Absorb user forum bvs in bifurcation dr vspvishwanath69
A 55-year-old male with diabetes and previous coronary artery disease underwent a coronary angiogram that showed a 50% lesion in the LAD and a tight stenosis with calcium in the D1 branch. Percutaneous coronary intervention was performed on the D1 branch using a drug-eluting bioresorbable vascular scaffold. Optical coherence tomography showed incomplete expansion of the scaffold, so high-pressure balloon dilatation was performed, which improved apposition but also caused some subintimal staining. The case highlights the importance of proper preparation and high-pressure post-dilatation when using bioresorbable scaffolds in calcified lesions, as well as the value of OCT guidance.
Absorb user forum bvs in bifurcation dr vspvishwanath69
A 55-year-old male with diabetes and previous coronary artery disease underwent coronary angiography (CAG) which showed 50% lesion in the left anterior descending artery and a tight stenosis with calcium in the D1 branch. Percutaneous coronary intervention (PCI) was performed on the D1 branch with balloon angioplasty followed by deployment of an Absorb bioresorbable vascular scaffold (BVS). Optical coherence tomography (OCT) showed under expansion of the distal part of the scaffold. High pressure balloon dilatation was then performed to achieve complete apposition, which OCT confirmed along with decreased subintimal staining. The message conveyed is that BVS require proper preparation for calcific lesions, high pressure ballooning
DKD- Clinical Practice Guidelines prof. Hussein SheashaaAhmed Albeyaly
This document outlines clinical practice guidelines for the treatment of diabetic kidney disease (DKD). It discusses evidence-based medicine and different modalities for renal replacement therapy. It provides guidance on when to start dialysis, which vascular access to use, and considerations for kidney transplantation in type 1 and type 2 diabetes. The document also addresses glycemic control through monitoring, medication management, and management of cardiovascular risks including coronary heart disease, blood pressure management, dyslipidemia, physical activity, antiplatelet therapy, and fasting during Ramadan.
This document discusses pulmonary arterial hypertension (PAH), including:
1) It provides an overview of the normal anatomy and physiology of the pulmonary vasculature and factors that influence vascular tone.
2) PAH is classified and primary pulmonary hypertension (PPH) is defined as PAH of unknown cause, with genetic and endothelial dysfunction thought to play a role in PPH.
3) The clinical presentation, course, and causes of death in PPH are outlined based on data from NIH registries, with the most common initial symptoms being dyspnea and fatigue.
4) Medical management options for PAH are reviewed, including vasodilator therapies such as calcium channel blockers, prostacyclins,
This document proposes a research plan to improve dialysis efficiency in patients with chronic kidney disease. It summarizes that hypotension during dialysis is a major problem, and an adequate dose of dialysis is essential for improving patient prognosis. Low blood pressure during dialysis occurs more frequently in patients with comorbidities, limiting dialysis time and effectiveness. The document reviews causes of intradialytic hypotension and potential solutions, including increasing blood pressure through transcutaneous muscle stimulation or passive cycling movements during dialysis.
Absorb user forum bvs in bifurcation dr vspvishwanath69
A 55-year-old male with diabetes and previous coronary artery disease underwent a coronary angiogram that showed a 50% lesion in the LAD and a tight stenosis with calcium in the D1 branch. Percutaneous coronary intervention was performed on the D1 branch using a drug-eluting bioresorbable vascular scaffold. Optical coherence tomography showed incomplete expansion of the scaffold, so high-pressure balloon dilatation was performed, which improved apposition but also caused some subintimal staining. The case highlights the importance of proper preparation and high-pressure post-dilatation when using bioresorbable scaffolds in calcified lesions, as well as the value of OCT guidance.
