PubMed · 688054
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W Grégoir. 1978. [Anuria].. https://pubmed.ncbi.nlm.nih.gov/688054/
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Twin-twin transfusion is a condition that was previously associated with close to a 100% perinatal mortality. Recent reports suggest that a survival rate of about 60% can be achieved with serial amniocentesis and modern neonatal care. However, it is now apparent that the survivors of this condition have multisystem complications that can result in neonatal mortality and long-term morbidity. Fourteen cases of twin-twin transfusion were examined to determine the antenatal findings that may predict the postnatal outcomes of these infants. The overall survival was 61% (17 of 28). The mean gestation at diagnosis was 23.0 weeks (range 18-34 weeks) and the mean gestation at delivery was 29.0 weeks (range 23-37 weeks). The mean number of amniocenteses was 2.9 and the average total volume of amniotic fluid removed was 6,114 mL. Different patterns of complications were seen in the donor and recipient twins. Hypertrophic cardiomyopathy affected 9 of the recipient twins. Anuria/oliguria was found in 4 of the donor twins and none of the recipients. Periventricular leukomalacia was found in 8 twins and 7 also had mild ventriculomegaly; of the surviving 17 twins, 5 had either periventricular leukomalacia, mild ventriculomegaly or both. Amniotic fluid leakage and perforation of the intervening membrane subsequent to serial amniocentesis were seen in 5 cases. Severe intrauterine growth retardation and abnormal cardiotocographs were a common feature. These complications directly resulted in neonatal mortality and long-term morbidity in the survivors. Not all complications were detected antenatally and the severity was not able to be anticipated.
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The limitations of the ratio of estimated-over-predicted creatinine generation (E/P) as an index of noncompliance were investigated in hypothetical continuous ambulatory peritoneal dialysis (CAPD) populations with steady-state E/ P ranging between 0.5 and 1.5 (mean 1.0), anuria or urine creatinine clearance of 50 L weekly, and omission during the noncompliant state of one, two, or three daily exchanges from a schedule of four daily exchanges, which would provide, in the compliant state, a peritoneal creatinine clearance of 50 L weekly. Standard pharmacokinetic methods were applied to estimate both serum creatinine concentration at the end of the first 24-hour period after resumption of the schedule with four daily exchanges and the amount of creatinine lost from the body in the same nonsteady-state period. The shift of the E/P frequency distribution curve to higher values between the steady and nonsteady states was sufficient to create a clear separation of these curves only in anuria with three-exchange daily noncompliance (nonsteady state: E/P 1.02 - 3.04, with a mean of 2.03). In all other cases, the shift of the E/P curve was small and did not create a clear separation of the E/P frequency distribution curves. Because of the wide variation of the E/P values in the steady state and the relatively small shift of E/P distribution to higher values in the nonsteady state after a sudden increase in total creatinine clearance, E/P is not a suitable test for noncompliance in cross-sectional studies.