Case Report: Early signs of tamponade may be detected by cardiac point-of-care ultrasound

POCUS Journal ◽  
2017 ◽  
Vol 2 (3) ◽  
pp. 24-25 ◽  
Author(s):  
Michael Cenkowski, MD ◽  
Amer M. Johri, MD ◽  
Raveen Pal, MD ◽  
Jennifer Hutchison, RDCS
Keyword(s):  
Blood Pressure ◽  
End Stage Renal Disease ◽  
Point Of Care ◽  
Vital Signs ◽  
Point Of Care Ultrasound ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 35-year-old male with a past medical history of end stage renal disease on hemodialysis and a chronic pericardial effusion secondary to dialysis presented to the Emergency Room (ER) with a 2-week history of a flu-like illness and pleuritic chest pain. He was compliant with dialysis three times per week. His blood pressure was 150/85 mmHg with a heart rate of 85 beats per minute and the remainder of his vital signs were stable. Pulsus paradoxus was not present.

scholarly journals Point-of-care Ultrasound in the Diagnosis of Calciphylaxis

2020 ◽  
Vol 4 (3) ◽  
pp. 495-496
Author(s):  
Natasha Tobarran ◽  
Mark Collin
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Computed Tomography Imaging ◽  
Case Presentation ◽  
Tomography Imaging ◽  
History Of ◽  
Calcium Deposits ◽  
Stage Renal Disease ◽  
End Stage

Case Presentation: A 63-year-old male with a past medical history of end stage renal disease presented to the emergency department with painful, lower-extremity necrotic ulcerations. Ultrasound and computed tomography imaging showed concerns for calcium deposits. Biopsy confirmed the diagnosis of calciphylaxis, a rare lethal disease. Discussion: Emergency physicians should keep this disease on their differential due to the high mortality rate.

scholarly journals Hypoglycemia Secondary to Sulfonylurea Ingestion in a Patient with End Stage Renal Disease: Results from a 72-Hour Fast

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Alice Abraham ◽  
Mishaela Rubin ◽  
Domenico Accili ◽  
John P. Bilezikian ◽  
Utpal B. Pajvani
Keyword(s):  
End Stage Renal Disease ◽  
Dialysis Patient ◽  
Past Medical History ◽  
Dialysis Patients ◽  
C Peptide ◽  
Normal Limits ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Insight Into

Insulin, proinsulin, and C-peptide levels increase with sulfonylurea exposure but the acuity of increase has not been described in dialysis patients. We present a case of a dialysis patient who presented with hypoglycemia and was found to have accidental sulfonylurea ingestion. This is a 73-year-old man with ESRD on peritoneal dialysis, without history of diabetes, who presented with hypoglycemia. Past medical history includes multiple myeloma, congestive heart failure, and hypertension. At initial presentation, his blood glucose was 47 mg/dL, with concomitant elevations in the following: C-peptide 30.5 (nl: 0.8–3.5 ng/mL), insulin 76 (nl: 3–19 μIU/mL), and proinsulin 83.3 (nl: ≤8.0 pmol/L). During the 72-hour fast, which he completed without hypoglycemia, insulin declined to be within normal limits (to 12 μIU/mL); proinsulin (to 12.1 pmol/L) and C-peptide (to 7.2 ng/mL) levels decreased but remained elevated. The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis. This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea. The 72-hour fast conducted gives insight into the clearance of insulin, proinsulin, and C-peptide after sulfonylurea ingestion in ESRD.

