan-neck straight catheter (SNC), or a swan-neck curled tip catheter (SNC) in 2:1:1 ratio.ResultsThe exit-site infection (ESI) rate was slightly lower with swan-neck catheters as compared with straight catheters, but the difference was not statistically significant. The peritonitis rate and overall catheter survival were similar. In Staphylococcus aureus nasal non carriers as compared with carriers, ESI-free catheter survival was significantly better with swan-neck catheters ( p = 0.0302 and p = 0.82 respectively). As compared with SC catheters, SNC catheters had a significantly higher migration rate ( p = 0.022).ConclusionsSwan-neck catheters were associated with a slightly better ESI rate, but SNC catheters are not routinely recommended because of a high migration rate. The SNS catheter is therefore recommended as the first-line catheter of choice, particularly in populations with a low rate of S. aureus nasal carriage.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sing-Leung Lui
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Fu-Keung Li
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Bo-Ying Choy
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Man-Fai Lam
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Chung Tse
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Terence P.S. Yip
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Flora S.K. Ng
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Ching Lam
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Ling Chu
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Wai Cheng
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
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Abstract
We report 3 patients on continuous ambulatory peritoneal dialysis (CAPD) who developed reversible ultrafiltration failure secondary to retroperitoneal leakage. The patients presented with pulmonary edema and fluid overload following a sudden onset of ultrafiltration failure on maintenance CAPD. There was no localized edema, suggesting peritoneal leakage in the abdominal wall or the perineum. Radiological examination showed no migration of the Tenckhoff catheter. Leakage of dialysate into the retroperitoneal space was only revealed by computed tomographic (CT) peritoneography. These patients were then treated with intermittent peritoneal dialysis twice weekly. After repeated CT peritoneography showing complete resolution of the leakage, they successfully resumed CAPD treatment 2 months later, without ultrafiltration problems. Our finding suggests that retroperitoneal leakage could be one of the uncommon, yet reversible, causes of acute ultrafiltration failure that can be diagnosed with CT peritoneography.
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Affiliation(s)
- Man-Fai Lam
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai-Kei Lo
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ferdinand S.K. Chu
- Department of Medicine, Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Fu-Keung Li
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Terence P.S. Yip
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kai-Chung Tse
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tak-Mao Chan
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar-Neng Lai
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Yip T, Tse KC, Lam MF, Tang S, Li FK, Choy BY, Lui SL, Chan TM, Lai KN, Lo WK. Risk Factors and Outcomes of Extended-Spectrum Beta-Lactamase-Producing E. Coli Peritonitis in Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080602600213] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined. Results Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coli peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12). Conclusion Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
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Affiliation(s)
- Terence Yip
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Kai-Chung Tse
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Man-Fai Lam
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Sydney Tang
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Fu-Keung Li
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Bo-Ying Choy
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Sing-Leung Lui
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Tak-Mao Chan
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Kar-Neng Lai
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
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Tse KC, Li FK, Tang S, Tang CSO, Lai KN, Chan TM. Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria. Lupus 2016; 14:947-52. [PMID: 16425574 DOI: 10.1191/0961203305lu2249oa] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) reduces proteinuria and the rate of renal function deterioration in diabetic nephropathy and other glomerular diseases, but its role in quiescent lupus nephritis has not been established. We conducted a retrospective study to investigate the effects of ACEI/ARB on proteinuria and renal function in patients with persistent proteinuria (>1 g/day) despite resolution of acute lupus nephritis following immunosuppressive treatment. Fourteen out of 92 patients were included. The duration of treatment with ACEI/ARB was 52.1 ± 35.7 months. The levels of proteinuria, serum albumin, serum creatinine, systolic and diastolic blood pressure were 1.10 to 6.90 g/day, 35.8 ± 3.6 g/L, 102.54 ± 34.48 μmol/L, 137.6 ± 10.9 and 81.9 ± 9.2 mmHg at baseline. Proteinuria and serum albumin showed significant sustained improvements after 6 and 24 months of treatment. Comparison of slopes for serial proteinuria, albumin and reciprocal of serum creatinine before and after treatment showed significant improvements in six (43%), eight (57%) and two patients, respectively. At last follow-up proteinuria remained significantly lower (0.36 g/day, P = 0.043) and albumin higher (41.3 ± 2.2 g/L, P = 0.023). Eleven (78.6%) patients had proteinuria improved by >50%, and five had insignificant proteinuria at last follow-up. Systolic blood pressure was significantly reduced from 6 months onwards, but this did not correlate with proteinuria reduction. Diastolic blood pressure, serum creatinine, creatinine clearance, anti-dsDNA, C3 and haemoglobin were not altered. We conclude that ACEI/ARB effectively reduces proteinuria and improves serum albumin in patients with persistent proteinuria despite quiescent lupus nephritis.
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Affiliation(s)
- K C Tse
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Yip T, Tse KC, Ng F, Hung I, Lam MF, Tang S, Lui SL, Lai KN, Chan TM, Lo WK. Clinical course and outcomes of single-organism Enterococcus peritonitis in peritoneal dialysis patients. Perit Dial Int 2011; 31:522-8. [PMID: 21532006 DOI: 10.3747/pdi.2009.00260] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear. METHODS We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009. RESULTS During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005). CONCLUSIONS Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.
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Affiliation(s)
- Terence Yip
- Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, The University Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China.
