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1.
JNMA J Nepal Med Assoc ; 60(245): 83-85, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35199683

RESUMO

Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.


Assuntos
Anuria , Leptospirose , Feminino , Febre , Humanos , Leptospirose/diagnóstico , Leptospirose/tratamento farmacológico , Pessoa de Meia-Idade , Nepal , Diálise Renal
4.
Exp Clin Transplant ; 19(10): 1032-1040, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34498551

RESUMO

OBJECTIVES: Antibody-mediated rejection in patients with positive crossmatches can be severe and result in sudden onset of oliguria, leading to graft loss. In an attempt to prevent posttransplant oliguria, we adopted a preoperative desensitization protocol involving the use of high-dose intravenous immunoglobulin/plasmapheresis and the anti-CD20 antibody, rituximab, in 41 transplant recipients with positive crossmatch test results. MATERIALS AND METHODS: We retrospectively examined the clinical courses of the 41 kidney transplant recipients, paying special attention to renal graft function, urine volume, and changes in the titers of donor-specific antibodies. RESULTS: Four grafts were lost during an average of 4.5-year follow-up. Average graft function was excellent, with a serum creatinine level of 1.3 ± 0.4 mg/dL. Sufficient urine output, with no oliguria or anuria, was achieved postoperatively in 40 of the 41 patients. However, among the 34 patients who underwent graft biopsies, the biopsies revealed acute antibody-mediated rejection in 21 patients (62%), and chronic antibodymediated rejection in 10 patients (30%). CONCLUSIONS: The high-dose intravenous immunoglobulin treatment included in our desensitization protocol was shown to be safe and effective for achieving successful transplant outcomes and allowed the avoidance of more aggressive B-cell-targeted treatments, such as C5 inhibitors and/or proteosome inhibitors, for preventing posttransplant oliguria and anuria.


Assuntos
Anuria , Transplante de Rim , Anticorpos Monoclonais Humanizados , Bortezomib/efeitos adversos , Dessensibilização Imunológica/efeitos adversos , Dessensibilização Imunológica/métodos , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Antígenos HLA , Teste de Histocompatibilidade , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Masculino , Oligúria/tratamento farmacológico , Plasmaferese/efeitos adversos , Estudos Retrospectivos , Rituximab/efeitos adversos , Transplantados , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(29): e26231, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398000

RESUMO

RATIONALE: Neuromyelitis optica spectrum disorders (NMOSD) is a rare autoimmune disease predominantly involving optic nerves and spinal cord, and possible comorbidities including syndrome of inappropriate antidiuretic hormone secretion or urinary complication. We reported a young girl diagnosed with NMOSD presented with refractory hyponatremia, acute urine retention, and general weakness. Clinical symptoms improved gradually after receiving intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. NMOSD should be kept in mind in adolescence with acute urine retention, intermittent fever, and hyponatremia. PATIENT CONCERNS: A 15-year-old girl admitted to our hospital due to no urination for 2 days. DIAGNOSIS: Aquaporin-4 antibodies were detected showing positive both in serum and cerebrospinal fluid. Long transverse myelitis in cervical and thoracic spinal cord and optic neuritis was revealed in magnetic resonance imaging. INTERVENTIONS: Intravenous immunoglobulin 2 g/kg was infused totally in 4 days, and methylprednisolone pulse therapy was subsequently followed in 5 days; followed by 5 courses of plasmapheresis a week later. OUTCOMES: Her muscle power, syndrome of inappropriate antidiuretic hormone secretion condition, and urinary function were all improved after immune-modulated treatment course; NMOSD relapsed twice within the first year after diagnosis, however no relapse of NMOSD in the subsequent 1 year. LESSONS: To the best of our knowledge, this was the first childhood case of NMO accompanied by refractory hyponatremia in the reported literature. In childhood cases presenting with refractory hyponatremia and limb weakness, NMO or NMOSD should be considered possible diagnoses despite their rarity in pediatric cases.


Assuntos
Hiponatremia/classificação , Neuromielite Óptica/complicações , Adolescente , Anuria/etiologia , Feminino , Humanos , Hiponatremia/etiologia , Imunoglobulinas Intravenosas/farmacologia , Imunoglobulinas Intravenosas/uso terapêutico , Pediatria
9.
BMJ Case Rep ; 14(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33986003

RESUMO

We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.


