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 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the case of a young man with prolonged and severe chyluria from a previous parasitic infection. He presented with an acute myocardial infarction most likely secondary to increased clotting tendency. He had a spontaneously formed blood clot in his left anterior descending coronary artery. In the setting of hypo-albuminemia (which has occurred because of obligate losses of protein from lymphuria), he has increased production of factor VIII levels and increased clotting tendency. In addition, because of obligate and unregulated fluid losses he has chronic dehydration, miscrovascular ischemia and secondary polycythemia. This polycythemia further increases his risk of hypercoagulability.
Nephrol Dial Transplant 2009 Oct
PMID:Hypercoagulability in a patient with chronic chyluria, proteinuria and hypoalbuminaemia. 1953 72

The past decade has witnessed an evolution of the specialty of Nephrology in the United States to an interventional discipline. Traditionally, Interventional Nephrologists have focused on the venous side of an arteriovenous access. However, these specialists are beginning to include arterial disease related to renal patients under the purview of this specialty. Recent data have emphasized that inflow stenosis of an arteriovenous access frequently results in vascular access dysfunction. Peripheral vascular disease, resulting in distal hypoperfusion ischemia syndrome of the hand bearing the access, is similarly being recognized and managed more frequently by these experts. Two distinct entities, subclavian artery and renal artery stenosis, are also being addressed by interventional nephrologists. This article focuses on arterial interventions performed by interventional nephrologists and describes the epidemiology, techniques, and outcomes of arterial intervention as they relate to the care of patients with hemodialysis access and chronic kidney disease.
Semin Dial
PMID:Arterial interventions in arteriovenous access and chronic kidney disease: a role for interventional nephrologists. 1974 74

A chronic hemodialysis patient was referred to interventional nephrology for evaluation of left hand pain. The patient had been receiving hemodialysis through a left radial-cephalic arteriovenous fistula and reporting hand pain during dialysis. Physical examination demonstrated cold hand and reduced capillary refill compared with the right hand. Clinical features, differential diagnosis, and physical examination findings were consistent with the diagnosis of hand ischemia due to dialysis access. Arteriography revealed >80% stenosis of the distal ulnar artery. Percutaneous balloon angioplasty successfully dilated the lesion with resolution of symptoms. Although uncommon, patients with forearm fistula can also experience symptoms of hand ischemia. This case demonstrates that in addition to the history, clinical features, differential diagnosis, and physical examination, arteriography is a vital step in the management of patients presenting with signs and symptoms of hand ischemia. Further, employment of a basic procedure (percutaneous balloon angioplasty) can successfully resolve the condition and maintain the dialysis access.
Semin Dial
PMID:Arterial angioplasty to treat hand ischemia in a radial-cephalic fistula. 1974 75

Arterial stenoses in patients with arteriovenous dialysis access can create a variety of problems including access dysfunction, thrombosis, and hand ischemia. While percutaneous balloon angioplasty is largely successful in the management of arterial stenoses, elastic recoil can present a real predicament to this treatment. In this report, we present two cases of arterial stenosis that demonstrated elastic recoil after angioplasty and required endovascular stent insertion. Both cases were treated successfully without any complications on an outpatient basis. This report describes arterial stent placement in patients with arteriovenous access and discusses anticoagulation considerations in such cases.
Semin Dial
PMID:Arterial stent placement in arteriovenous dialysis access by interventional nephrologists. 1974 77

Patients with chronic kidney disease (CKD) are considered to belong to the highest risk group for the development of cardiovascular events. These patients should be subject to aggressive risk-factor modification. However, management of coronary artery disease in patients with CKD can be uniquely challenging. Many of the medications used in the treatment and prevention of coronary artery disease are metabolized or excreted by the kidney. Thus, patients with CKD are more likely to experience adverse effects from any attempt to aggressively modify risk factors for coronary artery disease. Little is known regarding revascularization in patients with CKD. Patients with CKD may benefit from off-pump strategies during coronary artery bypass. Percutaneous coronary intervention in patients with CKD is associated with lower procedural success and increased peri-procedural myocardial infarction, ischemia, and target vessel revascularization. In this review, we discuss the unique challenges of managing coronary artery disease in patients with CKD.
Adv Perit Dial 2009
PMID:Management of coronary artery disease in patients with chronic kidney disease. 1988 33

This study was performed on seven patients affected by the atrophic form of age-related macular degeneration (AF-ARMD). The patients under investigation belonged to a larger study aimed at evaluating the efficacy of rheopheresis treatment (RT) on the visual function of AF-ARMD patients. Following the protocol of the larger study, patients received RT twice a week, every two weeks, for a total of ten treatments, as well as high-dose supplementation with zinc and vitamins A, E and beta-carotene. Recruited patients underwent skin laser Doppler flowmetry coupled with skin iontophoresis of the endothelium-dependent vasodilator acetylcholine (ACh) and a test of skin post-ischemic reactive hyperemia, before and after the first RT (time 1: all seven patients) and the fifth RT (time 2: six patients). A significantly higher absolute (anova for repeated measures) and relative (percentage change from the baseline) skin blood flux response (SBFR) to ACh iontophoresis was observed after RT, compared to before RT at time 1 (679 +/- 43% and 436 +/- 78%, respectively; P < 0.05), as well as before RT at time 2 compared to before RT at time 1 (683 +/- 74% and 436 +/- 78%, respectively; P < 0.05). Absolute and relative SBFR to ischemia did not differ either after RT compared to before RT at time 1, or before RT at time 2 compared to before RT at time 1. These findings are consistent with an acute and subacute beneficial effect of RT on skin microvascular endothelial function in the studied AF-ARMD patients.
Ther Apher Dial 2009 Dec
PMID:Acute and subacute effect of rheopheresis on microvascular endothelial function in patients suffering from age-related macular degeneration. 1995 79

