Journal of the American Society of Nephrology : JASN
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J. Am. Soc. Nephrol. · Jan 1994
Case ReportsThe neuroleptic malignant syndrome and acute renal failure.
Rhabdomyolysis is a clinical disorder arising from skeletal muscle injury. Many potentially fatal complications may develop after rhabdomyolysis, including hyperkalemia, disseminated intravascular coagulation, and acute renal failure. Both traumatic and nontraumatic causes of rhabdomyolysis are seen. ⋯ The use of dantrolene or bromocriptine may hasten recovery from NMS. Although mortality from NMS alone is unusual, NMS with concomitant renal failure carries a worse prognosis. The treatments outlined here may avert progressive renal failure and reduce mortality in patients with NMS-induced rhabdomyolysis and renal failure.
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J. Am. Soc. Nephrol. · Aug 1993
Variation in the attitudes of dialysis unit medical directors toward decisions to withhold and withdraw dialysis.
Increasingly, physicians who treat patients with renal failure are deciding with patients and families whether to withhold or withdraw dialysis. These decisions as well as those concerning whether medical directors of dialysis units felt prepared to make them were studied using three hypothetical scenarios. A questionnaire survey of 524 physician medical directors of adult chronic dialysis units throughout the United States was conducted. ⋯ Almost all medical directors of dialysis units believe that they are prepared to make decisions to withhold and withdraw dialysis. Nevertheless, this study revealed significant variation in their attitudes toward these decisions. Practice guidelines and consultation with ethics committees might assist dialysis unit medical directors in making these decisions more uniformly and in a way that promotes patient benefit.
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Long-term i.v. catheters for hemodialysis have the outflow tip extending approximately 2 to 3 cm beyond the inflow tip to prevent blood recirculation during dialysis; however, the lumens are frequently reversed because of inflow failure (i.e., inadequate flow when the inflow lumen is used for blood inflow into the dialyzer). Blood recirculation with reversed lumens (outflow lumen used for blood inflow) in inflow failure catheters and with standard and reversed lumens in well-functioning catheters was measured. Recirculation was measured at a blood flow of 300 mL/min. ⋯ Whereas recirculation with standard lumens of well-functioning catheters is negligible, reversal of lumens causes considerable recirculation. Recirculation in inflow failure catheters with reversed lumens is significantly less than that with reversed lumens of well-functioning catheters. It was proposed that a blood clot attached at and/or immediately distal to the inflow lumen may disperse outflowing blood and diminish recirculation in inflow failure catheters.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patients with renal failure are believed to have a poor survival rate after cardiopulmonary resuscitation, but there is little specific information about the outcomes of cardiopulmonary resuscitation in dialysis patients. To be better able to inform dialysis patients and assist them in decision making about cardiopulmonary resuscitation, the eight-year experience with cardiopulmonary resuscitation in dialysis patients at a university dialysis program was analyzed and outcomes were compared with those of a control group of nondialysis patients undergoing cardiopulmonary resuscitation during the same time period in the same hospital. Of 221 dialysis patients experiencing cardiopulmonary arrest, 74 (34%) had CPR compared with 247 (21%) of 1,201 control patients (P = 0.0002). ⋯ Twenty-one (78%) of the 27 successfully resuscitated dialysis patients died a mean of 4.4 days later; 95% were on mechanical ventilation in an intensive care unit at the time of death. It was concluded that cardiopulmonary resuscitation is a procedure that rarely results in extended survival for dialysis patients. In discussions about cardiopulmonary resuscitation with dialysis patients, nephrologists should provide this information.
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J. Am. Soc. Nephrol. · Oct 1992
Comparative StudyShort- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients.
A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. ⋯ Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.