Fibrin sheath and its relation to subsequent events after tunneled dialysis catheter exchange.

The use of tunneled catheters (TDC) for chronic hemodialysis is frequent and often fails due to fibrin or thrombus and infection. We hypothesized that the presence of fibrin sheath in TDC increases the risk for subsequent catheter malfunction and infection. We did a retrospective review of TDC exchanges and de novo placements from January 2005 to September 2011.

Failure of sonography to visualize a kidney affected by emphysematous pyelonephritis.

We describe a diabetic patient who presented with acute renal failure as a result of acute bilateral emphysematous pyelonephritis. Initially, both an abdominal X-ray examination and a renal sonogram were unremarkable. Two days later, however, the previously visualized right kidney could not be demonstrated again by a repeat renal sonogram.

Symptomatic hypocalcemia due to the inadvertent use of a calcium-free hemodialysate.

Hemodialysis using a bath with less-than-normal calcium level can cause hypocalcemia. The development of symptomatic hypocalcemia with resultant hypotension after the inadvertent use of a calcium-free dialysate in a maintenance hemodialysis patient is described. It is suggested that the occurrence of similar mishaps in the future can be reduced by close checking of dialysate concentrate labels.