Absorb user forum bvs in bifurcation dr vspvishwanath69
A 55-year-old male with diabetes and previous coronary artery disease underwent coronary angiography (CAG) which showed 50% lesion in the left anterior descending artery and a tight stenosis with calcium in the D1 branch. Percutaneous coronary intervention (PCI) was performed on the D1 branch with balloon angioplasty followed by deployment of an Absorb bioresorbable vascular scaffold (BVS). Optical coherence tomography (OCT) showed under expansion of the distal part of the scaffold. High pressure balloon dilatation was then performed to achieve complete apposition, which OCT confirmed along with decreased subintimal staining. The message conveyed is that BVS require proper preparation for calcific lesions, high pressure ballooning
DKD- Clinical Practice Guidelines prof. Hussein SheashaaAhmed Albeyaly
This document outlines clinical practice guidelines for the treatment of diabetic kidney disease (DKD). It discusses evidence-based medicine and different modalities for renal replacement therapy. It provides guidance on when to start dialysis, which vascular access to use, and considerations for kidney transplantation in type 1 and type 2 diabetes. The document also addresses glycemic control through monitoring, medication management, and management of cardiovascular risks including coronary heart disease, blood pressure management, dyslipidemia, physical activity, antiplatelet therapy, and fasting during Ramadan.
This document discusses pulmonary arterial hypertension (PAH), including:
1) It provides an overview of the normal anatomy and physiology of the pulmonary vasculature and factors that influence vascular tone.
2) PAH is classified and primary pulmonary hypertension (PPH) is defined as PAH of unknown cause, with genetic and endothelial dysfunction thought to play a role in PPH.
3) The clinical presentation, course, and causes of death in PPH are outlined based on data from NIH registries, with the most common initial symptoms being dyspnea and fatigue.
4) Medical management options for PAH are reviewed, including vasodilator therapies such as calcium channel blockers, prostacyclins,
This document proposes a research plan to improve dialysis efficiency in patients with chronic kidney disease. It summarizes that hypotension during dialysis is a major problem, and an adequate dose of dialysis is essential for improving patient prognosis. Low blood pressure during dialysis occurs more frequently in patients with comorbidities, limiting dialysis time and effectiveness. The document reviews causes of intradialytic hypotension and potential solutions, including increasing blood pressure through transcutaneous muscle stimulation or passive cycling movements during dialysis.
This document discusses peritoneal dialysis (PD) in diabetic patients. It notes that about one third of new dialysis patients have diabetes as their primary diagnosis. PD has several potential advantages for diabetics including no need for vascular access, better preservation of renal function, and lifestyle benefits. However, concerns with PD in diabetics include higher peritonitis rates and differences in peritoneal membrane characteristics that may impact transport. Maintaining good glycemic control, preserving residual renal function, and intensive patient education are important factors for successful PD treatment in diabetics.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
This document discusses the cardiorenal syndrome (CRS), which refers to the bidirectional relationship between heart and kidney diseases where dysfunction in one organ can induce dysfunction in the other. It describes the five subtypes of CRS and risk factors. It also discusses biomarkers that may help earlier diagnosis and management strategies including avoiding nephrotoxic drugs and maintaining euvolaemia. Contrast-induced nephropathy is also summarized, including risk factors, proposed pathogenesis, and strategies to reduce risk such as hydration protocols and pharmacological interventions.
This document discusses intradialytic hypotension (IDH), a common problem where patients experience low blood pressure during hemodialysis treatment. IDH can limit the dose of dialysis received and impair patient prognosis. The document examines various causes of IDH related to patient factors and dialysis procedures. It also explores potential management strategies, including targeting dry weight and medication adjustments. The document summarizes studies showing that passive cycling movements and transcutaneous muscle stimulation during dialysis can significantly increase blood pressure, likely by enhancing cardiac output. Future research on passive exercise may investigate its effects on dialysis efficiency and relationships to cardiovascular health outcomes.
This document discusses different types of vascular access for hemodialysis including arteriovenous fistulae (AVF), polytetrafluoroethylene grafts, and temporary and tunnelled dialysis catheters. It provides details on AVF maturation criteria, cannulation techniques, and care. Complications of fistulae and grafts like clotting, infection, and steal syndrome are outlined. The use of temporary catheters, characteristics of tunnelled catheters, and management of catheter malfunction are summarized.
Physiology of the kidney proff ahmed donia FarragBahbah
The document discusses the physiology of the kidney. It covers topics like renal blood flow, glomerular filtration rate (GFR) measurement and estimation, urine formation, tubular functions including reabsorption and secretion, and electrolyte handling. GFR is normally around 125 ml/min but can be estimated using creatinine clearance or equations. The kidney plays important roles in homeostasis through excretory and endocrine functions.
