Abstract:
BACKGROUND:Patients with irreversible chronic kidney disease who require dialysis immediately are a subset of ultra late referrals for whom the term chronic kidney disease presenting acutely might usefully be applied. Although well known to nephrologists and recognised as a specific group with considerable problems, little has been written about them. OBJECTIVE:To describe the presentation, clinical features and outcome of irreversible chronic kidney disease presenting acutely, with particular reference to nausea and vomiting as presenting symptoms. METHOD AND RESULTS:Review of 202 consecutive patients with irreversible chronic kidney disease who had dialysis between 1996 and 2006 showed that 15 (7%) had required dialysis immediately or within 7 days of presentation. Analysis of 14 available case records showed eight avoidable late referrals: previous evidence of renal failure in six, and two patients with diabetes who had not had their renal function checked. Gastrointestinal symptoms were common and led to further delays in diagnosis, with three patients having endoscopy requested before their bloods were checked. Physical and psychological morbidity associated with this form of presentation was high. CONCLUSIONS:Chronic kidney disease presenting acutely is not uncommon, often avoidable and associated with adverse outcomes. The identification, follow-up and appropriate referral of patients with raised serum creatinine is likely to reduce its incidence. Nausea and vomiting may occur sufficiently frequently in advanced renal failure to justify measuring renal function before proceeding to endoscopy when patients present with gastrointestinal symptoms.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Wolfe M,Almond A,Robertson S,Donaldson K,Isles Cdoi
10.1136/pgmj.2009.078956subject
Has Abstractpub_date
2010-07-01 00:00:00pages
405-8issue
1017eissn
0032-5473issn
1469-0756pii
86/1017/405journal_volume
86pub_type
杂志文章abstract::Stroke is a recognised complication of pregnancy, contributing to more than 12% of all maternal deaths. Estimated incidence rates vary considerably from 4.3 to 210 strokes per 100,000 deliveries. Atherosclerosis is rare in young adults, and so other causes of stroke become increasingly likely. Aetiological factors imp...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2007.066167
更新日期:2008-05-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
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journal_title:Postgraduate medical journal
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doi:10.1136/pgmj.61.722.1067
更新日期:1985-12-01 00:00:00
abstract::This is a study of the use of myocutaneous flaps by general surgeons in a district general hospital over a 5 year period, and shows that such work can be satisfactorily performed by general surgeons. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.768.738
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journal_title:Postgraduate medical journal
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journal_title:Postgraduate medical journal
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journal_title:Postgraduate medical journal
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1979-01-01 00:00:00
abstract:BACKGROUND:The grade cricket competition, also known as premier cricket, supplies players to the state and national teams in Australia. The players involved are generally high-performing amateur (subelite) club cricketers. However, to date, there is no study on the injury epidemiology of Australian grade cricket. AIM:...
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pub_type: 杂志文章
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1980-12-01 00:00:00
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journal_title:Postgraduate medical journal
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更新日期:2009-06-01 00:00:00
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pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00
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journal_title:Postgraduate medical journal
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.53.623.538
更新日期:1977-09-01 00:00:00
abstract::Tissue auto-antibodies were investigated in fifty-one patients (twenty-five female, twenty-six male) receiving practolol for ischaemic heart disease or dysrhythmias and compared with those found in 204 patients (fifty-eight female, 146 male) with ischaemic heart disease who did not receive practolol. Antinuclear facto...
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pub_type: 临床试验,杂志文章
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更新日期:1977-02-01 00:00:00
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更新日期:2000-04-01 00:00:00