1/44. Cardiovascular consequences of renal anaemia and erythropoietin therapy.Cardiovascular disease is the leading cause of increased mortality in patients with renal failure and vigorous attention to cardiovascular risk factors is therefore required to improve patient outcome. The availability of recombinant human Epo has focused the interest on the role of chronic anaemia in the pathogenesis of cardiovascular disease. Severalfold evidence indicates that anaemia can contribute to cardiac volume overload and together with overhydration, fistula flow and the pressure overload secondary to arterial hypertension, it may play a significant role in the development of cardiac hypertrophy. As in the general population left ventricular hypertrophy is a severe adverse risk factor in renal patients. In addition, in the presence of ischaemic heart disease anaemia may further worsen cardiac oxygen supply. This dual effect of anaemia probably explains why epidemiological studies have shown that a 1 g/dl decrease in haemoglobin levels is an independent, statistically significant risk factor for the development of cardiac morbidity and mortality. Follow-up examinations have demonstrated that partial correction of anaemia with recombinant Epo can improve cardiac oxygen supply and partially reverse pathological changes in left ventricular geometry. However, although partial anaemia correction regularly reduces left ventricular volume, the effects on wall thickness are far less significant. Moreover, in patients with advanced cardiac disease it has recently not been possible to demonstrate that a normalization of haemoglobin levels provides further benefit. It is not unlikely therefore that the development of severe anaemia has to be prevented by early implementation of Epo therapy in order to achieve the maximum benefit with respect to the cardiovascular system.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/44. percutaneous coronary intervention as a bridge to renal transplantation in a patient with end-stage renal disease--a case report.Renal transplantation is one of the preferred modes of replacement therapy in patients with end-stage renal disease. Cardiovascular disease remains the leading cause of morbidity and mortality in patients with end-stage renal disease and renal transplant recipients. The authors describe a patient with end-stage renal disease who developed unstable angina before renal transplantation. Emergent cardiac catheterization and percutaneous coronary intervention served as a bridge to his successful renal transplantation without complications.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
3/44. Detection of cardiac calcinosis in hemodialysis patients by whole-body scintigraphy with 99m-technetium methylene diphosphonate.A noninvasive method for the diagnosis of cardiac calcinosis, a life-threatening complication in hemodialysis patients with end-stage renal disease (ESRD), has not, as yet, been firmly established. We tested whether whole body scanning with 99m-technetium methylene diphosphonate (MDP) might visualize cardiac calcinosis. In 19 consecutive chronic hemodialysis ESRD patients (13 males and 6 females, aged 40-81, mean 63 /- 8 years) with cardiovascular disease [mitral annular calcinosis and/or calcified aortic valve (n = 4), hemodialysis cardiomyopathy (n = 1), coronary artery disease (n = 9) and peripheral artery atherosclerotic disease (n = 6)], MDP uptake in the heart was compared to that in 7 non-ESRD controls with hyperparathyroidism due to adenoma. Cardiac and lung field MDP uptake was confirmed in only 3 (16%) and 5 (26%) of the 19 ESRD subjects, respectively, but was absent in controls. Positive cardiac uptake was related to cardiac calcified complications (mobile intracardiac calcinosis, myocardial calcinosis and mitral annular calcification) and the duration of hemodialysis (p = 0.015). While it was statistically insignificant, subjects showing MDP uptake were elder and had higher serum Ca or Ca x P product and lower intact parathyroid hormone levels. These results suggest that cardiac calcinosis in ESRD patients can be detected noninvasively by myocardial scintigraphy with 99m-technetium MDP.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
4/44. carbon disulfide nephropathy.A 45-year-old nondiabetic man presented with features resembling diabetic triopathy. He worked in a rayon manufacturing plant and was exposed to toxic levels of carbon disulfide (CS(2)). Clinical abnormalities included peripheral and central nervous system abnormalities as well as retinopathy, dyslipidemia, cardiovascular disease, and nephrotic syndrome. He later developed focal sclerosing glomerulonephritis. The latter has not previously been described in cases of CS(2) exposure. Terminally, he developed end-stage renal disease and progressive dementia, both of which were thought to be consequences of CS(2) exposure earlier in life.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
