A case study of initiating hemodialysis in a patient with tetralogy of Fallot (TOF)

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  • Shimizu Ari
    Department of Medicine, Kidney Center, Tokyo Women's Medical University
  • Takei Takashi
    Department of Medicine, Kidney Center, Tokyo Women's Medical University
  • Moriyama Takahito
    Department of Medicine, Kidney Center, Tokyo Women's Medical University
  • Itabashi Mitsuyo
    Department of Medicine, Kidney Center, Tokyo Women's Medical University
  • Otsubo Shigeru
    Department of Medicine, Kidney Center, Tokyo Women's Medical University
  • Akiba Takashi
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Nitta Kosaku
    Department of Medicine, Kidney Center, Tokyo Women's Medical University

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Other Title
  • 血液透析導入となった成人ファロー四徴症の１例
  • 症例報告 血液透析導入となった成人ファロー四徴症の1例
  • ショウレイ ホウコク ケツエキ トウセキ ドウニュウ ト ナッタ セイジン ファロー シチョウショウ ノ 1レイ

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Abstract

A 44-year-old male patient with tetralogy of Fallot (TOF) who had not undergone radical surgery, developed chronic renal failure that necessitated the initiation of hemodialysis. Cyanosis was observed in the patient three months after the birth. At seven months, he was diagnosed as having TOF. At the age of 17 years, ascending aorticopulmonary shunt surgery was performed. At the age of 41 years, laboratory data demonstrated an elevated serum creatinine level, and he was suspected of having chronic renal failure due to cyanotic nephropathy. At the age of 43 years, the patient caught a cold, followed by the appearance of generalized fatigue, oliguria and numbness of the feet. The BUN, serum creatinine and serum potassium levels were 10.1 mg/dL, 3.38 mg/dL and 8.0 mEq/L, respectively. Acute chronic renal failure was diagnosed based on these findings. Therefore, hemodialysis was performed three times. The patient subsequently showed diuresis, with improvement in his general condition. However, only 4 months later, he caught a cold again, followed by the development of oliguria, and edema of the legs and eyelids. Chest X-ray demonstrated massive pleural effusion, associated with hypoxia. The urinary volume failed to improve, despite the initiation of hemodialysis. However, the general condition improved and the patient was continued on stable maintenance hemodialysis. The rate of survival to 40 years of age in cases of TOF without radical surgery has been reported to be only 3%. In this article, we report a rare patient with TOF who survived until the age of 44 years without radical surgery. The subsequent clinical course of this patient was complicated by the development of chronic renal failure due to cyanotic nephropathy necessitating hemodialysis.

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