10 research outputs found
Stomach phytobezoars in two uremic anorexic patients
Conglomerates of food and mucus or phytobezoars composed of vegetable
matter are sometimes found in the stomach in the general population.
Reports of phytobezoars in uremic patients are, however, scarce. Here we
describe 2 uremic patients in which esophagogastroduodenoscopy was
performed due to dyspepsia associated with weight loss and in which stomach
phytobezoars were discovered. Theoretically, uremic patients should be at
risk for producing bezoars. In fact, these patients frequently present
predisposing conditions such as autonomic neuropathy, diabetes mellitus and
delayed gastric emptying. Gastric bezoars cause anorexia. Anorexia is a
frequent symptom in dialysis patients and is associated with malnutrition.
In these patients, malnutrition is strongly associated with mortality and
is quite difficult to reverse. Similarly, phytobezoars cause chronic
anorexia. We suggest that clinicians working in dialysis units should
consider the possibility of a gastric bezoar when evaluating anorexic
uremic patients
Acute renal failure due to a calculus obstructing a transplanted kidney
Nephrolithiasis is a rare finding in kidney transplantation and anuria
could be the only clinical sign. We report the case of a 52-year-old
Caucasian male renal transplant recipient admitted due to acute renal
failure (ARF) and anuria. He reported no symptoms and a palpable bulge in
the right iliac fossa corresponding to the graft was present.
Ultrasonography showed hydronephrosis of the graft. A double-J ureteral
stent was inserted with resolution of ARF. ARF with anuria and the presence
of a palpable non-tender, elastic mass over the graft could be the clinical
picture of obstructive ARF in a transplanted kidney
Vascular calcification of the venous side of an arterious-venous fistula
While reports of venous calcifications are scarce, vascular calcifications
frequently occur in the arteries of uraemic patients. Venous calcification
of an aged arterious-venous (a-v) fistula in a young patient with a
long-standing history of hyperparathyroidism was detected on a forearm
X-ray. Risk factors for vascular calcifications are still under debate, but
calcium-phosphate product appears to be involved in its pathogenesis. We
suggest that a-v fistula of patients with hyperparathyroidism history
should be monitored as calcifications could be a risk factor for access
thrombosis
Ash split cath(registered trademark) in geriatric dialyzed patients
Vascular access is the essential step in performing hemodialysis in uremic
patients. In the absence of a permanent and utilizable native
arterio-venous fistula, the use of a tunnelled catheter makes dialysis
therapy possible. The Ash Split Cath, a recently introduced chronic
hemodialysis catheter, was inserted in five patients (7.1 % of our
prevalent dialysis population) because of repeated venous thrombosis in
three patients and a poor venous tree in two. The mean age of patients was
78 years (plus or minus) 7. The average blood flow rate was 250 (plus or
minus) 50 ml/minute and the mean venous pressure 140mm Hg (plus or minus)
35. Recirculation determined by low flux technique was less than 2 %. KT/V
calculated 3 months after the catheter placement was 1.2 (plus or minus)
0.02. During the follow-up we did not document any infection of the exit
site or related to the catheter. This device is simple to place, gives
adequate dialysis treatment and is useful in geriatric dialyzed patients in
whom the arterio-venous fistula can no longer be used
Thoracic lymphadenopathy due to vascular transformation of lymph node sinuses associated with upper limb edema in a chronic hemodialysis patient with congestive heart failure
BACKGROUND: Vascular transformation of lymph node sinuses (VTLS) is a rare
disorder characterized by transformation of lymph node sinuses into
endothelium-lined capillary-like channels. This phenomenon was originally
discovered by accident whilst examining regional lymph nodes draining
cancer. However, it has been found in association with other conditions
associated with lympho venous congestion and distension, such as congestive
heart failure (CHF) or even lymphoadenopathy alone. CASE REPORT: We
describe the clinical case of a male dialysis patient with CHF (secondary
to ischemic-hypertensive cardiac failure) who developed gross edema of the
upper left limb on the arteriovenous fistula (AVF) side. Edema appeared
within a month after carotid endoarteriectomy following approximately
twenty years of chronic hemodialysis. Doppler ultrasound with other
investigations showed that subclavian and upper cava veins were patent, but
revealed many enlarged lymph nodes in the upper left thorax and in the left
axilla. Suspicion of lymphoproliferative disease or metastatic involvement
was raised and a lymph node biopsy was performed, revealing VTLS. Bone
marrow biopsy and abdominal tomographies showed no mass or a proliferative
disorder. Based on a hypothesis of an association between upper limb edema
and ipsilateral AVF, the AVF was tied. The upper limb edema decreased
dramatically within weeks, whilst RRT was continued by means of a central
venous catheter. However, a few months later the patient's condition
worsened; he developed relapsing pleural effusions and eventually died.
Post-mortem examination revealed severe ischemic-calcific cardiopathy and
showed that major thoracic and brachial vessels were patent whilst most
thoracic and hilar lymph nodes showed VTLS and fibrosis. CONCLUSIONS: We
believe that in our patient CHF was the primary cause of thoracic
adenomegaly and that CHF, together with venous hypertension at the left
fistula's arm, caused ipsilateral limb edema. Thus, adenomegaly due to VTLS
could represent an accompanying feature even in upper limb edema in chronic
hemodialysis patients. To our knowledge, this is the first report of such
an association. In our patient months were "lost" because we thought that
limb edema was secondary to the adenomegaly. It is important that
clinicians working in dialysis units are aware that when upper limb edema
is present, adenomegaly might just be an accompanying symptom, especially
in case of concomitant diagnosis of CHF