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Yap DYH, Tse KC, Lam MF, Chan TM, Lai KN. Polymicrobial CAPD peritonitis after hysteroscopy. Perit Dial Int 2009; 29:237-238. [PMID: 19293366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Tse KC, Yung S, Tang C, Yip TPS, Chan TM. Management of hepatitis B reactivation in patients with lupus nephritis. Rheumatol Int 2009; 29:1273-7. [PMID: 19159933 DOI: 10.1007/s00296-008-0823-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 12/12/2008] [Indexed: 12/30/2022]
Abstract
Hepatitis B is endemic in many Asian countries and immunosuppression may precipitate hepatitic flare. There is little data on the treatment of hepatitis B in patients with systemic lupus erythematosus. We monitored serial transaminase and HBV DNA levels in our HBsAg-positive patients with a history of lupus nephritis and instituted anti-viral treatment in patients who showed virological reactivation. This retrospective pilot study reports the data with this pre-emptive management strategy. Amongst 228 patients with lupus nephritis, eight (3.51%) were HBsAg-positive and five had received Lamivudine treatment for hepatitis B. In two patients the virological flares were preceded by lupus flares that necessitated an increase in immunosuppressive treatment. Median HBV DNA level was 1.9 x 10(7) copies/mL (range 1.2 x 10(4)-1.0 x 10(9) copies/mL) at baseline, and it decreased by 2-5 logs after treatment. Four patients had abnormal transaminase levels at baseline, with mean alanine aminotransferase at 125.0 +/- 67.4 U/L, and all achieved normalisation after 3-24 months (median 13 months) of treatment. Discontinuation of Lamivudine treatment was attempted in three patients after 9-15 months. In one patient treatment was recommenced because of virological flare. For the remaining two patients in whom treatment was not interrupted, one showed sustained viral suppression and one developed drug resistance. All antiviral treatments were well-tolerated. These results indicate the importance of serial monitoring of HBV DNA and transaminase levels, and prompt anti-viral therapy, in the management of HBsAg-positive lupus patients. Also, it may be feasible to discontinue treatment in stable patients to avoid the selection of drug-resistant variants.
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Affiliation(s)
- Kai-Chung Tse
- Department of Medicine, Queen Mary Hosptial, University of Hong Kong, Pokfulam, Hong Kong, China,
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Yuen LK, Lai WM, Lau SC, Tong PC, Tse KC, Chiu MC. Ten-year review of disease pattern from percutaneous renal biopsy: an experience from a paediatric tertiary renal centre in Hong Kong. Hong Kong Med J 2008; 14:348-355. [PMID: 18840904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To study the childhood renal disease pattern based on the renal biopsy histology in a local paediatric tertiary renal centre. DESIGN Retrospective study. SETTING Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong. PATIENTS All patients who underwent real-time ultrasound-guided closed renal biopsy from 1 April 1997 to 31 March 2007 were included. RESULTS A total of 209 renal biopsies were performed, 162 on native kidneys and 47 on grafts. In the native group, major indications were renal manifestations secondary to systemic diseases (34%), followed by idiopathic nephrotic syndrome (28%) and haematuria (27%). In 94% the histopathology revealed glomerular diseases. Among the primary glomerular diseases, thin glomerular basement membrane disease, immunoglobulin A nephropathy, minimal change disease, and focal segmental glomerulosclerosis accounted for most. In all, 37% of patients with steroid-resistant nephrotic syndrome had focal segmental glomerulosclerosis and its relative incidence was increased when compared to previous studies. Minimal change disease and minimal change disease with mesangial immunoglobulin M deposits accounted for the majority of steroid dependent and frequent relapsers. Among patients with isolated microscopic haematuria, 73% had thin glomerular basement membrane disease, while patients with concomitant haematuria and proteinuria had a wide variety of pathology. In the kidney graft group, acute graft dysfunction was due to acute rejection in 38% of the patients, followed by calcineurin inhibitor toxicity in 14%. Chronic allograft nephropathy caused chronic allograft dysfunction in the majority of cases. Post-transplant proteinuria was caused by recurrence of the primary renal disease in all of our patients. CONCLUSION This study provides updated epidemiological information for childhood renal disease and a change in the pattern of disease was observed.
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Affiliation(s)
- L K Yuen
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
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Tse KC, Tang SCW, Chan TM, Lai KN. Rhodococcus lung abscess complicating kidney transplantation: successful management by combination antibiotic therapy. Transpl Infect Dis 2008; 10:44-7. [PMID: 17428277 DOI: 10.1111/j.1399-3062.2007.00231.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this report, a renal transplant recipient with Rhodococcus lung abscess is described. A high clinical suspicion and appropriate combination antibiotic therapy obviated the need for surgical intervention and was associated with a good clinical outcome. The optimal regimen of combination antibiotic therapy is discussed.
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Affiliation(s)
- K C Tse
- Department of Medicine, Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Tse KC, Lui SL, Cheng VCC, Yip TPS, Lo WK. A cluster of rapidly growing mycobacterial peritoneal dialysis catheter exit-site infections. Am J Kidney Dis 2007; 50:e1-5. [PMID: 17591517 DOI: 10.1053/j.ajkd.2007.04.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 04/17/2007] [Indexed: 11/11/2022]
Abstract
In this case series, a cluster of 5 consecutive peritoneal dialysis patients with atypical mycobacterial exit-site infections in a single center within 20 months are described. Clinical features, treatment, and outcomes are discussed. Most patients had been treated with prolonged systemic antibiotic therapy for recurrent bacterial exit-site infections in the preceding months, and all had used topical gentamicin ointment for exit-site infection treatment or prophylaxis. It is postulated that this might have predisposed them to atypical mycobacterial exit-site infection as a result of selection pressure on uncommon organisms.
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Affiliation(s)
- Kai-Chung Tse
- Department of Microbiology, Queen Mary Hospital, Hong Kong
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Lam MF, Au WY, Tse KC, Chan TM, Chan GSW, Chan KW, Lai KN. Late onset membranous nephropathy complicating donor lymphocyte infusion for leukaemia relapse after allogeneic stem cell transplantation. Am J Hematol 2007; 82:327-8. [PMID: 17177190 DOI: 10.1002/ajh.20788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tse KC, Lam MF, Tang SCW, Tang CSO, Chan TM. A pilot study on tacrolimus treatment in membranous or quiescent lupus nephritis with proteinuria resistant to angiotensin inhibition or blockade. Lupus 2007; 16:46-51. [PMID: 17283585 DOI: 10.1177/0961203306073167] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent proteinuria in patients with quiescent lupus can result from membranous lupus nephritis and/or glomerular scarring following previous flares. This pilot study examined the effects of tacrolimus over two years in six patients with membranous/inactive lupus nephritis and persistent proteinuria despite angiotensin inhibition/blockade. Tacrolimus treatment reduced proteinuria and increased serum albumin (time effect, P = 0.047 and 0.032 respectively). Compared with baseline levels, proteinuria improved by more than 50% in five patients (83.3%) and hypoalbuminaemia was corrected in four patients. The efficacy was most prominent in four patients with biopsy-proven membranous lupus nephritis, whose protienuria improved by over 80%. One patient developed biopsy-proven chronic nephrotoxicity after 10 months of tacrolimus treatment, despite non-excessive blood levels. These data suggest that tacrolimus is an effective treatment for proteinuria due to membranous lupus nephritis, but should probably be reserved for patients who are refractory to other non-nephrotoxic treatments, in view of the potential risk of subclinical nephrotoxicity.