MO104RISK OF END-STAGE RENAL DISEASE: PREDICTION USING CUMULATIVE NUMBER OF HYPERTENSION DIAGNOSES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Chang Seong Kim ◽  
Hong Sang Choi ◽  
Tae Ryom Oh ◽  
Eun hui Bae ◽  
Soo Wan Kim
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Population ◽  
Cumulative Number ◽  
Diastolic Hypertension ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between repeated measurements of high blood pressure and ESRD is not well-established. This study investigated whether the cumulative number of diagnoses of hypertension is a substantial risk factor for ESRD. Method The incidence of ESRD among 2,144,801 participants, identified from the Korean National Health Insurance Service database, who did not have a history of antihypertensive therapy and had documented blood pressure assessments for 4 consecutive years was determined retrospectively. Data were extracted from the database where events of hypertension were defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Results Over a median follow-up of 7.2 years, ESRD was identified in 1758 of the 2,144,801 participants. In a multivariable Cox model adjusted for age, sex, smoking, alcohol consumption, exercise, and history of diabetes and chronic kidney disease, a positive dose-dependent relationship between the cumulative number of diagnoses of hypertension and ESRD was found (adjusted hazard ratio for ESRD, 2.70 in 4 cumulative number of diagnoses of hypertension compared to no history of hypertension). This association was maintained for the cumulative number of diagnoses of both systolic and diastolic hypertension. Conclusion The cumulative number of diagnoses of systolic or diastolic hypertension increases the risk of ESRD. Therefore, preventive treatment to avoid repetitive events of systolic or diastolic hypertension may be important to lower the risk of ESRD in this clinical population.

The impact of kidney transplantation on 24–hour ambulatory blood pressure in end–stage renal disease patients

2015 ◽  
Vol 9 (6) ◽  
pp. 427-434 ◽  
Author(s):  
Myung Hyun Lee ◽  
Kyung Min Ko ◽  
Seung Won Ahn ◽  
Myoung Nam Bae ◽  
Bum Soon Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Transplantation ◽  
Renal Disease ◽  
Ambulatory Blood Pressure ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

scholarly journals Association between strict blood pressure control during chronic kidney disease and lower mortality after onset of end-stage renal disease

2015 ◽  
Vol 87 (5) ◽  
pp. 1055-1060 ◽  
Author(s):  
Elaine Ku ◽  
David V. Glidden ◽  
Kirsten L. Johansen ◽  
Mark Sarnak ◽  
Hocine Tighiouart ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Blood Pressure Control ◽  
End Stage Renal Disease ◽  
Pressure Control ◽  
Lower Mortality ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea

2019 ◽  
Vol 8 (5) ◽  
pp. 755 ◽  
Author(s):  
Mee Kyoung Kim ◽  
Kyungdo Han ◽  
Hun-Sung Kim ◽  
Yong-Moon Park ◽  
Hyuk-Sang Kwon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
General Population ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Variability ◽  
Metabolic Parameters ◽  
Metabolic Parameter ◽  
Stage Renal Disease ◽  
End Stage

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.

The Potential Role of Catheter-Based Renal Sympathetic Denervation in Chronic and End-Stage Kidney Disease

2016 ◽  
Vol 21 (4) ◽  
pp. 344-352 ◽  
Author(s):  
Yusuke Sata ◽  
Markus P. Schlaich
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
Renal Denervation ◽  
Potential Role ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Sympathetic

Sympathetic activation is a hallmark of chronic and end-stage renal disease and adversely affects cardiovascular prognosis. Hypertension is present in the vast majority of these patients and plays a key role in the progressive deterioration of renal function and the high rate of cardiovascular events in this patient cohort. Augmentation of renin release, tubular sodium reabsorption, and renal vascular resistance are direct consequences of efferent renal sympathetic nerve stimulation and the major components of neural regulation of renal function. Renal afferent nerve activity directly influences sympathetic outflow to the kidneys and other highly innervated organs involved in blood pressure control via hypothalamic integration. Renal denervation of the kidney has been shown to reduce blood pressure in many experimental models of hypertension. Targeting the renal nerves directly may therefore be specifically useful in patients with chronic and end-stage renal disease. In this review, we will discuss the potential role of catheter-based renal denervation in patients with impaired kidney function and also reflect on the potential impact on other cardiovascular conditions commonly associated with chronic kidney disease such as heart failure and arrhythmias.