Assuntos
Anuria , Nefrostomia Percutânea , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico , Obstrução Ureteral , Feminino , Humanos , Diafragma da Pelve/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
10.
Kidney Blood Press Res ; 46(3): 387-392, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33979795

RESUMO

INTRODUCTION: Hyponatraemia is associated with increased mortality in patients undergoing maintenance haemodialysis. In anuric patients, hyponatraemia development depends on the water-sodium ratio in retained fluid within the interdialysis interval (IDI). OBJECTIVE: This study aimed to calculate the retained sodium-retained water ratio in patients on maintenance haemodialysis and make a differential diagnosis of hyponatraemia according to these data. METHODS: The amount of retained water was determined as body weight gain (ΔBW) within the IDI. Sodium retention was calculated using our formula: eRNa+ = ΔBW × (SNa+)t2 - total body water (TBW)t1 × ([SNa+]t1 - [SNa+]t2), where TBW represents the calculated volume of the total body water and (SNa+)t1 and (SNa+)t2 represent the sodium concentration at the beginning and at the end of the IDI, respectively. We performed 89 measurements in 32 anuric patients on maintenance haemodialysis. RESULTS: Hyponatraemia was detected in 13 measurements at the end of the IDI. The ΔBW had no statistically significant difference between normonatraemic and hyponatraemic patients. Hyponatraemic patients had significantly lower levels of retained sodium. The retained water--retained sodium ratio facilitated in differentiating dilution hyponatraemia, nutritional hyponatraemia, depletion hyponatraemia, and dilution hyponatraemia associated with sodium wasting or malnutrition. CONCLUSION: The composition of retained fluid during the IDI may be hypotonic, hypertonic, or isotonic in relation to the extracellular fluid. Most of the hyponatraemic patients had hypotonic fluid retained during the IDI because of dilution as well as gastrointestinal sodium loss and/or malnutrition.


Assuntos
Anuria/terapia , Hiponatremia/diagnóstico , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Anuria/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hiponatremia/complicações , Masculino , Pessoa de Meia-Idade , Sódio/análise , Equilíbrio Hidroeletrolítico
11.
Am J Case Rep ; 22: e931319, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33888675

RESUMO

BACKGROUND Acetazolamide (ACTZ) is commonly used in the prevention and treatment of various clinical conditions, and anuric acute kidney injury (AKI) is one of its known life-threatening complications. CASE REPORT We hereby report the case of a middle-aged man known to have compensated heart failure and hypertension with previously normal kidney function, who received a total dose of 2250mg of ACTZ over 3 days after cataract surgery. One week after the operation, he presented with anuria and severe bilateral renal colic, as well as progressively worsening kidney function and metabolic profile, which eventually required hemodialysis prior to recovery. CONCLUSIONS The cause of the AKI was attributed to intra-tubular obstruction by ACTZ-induced crystalluria, which required discontinuing the offending agent and dialysis to correct the kidney functions.


Assuntos
Injúria Renal Aguda , Anuria , Catarata , Acetazolamida/efeitos adversos , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/terapia , Anuria/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal
12.
J Obstet Gynaecol Res ; 47(3): 1195-1198, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33522051

RESUMO

Reflex anuria is a rare cause of acute renal failure, which may occur following ureteric manipulation or painful stimuli to adjacent organs during pelvic surgery. This condition, relatively unfamiliar to the general gynecologist, should be considered even when no obvious cause of anatomical obstruction is found. We present a case of reflex anuria in a 28-year-old woman for two large intramural fibroids. Evaluation did not reveal any organic obstruction of the urinary tract. Bilateral ureteric stenting and other supportive measures resulted in diuresis and improvement of renal function. Stents were removed after 10 days and patient was discharged on the 15th postoperative day with normal renal parameters. Intrarenal arteriolar spasm or ureteric spasm following pelvic manipulation can cause reflex anuria and should be considered in the differential diagnosis of acute renal failure in cases following pelvic surgery.


Assuntos
Injúria Renal Aguda , Anuria , Miomectomia Uterina , Injúria Renal Aguda/etiologia , Adulto , Feminino , Humanos , Rim , Reflexo , Miomectomia Uterina/efeitos adversos
13.
J Pediatr Hematol Oncol ; 43(8): e1156-e1158, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625080

RESUMO

No reports describe high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (auto-PBSCT) in pediatric patients with neuroblastoma and end-stage renal disease. Here, we report the case of a patient with high-risk neuroblastoma who developed anuria during treatment. HDCT with auto-PBSCT under hemodialysis, with strict attention to the ultrafiltration volume and dose modification of alkylating agents, was performed. Although the first auto-PBSCT led to engraftment failure, the second auto-PBSCT resulted in successful myeloid engraftment 8 months after anuria. This case demonstrated that HDCT with auto-PBSCT can be safely performed in children with renal failure under hemodialysis.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Anuria/terapia , Falência Renal Crônica/terapia , Neuroblastoma/terapia , Transplante de Células-Tronco de Sangue Periférico/métodos , Diálise Renal/métodos , Anuria/etiologia , Anuria/patologia , Pré-Escolar , Terapia Combinada , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/patologia , Masculino , Neuroblastoma/complicações , Neuroblastoma/patologia , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Prognóstico , Transplante Autólogo
14.
Clin Med (Lond) ; 21(1): e103-e105, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33479088