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Affiliation(s)
- K C Tse
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Tse KC, Tang CSO, Lio WI, Lam MF, Chan TM. Quality of life comparison between corticosteroid- and-mycofenolate mofetil and corticosteroid- and-oral cyclophosphamide in the treatment of severe lupus nephritis. Lupus 2007; 15:371-9. [PMID: 16830884 DOI: 10.1191/0961203306lu2307xx] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is accumulating evidence that mycophenolate mofetil (MMF), when combined with corticosteroid, is an effective induction treatment for severe proliferative lupus nephritis and is associated with fewer adverse effects compared to cyclophosphamide (CTX), but the quality of life (QOL) associated with these regimens as perceived by the patient has not been compared. This study included patients who had experienced both treatment regimens, for distinct episodes of diffuse proliferative lupus nephritis. QOL parameters during the first six months of each treatment were assessed through SF36 and WHOQOL questionnaires. Twelve patients and 24 episodes of severe lupus nephritis were studied. CTX-treated and MMF-treated episodes showed comparable baseline characteristics and response rate, with complete remission occurring in 83.3%. MMF treatment was associated with higher numerical scores for all domains across both QOL instruments than CTX. MMF treatment was associated with significantly less fatigue, less impediment of physical and social functioning, and better psychological well being compared to CTX. When each patient served as her/his own control, most patients ascribed higher QOL domain scores to the MMF-treated episode. Seventy-five percent of patients found MMF treatment more acceptable and preferred when compared with CTX, and the complications that most concerned them included Cushingoid features, alopecia, menstrual disturbance and infections. These data showed that MMF-based induction immunosuppression for severe lupus nephritis was associated with better QOL than CTX as perceived by patients, which was most likely attributed to the reduced side-effects during MMF treatment.
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Affiliation(s)
- K C Tse
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Affiliation(s)
- Chi-Keung Yeung
- Division of Dermatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Tse KC, Yao Q, Yip PS, Lam MF, Li FK, Lai KN, Chan TM. Comparison of Atorvastatin and Simvastatin in the Long-term Treatment of Hyperlipidemia After Kidney Transplantation. Int J Organ Transplant Med 2006. [DOI: 10.1016/s1561-5413(09)60225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Yip T, Tse KC, Lam MF, Tang S, Li FK, Choy BY, Lui SL, Chan TM, Lai KN, Lo WK. Risk factors and outcomes of extended-spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients. Perit Dial Int 2006; 26:191-7. [PMID: 16623424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined. RESULTS Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coil peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12). CONCLUSION Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
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Affiliation(s)
- Terence Yip
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong.
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Lam MF, Leung JCK, Tam S, Tse KC, Lui SL, Lo WK, Chan TM, Lai KN. Increased Serum Leptin Levels During PD-related Peritonitis Associated with Prolonged Inflammation and Loss of Lean Body Mass. Int J Organ Transplant Med 2005. [DOI: 10.1016/s1561-5413(09)60197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lo WK, Lui SL, Chan TM, Li FK, Lam MF, Tse KC, Tang SCW, Choy CBY, Lai KN. Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis. Kidney Int 2005; 67:2032-8. [PMID: 15840054 DOI: 10.1111/j.1523-1755.2005.00305.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Residual renal clearance has been shown to be much more predictive of survival than peritoneal clearance. There has been little data to support a target level of peritoneal clearance. A retrospective study was therefore conducted to see how the peritoneal Kt/V had affected the survival of anuric patients in our center. METHODS Over a period of 10 years, there were 150 peritoneal dialysis patients with documented anuria. Their survival was analyzed according to their baseline peritoneal Kt/V at the time of documentation of anuria and at the time of their latest altered peritoneal dialysis (PD) prescription (subsequent Kt/V). RESULTS There were 90 females and 42 diabetics. The mean age and duration of dialysis were 57.7 +/- 14.7 and 44.1 +/- 31.3 months, respectively. The 2-year and 5-year survival rates were 88.7% and 66.7%, respectively. We found that patients with baseline peritoneal Kt/V below 1.67 had poorer survival after the documentation of anuria than those above [relative risk (RR) 1.985, P= 0.01], although the baseline Kt/V was not an independent risk factors in the whole group of patients. However, such effect was mainly observed in female patients. The survival was identical between those with Kt/V above or below 1.80 (P= 0.98). Among female patients, the group with baseline Kt/V 1.67 to 1.86 had the best survival, followed by those greater than 1.86 and lowest in those below 1.67 (P= 0.0016). For patients with baseline Kt/V below 1.80, those with subsequent Kt/V above 1.76 had better survival than those below (P= 0.033). CONCLUSION Our data suggested that a negative effect of peritoneal Kt/V on survival is apparent at a level below 1.67 and there exists a limit of its effect at around 1.80. We suggested a minimal Kt/V target of 1.70 and an optimal target at 1.80 in anuric patients based on survival data. Prospective randomized study is required to confirm this finding.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong.
