American journal of kidney diseases : the official journal of the National Kidney Foundation
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Randomized Controlled Trial Clinical Trial
Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study.
Extended dialysis is an increasingly used modality of renal replacement therapy that theoretically offers advantages of both intermittent and continuous therapies in the intensive care unit (ICU). ⋯ Extended dialysis combines excellent detoxification with cardiovascular tolerability, even in severely ill patients in the ICU. The technically simple dialysis system used offers flexibility of treatment time.
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Acute renal failure (ARF) is an unusual complication of wasp stings and mostly results from toxic-ischemic acute tubular necrosis. This patient, who was stung by a swarm of wasps, experienced an allergic reaction, rhabdomyolysis, intravascular hemolysis, and subsequent ARF. ⋯ Renal biopsy should be encouraged, especially for a patient with delayed recovery of renal function after wasp stings, to facilitate early steroid treatment for the patient with the histological change of acute interstitial nephritis. Early use of steroid therapy may hasten renal recovery by preventing the development of interstitial fibrosis.
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Many nephrologists perform clinical procedures, and perhaps the most common is placement of a noncuffed dialysis catheter to obtain vascular access necessary for immediate hemodialysis therapy. The right internal jugular vein frequently is the site of choice for placement of such catheters in most patients, but placement in the left internal jugular vein would not be unusual; for example, if another central catheter is present in the right internal jugular vein or there has been a failed attempt at that site. Nephrologists who place hemodialysis catheters in the left internal jugular vein should be aware of the existence of an anatomic variant, a persistent left superior vena cava, to prevent alarming misinterpretation and inappropriate clinical responses to routine chest radiographs taken to confirm adequate placement of such catheters.
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The patient presented to the emergency room with hemoptysis and pleuritic chest pain. A chest x-ray revealed a broken dialysis catheter tip lodged in the pulmonary artery. The fractured catheter tip was removed via the femoral vein using a loop snare. As has been described for central lines and venous ports, a fractured catheter tip from a hemodialysis catheter may also lead to pulmonary embolism.