A 31-year-old woman referred to ophthalmology for evaluation of renal function after having been diagnosed with bullous epidermolysis from birth and dysphagia to solid foods that did not require endoscopic treatment.
Endocrinology ruled out hypothyroidism and associated adrenal insufficiency.
With no previous diagnosis of chronic kidney disease in the last year, it is sent by azoemia.
On admission she presented: weight 45kg, height 1.55 disseminated hands, tegumentary dryness +, partial alopecia, oral cavity with bilateral erythematous crusts, scattered areas of erythema, generalized microstomy to oral cavity.
1.
Relevant laboratory abnormalities: hemoglobin 9.1g/dl, K 7.2mol/l, urea 345mg/dl, creatinine 9.5mg/dl, albumin 2g/cc left erythrocytes 7, 150μc, urine output 100cm (EG)
Electrocardiogram: Pictured and symmetric T waves with isolated ventricular extrasystoles in all precordial leads.
It was decided to place a tunneled permanent catheter due to the risk of increased infection with a Tenckhoff catheter.
After cardiac monitoring, non-invasive blood pressure monitoring and pulse oximetry, intravenous analgesics and sedation were administered.
We identified the right jugular region and the exit site with minimal epithelial damage, tunneled the catheter and placed Permacath catheter, checking its position with portable chest X-ray.
Adequate arterial and venous return was obtained, so the skin was sutured.
He started hemodialysis with remission of symptoms, being discharged for clinical improvement and joining the chronic hemodialysis program.