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Chan TM, Tse KC, Tang CSO, Lai KN, Li FK. Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine. Lupus 2005; 14:265-72. [PMID: 15864912 DOI: 10.1191/0961203305lu2081oa] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The short-term outcome of patients with diffuse proliferative lupus nephritis (DPLN) has improved with advances in immunosuppressive treatment. However, the impact of different immunosuppressive regimens on long-term renal function remains to be defined. This prospective cohort study examined the long-term renal function and disease relapse in adults with biopsy-proven DPLN, significant proteinuria, and hypoalbuminemia, who had been treated with sequential immunosuppression comprising prednisolone and oral cyclophosphamide as induction followed by low-dose prednisolone and azathioprine as maintenance. Sixty-six patients with 68 episodes of DPLN were included, with follow-up of 91.7 +/- 36.7 months. 82.4% achieved complete remission and 39.1% relapsed during follow-up. Patients in partial remission were at higher risk of relapse compared with those in complete remission (hazard ratio 6.2, P < 0.001). Serum creatinine remained stable over time (P = 0.931), while creatinine clearance showed a significant increase with time after treatment (P = 0.032). Three (4.4%) patients had doubling of baseline creatinine, but none reached end-stage renal failure or died. Univariate and mixed model analyses showed that the evolution of long-term renal function was significantly influenced by the chronicity score and creatinine clearance at baseline, and by the renal function at one year after treatment. These data demonstrate the efficacy of sequential immunosuppression in preserving renal function in most Chinese subjects with DPLN. The results also indicate that irreversible renal scarring (as reflected by baseline chronicity score), renal reserve (as reflected by renal function at baseline and one year), and an induction regimen that is effective in preserving the nephron mass are critical determinants of long-term renal outcome.
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Affiliation(s)
- T M Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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Lai KN, Leung JCK, Chan LYY, Li FFK, Tang SCW, Lam MF, Tse KC, Yip TP, Chan TM, Wieslander A, Vlassara H. Differential expression of receptors for advanced glycation end-products in peritoneal mesothelial cells exposed to glucose degradation products. Clin Exp Immunol 2005; 138:466-75. [PMID: 15544624 PMCID: PMC1809241 DOI: 10.1111/j.1365-2249.2004.02629.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Autoclaving peritoneal dialysate fluid (PDF) degrades glucose into glucose degradation products (GDPs) that impair peritoneal mesothelial cell functions. While glycation processes leading to formation of advanced glycation end-products (AGE) were viewed commonly as being mediated by glucose present in the PDF, recent evidence indicates that certain GDPs are even more powerful inducers of AGE formation than glucose per se. In the present study, we examined the expression and modulation of AGE receptors on human peritoneal mesothelial cells (HPMC) cultured with GDPs, conventional PDF or PDF with low GDP content. HPMC cultured with GDPs differentially modulated AGE receptors (including RAGE, AGE-R1, AGE-R2 and AGE-R3) expression in a dose-dependent manner. At subtoxic concentrations, GDPs increased RAGE mRNA expression in HPMC. 2-furaldehyde (FurA), methylglyoxal (M-Glx) and 3,4-dideoxy-glucosone-3-Ene (3,4-DGE) increased the expression of AGE-R1 and RAGE, the receptors that are associated with toxic effects. These three GDPs up-regulated the AGE synthesis by cultured HPMC. In parallel, these GDPs also increased the expression of vascular endothelial growth factor (VEGF) in HPMC. PDF with lower GDP content exerted less cytotoxic effect than traditional heat-sterilized PDF. Both PDF preparations up-regulated the protein expression of RAGE and VEGF. However, the up-regulation of VEGF in HPMC following 24-h culture with conventional PDF was higher than values from HPMC cultured with PDF containing low GDP. We have demonstrated, for the first time, that in addition to RAGE, other AGE receptors including AGE-R1, AGE-R2 and AGE-R3 are expressed on HPMC. Different GDPs exert differential regulation on the expression of these receptors on HPMC. The interactions between GDPs and AGE receptors may bear biological relevance to the intraperitoneal homeostasis and membrane integrity.
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Affiliation(s)
- K N Lai
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Chan TM, Tse KC, Tang CSO, Mok MY, Li FK. Long-Term Study of Mycophenolate Mofetil as Continuous Induction and Maintenance Treatment for Diffuse Proliferative Lupus Nephritis. J Am Soc Nephrol 2005; 16:1076-84. [PMID: 15728784 DOI: 10.1681/asn.2004080686] [Citation(s) in RCA: 314] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycophenolate mofetil (MMF) and the sequential use of cyclophosphamide followed by azathioprine (CTX-AZA) demonstrate similar short-term efficacy in the treatment of diffuse proliferative lupus nephritis (DPLN), but MMF is associated with less drug toxicity. Results from an extended long-term study, with median follow-up of 63 mo, that investigated the role of MMF as continuous induction-maintenance treatment for DPLN are presented. Thirty-three patients were randomized to receive MMF, and 31 were randomized to the CTX-AZA treatment arm, both in combination with prednisolone. More than 90% in each group responded favorably (complete or partial remission) to induction treatment. Serum creatinine in both groups remained stable and comparable over time. Creatinine clearance increased significantly in the MMF group, but the between-group difference was insignificant. Improvements in serology and proteinuria were comparable between the two groups. A total of 6.3% in the MMF group and 10.0% of CTX-AZA-treated patients showed doubling of baseline creatinine during follow-up (P = 0.667). Both the relapse-free survival and the hazard ratio for relapse were similar between MMF- and CTX-AZA-treated patients (11 and nine patients relapsed, respectively) and between those with MMF treatment for 12 or >/=24 mo. MMF treatment was associated with fewer infections and infections that required hospitalization (P = 0.013 and 0.014, respectively). Four patients in the CTX-AZA group but none in the MMF group reached the composite end point of end-stage renal failure or death (P = 0.062 by survival analysis). It is concluded that MMF and prednisolone constitute an effective continuous induction-maintenance treatment for DPLN in Chinese patients.
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Affiliation(s)
- Tak-Mao Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, New Clinical Building, Room 303, Pokfulam Road, Hong Kong.