Peritoneal dialysis involves 3 phases: a fill phase where fluid containing an osmotic agent and electrolytes is infused into the peritoneal cavity for dialysis, a dwell phase where waste diffuses out of the bloodstream into the fluid for 4-8 hours, and a drain phase where the used fluid is drained from the cavity in under 20 minutes.
This document provides guidelines for evaluating potential renal transplant recipients and living kidney donors. For recipients, a thorough history, clinical exam, lab tests, imaging and biopsies are recommended to assess suitability and detect contraindications. Original kidney disease must be evaluated for risk of recurrence. For donors, standard criteria include age over 21, no infections, diseases, or malignancies. Donors require medical, lab and imaging exams as well as informed consent regarding risks. High risk donors like those with obesity, hypertension or hematuria may require further testing or be deemed unsuitable to donate.
1) Contrast induced nephropathy (CIN) is a serious complication of cardiac procedures and can lead to acute renal failure, increased mortality, and long term renal dysfunction.
2) Many risk factors increase a patient's likelihood of developing CIN, including pre-existing renal insufficiency, diabetes, older age, hypotension, and the volume and osmolality of contrast agent used.
3) Preventive strategies aim to reduce renal ischemia and oxidative stress through hydration with intravenous fluids like sodium bicarbonate or sodium chloride, as well as pharmacological interventions including N-acetylcysteine. Larger clinical trials are still needed to determine the most effective prevention protocols.
Catheter related infections- DR Nadia MohsenFarragBahbah
This document discusses catheter-related bloodstream infections (CRBSIs) in patients undergoing hemodialysis. It defines CRBSIs and describes the types of dialysis catheters and associated infection risks. Common causative organisms are gram-positive cocci like Staphylococcus aureus. The diagnostic approach involves clinical evaluation and blood cultures, with treatment tailored based on culture results. Management typically requires systemic antibiotics and often catheter removal, with options for catheter exchange or salvage with antibiotic locks in some cases.
This document outlines treatment protocols for rapidly progressive glomerulonephritis (RPGN) in children at Mansoura University Children's Hospital in Egypt. It defines RPGN and lists inclusion criteria. Four treatment protocols are provided: Protocol I involves steroids, Protocol II adds cyclophosphamide, Protocol III uses lower doses of cyclophosphamide and adds azathioprine, and Protocol IV focuses on plasma exchange with steroids and cyclophosphamide. Each protocol provides details on drug doses, administration schedules, and monitoring of patients. The goal is to control inflammation during induction and prevent further kidney damage and relapses during maintenance therapy.
Dialysate Calcium Concentartions and CKD MBD Dr. Karem Salem Ahmed Albeyaly
This study investigated the effects of different dialysate calcium concentrations on parathyroid hormone levels, cardiovascular stability, and valvular calcifications in end-stage renal disease patients on regular hemodialysis. 80 patients were divided into two groups - Group A received 1.25 mmol/L dialysate calcium while Group B received 1.75 mmol/L. Results showed higher levels of parathyroid hormone and valvular calcifications in Group B compared to Group A. The study recommends individualizing dialysate calcium concentrations and performing echocardiography on all new hemodialysis patients to monitor for valvular calcifications.
This document summarizes peritoneal dialysis (PD) as a treatment for kidney failure. It discusses PD's role in removing waste and excess water and salts from the body. It outlines the symptoms of renal failure like accumulation of waste, high blood pressure, edema, and hormonal deficiencies. The document emphasizes PD as a complementary rather than competitive treatment option. It then provides details about the PD program at New Mansoura General Hospital, including its multidisciplinary treatment team and initial reliance on donations. It concludes by noting cost and resource limitations that can challenge expanding PD programs, such as the high cost of imported peritoneal bags and lack of insurance coverage.
This document provides an overview of plasmapheresis, which is a medical procedure that separates plasma from the blood. It discusses the indications for plasmapheresis, including autoimmune diseases, hyperviscosity syndromes, and thrombotic thrombocytopenic purpura. The techniques section outlines two main methods - centrifugal plasma separation and membrane plasma separation. Membrane plasma separation uses hollow fiber membranes to filter plasma from blood while retaining other components. The document also discusses replacement fluids, vascular access methods, anticoagulation options, plasma volume calculations, treatment regimens and frequencies, and the kinetics of target molecule clearance with plasmapheresis.