5/44. Repeated transient anuria following losartan administration in a patient with a solitary kidney.We report the case of a 70-year-old hypertensive man with a solitary kidney and chronic renal insufficiency who developed two episodes of transient anuria after losartan administration. He was hospitalized for a myocardial infarction with pulmonary edema, treated with high-dose diuretics. Due to severe systolic dysfunction losartan was prescribed. Surprisingly, the first dose of 50 mg of losartan resulted in a sudden anuria, which lasted eight hours despite high-dose furosemide and amine infusion. One week later, by mistake, losartan was prescribed again and after the second dose of 50 mg, the patient developed a second episode of transient anuria lasting 10 hours. During these two episodes, his blood pressure diminished but no severe hypotension was noted. Ultimately, an arteriography showed a 70-80% renal artery stenosis. In this patient, renal artery stenosis combined with heart failure and diuretic therapy certainly resulted in a strong activation of the renin-angiotensin system (RAS). Under such conditions, angiotensin ii receptor blockade by losartan probably induced a critical fall in glomerular filtration pressure. This case report highlights the fact that the angiotensin ii receptor antagonist losartan can cause serious unexpected complications in patients with renovascular disease and should be used with extreme caution in this setting.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
6/44. Successful renal transplantation after endovascular bifurcated stent graft repair of an abdominal aortic aneurysm.Renal transplantation after repair of aortoiliac aneurysms with traditional prosthetic vascular grafts has been shown to be effective. Vascular surgery continues to rapidly evolve, most notably with the advancement of endovascular repair of abdominal aortic aneurysms. Controlled trials continue to support the trend toward the use of endovascular bifurcated aortic stent grafts. For this we describe the first renal transplant in a patient with an endovascular bifurcated aortoiliac stent graft. No intraoperative difficulties were encountered. At 1-year follow-up, the transplanted kidney is functioning well with a normal serum creatinine level of 1.3 mg/dl, and the patient has no worsening of peripheral vascular disease. We recommend that the presence of an endovascular aortic graft not be a contraindication to renal transplantation.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
7/44. gadolinium-based coronarography in a patient with renal failure: first clinical report.This article reports the use of gadolinium to perform a coronarography in a patient with renal insufficiency, unstable angina, and peripheral vascular disease. The examination was well tolerated and the images obtained of good quality. Cathet Cardiovasc Intervent 2001;54:68-69.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
8/44. The hemodialysis patient and hand amputation.The hemodialysis patient requires continued attention once an access surgery has been performed. These procedures lead to an anticipated physiological steal in the involved hand, but rarely lead to hand loss. When the patient has had previous peripheral vascular disease, known diabetes mellitus, multiple interventions on the same extremity, and the use of a synthetic graft, the incidence of digital or hand ischemia is significantly increased. This article represents 3 individuals who required hand amputation for severe ischemia. The pertinent clinical features in each individual will be explained and the literature reviewed for the factors promoting this complication and the all-autogenous access policies which may help to prevent hand ischemia.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
9/44. Two cases of penile necrosis in diabetics with end-stage renal failure.Distal penile necrosis associated with renal failure is a rare entity; only a few cases have been reported in the literature. Penile necrosis can frequently be a difficult management problem, the etiology of which is infectious, traumatic, or vascular. Physiological abnormalities are usually found in association with this condition, including diabetes, hyperparathyroidism, and peripheral vascular disease. Penile necrosis is a poor prognostic factor associated with high morbidity. We report two cases of this condition, presenting the clinical and pathophysiological background.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
10/44. Hemoglobin levels, cardiovascular disease, and left ventricular hypertrophy in patients with chronic kidney disease. Case study of the anemic patient.Cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease. anemia, a well-defined risk factor for cardiovascular disease, has been shown to contribute to the development of angina pectoris, ischemic events, and left ventricular hypertrophy. Data indicate that these cardiovascular-related disorders are often ameliorated or reversed in patients who maintain hemoglobin (Hb) levels in the 11 to 12 g/dL range recommended by NKF-K/DOQI. Conversely, Hb levels below 11 g/dL result in an increase in cardiovascular disorders and a 2.9-fold increased risk of death. nephrology nurses should understand the interplay between Hb levels and cardiovascular disease, and how their efforts to maintain Hb levels > or = 11 g/dL can positively affect patient outcomes.- - - - - - - - - - ranking = 3.5keywords = vascular disease (Clic here for more details about this article) |
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