| Theme | Destructive Spondyloarthropathy in Long-term Hemodialysis Patients | |
|---|---|---|
| Title | Pre-and postoperative management of patients with destructive spondyloarthropathy | |
| Publish Date | 1998/01 | |
| Author | Hiroki Maruyama | Departments of Medicine II, Niigata University School of Medicine |
| Author | Saori Omori | Departments of Medicine II, Niigata University School of Medicine |
| Author | Masaaki Nagai | Departments of Medicine II, Niigata University School of Medicine |
| Author | Minako Wakasugi | Departments of Medicine II, Niigata University School of Medicine |
| Author | Hiroaki Obayashi | Departments of Medicine II, Niigata University School of Medicine |
| Author | Isei Ei | Departments of Medicine II, Niigata University School of Medicine |
| Author | Masaaki Arakawa | Departments of Medicine II, Niigata University School of Medicine |
| Author | Seiji Uchiyama | Department of Orthopedics Surgery, Niigata University School of Medicine |
| Author | Tatsuhiko Tanizawa | Department of Orthopedics Surgery, Niigata University School of Medicine |
| [ Summary ] | The presence of neurologic symptoms and signs as well as cord compression comfirmed by magnetic resonance imaging, is an indication for orthopedic surgery for destructive spondyloarthropathy (DSA). The main pathogenesis of DSA is dialysis-related amyloidosis. DSA appears in long-term dialysis patients who usually have the complication of renal osteodystrophy. These patients should be carefully assessed, because neurologic symptoms may develop, and must maintain good general health including the iliac bone which is used for anterior fixation. It is important to avoid hyperkalemia by sufficient hemodialysis before surgery. Upon awaking from anesthesia, hypertensive patients are more susceptible to hypertension, which may give rise to serious cord compression via hematoma due to rebleeding. The graft function of transplant recipients is usually impaired, and the capacities to concentrate urine and lower the urinary sodium concentration may be limited. Maintenance of hydration is important perioperatively to avoid further reduction of graft function. |
|