scholarly journals Hemolysis in a Patient during Hemodialysis

2021 ◽  
pp. 348-354
Author(s):  
Maxime Taghavi ◽  
Lucas Jacobs ◽  
Saleh Kaysi ◽  
Maria do Carmo Filomena Mesquita
Keyword(s):  
Intensive Care Unit ◽  
Blood Transfusion ◽  
Oxygen Therapy ◽  
Artificial Ventilation ◽  
Renal Involvement ◽  
Immunosuppressive Treatment ◽  
Sudden Onset ◽  
End Stage Kidney Disease ◽  
Massive Blood Transfusion ◽  
End Stage

We report a case of hemolysis during a hemodialysis (HD) session in a 71-year-old man. His end-stage kidney disease is secondary to light-chain amyloidosis with renal involvement. Despite immunosuppressive treatment, his renal function continued to decline, and dialysis had to be initiated. Peritoneal dialysis (PD) was started but that had to be converted to HD because of pleural effusion due to PD fluid leakage. On the event day, the patient presented a respiratory distress 2 h after the initiation of HD. He developed a sudden onset of dyspnea with hypoxemia, associated with abdominal pain, nausea, and vomiting. He also presented chest pain with arterial hypertension. The pre-pump arterial and post-pump pressures were, respectively, 40 and 100 mm Hg, with no machine alarm. The blood color in the circuit changed and became darker, so HD was stopped immediately without blood restitution, and then a blood workup was obtained, and the patient was treated with oxygen therapy, IV methylprednisolone 40 mg, and IV furosemide 100 mg. Tubing checkup performed after the incident showed a kinked arterial tube which led to the suspicion of acute hemolysis. Blood transfusion was therefore urgently ordered, and the patient was immediately transferred to the intensive care unit (ICU). Artificial ventilation was required for 4 days, with initial massive blood transfusion. A 24-h treatment with extracorporeal cytokine adsorber CytoSorb<sup>®</sup> was also performed, followed by the regular HD sessions thrice weekly. Evolution was favorable, and the patient was discharged from the ICU 18 days later.

scholarly journals A dialysis doctor’s memories with COVID-19 disease

2021 ◽  
Vol 4 (2) ◽  
pp. 137-143
Author(s):  
Guy Rostoker
Keyword(s):  
Intensive Care Unit ◽  
Oxygen Therapy ◽  
Editorial Staff ◽  
Proper Treatment ◽  
End Stage Kidney Disease ◽  
Home Dialysis ◽  
Long Period ◽  
The Will ◽  
End Stage ◽  
Sufficient Oxygen

This is the testimony of a nephrologist who was infected at the very beginning of the pandemic, in France, while treating his patients. On April 8, 2020, as he was finishing visiting his patients, he experienced myalgia, dyspnea, chills and fever. After two days of trying to stay at home, it became necessary to admit him to the intensive care unit to ensure proper treatment and sufficient oxygen therapy. In this testimony, he describes his own experience as a sick doctor, the effectiveness of the treatments he received, the empathy of his colleagues and the caregivers who took care of him, in a diary kept from day to day. This was followed by a long period of rehabilitation during which he wrote a plea to promote home dialysis methods in order to limit the contamination of end-stage kidney disease patients on dialysis. The editorial staff has deemed it useful to publish this medical testimony full of humanity, written with modesty and the will to bring support and hope to those brutally victimized by the COVID-19 disease.

scholarly journals Acute intermittent renal replacement therapy in a rural Scottish intensive care unit – a review of patient and renal outcomes

2021 ◽  
pp. 175114372110186
Author(s):  
Elaine Rutherford ◽  
James F Leach ◽  
Ella JA Bennett ◽  
John S Rutherford ◽  
Leo Urquhart ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
End Stage Kidney Disease ◽  
Patient Admissions ◽  
Icu Discharge ◽  
End Stage ◽  
Intermittent Renal Replacement Therapy

In this study we report 5-year outcomes for patients who received intermittent haemodiafiltration for Acute Kidney Injury (AKI) between 2010 and 2014 in a small Scottish Intensive Care Unit (ICU). Dialysis independence and mortality at ICU discharge, 30 and 90 days, one and five years were determined. There were 1496 admissions to ICU during the study period. 12% of patient admissions required Renal Replacement Therapy (RRT). 56.3% of patients survived to ICU discharge and all were RRT independent at ICU discharge. 30 day, 90 day, 1 year and 5 year survival was 52.3%, 50.6%, 46.6% and 30.7% respectively. By 5 years, 2 patients had developed end stage kidney disease.

scholarly journals Laurence-Moon-Bardet-Biedl Syndrome: A 19 Years Girl with Total Blindness and End Stage Renal Disease

