A 17-year-old woman, deaf, with no known allergic reactions.
The personal history included: Deep sensorineural deafness (non-functioning cochlear implant since 2003), Static myoclonic crisis in treatment with Valproato, psychomotor retardation of mitochondrial origin with disorder of the respiratory chain and urinary retention 1
Family history: A single older brother affected as she of Mitochondrial Disease, dull, on peritoneal dialysis for 4 years, currently deceased donor kidney disease in 2006.
Socio-family history: Parental separation after the siblings transplant.
The mother and maternal grandparents take care of both.
Since the pediatric nephrology consultation, the living donor transplant had been proposed, and the study was pending.
The girl before separation was well, maintained a good relationship with her parents and attended a special educational center where she was integrated with her normal condition. However, after separation from her parents, she suffered abrupt changes in her aggressive renal behavior.
On April 13, 2010 the patient was admitted for several weeks of evolution characterized by general deterioration, weakness, asthenia, insomnia, impossibility to walk, myoclonus and spastic movements of the four limbs.
Preserved diuresis of 1-2 l/day, no nausea or vomiting, especially in analytical performed Cr 7.2mg/dl, Ca.
11 mg/l, P. 6.8 mg/l.
During admission, hypercalcemia is corrected, but the patient presents significant agitation and aggressiveness, denying any proposal made to her, so she is assessed by psychiatry, skull CT and normal ECG.
It was decided to start renal replacement therapy with HD.
In order to be able to insert a femoral catheter in M.I.D., neuroperidol® (haloperidol) is needed.
After 4 sessions, a permanent jugular catheter was implanted in the operating room under sedation, and after the patient improved, the patient was discharged with sedating treatment by psychiatrist (haloperidol and benzodiazepines).
He maintained good control of analytical parameters and HD efficacy.
After discharge, the patient manifests a more aggressive behavior, with a suicide attempt and injury to family members, especially when it comes close to the time to attend hemodialysis sessions, having to be forced to walk even when necessary.
During the session she needs permanent surveillance by two people and assistance from the mother to the sessions because she is the only one who can communicate with her with sign language.
A new consultation is requested with a psychiatrist and psychologist.
In the 8 HD session, the patient attempts to adhere to the tunneled catheter, and in the following sessions, always arrives altered, yelling at controlling personalities, connecting it, showing continuous signs of bed aggression, such as
During dialysis, the monitor alarm sounds continuously due to lack of flow as it does not stop moving.
Anesthesia was requested sedation and treatment with intravenous Midazolam and Propofol 4.5.6 was necessary, with six sessions being held in the Resuscitation Service with the anesthesiologist's supervision.
The difficulty of communication of nephrologists and nurses with the patient made necessary the presence of the mother or father always (although she preferred this), with evident poor relationship between parents that interfered with the disease emotional stability.
Despite parental explanations, the patient did not accept renal replacement therapy including peritoneal dialysis and manifested her desire to die.
The mother had requested a legal incapacity.
Living kidney transplantation was proposed, in this case of the father, since the mother was the caregiver of the two brothers, but this was somewhat ambiguous in her consent, although in the end she agreed to be serious due to the fact that the tests were performed.
At the same time, the need for a preferential transplant was raised to the ONT.
On May 18, 2010 they informed of the ONT that they had a donor for kidney transplantation.
The patient arrives at our unit in the same situation as previous days.
Once the tests were performed according to protocol, the patient underwent surgery for transplantation.
It is performed without complications and after 24 hours in the ICU with sedation leaves the TX unit.
Renal.
During his stay in this unit, he became ill, rebellious, very agitated, nervous and tried to take the medication.
Venous catheter exit and bladder catheter "double J" as well as abdominal drainage were established.
She was discharged from hospital on May 26, 2010 and regularly attended the journal.
During the first visits to the doctor's office, he comes forcefully, screaming, aggressive and with a lack of cooperation, requiring the intervention of several people to attend the doctor's appointments for extra-blood, arriving at the same time
