COMPLICATIONS The major complications associated with PCNL are hemorrhagic. Occasionally, PCNL procedures need to be aborted before complete stone ablation if bleeding prohibits adequate stone visualization. Bleeding is most commonly…
PROCEDURE Most patients are positioned supine on the lithotripter bed; however, those with stones in anteriorly located kidneys, medial portions of a horseshoe kidney, or transplanted kidneys should be positioned…
Continuous veno-venous hemodialysis (CVVHD)—CVVHD is similar to hemodialysis as described earlier but is continuous rather than episodic. This modality consists primarily of diffusive clearance of small molecules. Some convective clearance…
Unusual collecting system anatomy, in particular infundibular stenosis, often precludes successful elimination of stone fragments following ESWL and URSLL, again making PCNL the better choice. Finally, congenitally abnormal kidneys, such…
The dialysate is instilled into the abdominal cavity through a surgically tunneled catheter (Tenckhoff), which remains in place between sessions. Given the risk of peritonitis with an indwelling catheter, patients…
The patient’s vasculature can be accessed using either a central venous catheter (CVC) or a connection between an artery and vein (fistula or graft). A CVC used for dialysis contains…
Occasionally, patients may have isolated hematuria (i.e., without proteinuria or renal insufficiency). The differential diagnosis for such patients includes thin basement membrane disease, mild IgA nephropathy, and hereditary nephritis. A…
COMPLICATIONS The main complications of a renal biopsy include bleeding, pain, damage/puncture of surrounding structures (liver, spleen, bowel), and arteriovenous fistula formation. Bleeding is by far the most common complication,…
ADVERSE EFFECTS The major adverse effects of potassium-sparing diuretics include: Hyperkalemia Metabolic acidosis. Through the same mechanisms used to reduce K+ secretion, these agents also reduce H+ secretion into the…
ANGIOTENSIN II RECEPTOR BLOCKERS The ARBs are a class of competitive and noncompetitive antagonists of the AT1 angiotensin receptor. These agents are very similar to ACE inhibitors, but they do…