2014 ◽  
Vol 15 (1) ◽  
pp. 94-97
Author(s):  
Matiur Rahman ◽  
Nurul Islam ◽  
Sarmistha Biswas ◽  
H A Zaved ◽  
Gourab Dewan
Keyword(s):  
End Stage Renal Disease ◽  
Autosomal Recessive ◽  
Renal Involvement ◽  
Autosomal Recessive Disorder ◽  
End Stage Kidney Disease ◽  
Bardet Biedl Syndrome ◽  
Prognostic Importance ◽  
Total Blindness ◽  
Stage Renal Disease ◽  
End Stage

Laurence-Moon-Bardet-Biedl syndrome is a rare autosomal recessive disorder characterized bystructural and functional abnormalities of different organ and tissues. Renal involvement is the single most feature of prognostic importance. We report a case with end stage kidney disease. The diagnosis was missed until patient presented with renal dysfunction. Early diagnosis and screening for renal involvement is crucial for prolong survival.DOI: http://dx.doi.org/10.3329/jom.v15i1.19885 J Medicine 2014; 15: 94-97

scholarly journals Kidney transplantation in patients with multiple myeloma: A word of caution

2020 ◽  
Vol 4 (1-2) ◽  
pp. 22-25
Author(s):  
Vinay Nair
Keyword(s):  
Multiple Myeloma ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Hematologic Malignancy ◽  
Renal Involvement ◽  
End Stage Kidney Disease ◽  
Frequent Relapses ◽  
Complex Population ◽  
Substantial Risk ◽  
End Stage

Multiple myeloma is the most common hematologic malignancy to result in end-stage kidney disease. Due to frequent relapses and extensive renal involvement, it has historically been seen as a relative contraindication to kidney transplantation. As newer medications arrive and overall prognosis improves, the question of whether kidney transplantation is now appropriate has resurfaced. A review of the published literature suggests that it still carries substantial risk. In addition, current literature is of insufficient quality to advocate routine allocation of kidneys to this complex population.

scholarly journals AB0513 GLOMERULONEPHRITIS IN LEVAMISOLE-ADULTERATED COCAINE VASCULOPATHY (LACIV): A 51-CASE SERIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1554.3-1554
Author(s):  
C. Muñoz ◽  
D. Jaramillo Arroyave ◽  
L. Hernandez ◽  
L. A. González ◽  
G. Vásquez ◽  
...  
Keyword(s):  
Immune Complex ◽  
Renal Involvement ◽  
Case Series ◽  
Membranous Glomerulonephritis ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
End Stage Kidney Disease ◽  
Anca Associated Vasculitis ◽  
Patients At Risk ◽  
End Stage ◽  
Retiform Purpura

Background:Up to 88% of cocaine is tainted with levamisole, anthelmintic withdrawn from the market due to toxicity. Since 2010 LACIV patients, characterized by retiform purpura, ear necrosis, multisystemic compromise and positivity for multiple autoantibodies, have been reported. Renal involvement is the most serious and heterogeneous clinical manifestation.Objectives:To describe the renal involvement of patients with LACIV.Methods:We describe the renal manifestations of a 51 case series with LACIV admitted in four high complexity institutions in Colombia from December 2010 to December 2019.Results:All patients were mestizos, with median age of 32.5 years (SD 7.8), the male:female ratio was 4.7:1, and the time from symptoms to diagnosis 12 months (IR 32). Nephritis was found in 60.8%, with creatinine elevation in 61%, median 2.0 mg/dl (IR 3), 87% had proteinuria, median 3184 mg/day (IR 5735), 43% in nephrotic-range; 93% had hematuria and 48% pyuria and cilindruria. Biopsy was performed in 21 patients (64%), with immune complex mediated extracapillary glomerulonephritis (35%), immune complex mediated membranoproliferative glomerulonephritis (20%) pauci-immune proliferative glomerulonephritis (20%), membranous glomerulonephritis (15%), focal and segmental glomerulosclerosis (5%) and C3 mediated extracapillary glomerulonephritis (5%). Six patients (19%) developed end-stage kidney disease. Patients with nephritis had more ear necrosis, retiform purpura, leukopenia, lymphopenia, anemia, hypocomplementemia, anti-PR3 and anti-MPO antibodies, compared to patients without nephritis.Conclusion:Due to the higher abuse of cocaine and its contamination with levamisole, LACIV is an increasingly reported disease. Although skin manifestations are the most characteristic and prevalent, renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious. Cytopenias, hypocomplementemia and antineutrophil cytoplasmic antibodies could identify patients at risk of nephritisReferences:[1]Collister D, Sathianathan C, Ryz K, Karpinski M, Bernstein K, Gibson IW. ANCA Associated Vasculitis Secondary to Levamisole-Adultered Cocaine with Associated Membranous Nephropathy: A Case Series. Am J Nephrol. 2017;45(3):209–16.[2]Carlson AQ, Tuot DS, Jen K-Y, Butcher B, Graf J, Sam R, et al. Pauci-immune glomerulonephritis in individuals with disease associated with levamisole-adulterated cocaine: a series of 4 cases. Medicine (Baltimore). 2014 Oct;93(17):290–7.Disclosure of Interests:None declared

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