Cases reported "Kidney Failure, Chronic"

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1/21. Efficacy of intraperitoneal amino acid (IPAA) dialysate in an Asian vegetarian patient with chronic hypoalbuminaemia.

    Protein-calorie malnutrition is commonly found in chronic CAPD patients and is a matter of concern since low serum albumin levels correlate with an increased risk of morbidity and mortality. Recognition of this link has therefore led to a growing interest in the efficacy of IPAA therapy as a possible treatment option. The present case study took place within a larger, ongoing clinical trial and outlines our experience of administering one exchange of 1.1% IPAA (Nutrineal, Baxter Healthcare Ltd) per day over 18 weeks to a patient identified as being protein malnourished.
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2/21. Another choice for the blind.

    Automated peritoneal dialysis has proved to be an effective treatment for many patients. This presentation outlines the training issues and management of a 48-year-old registered blind, insulin dependent diabetic, who developed renal failure.
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3/21. Primary hyperoxaluria type 1 causing end-stage renal disease in a 45-year-old patient.

    Primary hyperoxaluria type 1 (PH1) is caused by deficiency of peroxisomal alanine-glyoxylate aminotransferase which is in humans exclusively expressed in liver cells. The disease is inherited as an autosomal recessive trait, and initial symptoms usually occur in early childhood. Up to the age of 25 years, 90% of the patients are symptomatic, and many patients develop end-stage renal failure. Pronounced medical care is necessary in PH1 patients to prevent generalized oxalosis with complications due to bone disease and peripheral gangrene. The rather short survival of patients on hemodialysis is caused by sudden arrhythmias and heart block. As no dialysis procedure is able to remove the daily produced oxalate, early transplantation is mandatory. Our 45-year-old patient is remarkable on the basis of the late manifestations of PH1. The diagnosis was delayed by unspecific symptoms of nephrolithiasis with recurrent pyelonephritis. Clinical course and diagnostic cornerstones of primary hyperoxaluria are outlined. The principles of conservative treatment and experiences with dialysis and transplantation are discussed.
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4/21. Anesthetic management for coronary bypass patients on hemodialysis: report of 4 patients.

    We reported our own experience in four patients with chronic renal failure on maintenance hemodialysis undergoing coronary artery bypass graft surgery (CABGS). A balanced general anesthesia with endotracheal intubation was successfully achieved by using midazolam, atracurium, fentanyl, pentothal, nitrous oxide in oxygen and isoflurane. All patients were hemodialyzed within 24 hours before operation. One patient started peritoneal dialysis 10 hours after surgery. Three other patients were managed by hemodialysis the day after surgery. There was no hospital mortality. Many aspects of management of these patients which differ from those of routine cardiac surgical patients are outlined and discussed.
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5/21. Non-tropical thoraco-abdominal pyomyositis caused by group A streptococcus in an immunocompetent adult.

    We present a case of group A streptococcal pyomyositis of the thoraco-abdominal wall of an immunocompetent adult. This diagnosis was made when soft tissue swelling was seen on chest X-ray. Complete recovery followed drainage of the collection and short-course i.v. penicillin. The importance, diagnosis and treatment of pyomyositis are outlined.
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6/21. Prolonged hemolysis from overheated dialysate.

    A patient with chronic renal failure exposed to overheated dialysate (50 degrees C) for 20 minutes developed evidence of delayed and protracted hemolysis, which continued for several days. By contrast, in the only previously reported similar case, sudden gross hemolysis followed by cardiac arrest occurred. It is emphasized that the rapidity and severity of hemolysis due to thermal injury to erythrocytes are dependent upon the duration of exposure and the height of temperature to which extracorporeal blood is exposed. methods of preventing such incidents and therapeutic approaches are outlined.
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7/21. Organ recovery from a donor with end-stage renal disease: a case study.

    As the field of transplantation enters the new millennium, maximizing organs per donor remains one of the greatest challenges of procurement. This case study outlines nontraditional medical management techniques that facilitated the recovery of 5 transplantable organs from a patient with end-stage renal disease. Strategies utilized in this case included the use of continuous veno-venous hemodialysis and airway pressure release ventilation to maximize the outcomes of the donation. Although the use of these strategies is admittedly limited to hospitals where the resources are available, this case study suggests that utilizing available resources in any clinical setting can make more organs available to people on the waiting list for solid organ transplantation.
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8/21. Unstable diabetes and peritoneal dialysis--what are the challenges?

    This case study outlines the care of a young woman undergoing peritoneal dialysis (PD) who has Type 1 diabetes mellitus as the underlying cause of her renal disease. Although she is able to manage the practical aspects of her fluid exchanges and exit-site care, she has difficulty with managing her fluid balance. This necessitates the use of two 3.86% glucose bags per day, which in turn sometimes leads to high, unstable, blood glucose levels. This study will outline the nursing challenges and interventions and will evaluate the nursing management.
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9/21. bardet-biedl syndrome and cystinuria.

    An unusual association of bardet-biedl syndrome with cystinuria was described in one patient. A 21-year-old male was admitted to hospital because of renal failure, severe deterioration of visual acuity, polydactyly, brachydactyly, and mental retardation. Laboratory investigations revealed a serum creatinine of 292 mumol/L (3.3 mg/dL) and a GFR of 25 mL/min per 1.73 m2. Quantitative ion exchange chromatography demonstrated an increased urinary excretion rate of cystine, lysine, arginine, and ornithine. The ophthalmologic examination showed a severe atypical retinal dystrophy. visual acuity was severely deteriorated and the patient could only count the examining physician's fingers. The patient had been previously evaluated at the age of 7 years for polyuria, polydipsia, and growth failure. His workup at that time demonstrated nephrogenic diabetes insipidus, normal GFR, and a urinary amino acid pattern consistent with the cystinuric phenotype. There was mental retardation notwithstanding the normal ophthalmologic examination. Intravenous pyelography showed calyceal clubbing, calyceal cysts, and lobulated renal outlines of the fetal type. The patient was evaluated again at the age of 13 years for deterioration of visual acuity and the ophthalmologic examination showed an atypical retinal dystrophy, with sparse pigmentation, central and peripheral atrophy, attenuated vessels, and marked optic disk pallor. To our knowledge the association of bardet-biedl syndrome with cystinuria has never been reported. It is unlikely that cystinuria may have contributed to the kidney damage. The possibility that mental retardation has been induced or aggravated by cystinuria cannot be excluded.
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10/21. Retrieval of a fractured piece of Tessio catheter with a snare using a transcutaneous transvenous approach.

    Approximately 20% of end-stage renal disease patients requiring hemodialysis have central dialysis catheters as their vascular access. The major cause of central dialysis catheters removal or revision is infection or occlusion. Catheter occlusions may occur as a result of thrombosis or fibrin sheath formation. However, the presence of a fractured dialysis catheter tip requiring immediate extraction to prevent serious complications is rare. Herein we present the case of a central dialysis catheter referred to us for malfunction. An incidental finding was a piece of catheter that had broken off the venous port and was seen in the right atrium. The retrieval and subsequent placement of a new central dialysis catheter are outlined.
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