Encapsulating peritoneal sclerosis (EPS) is an uncommon complication of peritoneal dialysis (PD), with high mortality and morbidity. The peritoneum thickens, dysfunctions, and forms a cocoon that progressively "strangulates" the small intestine, causing malnutrition, ischemia, and infarction. There is as yet no reliable noninvasive means of diagnosis, but recent developments in image analysis of cine magnetic resonance imaging for the recognition of adhesions offers a way forward. We used this protocol before surgery in 3 patients with suspected EPS. Image analysis revealed patterns of abdominal movement that were markedly different from the patterns in healthy volunteers. The volunteers showed marked movement throughout the abdomen; in contrast, movement in EPS patients was restricted to just below the diaphragm. This clear difference provides early "proof of principle" of the approach that we have developed.
Perit Dial Int
PMID:Initial observations using a novel "cine" magnetic resonance imaging technique to detect changes in abdominal motion caused by encapsulating peritoneal sclerosis. 2145 94

High arteriovenous fistula (AV fistula) blood flow may impair distal limb perfusion and cause irreversible ischemic damage. Since tissue temperature reflects blood perfusion, we tried to assess distal blood flow using an infrared camera. We examined all 12 patients with an AV fistula in our dialysis unit. Seven were pediatric patients aged 11.0-18.9 years (mean 14.9 years) and five were adults aged 26.9-62.1 years (mean 38.6 years). Infrared thermal imaging (thermography) of their hands was performed after the completion of their regular dialysis sessions. In each patient, the spot temperature of each fingertip on both hands was assessed separately, with three measurements being performed for each measuring point. The mean spot temperature of all fingertips was calculated for each hand and the results compared. A statistically significant difference (P < 0.05) indicated distal perfusion insufficiency. Perfusion of the hands was also assessed by inspecting the visualized temperature distribution on the thermal image. Finally, we compared the results to the clinical findings in relevant patients. In 8/12 patients (66.7%), the mean spot temperature of the fingertips was statistically significantly lower on the fistula side (P < 0.05). Only 4/12 patients (33.3%) had clinical symptoms, and all were detected by thermography. Abnormal findings were more frequent in elderly patients. Although we realize that the diagnosis of steal syndrome is primarily clinical, thermography might be a safe, noninvasive, cheap tool for the timely detection of children at risk of developing symptoms of hand ischemia.
Ther Apher Dial 2011 Jun
PMID:Detection of dialysis access induced limb ischemia by infrared thermography in children. 2162 80

Lipid apheresis effectively lowers LDL-cholesterol even in drug-unresponsive severely hypercholesterolemic patients. This results in improvement of symptoms of coronary artery disease, reduces progression of coronary atherosclerosis, and decreases coronary event rates. Besides aggressive lipid lowering itself, these effects may also be due to nonselective removal of other high molecular weight proteins leading to improved hemorheology. Lipid apheresis is also used for treating symptoms of vascular diseases outside the coronary arteries, such as peripheral arterial disease and the angioneuropathic diabetic foot syndrome. This review discusses putative effects of lipid apheresis and rheophereis on restoring pathophysiological processes involved in the development of symptoms of peripheral arterial disease, critical limb ischemia, and the diabetic foot syndrome. The clinical experience with lipid apheresis and rheopheresis in treating patients with peripheral arterial disease and the diabetic foot syndrome is critically reviewed and put into the context of currently available established treatment options. Based on this analysis, the limitations of current evidence are discussed and potential fields of research are suggested.
Semin Dial
PMID:A critical review on the use of lipid apheresis and rheopheresis for treatment of peripheral arterial disease and the diabetic foot syndrome. 2217 77

Structural abnormalities of the brain are common in hemodialysis (HD) patients, as are a wide range of severe functional deficiencies of cerebral function. Both depression and increasing dependency are highly prevalent in HD patients and worsen severely within the first 12 months of dialysis initiation. HD, as it is commonly practiced, is associated with significant recurrent episodes of circulatory stress. This results in acute injury to the heart, skin, kidney and gut, and drives longer term end-organ chronic injury. This article aims to explore the hypothesis that the cerebral microcirculation is also sensitive to dialysis-based circulatory stress (and other multiorgan consequences of recurrent dialysis-induced ischemia), and that this may drive specific patterns of brain injury with resultant psychiatric and functional consequences.
Semin Dial 2012 May
PMID:Are there neurological consequences of recurrent intradialytic hypotension? 2235 38


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