Case presentation 2014 BMD . DR. Mahmoud Samir Foda Ahmed Albeyaly
This document describes a case of a 43-year-old male farmer with end-stage renal disease and hypertension who presented with left foot pain and a left big toe ulcer. Examination found erythema of both feet. Tests showed elevated parathyroid hormone, calcium, and phosphate levels consistent with calciphylaxis. The patient was treated with calcium-lowering drugs and prepared for parathyroidectomy to reduce further complications from calciphylaxis, a condition of vascular calcification and skin necrosis seen in long-term kidney disease.
This document provides protocols for the management of nephrotic syndrome in children from Mansoura University Children's Hospital Nephrology Unit. It includes definitions and criteria for diagnosing nephrotic syndrome and differentiating between steroid sensitive and resistant forms. Protocols are provided for induction therapy with steroids, maintenance therapy, and management of frequent relapses including additional treatments with levamisole or MMF. Guidelines are given for renal biopsy indications and steroid dosing schedules tailored for initial presentations, relapses, and steroid dependent/frequent relapsing nephrotic syndrome.
2 gastrointestinal disease in kidney disease 1FarragBahbah
This document discusses gastrointestinal and hepatobiliary problems that are common in patients with chronic kidney disease. It outlines several conditions that occur more frequently or are specific to renal patients, such as gastroparesis, peptic ulcers, acute pancreatitis, and gastrointestinal bleeding. It also notes that concurrent gut and kidney disease can be seen in disorders like polycystic kidney disease, vasculitis, diabetes, and amyloidosis. Finally, it mentions several drugs used to treat chronic kidney disease that can cause gastrointestinal side effects.
Clinical Practice Guideline on management of patients with diabetes and chron...Ahmed Albeyaly
This document provides a summary of a clinical practice guideline on managing patients with diabetes and chronic kidney disease (CKD) stage 3b or higher. It outlines the composition of the guideline development group, which included nephrologists, endocrinologists, and epidemiologists from several European countries. The group aimed to provide guidance on evidence-based approaches to improve care for this patient population. The guideline's target audience is healthcare professionals treating adults with both diabetes and reduced kidney function (eGFR <45 mL/min). It focuses on developing standards of care for managing this complex patient group.
This document discusses peritoneal dialysis (PD) in diabetic patients. It notes that about one third of new dialysis patients have diabetes as their primary diagnosis. PD has several potential advantages for diabetics including no need for vascular access, better preservation of renal function, and lifestyle benefits. However, concerns with PD in diabetics include higher peritonitis rates and differences in peritoneal membrane characteristics that may impact transport. Maintaining good glycemic control, preserving residual renal function, and intensive patient education are important factors for successful PD treatment in diabetics.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
This document discusses the cardiorenal syndrome (CRS), which refers to the bidirectional relationship between heart and kidney diseases where dysfunction in one organ can induce dysfunction in the other. It describes the five subtypes of CRS and risk factors. It also discusses biomarkers that may help earlier diagnosis and management strategies including avoiding nephrotoxic drugs and maintaining euvolaemia. Contrast-induced nephropathy is also summarized, including risk factors, proposed pathogenesis, and strategies to reduce risk such as hydration protocols and pharmacological interventions.
This document discusses intradialytic hypotension (IDH), a common problem where patients experience low blood pressure during hemodialysis treatment. IDH can limit the dose of dialysis received and impair patient prognosis. The document examines various causes of IDH related to patient factors and dialysis procedures. It also explores potential management strategies, including targeting dry weight and medication adjustments. The document summarizes studies showing that passive cycling movements and transcutaneous muscle stimulation during dialysis can significantly increase blood pressure, likely by enhancing cardiac output. Future research on passive exercise may investigate its effects on dialysis efficiency and relationships to cardiovascular health outcomes.