Case of eustachian valve endocarditis and the importance of synergistic antibiotic therapy

2021 ◽  
Vol 14 (6) ◽  
pp. e242553
Author(s):  
Dilpat Kumar ◽  
James Boyer ◽  
Warsha Fnu ◽  
Harry Boamah
Keyword(s):  
End Stage Renal Disease ◽  
Altered Mental Status ◽  
Blood Levels ◽  
Chronic Haemodialysis ◽  
Dialysis Catheter ◽  
Left Forearm ◽  
Eustachian Valve ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 46-year-old woman with a history of end-stage renal disease on chronic haemodialysis presented with 1 week of fever, chills, altered mental status and hand pain. She was febrile and ill-appearing on presentation with a pulse rate of 102 beats per minute. She had a tunnelled dialysis catheter in her right neck. Hand examination demonstrated a swollen, erythematous and tender wrist. Cardiovascular examination demonstrated no murmurs. CT of the hand showed abscesses involving the left forearm. Blood and abscess cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography (TEE) showed a 1.0×1.0 cm mobile vegetation involving the eustachian valve (EV), confirming EV endocarditis. She remained bacteraemic for 18 days despite being on vancomycin with appropriate blood levels. Vancomycin was switched to daptomycin and ceftaroline, which cleared her cultures. Repeat TEE showed improved vegetation size. Our case highlights the rarity and management of EV endocarditis and the importance of synergy for treatment of persistent MRSA bacteraemia.

Abstract 498: Increased Blood Pressure Variability and Baroreflex Impairment in Patients With End-stage Renal Disease Undergoing Hemodialysis

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Kátia B Scapini ◽  
Valéria C Hong ◽  
Janaína B Ferreira ◽  
Sílvia B Souza ◽  
Naomi V Ferreira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Blood Pressure Variability ◽  
Baroreflex Sensitivity ◽  
Low Frequency ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Alpha Index

Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis are susceptible to the development of autonomic dysfunction, which is associated with an increased risk of sudden death. Experimental and clinical evidence suggest a crucial role of autonomic dysfunction for both, the progression of renal disease and for the high rate of cardiovascular events in these patients. In the present study, we evaluated the heart rate variability (HRV), the blood pressure variability (BPV) and the baroreflex sensitivity (BRS) in ESRD patients undergoing hemodialysis and normal controls. Methods: Nine ESRD patients undergoing hemodialysis (mean age 53.4±10.2 years, 4 male) and nine age-matched healthy controls (mean age 52.8±10.2 years, 4 male) were assessed. Non−invasive curves of blood pressure (BP) were recorded continuously (Finometer ®) for 10 minutes, at rest, in the supine position. The heart rate variability (HRV) and systolic blood pressure variability (BPV) were estimated in the time and frequency domain (spectral analysis). The BRS was quantified by alpha index. Statistical analyzes were performed by Student's t test and the results were expressed as mean ± standard deviation. Results: ESRD patients presented lower HRV in time domain than healthy controls (SDNN: 25.8±10.7 vs. 44.6±11.7 ms, p<0.01; VAR NN: 768.3±607.4 vs. 2113.9±1261.6 ms 2 , p=0.01). All frequency domain analyzed indexes, i.e., total power (361.9±297.0 vs. 1227.2±696.3 ms 2 , p<0.01), high-frequency (181.8±128.7 vs. 358.7±179.8 ms 2 , p=0.047), low-frequency (55.1±44.2 vs. 444.6±389.9 ms 2 , p=0.02) and very-low-frequency (72.5±75.1 vs. 279.2±119.5 ms 2 , p<0.01) of HRV were lower in ESRD patients. The BPV was higher in ESRD patients when compared to controls (VAR PAS: 98.4±72.0 vs. 35.4±21.4 ms 2 , p=0.03) and BRS was lower in ESRD patients (alpha index: 4.34±3.05 vs. 7.56±2.50 ms/mmHg, p<0.02). Conclusion: ESRD patients undergoing hemodialysis presents reduced HRV, increase in BPV and reduced baroreflex sensitivity. These impairments may be associated with mortality in ESRD.

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