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Chan GSW, Lam MF, Au WY, Tse KC, Chan TM, Lai KN, Chan KW. IgA nephropathy complicating graft-versus-host disease, another nephropathy causing nephrotic syndrome after bone marrow transplantation. Histopathology 2004; 45:648-51. [PMID: 15569061 DOI: 10.1111/j.1365-2559.2004.01958.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
OBJECTIVES Hyperlipidemia is a common and important risk factor after renal transplantation, but there is little long-term data on its incidence, pattern, and evolution in stable renal allograft recipients on low dose maintenance immunosuppression. PATIENTS AND METHODS A retrospective study was conducted on all patients who received kidney transplants from April 1, 1990 to March 31, 2000 at a single center, on their serial lipid profile during the first 3 yr after kidney transplantation. RESULTS A total of 221 (122 male, 99 female; mean age 37.8 +/- 10.0 yr at the time of transplantation) Chinese adult renal allograft recipients were included. A 95.3% of patients were on cyclosporine and prednisolone based immunosuppression. Increases in total cholesterol (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL) were noted, while the level of triglyceride (TG) decreased after renal transplant. The incidence of hypercholesterolemia (defined as TC >/= 6.3 mmol/L or LDL >/= 4.2 mmol/L) within the first year was 28.2 and 20.3%, respectively. The incidence rate decreased significantly in the second (5.4%, p = 0.000 and 6.4%, p = 0.003) and third year (9.5%, p = 0.003 and 4.9%, p = 0.021), but the incidence of patients having a high risk-ratio (defined as TC/HDL >/= 5) remained unchanged (6.9, 4.9 and 10.3% within the first, second, and third year, respectively). Treatment with statin was necessitated in 6.8, 13.6 and 21.7% of the patients at 1, 2, and 3 yr after transplantation, respectively. The prevalence rates of elevated TC and LDL were 18.3 and 18.9% at baseline, 40.6 and 33.3% after 1 yr, 32.8 and 27.3% after 2 yr, and 24.8 and 19.0% after 3 yr, despite treatment. The prevalence of patients with a high risk-ratio was 45.0% at baseline, 30.5% after 1 yr (p = 0.002), 22.6% after 2 yr (p = 0.000) and 21.8% after 3 yr (p = 0.000). Hypercholesterolemia at the time of transplantation was an independent predictor for post-transplant hypercholesterolemia (odds ratio 3.76, 95% confidence interval 1.47-9.62, p = 0.006). CONCLUSION Renal transplantation is associated with a characteristic pattern of dyslipidemia, with increased TC, LDL and HDL, and a decrease in TG. Patients with pre-existing hypercholesterolemia were at higher risk for post-transplant hypercholesterolemia. Although the incidence of hypercholesterolemia peaks within the first year after transplantation, this remains a long-term complication in a significant proportion of patients on low dose immunosuppressive medications.
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Affiliation(s)
- Kai-Chung Tse
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lam MF, Lo WK, Chu FSK, Li FK, Yip TPS, Tse KC, Chan TM, Lai KN. Retroperitoneal leakage as a cause of ultrafiltration failure. Perit Dial Int 2004; 24:466-70. [PMID: 15490987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
We report 3 patients on continuous ambulatory peritoneal dialysis (CAPD) who developed reversible ultrafiltration failure secondary to retroperitoneal leakage. The patients presented with pulmonary edema and fluid overload following a sudden onset of ultrafiltration failure on maintenance CAPD. There was no localized edema, suggesting peritoneal leakage in the abdominal wall or the perineum. Radiological examination showed no migration of the Tenckhoff catheter. Leakage of dialysate into the retroperitoneal space was only revealed by computed tomographic (CT) peritoneography. These patients were then treated with intermittent peritoneal dialysis twice weekly. After repeated CT peritoneography showing complete resolution of the leakage, they successfully resumed CAPD treatment 2 months later, without ultrafiltration problems. Our finding suggests that retroperitoneal leakage could be one of the uncommon, yet reversible, causes of acute ultrafiltration failure that can be diagnosed with CT peritoneography.
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Affiliation(s)
- Man-Fai Lam
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Abstract
OBJECTIVES Hyperlipidemia is a common and important risk factor after renal transplantation, but there is little long-term data on its incidence, pattern, and evolution in stable renal allograft recipients on low dose maintenance immunosuppression. PATIENTS AND METHODS A retrospective study was conducted on all patients who received kidney transplants from April 1, 1990 to March 31, 2000 at a single center, on their serial lipid profile during the first 3 yr after kidney transplantation. RESULTS A total of 221 (122 male, 99 female; mean age 37.8 +/- 10.0 yr at the time of transplantation) Chinese adult renal allograft recipients were included. A 95.3% of patients were on cyclosporine and prednisolone based immunosuppression. Increases in total cholesterol (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL) were noted, while the level of triglyceride (TG) decreased after renal transplant. The incidence of hypercholesterolemia (defined as TC >/= 6.3 mmol/L or LDL >/= 4.2 mmol/L) within the first year was 28.2 and 20.3%, respectively. The incidence rate decreased significantly in the second (5.4%, p = 0.000 and 6.4%, p = 0.003) and third year (9.5%, p = 0.003 and 4.9%, p = 0.021), but the incidence of patients having a high risk-ratio (defined as TC/HDL >/= 5) remained unchanged (6.9, 4.9 and 10.3% within the first, second, and third year, respectively). Treatment with statin was necessitated in 6.8, 13.6 and 21.7% of the patients at 1, 2, and 3 yr after transplantation, respectively. The prevalence rates of elevated TC and LDL were 18.3 and 18.9% at baseline, 40.6 and 33.3% after 1 yr, 32.8 and 27.3% after 2 yr, and 24.8 and 19.0% after 3 yr, despite treatment. The prevalence of patients with a high risk-ratio was 45.0% at baseline, 30.5% after 1 yr (p = 0.002), 22.6% after 2 yr (p = 0.000) and 21.8% after 3 yr (p = 0.000). Hypercholesterolemia at the time of transplantation was an independent predictor for post-transplant hypercholesterolemia (odds ratio 3.76, 95% confidence interval 1.47-9.62, p = 0.006). CONCLUSION Renal transplantation is associated with a characteristic pattern of dyslipidemia, with increased TC, LDL and HDL, and a decrease in TG. Patients with pre-existing hypercholesterolemia were at higher risk for post-transplant hypercholesterolemia. Although the incidence of hypercholesterolemia peaks within the first year after transplantation, this remains a long-term complication in a significant proportion of patients on low dose immunosuppressive medications.