This document discusses different types of vascular access for hemodialysis including arteriovenous fistulae (AVF), polytetrafluoroethylene grafts, and temporary and tunnelled dialysis catheters. It provides details on AVF maturation criteria, cannulation techniques, and care. Complications of fistulae and grafts like clotting, infection, and steal syndrome are outlined. The use of temporary catheters, characteristics of tunnelled catheters, and management of catheter malfunction are summarized.
Physiology of the kidney proff ahmed donia FarragBahbah
The document discusses the physiology of the kidney. It covers topics like renal blood flow, glomerular filtration rate (GFR) measurement and estimation, urine formation, tubular functions including reabsorption and secretion, and electrolyte handling. GFR is normally around 125 ml/min but can be estimated using creatinine clearance or equations. The kidney plays important roles in homeostasis through excretory and endocrine functions.
Peritoneal dialysis involves 3 phases: a fill phase where fluid containing an osmotic agent and electrolytes is infused into the peritoneal cavity for dialysis, a dwell phase where waste diffuses out of the bloodstream into the fluid for 4-8 hours, and a drain phase where the used fluid is drained from the cavity in under 20 minutes.
This document provides guidelines for evaluating potential renal transplant recipients and living kidney donors. For recipients, a thorough history, clinical exam, lab tests, imaging and biopsies are recommended to assess suitability and detect contraindications. Original kidney disease must be evaluated for risk of recurrence. For donors, standard criteria include age over 21, no infections, diseases, or malignancies. Donors require medical, lab and imaging exams as well as informed consent regarding risks. High risk donors like those with obesity, hypertension or hematuria may require further testing or be deemed unsuitable to donate.
1) Contrast induced nephropathy (CIN) is a serious complication of cardiac procedures and can lead to acute renal failure, increased mortality, and long term renal dysfunction.
2) Many risk factors increase a patient's likelihood of developing CIN, including pre-existing renal insufficiency, diabetes, older age, hypotension, and the volume and osmolality of contrast agent used.
3) Preventive strategies aim to reduce renal ischemia and oxidative stress through hydration with intravenous fluids like sodium bicarbonate or sodium chloride, as well as pharmacological interventions including N-acetylcysteine. Larger clinical trials are still needed to determine the most effective prevention protocols.
Catheter related infections- DR Nadia MohsenFarragBahbah
This document discusses catheter-related bloodstream infections (CRBSIs) in patients undergoing hemodialysis. It defines CRBSIs and describes the types of dialysis catheters and associated infection risks. Common causative organisms are gram-positive cocci like Staphylococcus aureus. The diagnostic approach involves clinical evaluation and blood cultures, with treatment tailored based on culture results. Management typically requires systemic antibiotics and often catheter removal, with options for catheter exchange or salvage with antibiotic locks in some cases.
This document outlines treatment protocols for rapidly progressive glomerulonephritis (RPGN) in children at Mansoura University Children's Hospital in Egypt. It defines RPGN and lists inclusion criteria. Four treatment protocols are provided: Protocol I involves steroids, Protocol II adds cyclophosphamide, Protocol III uses lower doses of cyclophosphamide and adds azathioprine, and Protocol IV focuses on plasma exchange with steroids and cyclophosphamide. Each protocol provides details on drug doses, administration schedules, and monitoring of patients. The goal is to control inflammation during induction and prevent further kidney damage and relapses during maintenance therapy.
Dialysate Calcium Concentartions and CKD MBD Dr. Karem Salem Ahmed Albeyaly
This study investigated the effects of different dialysate calcium concentrations on parathyroid hormone levels, cardiovascular stability, and valvular calcifications in end-stage renal disease patients on regular hemodialysis. 80 patients were divided into two groups - Group A received 1.25 mmol/L dialysate calcium while Group B received 1.75 mmol/L. Results showed higher levels of parathyroid hormone and valvular calcifications in Group B compared to Group A. The study recommends individualizing dialysate calcium concentrations and performing echocardiography on all new hemodialysis patients to monitor for valvular calcifications.
