PSS (進行性全身性硬化症) による腎不全の透析看護例

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  • A case of chronic renal failure due to progressive systemic sclerosis

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A case of progressive systemic sclerosis (PSS) with renal failure is described. A 42-year-old woman was admitted to hospital because of slight fever, easy fatigability and swelling of the extremities, which were noticed 2 months prior to admission. She had undergone nephrectomy because of tuberculosis at the age of 17. On admission, she had taut skin over the forearms and fingers. Her blood pressure was 130/94mmHg. The laboratory findings were: blood urea nitrogen (BUN), 10mg/dl; creatinine (Cr), 0.9mg/dl; hemoglobin, 11.4g/dl; proteinuria 1 (+) and microhematuria; and plasma renin activity (PRA), 1.52ng/ml/h. A chest x-ray did not reveal pulmonary fibrosis. Histologic examinations of a skin specimen showed sclerodermal changes. Two months later, pericardiotomy was performed because of pericardial effusion. The patient then became uremic (BUN, 144mg/dl; Cr, 7.5mg/dl) and hemodialysis, 3 times a week, was started. At that time, she became depressive because of the rapid progress of her disease. She refused to receive the treatments and hoped for death. We nursed the patient to the best of our ability in cooperation with her family, maintaining contact with her for hours a day and encouraging her. Ten months after the induction of hemodialysis, her depressive state gradually improved and she began to rehabilitate. The PRA was not high in this patient, and the single kidney might not elevate the PRA and might prevent vascular changes. Her good prognosis could be attributable to these factors.

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