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Affiliation(s)
- Kai-Chung Tse
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lam MF, Tse KC, Chan KW, Au WY. Acute renal tubular necrosis due to grass carp ingestion in a myeloma patient after allogeneic stem cell transplantation. Bone Marrow Transplant 2004; 33:669-70. [PMID: 14730340 DOI: 10.1038/sj.bmt.1704403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Objective We investigated the clinical condition and complications of patients on peritoneal dialysis (PD) and on hemodialysis (HD) for more than 12 years. Design This retrospective review was carried out in the renal unit of the Tung Wah Hospital, Hong Kong. Patients and Methods Of 103 HD and 341 PD patients who started dialysis before 1990, 14 HD and 22 PD patients were dialyzed for more than 12 years. We evaluated basic demography at the 12th year of dialysis and at the most recent follow-up, and assessed the prevalence of cardiovascular disease, bone disease, dialysis-related amyloidosis (DRA), and acquired cystic disease (ACD). Outcomes and mortality were recorded. Results The 36 patients in the study included 22 women and 14 men. The PD patients were older ( p = 0.021) and had lower levels of serum phosphate and calcium × phosphate product. Only 3 patients were diabetic. Cardiovascular disease was present in 30 patients (83.3%), the most common types being ischemic heart disease (IHD, n = 11) and left ventricular hypertrophy (LVH, n = 22). Symptomatic DRA was found in 13 patients (36.1%), more commonly in the HD group ( p = 0.014). Bone disease was present in 32 patients (88.9%), with parathyroidectomy being more frequently performed in the PD patients ( p = 0.048). Symptomatic ACD occurred in 5 patients (13.9%). At the most recent follow-up, 26 patients were still on dialysis, 3 patients had undergone renal transplantation, and 7 patients had died, the causes of death being sudden death ( n = 3), cerebrovascular accident ( n = 1), chest infection ( n = 2), and peritonitis ( n = 1). Patient survival was similar in the PD and HD groups. Age at commencement of dialysis predicted mortality ( p = 0.012), but mode of dialysis, sex, and presence of diabetes mellitus did not. Conclusions Long-term survival is possible for both dialysis modalities (PD and HD), particularly for young, non diabetic patients. Symptomatic DRA is less common in PD patients, but the prevalence of other long-term complications is similar for both groups. Cardiovascular-related problems remain the leading cause of death.
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Affiliation(s)
- Kai-Chung Tse
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Sing-Leung Lui
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
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Lo WK, Lui SL, Li FK, Choy BY, Lam MF, Tse KC, Yip TPS, Ng FSK, Lam SC, Chu WL, Cheng SW. A prospective randomized study on three different peritoneal dialysis catheters. Perit Dial Int 2003; 23 Suppl 2:S127-S131. [PMID: 17986531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE We compared outcomes for catheters with different configurations: conventional straight, swan-neck straight tip, and swan-neck curled tip. DESIGN The study was conducted as a prospective randomized controlled trial in the continuous ambulatory peritoneal dialysis (CAPD) unit of a university center. PATIENTS AND METHODS We randomized 93 new regular CAPD patients without prior peritoneal dialysis (PD) catheter insertion to receive a conventional straight, double-cuffed catheter (CS), a swan-neck straight catheter (SNC), or a swan-neck curled tip catheter (SNC) in 2:1:1 ratio. RESULTS The exit-site infection (ESI) rate was slightly lower with swan-neck catheters as compared with straight catheters, but the difference was not statistically significant. The peritonitis rate and overall catheter survival were similar. In Staphylococcus aureus nasal non carriers as compared with carriers, ESI-free catheter survival was significantly better with swan-neck catheters (p = 0.0302 and p = 0.82 respectively). As compared with SC catheters, SNC catheters had a significantly higher migration rate (p = 0.022). CONCLUSIONS Swan-neck catheters were associated with a slightly better ESI rate, but SNC catheters are not routinely recommended because of a high migration rate. The SNS catheter is therefore recommended as the first-line catheter of choice, particularly in populations with a low rate of S. aureus nasal carriage.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
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Tse KC, Lui SL, Lo WK. Comparison of long-term survival (beyond 12 years) in patients on peritoneal dialysis and on hemodialysis. Perit Dial Int 2003; 23 Suppl 2:S104-S108. [PMID: 17986526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE We investigated the clinical condition and complications of patients on peritoneal dialysis (PD) and on hemodialysis (HD) for more than 12 years. DESIGN This retrospective review was carried out in the renal unit of the Tung Wah Hospital, Hong Kong. PATIENTS AND METHODS Of 103 HD and 341 PD patients who started dialysis before 1990, 14 HD and 22 PD patients were dialyzed for more than 12 years. We evaluated basic demography at the 12th year of dialysis and at the most recent follow-up, and assessed the prevalence of cardiovascular disease, bone disease, dialysis-related amyloidosis (DRA), and acquired cystic disease (ACD). Outcomes and mortality were recorded. RESULTS The 36 patients in the study included 22 women and 14 men. The PD patients were older (p = 0.021) and had lower levels of serum phosphate and calcium x phosphate product. Only 3 patients were diabetic. Cardiovascular disease was present in 30 patients (83.3%), the most common types being ischemic heart disease (IHD, n = 11) and left ventricular hypertrophy (LVH, n = 22). Symptomatic DRA was found in 13 patients (36.1%), more commonly in the HD group (p = 0.014). Bone disease was present in 32 patients (88.9%), with parathyroidectomy being more frequently performed in the PD patients (p = 0.048). Symptomatic ACD occurred in 5 patients (13.9%). At the most recent follow-up, 26 patients were still on dialysis, 3 patients had undergone renal transplantation, and 7 patients had died, the causes of death being sudden death (n = 3), cerebrovascular accident (n = 1), chest infection (n = 2), and peritonitis (n = 1). Patient survival was similar in the PD and HD groups. Age at commencement of dialysis predicted mortality (p = 0.012), but mode of dialysis, sex, and presence of diabetes mellitus did not. CONCLUSIONS Long-term survival is possible for both dialysis modalities (PD and HD), particularly for young, non diabetic patients. Symptomatic DRA is less common in PD patients, but the prevalence of other long-term complications is similar for both groups. Cardiovascular-related problems remain the leading cause of death.
