• Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access.

      Sultan, Sherif; Hynes, Niamh; Hamada, Nader; Tawfick, Wael; Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland. sherif.sultan@hse.ie (2012-11)
      Patients with end-stage renal disease should have arteriovenous fistula (AVF) formation 3 to 6 months prior to commencing hemodialysis (HD). However, this is not always possible with strained health care resources. We aim to compare autologous proximal AVF (PAVF) with distal AVF (DAVF) in patients already on HD. Primary end point is 4-year functional primary. Secondary end point is freedom from major adverse clinical events (MACEs). From January 2003 to June 2009, out of 495 AVF formations, 179 (36%) patients were already on HD. These patients had 200 AVF formations (49 DAVF vs 151 PAVF) in arms in which no previous fistula had been formed. No synthetic graft was used. Four-year primary functional patency significantly improved with PAVF (68.9% ± SD 8.8%) compared to DAVF (7.3% ± SD 4.9%; P < .0001). Five-year freedom from MACE was 85% with PAVF compared to 40% with DAVF (P < .005). Proximal AVF bestows long-term functional access with fewer complications compared to DAVF for patients already on HD.
    • Pattern of change in renal function following radical nephrectomy for renal cell carcinoma

      Coyle, D; Quinlan, MR; D’Arcy, FT; Kelly, BD; Corcoran, O; Durkan, GC; Jaffry, S; Walsh, K; Rogers, E (2015-09)
      Radical nephrectomy (RN) is an independent risk factor for the development of chronic kidney disease (CKD) in those with renal cell carcinoma (RCC). We aimed to examine the pattern of change in post-operative renal function in patients who underwent RN for RCC over a 3 year period at our institution. We performed a retrospective review of histological and biochemical findings in patients undergoing RN for RCC over a 38 month period. Estimated glomerular filtration rate (eGFR) was recorded pre- and post-operatively and at follow-up. We analysed data on 131 patients (median follow-up 24 months). The proportion of patients with advanced CKD increased significantly at follow-up with 48 (85.7%) patients, classified as having stage 2 CKD pre-operatively, being re-classified as stage 3-5. Mean eGFR was significantly lower pre-operatively (76.6 mL/min/1.73 m2) compared to hospital discharge (61 mL/ min/1.73 m2, p<0.001) and follow-up (55.5 mL/min/1.73 m2, p<0.001). Those with pT1 tumours sustained a significantly greater decline in eGFR compared to other stages. In conclusion, patients with pT1a and pT1b tumours sustain a disproportionate decline in renal function and may benefit the most from NSS.
    • Pitfalls of the urinary albumin creatinine ratio in detection of early diabetic kidney disease

      Garrahy, A; Tormey, WP (Irish Medical Journal, 2015-04)
      Diabetic Kidney Disease (DKD) is the leading cause of kidney disease world-wide, for which albuminuria is the currently accepted biomarker. Despite the increased use of glucose-lowering medications and renin-angiotensin-aldosterone system (RAAS) inhibitors, prevalence of DKD continues to rise in proportion to the prevalence of diabetes 1 . Development of chronic kidney disease in patients with diabetes is associated with a significant increase in morbidity and mortality as well as health care costs, even before the development of end stage renal failure (ESRF), and its onset can be clinically silent.
    • The Prevalence and Management of Metabolic Acidosis of Chronic Kidney Disease

      Ahmed, A.R.; Satti, M.M.; Abdalla, A.E.; Giblin, L.; Lappin, D. (Irish Medical Journal, 2019-10)
      Emerging evidence supports initiating oral sodium bicarbonate (OSB) at a serum bicarbonate (HCO3) level of less than 22mmol/L. We look to identify the prevalence of metabolic acidosis of chronic kidney disease (MA-CKD) and its management with OSB at a regional university hospital.
    • Successful pregnancy after simultaneous pancreas-kidney transplantation:a case report

      Smyth, A; Gaffney, G; Hickey, D; Lappin, D; Redden, D; Dunne, F; Departments of Endocrinology, Obstetrics & Gynaecology and Nephrology, Galway University Hospitals, Galway, Ireland; Department of Urology & Transplantation, Beaumont Hospital, Dublin 9, Ireland. (Diabetic Pregnancy Study Group, 2011)
      The effect of pregnancy on simultaneous kidney pancreas transplant recipients has previously been described, but experience is limited. Compared to kidney transplant recipients, these patients experience higher rates of preterm delivery, low birth weight, hypertension, infection, pre-eclampsia, acute rejection and graft loss in later years. Risks are reduced by planning pregnancy with functional grafts and stable immunosuppression doses. We describe the case of a thirty-five year old female who six years previously underwent simultaneous kidney pancreas transplant. She had preceding type 1 diabetes mellitus for nineteen years, complicated by retinopathy and nephropathy that required haemodialysis. She also had polycystic ovarian syndrome and required hormonal support to achieve pregnancy. Immunosuppression included tacrolimus, prednisolone and mycophenolate mofetil which was changed to azathioprine prior to pregnancy. An integrated multidisciplinary team closely followed progress during pregnancy. She developed pregnancy-induced hypertension requiring labetolol. Tacrolimus doses were adjusted based on trough levels and blood glucose levels and HbA1c remained within normal limits. She did not require insulin treatment at any point and there was no deterioration in retinopathy despite progressive hypertension. She experienced deterioration in renal indices at twenty-six weeks gestation. Intramuscular betamethasone was administered. Due to further deterioration in renal indices delivery was planned and she underwent an uncomplicated, elective Caesarian section at thirty weeks gestation, performed by her obstetrician with assistance from her transplant surgeon. She delivered a male infant of 1.18kg, appropriate for gestational age, who had hypothermia and respiratory distress, which required intubation and ventilation and an eleven week stay in the special care baby unit. At eighteen month follow the infant shows normal development and there has been no deterioration in either graft’s function.