RESUMO

Tetanus is a rapidly progressive infection characterised by painful spasms and muscular rigidity with a series of complications including airway obstruction, respiratory failure, pulmonary infection, heart arrhythmias and acute kidney injury. Rhabdomyolysis with acute anuria renal failure is rarely reported as a complication in tetanus. We present a case of an adult who suffered from rhabdomyolysis combined with acute anuria renal failure caused by surgical injection-induced tetanus. This patient was treated with tetanus immunoglobulin, control of muscle spasm, mechanical ventilation and haemoperfusion plus continuous veno-venous haemofiltration (CVVH). The patient fully recovered and was discharged from hospital 5 weeks after admission. Good bowel preparation is an important prerequisite for preventing tetanus in a haemorrhoids operation. Effective control of muscle spasms with neuromuscular blockers and early administration of haemoperfusion plus CVVH are vital to the treatment of tetanus-induced rhabdomyolysis with acute renal failure.


Assuntos
Injúria Renal Aguda , Anuria , Rabdomiólise , Tétano , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/terapia , Adulto , Humanos , Respiração Artificial , Rabdomiólise/etiologia , Rabdomiólise/terapia
16.
BMC Nephrol ; 21(1): 488, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203373

RESUMO

BACKGROUND: Pregnancy-related Atypical Haemolytic Uremic Syndrome (P-aHUS) is a rare condition affecting genetically predisposed women during pregnancy. It is often difficult to diagnose and has a significant impact on maternal and foetal outcomes. It is characterised by microangiopathic haemolytic anaemia and kidney injury from thrombotic microangiopathy. CASE PRESENTATION: A 27-year-old female of Lebanese descent presented at 36 weeks' gestation with foetal death in-utero (FDIU) with placental abruption on a background of previously normal antenatal visits. She was coagulopathic and anaemic with anuric acute kidney injury, requiring emergency Caesarean section, intubation and dialysis. Her coagulopathy rapidly resolved, however, her anaemia and renal dysfunction persisted. A diagnosis of P-aHUS was made, and she was empirically treated with Eculizumab. Her ADAMTS13 level was normal, effectively excluding thrombotic thrombocytopenic purpura. Within 2 weeks of treatment her haematological parameters improved, and her renal function began to recover and within 2 months she became dialysis independent. CONCLUSION: This case highlights the challenges of a timely diagnosis of P-aHUS from other pregnancy-related diseases. Although our patient is dialysis-independent, her risk of relapse remains high with subsequent pregnancies. Currently we are awaiting her genetic sequencing to complete her assessment for underlying mutations and are determining the safest approach to a future planned pregnancy.


Assuntos
Descolamento Prematuro da Placenta , Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome Hemolítico-Urêmica Atípica/diagnóstico , Inativadores do Complemento/uso terapêutico , Complicações na Gravidez/diagnóstico , Injúria Renal Aguda/etiologia , Adulto , Anuria/etiologia , Síndrome Hemolítico-Urêmica Atípica/complicações , Síndrome Hemolítico-Urêmica Atípica/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Morte Fetal , Humanos , Rim/diagnóstico por imagem , Gravidez , Complicações na Gravidez/tratamento farmacológico , Microangiopatias Trombóticas/diagnóstico
17.
PLoS One ; 15(11): e0242254, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196667

RESUMO

BACKGROUND: Residual kidney function (RKF) is associated with improved survival and quality of life in dialysis patients. Previous studies have suggested that initiation of peritoneal dialysis (PD) may slow RKF decline compared to the pre-dialysis period. We sought to evaluate the association between PD initiation and RKF decline in the Initiating Dialysis Early And Late (IDEAL) trial. METHODS: In this post hoc analysis of the IDEAL randomized controlled trial, PD participants were included if results from 24-hour urine collections had been recorded within 30 days of dialysis initiation, and at least one value pre- and one value post-dialysis commencement were available. The primary outcome was slope of RKF decline, calculated as mean of urinary creatinine and urea clearances. Secondary outcomes included slope of urine volume decline and time from PD initiation to anuria. RESULTS: The study included 151 participants (79 early start, 72 late start). The slope of RKF decline was slower after PD initiation (-2.69±0.18mL/min/1.73m2/yr) compared to before PD (-4.09±0.33mL/min/1.73m2/yr; change in slope +1.19 mL/min/1.73m2/yr, 95%CI 0.48-1.90, p<0.001). In contrast, urine volume decline was faster after PD commencement (-0.74±0.05 L/yr) compared to beforehand (-0.57±0.06L/yr; change in slope -0.18L/yr, 95%CI -0.34--0.01, p = 0.04). No differences were observed between the early- and late-start groups with respect to RKF decline, urine volume decline or time to anuria. CONCLUSIONS: Initiation of PD was associated with a slower decline of RKF compared to the pre-dialysis period.