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Affiliation(s)
- Kai-Chung Tse
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
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Wu XC, Yi ZW, Tse KC, Liu CZ, Lai WM, Zhao MH. [Outcome and prognosis of children with vesicoureteral reflux]. Zhonghua Er Ke Za Zhi 2003; 41:854-5. [PMID: 14728896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Tse KC, Chan TM, Lai KN. A Misplaced Temporary Hemodialysis Catheter. Int J Organ Transplant Med 2003. [DOI: 10.1016/s1561-5413(09)60117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Chronic HBsAg carriers are known to have a higher risk of hepatitis-related mortality and morbidity when undergoing kidney transplantation. Immunosuppressants might flare up the infection that could be fulminating. Lamivudine and mycophenolate mofetil (MMF) have been shown to be effective in inhibiting replication of hepatitis B virus (HBV). With these two drugs, hepatitis related adverse outcome might be preventable when these patients are being transplanted. Four Chinese adolescents with chronic HBV infection were transplanted in our Department from 1999 to 2001. Immunosuppresants included prednisolone, cyclosporin A and MMF; azathioprine was not used for its potentially liver toxic effect. Prophylactic lamivudine 3 mg/kg and maximum 100 mg daily was given just before transplantation and was continued afterwards. HBV status and liver enzymes were monitored serially. Patients were followed up for 26.0 +/- 10.3 (11-34) months post-transplant and no mortality was reported. All grafts were functioning and no rejection was noted. MMF and lamivudine were well tolerated. Alanine transaminase was only transiently elevated in the first 2 months post-transplant in all patients and became normal afterwards. The patients were clinically well and liver function was normal at the last follow-up. However, HBV DNA became positive in three patients after the transplantation. YMDD mutant HBV was negative in one patient and undeterminable in the other three due to low virus load. In summary, with prophylactic lamivudine and MMF, short-term follow-up showed that renal transplant might be feasible and safe in chronic HBV carriers.
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Affiliation(s)
- S C Lau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
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Tse KC, Li FK, Chan TM, Lai KN. Listeria monocytogenes peritonitis complicated by septic shock in a patient on continuous ambulatory peritoneal dialysis. Clin Nephrol 2003; 60:61-2. [PMID: 12872862 DOI: 10.5414/cnp60061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tse KC, Lam MF, Yip PS, Li FK, Choy BY, Lai KN, Chan TM. Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrol Dial Transplant 2003; 18:1316-20. [PMID: 12808168 DOI: 10.1093/ndt/gfg134] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Minimal change nephrotic syndrome (MCNS) is a common form of nephrotic syndrome in children and young adults. We investigated its clinical presentations, steroid responsiveness, subsequent clinical course and patterns of relapse in older adults in whom it was diagnosed after the age of 50 years. METHODS The clinical records of renal patients followed-up in a single out patient clinic were retrieved and those patients with biopsy-proven MCNS were included. Patients in the 18-50-year age range (Group A) at the time of biopsy were compared with those older than 50 years (Group B) with regard to baseline demographic data, clinical features and outcome of treatment. RESULTS In all, 50 patients were studied, 35 in Group A (age at diagnosis: 38.8+/-11.91 years) and 15 in Group B (age at diagnosis: 70+/-6.85 years), with an overall follow-up duration of 72.08+/-63.42 months. Group B had a higher prevalence of hypertension and lower creatinine clearance at presentation, but the values of creatinine clearance for both groups were comparable with age-matched controls. One patient from Group B and two from Group A had spontaneous remission. Complete remission was achieved in 9.09, 45.45, 90.91 and 100% of Group B patients and 15.63, 62.5, 87.5 and 93.75% of Group A patients after 2, 4, 8 and 16 weeks of steroid therapy, respectively. The median time to complete remission and the duration of steroid treatment were similar for both groups. From Group B five patients and 22 patients from Group A relapsed during follow-up (P=0.055), with similar proportions of each group being early relapsers or frequent relapsers. The average number of relapses was 2.06 episodes for Group A, compared with 0.87 episodes for group B (P=0.062). Second agents were used in 20 Group A and four Group B patients (P=0.048). Complications of treatment were more common in Group A. None of the patients developed doubling of serum creatinine during follow-up. CONCLUSIONS Clinical presentations of older patients with MCNS were similar to younger patients apart from the age-related decline of renal function and higher prevalence of hypertension. Both groups have similar steroid responsiveness, but older patients tend to have fewer relapses and require fewer second agents for treatment of relapses.
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Affiliation(s)
- Kai-Chung Tse
- Nephrology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Choy BY, Chan TM, Li FK, Lui SL, Lo WK, Yip T, Tse KC, Lai KN. IL2-receptor antagonist (basiliximab) induction therapy is associated with lower morbidity and mortality in renal transplant recipients. Transplant Proc 2003; 35:195. [PMID: 12591363 DOI: 10.1016/s0041-1345(02)03980-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B Y Choy
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong, China.
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Tse KC, Chan KW, Tin VPC, Yip PS, Tang S, Li FK, Ho YW, Lai KN, Chan TM. Clinical features and genetic analysis of a Chinese kindred with Fabry's disease. Nephrol Dial Transplant 2003; 18:182-6. [PMID: 12480979 DOI: 10.1093/ndt/18.1.182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fabry's disease is an X-linked recessive inborn error of glycosphingolipid catabolism resulting from deficient activity of lysosomal enzyme alpha-galactosidase A causing occlusive microvascular diseases affecting the kidney, heart, peripheral nerves and brain. It is an uncommon disease in the Oriental population. METHODS AND RESULTS We report a Chinese kindred of Fabry's disease and the relevant clinical features are discussed. The diagnosis of Fabry's disease was based on serum alpha-galactosidase A activity and typical histological features from renal biopsy in the index patient. Genetic analysis of two hemizygous male patients revealed a missense mutation predicting a leucine to proline substitution (L14P) in the alpha-galactosidase gene causing classical Fabry's disease in this family. This is a novel point mutation not described previously in the literature and the second report describing novel genetic mutations for Fabry's disease in Chinese patients. CONCLUSIONS Fabry's disease is rare in Chinese patients but this diagnosis should be considered in patients with positive family history of kidney disease and relevant clinical features.
