ABSTRACT
Living kidney donors represent a unique population of patients. Potential donors are selected based on the belief that their preoperative fitness is likely to mitigate the risks of long- and short-term harm following uninephrectomy. Studies performed on postdonation outcomes have largely focused on mortality and the risk of end-stage renal failure, but have also investigated secondary outcomes such as cardiovascular morbidity and hypertension. It has been postulated that hypertension is a possible outcome of living kidney donation. A variety of studies have been conducted to investigate the prevalence, epidemiology, mechanisms, treatment strategies, and long-term ramifications of hypertension postdonation. These studies are heterogeneous in their population, design, methodology, and outcome measures and have presented contradicting outcomes. Additionally, the absence of a well-matched control group has made it challenging to interpret and generalise the reported findings. As such, it is not possible to definitively conclude that hypertension occurs at a higher rate among donors than the general population. This article will review the evidence of postdonation hypertension prevalence, mechanisms, treatment, and complications.
Subject(s)
Hypertension , Kidney Transplantation , Living Donors/statistics & numerical data , Nephrectomy/adverse effects , Humans , Hypertension/epidemiology , Hypertension/etiology , Hypertension/physiopathology , Hypertension/therapy , Kidney/physiopathology , Kidney/surgery , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapyABSTRACT
PURPOSE OF THE STUDY: Iron deficiency anaemia (IDA) is associated with increased morbidity and mortality in heart failure patients. The aim of our audit was to evaluate the current practice in diagnosis and assessment of IDA in patients admitted with heart failure. STUDY DESIGN: We conducted a retrospective audit of patients admitted to our hospital between January 2017 and June 2017 with a diagnosis of heart failure, and obtained data regarding each patient's demographics and anaemic status. We also conducted a qualitative survey to assess healthcare professionals' ability to diagnose IDA, and their knowledge of iron replacement in heart failure patients. RESULTS: Our audit identified 218 heart failure patients, nearly two-thirds (n=138, 63.3%) of which were anaemic. Of the 138 anaemic patients, only 40 had a full haematinic screen compared with 98 who had incomplete investigations (29% vs 71%, p=0.007). Iron studies were the most commonly performed haematinic investigation (n=87, 63%), and over half of these patients were iron deficient (n=49, 56.3%). Only 12 (24.5%) iron deficient patients were prescribed oral iron therapy, while 37 (75.5%) were left without iron replacement (X2=12.8, p=0.0003). Our survey demonstrated a lack of awareness among healthcare professionals with only 19.7% of participants being able to correctly define anaemia and 9.1% being aware of guidelines regarding treatment of IDA. CONCLUSION: Many patients admitted to hospital with heart failure also have a concomitant diagnosis of anaemia. The aetiology of the underlying anaemia is often poorly investigated, and where IDA is identified it is poorly treated.
Subject(s)
Anemia, Iron-Deficiency , Heart Failure , Hematologic Tests , Patient Care Management , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/epidemiology , Anemia, Iron-Deficiency/therapy , Clinical Audit , Comorbidity , Female , Heart Failure/blood , Heart Failure/epidemiology , Heart Failure/therapy , Hematologic Tests/methods , Hematologic Tests/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Male , Patient Care Management/methods , Patient Care Management/statistics & numerical data , Prevalence , Process Assessment, Health Care , Risk Assessment , United Kingdom/epidemiologyABSTRACT
An elderly man was found to have a large right atrioventricular mass and pericardial effusion. He was diagnosed and treated as having primary cardiac lymphoma. A dose-attenuated chemotherapy regimen of rituximab, cyclophosphamide, vincristine, and prednisolone, with a cytoreductive pre-phase, afforded complete regression of disease with resolution of the patient's symptoms, and without deterioration in cardiac function or immunosuppression. The patient remains well 12 months after presentation. (Level of Difficulty: Advanced.).
ABSTRACT
Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.
