ABSTRACT
Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.
ABSTRACT
Objective To explore the changes of mineral and bone metabolism before and after renal transplantation as well as the effect of preoperative parathyroid hormone (PTH) level on postoperative mineral and bone metabolism.Methods In this retrospective analysis,we recruited 82 cases of renal transplant recipients with normal renal function and receiving kidney transplantation in our hospital from January 2011 to January 2015.All of these patients had intact PTH (iPTH) level ＞300 pg/mL.We chose 26 cases of recipients whose preoperative iPTH was more than or equal to 800 pg/mL as very high PTH group,and 56 cases of recipients whose preoperative iPTH was between 301-799 pg/mL as high PTH group.We monitored and performed analysis of the total serum calcium (Ca),serum inorganic phosphorus (P),25-(hydroxyl) vitamin D3 (25 OHD),serum alkaline phosphatase (ALP),Beta C-terminal telopeptide (β-CTX),N-terminal/midregion (N-MID) pre-and 1 month,4 months,1 year,2 years,3 years post-kidney transplantation.Results Serum total calcium in the two groups was gradually increased,returned to normal range 1 month post-transplantation and reached the plateau 4 months post-transplantation.The incidence of hypercalcemia in very high PTH group was statistically significantly higher than in high PTH group.Serum phosphorus in the two groups showed a trend of gradual decline after renal transplantation,and returned to the normal range 1 month post-transplantation.The serum phosphorus level in very high PTH group reached the plateau 4 months post-transplantation,and that in high PTH group 1 month post-transplantation.Compared with high PTH group,very high PTH group has greater The incidence of long-term hypophosphatemia after renal transplantation was significantly higher in very high PTH group then in high PTH group.iPTH,ALP,β-CTX and N-MID in the two groups showed a downward trend after renal transplantation.At first month post-transplantation,iPTH,ALP,β-CTX and N-MID levels were reduced most significantly.The average levels of the three mentioned indicators in very high PTH group were higher than in high PTH group at every time point after surgery with the difference being significant during the early post-transplantation period.The anomalies of iPTH and β-CTX levels persisted to long term after transplantation in very high PTH group.25-OHD levels in these two groups showed rising trend after renal transplantation,reached the plateau 4 months posttransplantation,but failed to achieve the ideal reference level,and no significant difference was found between two groups at any time point monitored.Conclusion The anomalies of mineral and bone metabolism after renal transplantation could persist a long time.Conclusion hyperparathyroidism in the renal transplantation plays an important role in mineral and bone metabolism.Preoperative severe HPT could continue to post-transplantation period and increase the incidence of hyperphosphatemia and hypocalcemia long term after transplantation,which may aggravate bone turnover and this effect can last a long time after transplantation.