Nephrology Hypertension

Pharmacology and Toxicology: Treatment of Poisons – General Description of Problem

Does this patient have toxic effects of poisoning? The 2009 Annual Report of the American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) included 2,849,086 human exposure cases reported by 62 poison centers during 2009. This was an increase of 20% compared with 1999, and an increase of 118% as compared to…

Hemodialysis: Acute Complications – Intradialytic hemolysis

Does this patient have intrdialytic hemolysis? Grossly translucent hemolyzed blood in the extracorporeal blood line Symptoms vary depending on causes and severity Continue Reading Causes Mechanical High blood flow rate, single-needle dialysis, small-gauge cannula, kinked blood line, highly negative arterial pressure, offset blood pump Dialysate contamination Chloramine: dyspnea, cyanosis (methemoglobinemia, not improved by oxygen therapy),…

Kidney Transplantation: Prevention and Management of Transplant Associated Complications – Polyoma BK Virus Infection

Does this patient have BK virus infection? BK virus (BKV) is a DNA virus that typically infects children and remains latent in the immunocompetent host. BK viruria develops in 25% of transplant recipients and viremia in about 15%. Continue Reading Histologically confirmed Polyoma Virus Allograft Nephropathy (or PVAN) occurs in <5% of patients. Older age,…

Kidney Transplantation: Prevention and Management of Transplant Associated Complications – Cytomegalovirus

Does this patient have cytomegalovirus? Cytomegalovirus (CMV) after Kidney Transplantation CMV is a human herpes virus (DNA virus). Approximately 2/3 of adults have been exposed to CMV and are consequently seropositive. Continue Reading CMV can be contracted from the general community, transmitted via solid organ transplantation, or may be a reactivation of latent disease. Definitions…

Kidney Transplantation: Diagnosis and Management of Early Graft Dysfunction – Intrinsic Causes and Treatments

Does this patient have early graft dysfunction related to intrinsic causes? What is early graft dysfunction? Kidney transplantation is the preferred mode of renal replacement therapy for end stage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, 1-year patient survival is close…

Kidney Transplantation: Diagnosis and Management of Early Graft Dysfunction – Pre-Renal Causes and Treatments

Does this patient have early graft dysfunction related to pre-renal causes? What is early graft dysfunction? Kidney transplantation is the preferred mode of renal replacement therapy for end stage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, one year patient survival is…

Kidney Transplantation: Diagnosis and Management of Early Graft Dysfunction – Post-Renal Causes and Treatments

Does this patient have early graft dysfunction related to post-renal causes? What is early graft dysfunction? Kidney transplantation is the preferred mode of renal replacement therapy for end stage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, one year patient survival is…

Hemodialysis: Acute Complications – Seizure

Does this patient have seizure? Focal or generalized seizure Causes Hyponatremia Hypoglycemia Continue Reading Hypercalcemia Hypocalcemia Hypomagnesemia Uremic encephalopathy Dialysis disequilibrium syndrome Hard water syndrome (high calcium or magnesium in dialysate) Cerebrovascular accident (ischemic or hemorrhage) Subdural hematoma Malignant hypertension (hypertensive encephalopathy) Cerebral anoxia due to sustained hypotension Suboptimal anti-convulsant plasma level (removed during dialysis)…

Hemodialysis: Acute Complications – Dialysis-induced Headache

Does this patient have dialysis-induced headache? Symptoms Bifrontal discomfort (throbbing) Nausea with or without vomiting Aggravated by supine position No accompanying visual disturbances Continue Reading The International Headache Society (IHS) defines dialysis-related headache as a headache with no specific characteristics that develops during hemodialysis and resolves spontaneously within 72 hours of completion of the dialysis…

Hemodialysis: Acute Complications – Dialysis Disequilibrium Syndrome

Does this patient have dialysis disequilibrium syndrome? Symptoms Symptoms result from brain edema, varying from mild to severe: Headache Nausea with or without vomitingContinue Reading Dizziness Muscle cramp Blurred vision Tremors Restlessness Agitation Alteration of consciousness Seizure Coma Sudden cardiac arrest Syndrome is usually mild, transient, and self-limited Symptoms develop during dialysis, immediately post-dialysis or…

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