This document summarizes peritoneal dialysis (PD) as a treatment for kidney failure. It discusses PD's role in removing waste and excess water and salts from the body. It outlines the symptoms of renal failure like accumulation of waste, high blood pressure, edema, and hormonal deficiencies. The document emphasizes PD as a complementary rather than competitive treatment option. It then provides details about the PD program at New Mansoura General Hospital, including its multidisciplinary treatment team and initial reliance on donations. It concludes by noting cost and resource limitations that can challenge expanding PD programs, such as the high cost of imported peritoneal bags and lack of insurance coverage.
This document provides an overview of plasmapheresis, which is a medical procedure that separates plasma from the blood. It discusses the indications for plasmapheresis, including autoimmune diseases, hyperviscosity syndromes, and thrombotic thrombocytopenic purpura. The techniques section outlines two main methods - centrifugal plasma separation and membrane plasma separation. Membrane plasma separation uses hollow fiber membranes to filter plasma from blood while retaining other components. The document also discusses replacement fluids, vascular access methods, anticoagulation options, plasma volume calculations, treatment regimens and frequencies, and the kinetics of target molecule clearance with plasmapheresis.
Case presentation 2014 BMD . DR. Mahmoud Samir Foda Ahmed Albeyaly
This document describes a case of a 43-year-old male farmer with end-stage renal disease and hypertension who presented with left foot pain and a left big toe ulcer. Examination found erythema of both feet. Tests showed elevated parathyroid hormone, calcium, and phosphate levels consistent with calciphylaxis. The patient was treated with calcium-lowering drugs and prepared for parathyroidectomy to reduce further complications from calciphylaxis, a condition of vascular calcification and skin necrosis seen in long-term kidney disease.
This document provides protocols for the management of nephrotic syndrome in children from Mansoura University Children's Hospital Nephrology Unit. It includes definitions and criteria for diagnosing nephrotic syndrome and differentiating between steroid sensitive and resistant forms. Protocols are provided for induction therapy with steroids, maintenance therapy, and management of frequent relapses including additional treatments with levamisole or MMF. Guidelines are given for renal biopsy indications and steroid dosing schedules tailored for initial presentations, relapses, and steroid dependent/frequent relapsing nephrotic syndrome.
2 gastrointestinal disease in kidney disease 1FarragBahbah
This document discusses gastrointestinal and hepatobiliary problems that are common in patients with chronic kidney disease. It outlines several conditions that occur more frequently or are specific to renal patients, such as gastroparesis, peptic ulcers, acute pancreatitis, and gastrointestinal bleeding. It also notes that concurrent gut and kidney disease can be seen in disorders like polycystic kidney disease, vasculitis, diabetes, and amyloidosis. Finally, it mentions several drugs used to treat chronic kidney disease that can cause gastrointestinal side effects.
Clinical Practice Guideline on management of patients with diabetes and chron...Ahmed Albeyaly
This document provides a summary of a clinical practice guideline on managing patients with diabetes and chronic kidney disease (CKD) stage 3b or higher. It outlines the composition of the guideline development group, which included nephrologists, endocrinologists, and epidemiologists from several European countries. The group aimed to provide guidance on evidence-based approaches to improve care for this patient population. The guideline's target audience is healthcare professionals treating adults with both diabetes and reduced kidney function (eGFR <45 mL/min). It focuses on developing standards of care for managing this complex patient group.
Case presentation Dr. Shereef Mamdouh. 2nd Annual Nephrology Meeting, CKD-MBD...Ahmed Albeyaly
This patient is a 44-year-old male on long-term hemodialysis for end-stage renal disease secondary to primary membranoproliferative glomerulonephritis. He presents with generalized bone and joint pain. He is found to have secondary hyperparathyroidism and high bone turnover disease. Treatment is started with calcitriol, cinacalcet, and calcium supplements to control calcium, phosphorus, and PTH levels. When the patient's pain does not improve as expected, dialysis-related amyloidosis is suspected as a contributing factor and online hemodiafiltration is initiated, leading to improvement in his symptoms and beta-2 microglobulin levels.
