1/43. Heavy chain deposition disease: the disease spectrum.A 45-year-old white woman was found to have microscopic hematuria during her annual physical examination. After a negative urologic workup, she returned 5 months later with nephrotic syndrome, renal insufficiency, and hypocomplementemia. Renal biopsy showed a nodular sclerosing glomerulopathy that could not be further characterized because of inadequate tissue for immunofluorescence. The patient returned 8 months later with chronic renal failure. A repeat renal biopsy showed deposits composed of immunoglobulin g (IgG) heavy chain and complement components C3 and C1 along glomerular, tubular, and vascular basement membranes, with negativity for kappa and lambda light chains, findings consistent with heavy chain deposition disease (HCDD). The heavy chain subclass was exclusively IgG3. Staining with monoclonal antibodies to epitopes of the constant domains of IgG heavy chain showed a CH1 deletion, indicating a truncated heavy chain. On review of the previously reported cases of HCDD, common clinical presentations include nephrotic syndrome, renal insufficiency, hematuria, and, in some cases, hypocomplementemia. In most patients, the hematologic disorder is mild, without overt myeloma. light microscopy shows a nodular sclerosing glomerulopathy, and heavy chain deposits are detectable within basement membranes throughout the kidney by immunofluorescence and electron microscopy. There is no effective treatment for this condition, and virtually all patients progress to chronic renal failure.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/43. Focal segmental glomerulosclerosis: a need for caution in live-related renal transplantation.Focal segmental glomerulosclerosis (FSGS) has increasingly been recognized to occur in a familial pattern. We have observed the development of biopsy-confirmed FSGS and subsequent end-stage renal disease (ESRD) in one live related kidney donor and ESRD without biopsy in another. Both donors had family members with ESRD secondary to FSGS. Both donors were apparently healthy by routine physical examination, urinalysis, and serum creatinine at the time of evaluation as live related donors. We believe these cases emphasize the need for great caution when evaluating siblings as potential live related donors.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/43. Improving physical functioning in the elderly dialysis patient: relevance of physical therapy.Compromised physical functioning is characteristic of medically complicated patients on dialysis, but many of these deficits can be addressed by rehabilitation. This article describes the benefits and limitations of a 3-month physical therapy pilot program at an inner-city hemodialysis clinic. Program results indicate the difficulties in keeping patients participating in such a program, but, for those patients who did regularly participate, on-site physical therapy consultation was valuable in assisting staff to identify exercise regimens that were consistent with individual patients' needs and addressed their functional difficulties.- - - - - - - - - - ranking = 1.7527899625558keywords = physical (Clic here for more details about this article) |
4/43. Complex regional pain syndrome type-1: a rare complication of arteriovenous graft placement.Complex regional pain syndrome (CRPS) type-1 (previously termed reflex sympathetic dystrophy syndrome) may be manifested as sympathetically mediated pain and swelling in an extremity. Among the numerous causes of reflex sympathetic dystrophy, the most common is trauma. We describe a 71-year-old diabetic man with endstage renal disease who presented with CRPS type-1 of the left hand one month after construction of a PTFE (polytetrafluroethylene) arteriovenous graft. The symptoms of CRPS improved greatly with stellate ganglion blocks and physical therapy.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
5/43. nursing considerations in support of a patient pursuing his dream.A 30-year-old man with end stage renal disease (ESRD) undergoing thrice weekly hemodialysis set out to achieve a personal goal to ride his bicycle across the united states within 30 days. To support patients in achieving such a goal, nephrology nurses must consider not only nutritional components, but must be prepared to deal with the physical challenges that face patients in the daily struggles struggle to reach their goal. It became a priority and a challenge for the nephrology team to treat this young man as an athlete who also happened to have ESRD, rather than as a dialysis patient who was a cyclist.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
