We present the case of a 13-year-old male with a complex congenital cardiac history who was supported with extracorporeal membrane oxygenation for 394 days while awaiting cardiac transplantation. The patient underwent successful cardiac transplantation after 394 days of support with veno-arterial extracorporeal membrane oxygenation and is currently alive 2 years after cardiac transplantation. We believe that this case represents the longest period of time that a patient has been supported with extracorporeal membrane oxygenation as a bridge to cardiac transplantation.

We also review the literature associated with prolonged support with extracorporeal membrane oxygenation. This case report documents many of the challenges associated with prolonged support with extracorporeal membrane oxygenation, including polymicrobial bacterial and fungal infections, as well as renal dysfunction. It is possible to successfully bridge a patient to cardiac transplantation with prolonged support with extracorporeal membrane oxygenation of over 1 year; however, multidisciplinary collaboration is critical.

We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine. Two years later, clozapine was re-trialled due the refractory nature of her psychiatric symptoms. She subsequently developed renal failure and AIN was confirmed by renal biopsy. Renal function improved after cessation of clozapine; however, she never fully regained normal renal function.

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the renal system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

Although renal dysfunction and renal failure are known risks of congenital heart surgery, accurate estimates of the incidences of these complications are limited. This lack of knowledge is in part due to the lack of uniform definitions of these postoperative complications. The purpose of this effort is to propose consensus definitions for renal complications following congenital cardiac surgery so that collection of such data can be standardized. Clinicians caring for patients with congenital heart disease will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing strategies for treatment.

We describe three children with chronic renal failure who developed mitral obstructive disease over a period when maintained on hemodialysis. The development and progression of the mitral disease was documented by cardiac catheterization in one child and by Doppler echocardiography in the other two children. These three patients had the lowest body weight among the 16 children undergoing chronic dialysis who were examined cardiologically in our hospital. Autopsy in one child who died from heart failure revealed marked thickening of the leaflets and subvalvar apparatus of the mitral valve with severe obliteration of the intercordal spaces. We found no sign of calcification at the mitral annulus nor at the attachments of the leaflets of the aortic valve, and no Ashoff bodies. We attempted percutaneous catheter balloon valvoplasty in one child which permitted successful renal transplantation after failure of an initial transplantation because of severe pulmonary venous congestion. We conclude that mitral obstructive disease could be a complication of long-term hemodialysis for chronic renal failure. Catheter intervention may serve to release the obstruction, although the procedure is not curative.

Studies have demonstrated that isolated soya protein (ISP) can slow the progression of renal injury, reduce blood pressure and improve the serum lipid profile in experimental animals and human subjects. The mechanisms and components of soya responsible have not been fully established. The present study was designed to evaluate the effects of the hydrophilic supernatant fraction (SF) and the hydrophobic precipitate fraction (PF) isolated from soya protein hydrolysate on renal function, lipid metabolism and blood pressure in five-sixths nephrectomized rats. Experimental animals were subjected to a nephrectomy and allocated to four groups (180g casei/g, 180g IS/g, 100g casei/g with 80g S/g, and 100g casei/g with 80g P/g). The SF group had the most significant decreases in blood pressure and total cholesterol, as well as a significantly retarded progression of the experimentally induced renal disease, compared with the other groups. The PF group exhibited a significantly increased faecal excretion of total steroids. The serum creatinine, level of proteinuria, total cholesterol and LDL-cholesterol concentrations, and blood pressure were significantly reduced, and HDL-cholesterol was significantly increased, in the ISP and PF groups compared with the casein group, but no significant differences were observed between the ISP and PF groups. These results suggest that both soya protein hydrolysate fractions favourably affected chronic renal failure induced by a five-sixths nephrectomy, and the hydrophilic fraction of soya protein hydrolysate had the most pronounced effect on attenuating hypertension and slowing the progression of renal disease.

A man, aged 32, who had undergone surgical correction of complex congenital cardiac disease, had chronic severe right heart failure. Increasing reliance on diuretics led to deteriorating renal function, and he was rejected as a candidate for cardiac transplantation. By inserting a Tenckhoff catheter, and training him to drain his ascites at home, we achieved a dramatic improvement in both his cardiac and renal function. As far as we can ascertain, this is the first time this technique has been used for such a patient. We discuss the mechanisms of improvement, and suggest that other such patients with congenital cardiac disease might benefit from similar management.

The patient was a 54-year-old woman who had been suffering from chronic tubulo-interstitial nephritis for about seven years, requiring haemodialysis. More recently, she developed a polypoid mass in the left nasal cavity causing discomfort on breathing and slight epistaxis. The tumour was of gritty consistency and measured 28 × 8 × 5 mm. Microscopy showed a lobulated almost cystic structure composed of granulation tissue with comparatively few plasma cells and many multinucleated giant cells lining the spaces filled with crystalline deposits of calcium oxalate.

Background and objective Patients with end-stage chronic renal failure are at risk of developing several serious postanaesthetic complications. Many anaes-thesiologists perform brachial plexus anaesthesia with high doses of local anaesthetic in order to achieve an extensive blockade of the upper limb. Brachial plexus block is a suitable technique for anaesthesia for creation, repair or removal of vascular access for haemo-dialysis. The aim of this study was to measure mepivacaine plasma concentrations after axillary block with 650 mg plain mepivacaine in patients with end-stage chronic renal failure.

Methods Mepivacaine plasma concentrations were assessed throughout a 150-min period, in 10 patients after axillary block with 650 mg plain mepivacaine (600 mg for axillary block and 50 mg for supplementation).

Results Mepivacaine plasma concentrations expressed in μg mL−1 as medians and their ranges were: 1.69 (1.23–7.78) at 5min, 5.61 (4.36–8.19) at 30min, 8.28 (3.83–11.21) at 60min, 7.93 (5.63–11.1) at 90min and 6.49 (5.56–8.35) at 150 min without any symptoms of toxicity.

Conclusions Brachial plexus anaesthesia with 650 mg plain mepivacaine did not result in serious systemic toxicity in these patients despite the high mepivacaine plasma concentrations found.

A 37-year-old man with type I diabetes mellitus and chronic renal failure presented to the emergency department complaining of hallucinations. He was 5 days postoperative for left pars plana vitrectomy and intra-ocular lens implantation and had been taking ophthalmic atropine, tobramycin and prednisolone. He had presented 5 months earlier, on the same ophthalmic medications, with postoperative hallucinations after a right pars plana vitrectomy. Visual hallucinations are a major side effect of anticholinergic poisoning. Ophthalmic instillation of atropine has been documented to cause many central nervous sytstem symptoms, including hallucinations.