Dr mohammed yaseen case

1. Case presentation
Presented By
Dr. Mohamed Yaseen
Nephrology Resident
New Mansoura General Hospital(INTERNATIONAL)

2. A 50 years old male patient, from
Mansoura with no Special habits of medical
importance .

3. Complaint
Generalized weakness and easy
fatigability.
Accidentally discovered renal
impairment .

4. No history of D.M.
No history of HTN.
No history of NSAIDS abuse.
No history of immunological diseases.
No obvious cause of ESRD .
Residual renal function(good U.O.P).

5. Family history : +ve
Mother & sister are ESRD
without apparent cause
(atrophied both kidneys
by U/S)

6. Patient started RRT by
hemodialysis at December
2015
Dialysis through IJ Line for two
months
Later on, dialysis done by AV
fistula

7.  Patient experienced blurred vision for long
time
 Ophthalmology consultation concluded
retinal hemorrhage and the advise was to
shift to peritoneal dialysis
 Un controlled hypertension during H.D.
sessions ( pre 180/110 – post 200/120 ) on
Blokatens10/160
(amlodipine+losartan)once daily at night,
concor 10 mg(Bisoprolol) once daily and
capoten(captopril) 25 mg sublingual at
Haemodialysis sessions .
 Anorexia and weight loss(dry weight 75 kg)

8. Patient advised for PD
After evaluation patient is fit for PD
PD catheter inserted at 9/2016
Patient maintained on peritoneal dialysis till
3/2017 .
During this period ,The patient was
normotensive ( average BP 130/80 to 140/90
on amlodipine 5 mg) and developed weight
gain(dry weight 82 kg) with good appetite.
 At March 2017 due to lack of peritoneal
dialysis solutions Patient shifted again to
haemodialysis.

9.  BP start to rise again with out control 180/100
to 200/120 before & after session on the
same treatment before PD.
 Weight loss (dry weight 79 kg).
 Drop of haemoglobin up to 6.5 mg/dl inspite
of maintaining iron and Erythropoetin
therapy(Eprex 4000 u three times weekly).

10.  Few months later, peritoneal dialysis supplies become available
 Patient developed ?? intestinal fistula on conservative treatment
for 6 weeks
 After closure of the fistula, PD catheter did not work properly
 Malpositioning of PD catheter confirmed by X RAY
abdomen(erect)
 Our patient prepared for new PD catheter and was done at 10
/2017 and resumed P.D.

11. Pre operative lab

15. Our massage in this case:
1-Peritoneal dialysis may be the
better modality for blood pressure
control in patient with uncontrolled
hypertension while on
haemodialysis.
2-Anaemia can be improved rapidly
in peritoneal dialysis patient easier
than when on haemodialysis.
3-Residual renal function can be
maintained by P.D.