6/43. bacteroides pericardial effusion and cardiac tamponade in a patient with chronic renal failure.A 31-year-old woman with chronic renal insufficiency and recurrent pericarditis developed an enlarging cardiac silhouette and physical signs of cardiac tamponade. cardiac catheterization demonstrated pericardial effusion with hemodynamic evidence of cardiac compression. At pericardial exploration, 1.5 L. of foul-smelling purulent material was removed from a distended pericardial sac. Cultures of both the exudate and pericardium revealed pure growth of bacteroides fragiles. The patient was subsequently treated with intravenous chloramphenicol and has had an uncomplicated clinical course since that time. This represents the first reported case of cardiac tamponade secondary to culturally proved bacteroides pericarditis in the setting of chronic renal insufficiency.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
7/43. Use of midodrine (Gutron) to treat permanent hypotension in a chronic hemodialysis patient.Chronic hypotension, infrequent though possible in chronic renal failure patients on hemodialysis, has harmful consequences on their physical state and hence general well-being. These patients often experience acute intradialytic manifestations while non-pharmacologic interventions as pharmacologic agents are sometimes insufficient to improve symptoms. Well tolerated, midodrine appears to be a suitable and effective agent as it raises blood pressure significantly via its effect on peripheral alpha-adrenergic receptors. The authors describe their use of midodrine in a dialysis patient for the longest period of time reported up to now, documented by a pharmacokinetic study, confirming long-term both clinical efficacy and safety of the drug.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
8/43. Amyloid goiter in familial mediterranean fever (FMF): a clinicopathologic study of 10 cases.FMF amyloidosis is an important etiological factor of end stage renal disease (ESRD) in Mediterranean Countries. Apart from major target organs as cardiovascular, respiratory and gastrointestinal system, endocrine organs can also be involved. We planned to investigate the thyroid involvement in our amyloidosis group. The aim of this study was to determine clinical characteristics of amyloid goiter in FMF patients and the abnormalities of thyroid function, as well as to identify pathologic characteristics. Twenty-two hemodialysis patients (mean age 34.1 /- 14 years, range 17-68) whose ESRD secondary to FMF amyloidosis were evaluated with physical examination, serum levels of thyroid hormones, ultrasound examination of thyroid glands, thyroid syntigraphic studies. goiter was found in 10 patients (4 male, 6 female) having enlarged neck mass (mean age 35 /- 14 years, range 23-64). The serum levels of thyroid hormones and TSH were normal in 4 patients. Other four cases had euthyroid sick syndrome. Only one patient developed tender enlarged neck mass with subacute thyroiditis symptoms and one had primary hyperthyroidism. Ultrasound examination showed; hypoecoic nodules in 6 patients diffuse multinodular enlargement in 4 patients. Thyroid syntigraphic studies revealed hypoactive nodules in 7 patients and hyperactive nodules in 3 patients. After the laboratory tests were completed, in 10 patients diagnosis were made with fine needle aspiration biopsy. Of 10 patients 5 underwent subtotal thyroidectomy. Immunohistochemical evaluation demonstrated the presence of amyloid AA immunoreactivity in all cases. In conclusion fine needle aspiration from the thyroid when enlarged is useful in the diagnosis of suspected amyloidosis, especially since it is a safe, easily performed procedure. With the help of amyloid goiter diagnosis the patient's prognosis on hemodialysis and with renal transplantation can be predicted. Amyloid goiter must be searched in hemodialysis patients especially in Mediterranean Countries.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/43. infection and inflammation in dialysis patients: impact on laboratory parameters and anemia. Case study of the anemic patient.infection and inflammation trigger an acute-phase response that can precipitate the development of mild to moderate anemia. In many cases, changes in hematological parameters may be the initial sign of an occult infectious or inflammatory disorder. In dialysis patients, the decrease in erythropoiesis attributed to these conditions is often additive--aggravating the preexisting anemia associated with end-stage renal disease (ESRD). nephrology nurses are in a unique position to conduct regular physical assessments and laboratory evaluations to proactively detect infection or inflammation and limit the short- and long-term impact of these conditions.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
10/43. speech and language findings in a chronic hemodialysis patient: a case report.The speech and language findings in one patient who underwent chronic hemodialysis therapy are presented. The patient's degenerating physical status was first signaled by stutteringlike repetitions. The speech diagnosis is mixed dysarthria, apraxia of speech, and aphasia. Clinical implications are discussed.- - - - - - - - - - ranking = 0.15934454205053keywords = physical (Clic here for more details about this article) |
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