Assuntos
Rim/fisiopatologia , Diálise Peritoneal , Idoso , Anuria/etiologia , Creatinina/urina , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Ureia/urina
18.
BMC Nephrol ; 21(1): 241, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600269

RESUMO

BACKGROUND: Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and end-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was completely reversible after pericardectomy. CASE PRESENTATION: A 43-year-old female caucasian patient received a living kidney donation from her mother. She had developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease after allogenic stem-cell transplantation for aplastic anemia. The graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery, but the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography showed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion profiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem on ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive acute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused by severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis, which could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been apparent on previous x-rays, computed tomography scans, or echocardiographies, including those for transplantation evaluation. Conservative management of the constrictive pericarditis was not successful and the graft remained anuric. Eventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the graft started urine production again, which significantly increased within a few days. The clearance improved and 2 weeks later, the patient was free from dialysis. CONCLUSIONS: This case illustrates that special attention should be given to the pericardium during transplant evaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation.


Assuntos
Anuria/fisiopatologia , Função Retardada do Enxerto/fisiopatologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Pericardiectomia , Pericardite Constritiva/cirurgia , Adulto , Anemia Aplástica/terapia , Feminino , Doença Enxerto-Hospedeiro/complicações , Transplante de Células-Tronco Hematopoéticas , Humanos , Falência Renal Crônica/etiologia , Pericardite Constritiva/fisiopatologia
19.
Clin Rheumatol ; 39(9): 2811-2815, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32720260

RESUMO

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.


Assuntos
Síndrome Antifosfolipídica/imunologia , Infecções por Coronavirus/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Pneumonia Viral/imunologia , Adolescente , Anemia/etiologia , Anticorpos Anticardiolipina/imunologia , Anticorpos Antinucleares/imunologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Anuria/etiologia , Betacoronavirus , COVID-19 , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Complemento C3/imunologia , Complemento C4/imunologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , DNA/imunologia , Ecocardiografia , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Hematúria/etiologia , Humanos , Inibidor de Coagulação do Lúpus/imunologia , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Pandemias , Posicionamento do Paciente , Pericardiocentese , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Decúbito Ventral , Proteinúria/etiologia , Diálise Renal , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , SARS-CoV-2 , Trombocitopenia/etiologia , Trombose Venosa/etiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem
20.
BMC Nephrol ; 21(1): 266, 2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652947

RESUMO

BACKGROUND: Setting the dry weight and maintaining fluid balance is still a difficult challenge in dialysis patients. Overhydration is common and associated with increased cardiac morbidity and mortality. Pulmonary hypertension is associated with volume overload in end-stage renal dysfunction patients. Thus, monitoring pulmonary pressure by a CardioMEMS device could potentially be of guidance to physicians in the difficult task of assessing fluid overload in hemodialysis patients. CASE PRESENTATION: 61-year old male with known congestive heart failure deteriorated over 3 months' time from a state with congestive heart failure and diuresis to a state of chronic kidney disease and anuria. He began a thrice/week in-hospital hemodialysis regime. As he already had implanted a CardioMEMS device due to his heart condition, we were able to monitor invasive pulmonary artery pressure during the course of dialysis sessions. To compare, we estimated overhydration by both bioimpedance and clinical assessment. Pulmonary artery pressure correlated closely with fluid drainage during dialysis and inter-dialytic weight gain. The patient reached prescribed dry weight but remained pulmonary hypertensive by definition. During two episodes of intradialytic systemic hypotension, the patient still had pulmonary hypertension by current definition. CONCLUSION: This case report observes a close correlation between pulmonary artery pressure and fluid overload in a limited amount of observations. In this case we found pulmonary artery pressure to be more sensitive towards fluid overload than bioimpedance. The patient remained pulmonary hypertensive both as he reached prescribed dry weight and experienced intradialytic hypotensive symptoms. Monitoring pulmonary artery pressure via CardioMEMS could hold great potential as a real-time guidance for fluid balance during hemodialysis, though adjusted cut-off values for pulmonary pressure for anuric patients may be needed. Further studies are needed to confirm the findings of this case report and the applicability of pulmonary pressure in assessing optimal fluid balance.


Assuntos
Pressão Arterial/fisiologia , Hipertensão Pulmonar/diagnóstico , Falência Renal Crônica/terapia , Artéria Pulmonar/fisiopatologia , Diálise Renal/métodos , Desequilíbrio Hidroeletrolítico/diagnóstico , Anuria , Impedância Elétrica , Insuficiência Cardíaca/complicações , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipotensão/etiologia , Hipotensão/fisiopatologia , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial , Monitorização Fisiológica , Estado de Hidratação do Organismo , Diálise Renal/efeitos adversos , Desequilíbrio Hidroeletrolítico/fisiopatologia
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