Cardiovascular disease and chronic renal failure

Izhodišča. Srčnožilne bolezni so najpogostejši vzrok obolevnosti in umrljivosti bolnikov s kronično ledvično odpovedjo. V primerjavi s splošno populacijo je tveganje bolnikov s kronično ledvično odpovedjo za nastanek srčnožilnih bolezni 10- do 2-krat večje. Visoka prevalenca srčnožilnih bolezni med bolniki ob pričetku nadomestnega zdravljenja kronične ledvične odpovedi z dializo nakazuje domnevo, da se začne pospešen proces ateroskleroze že na začetni stopnji kronične ledvične odpovedi. Zaključki. Opisana je vloga znanih in manj znanih dejavnikov tveganja za razvoj srčnožilnih bolezni, ki so pri bolnikih s kronično ledvično odpovedjo pogosto prisotni in delujejo aditivno. Preprečevanje in zdravljenje srčnožilnih bolezni pri bolnikih s kronično ledvično odpovedjo je v prihodnosti velik izziv nefrologom.Background. Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with chronic renal failure. CVD morbidity is approximately 10-20 times higher in patients with chronic renal failure compared with that in general population. The high prevalence of CVD among patients with chronic renal failure starting dialysis treatment suggests that CVD begins in earlier stages of chronic renal failure or disease. Conclusions.This review discusses the major and other risk factors for CVD in patients with chronic renal failure. Prevention and treatment of CVD in patients with chronic renal failure should represent a great challenge for nephrologists in the future

CARDIOVASCULAR DISEASE AND CHRONIC RENAL FAILURE

Background. Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with chronic renal failure. CVD morbidity is approximately 10–20 times higher in patients with chronic renal failure compared with that in general population. The high prevalence of CVD among patients with chronic renal failure starting dialysis treatment suggests that CVD begins in earlier stages of chronic renal failure or disease.Conclusions. This review discusses the major and other risk factors for CVD in patients with chronic renal failure. Prevention and treatment of CVD in patients with chronic renal failure should represent a great challenge for nephrologists in the future.</p

Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented.</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal.</p> <p>Conclusion</p> <p>A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.</p