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Affiliation(s)
- Kai-Chung Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
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Abstract
The disease activity of patients suffering from lupus nephritis usually becomes quiescent after the onset of end stage renal failure. Reactivation of lupus activity, especially after a long period of dialysis, is uncommon. Factors that might trigger off lupus reactivation after dialysis have not been well defined. We report a case of a 43-year-old Chinese woman on long-term peritoneal dialysis, who developed lupus reactivation with cerebral involvement 2 weeks after she was diagnosed to have tuberculous peritonitis. The close temporal relationship between the tuberculous peritonitis and the lupus reactivation raise the possibility that the tuberculous infection might have triggered off the lupus reactivation.
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Affiliation(s)
- S L Lui
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong, People's Republic of China.
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Ngan RKC, Yiu HHY, Lau WH, Yau S, Cheung FY, Chan TM, Kwok CH, Chiu CY, Au SK, Foo W, Law CK, Tse KC. Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study. Ann Oncol 2002; 13:1252-8. [PMID: 12181249 DOI: 10.1093/annonc/mdf200] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m(2) days 1, 8 and 15; cisplatin 50 mg/m(2) days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions. RESULTS There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free. CONCLUSIONS Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.
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Affiliation(s)
- R K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.
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Tse KC, Yip PS, Lam MF, Li FK, Choy BY, Chan TM, Lai KN. Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Perit Dial Int 2002; 22:488-91. [PMID: 12322820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). DESIGN Single-center retrospective case review of patients on CAPD over a 10-year period. SETTING Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. PATIENTS 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. MAIN OUTCOME MEASURES Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D4/D0) with standard 2-L 2.5% glucose dialysate were assessed. RESULTS There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24-76 years) and mean duration of dialysis was 61.6 months (range 2-166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2-12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1-37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes (p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes (p = 0.91) or survival (p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. CONCLUSIONS Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.
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Affiliation(s)
- Kai-Chung Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Tse KC, Yip PS, Hui KM, Li FK, Yuen KY, Lai KN, Chan TM. Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure. Clin Diagn Lab Immunol 2002; 9:482-4. [PMID: 11874897 PMCID: PMC119963 DOI: 10.1128/cdli.9.2.482-484.2002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (Hong Kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. Plasma exchange was instituted in view of the severe hyperbilirubinemia (970 micromol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.
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Affiliation(s)
- Kai-Chung Tse
- Nephrology Division, Department of Medicine, University of Hong Kong
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Tse KC, Yeung CK, Tang S, Chan HH, Li FK, Chan TM, Lai KN. Majocchi's granuloma and posttransplant lymphoproliferative disease in a renal transplant recipient. Am J Kidney Dis 2001; 38:E38. [PMID: 11728998 DOI: 10.1053/ajkd.2001.29294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal transplant recipients are predisposed to infection and malignancy because of underlying long-term immunosuppressive therapy. In this case report, a renal transplant patient with coexisting Trichophyton rubrum granuloma (Majocchi's granuloma) and posttransplant lymphoproliferative disease (PTLD) is presented, showing the undesirable effects of heavy immunosuppression. Majocchi's granuloma was probably associated with PTLD as a reflection of overimmunosuppression.
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Affiliation(s)
- K C Tse
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Tse KC, Li FK, Tang S, Chan TM, Lai KN. Peritoneal dialysis in patients with refractory ascites. Perit Dial Int 2001; 21:626-7. [PMID: 11783779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Abstract
Alcaligenes xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). Peritonitis caused by A. xylosoxidans usually carries a poor prognosis because of the pathogen's virulence and its universal resistance to most antimicrobial agents. Even after early Tenckhoff catheter removal, the transport property of the peritoneum is often irreversibly damaged, leading to permanent technique failure. We report 2 patients with CAPD-associated peritonitis due to A. xylosoxidans sp. xylosoxidans who were successfully cured with a combination of piperacillin and tazobactam. One of them subsequently returned uneventfully to CAPD.
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Affiliation(s)
- S Tang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, People's Republic of China
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Tse KC, Li FK, Tang S, Lam MF, Chan TM, Lai KN. Delusion of worm infestation associated with clarithromycin in a patient on peritoneal dialysis. Perit Dial Int 2001; 21:415-6. [PMID: 11587409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Lee AWM, Ko WM, Foo W, Choi P, Tung Y, Sham J, Cheng B, Au G, Lau WH, Choy D, O SK, Sze WM, Tse KC, Law CK, Teo P, Yau TK, Kwan WK. Nasopharyngeal carcinoma---time lapse before diagnosis and treatment. Hong Kong Med J 1998; 4:132-136. [PMID: 11832564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
This is a descriptive study of 168 patients with nasopharyngeal carcinoma who were referred to public oncology departments for primary treatment between July and September 1996. The mean duration from the onset of the symptoms to histological diagnosis was 5.0 months; the duration ranged from 6.1 months (for patients presenting with nasal symptoms) to 1.8 months (for those with cranial nerve dysfunction). The mean period between the onset of symptoms and the seeking of medical advice was 2.9months. For 54% of the patients, there was a further delay of up to 2.4 months between the initial medical consultation and referral to the appropriate specialist. The majority (84%) of patients attended public institutions for histological confirmation. The mean total time taken from the onset of symptoms to the commencement of radiotherapy was 6.5 months (range, 1.3-74.0 months)---45% of the delay was attributed to the patient, 20% to initial consultations, 14% to diagnostic arrangement, and 21% to preparation for radiotherapy. Concerted efforts are needed to minimise further the time between the onset of symptoms and treatment. A substantial reduction in this delay can be achieved if both public and primary care doctors were made more aware of the significance of relevant symptoms.
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Affiliation(s)
- A WM Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Abstract
Basaloid-squamous carcinoma is a recently characterized, aggressive tumour occurring in the hypopharynx, larynx and base of tongue. We report a unique case involving the nasal cavity of a patient with a history of radiation therapy for nasopharyngeal carcinoma, raising the possibility that basaloid-squamous carcinoma can be radiation-associated.
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Affiliation(s)
- S K Wan
- Institute of Pathology, Queen Elizabeth Hospital, Hong Kong
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