Surgery for CKD-MBD Parathyroidectomy Prof. Ahmed Halawa Ahmed Albeyaly
This document discusses parathyroid glands and the surgical treatment of hyperparathyroidism in patients with chronic kidney disease. It provides information on pre-operative investigations and localization techniques, surgical approaches including bilateral neck exploration and considerations for redo parathyroidectomy. Complications specific to patients with kidney disease are outlined. Post-operative outcomes like recurrence and adynamic bone disease are also mentioned.
case presentation Dr. Neveen Nabeeh >>> 14 Annunal Meeting of Nephrology Dep...Ahmed Albeyaly
A 35-year-old female presented with a painful rash, fever, decreased urine output, and weakness for one month. Examination found purpuric lesions and splenomegaly. Labs showed kidney injury, low platelets, and cryoglobulins. A skin biopsy found leukocytoclastic vasculitis. She was diagnosed with mixed cryoglobulinemia and kidney involvement. She received treatments including plasmapheresis, steroids, cyclophosphamide, and antivirals.
Total parathyroidectomy with auto-transplantation was performed on 22 patients with end-stage renal disease and hyperparathyroidism. All four parathyroid glands were removed and small portions of one gland were reimplanted in the neck. Post-operatively, 28 patients had normal parathyroid hormone levels, showing the surgery was curative. Two patients had persistent hyperparathyroidism where glands were not found. The procedure showed encouraging results in treating hyperparathyroidism complications in patients with kidney failure.
A 44-year-old male patient had undergone 3 previous parathyroidectomy operations for hyperparathyroidism, with the first removing only 3 parathyroid lobes and leaving the left lower lobe. The second operation also did not fully address the remaining parathyroid tissue causing the hyperparathyroidism. This third operation aims to finally locate and remove the remaining overactive parathyroid tissue through another parathyroidectomy to successfully treat the patient's hypercalcemia.
This document contains emails between members of a parathyroidectomy surgery course discussing the success of a previous course and plans for an upcoming course. In the emails:
- Course directors Ahmed Halawa and Osama El Shahat inform Mohammed Benghanem that the previous course was successful with 8 attendees from Africa operating on 14 patients.
- Benghanem thanks Halawa and El Shahat for their support of African surgeons by offering a place to a Tunisian surgeon previously and two places on the upcoming course.
- Halawa responds that supporting their home countries in this way brings them great pleasure.
- Plans are discussed for reserving a place for an ISN-Africa member on the upcoming course
This document discusses renal replacement therapy (RRT) for acute kidney injury (AKI). It addresses when to start RRT, what modality to use, and how RRT can be delivered. The key points are:
1) There is no clear threshold for when to start RRT, and decisions should consider clinical context and trends in labs rather than single thresholds. Early initiation may improve outcomes.
2) Continuous RRT (CRRT) is preferred for hemodynamically unstable patients and may aid recovery of renal function compared to intermittent RRT.
3) Delivery of RRT involves considerations of vascular access, membranes, solutions, anticoagulation, and dose, with the goal of individualizing treatment
This document discusses acute kidney injury (AKI), including its definition, classification systems, causes, diagnosis, treatment including renal replacement therapy modalities, and management. It provides an overview of AKI and recommendations from clinical practice guidelines for its diagnosis and treatment. Key points include defining AKI as an acute decrease in kidney function and glomerular filtration rate, the RIFLE and AKIN classification systems, common causes of AKI including sepsis and nephrotoxins, the timing of nephrology consultation, and the use of renal replacement therapies like continuous renal replacement therapy for critically ill patients with AKI.
This document presents a case study of an 18-year-old female patient who presented with decreased urine output for 5 days. Her history revealed she had a cesarean section 17 days prior and developed oliguria and anuria thereafter despite diuretic treatment. Examination and tests showed signs of acute renal failure, including elevated creatinine and urea, as well as bilateral acute renal cortical necrosis seen on CT scan. She was treated supportively with antibiotics, dialysis, and nutritional support.
Case Presentation Dr. Hosam Fouda Supervised by Dr. Tarek TantawyAhmed Albeyaly
This document presents the case of a 48-year-old male patient with a history of membranous nephropathy who presented with shortness of breath and swelling of the face and lower limbs. Various tests were performed which showed nephrotic syndrome. The patient was previously treated with steroids and cyclosporine, achieving remission. The document discusses the diagnosis of membranous nephropathy, treatment options including conservative management and immunosuppressive drugs, risks and benefits of treatment, and contraindications to immunosuppressive therapy.