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Sample text
Patient: is there anything that will get rid of the amyloid? Doctor: no, I’m afraid that it’s extremely unlikely that it will be possible to get rid of it. But if the inflammation caused by the ankylosing spondylitis can be reduced, then the rate at which it increases can be slowed down and it may even improve a little. I am not an expert in this area, but we will discuss things with our colleagues in the rheumatology department and see if they can recommend any treatments to do this. This is something I am sure you’ll want to talk about with them in clinic.
Evidence of cardiac dysfunction, eg postoperative chest pain may go unnoticed but be an indication of myocardial infarction. 1 for discussion). Check in particular for features to support the diagnosis of renal hypoperfusion or postrenal problems. Evidence of likely renal hypoperfusion • Hypotension and postural hypotension (lying and sitting). • Low JVP. • Bladder outflow obstruction, particularly in elderly men due to prostatic enlargement: is the catheter properly positioned and draining freely?
Repeat measurements of serum electrolytes and creatinine regularly. Particular attention should be paid to the trend as well as the absolute values of abnormalities: if these are getting worse day by day, do not wait until they are extreme before seeking advice from renal services. Once the need for renal replacement therapy becomes clear, usually in the context of oliguria and worsening renal function, there is no point delaying its commencement until there is an emergency indication. • Always consider sepsis and set a low threshold for commencing broad-spectrum (non-nephrotoxic) antibiotics.