Acute chest pain and breathlessness in a haemodialysis patient

Abstract

We describe a 64-year-old end-stage renal failure patient who had exhausted autogenous arteriovenous fistulas after 4 years of regular haemodialysis. He had no known medical illness prior to his first presentation to healthcare in 2014 with a 1-month history of rapid progressive worsening signs and symptoms of renal failure. Vasculitis screening and renal biopsy revealed pauci-immune crescentic glomerulonephritis with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) pattern. Unfortunately, the ultrasound scan and renal biopsy at the time showed his kidneys already had significant chronicity changes. After shared decision-making with the patient, the risks of immunosuppressants were deemed to outweigh any possible benefits. Of note, 2 years later, the patient had survived a life-threatening episode of pulseless ventricular tachycardia during one of his fistuloplasty procedures; subsequently, a coronary angiogram demonstrated right coronary artery and left circumflex artery stenosis, which was treated conservatively with single antiplatelet therapy. Thereafter, he remained asymptomatic with medical therapy and had regular cardiology follow-up. His latest medication list includes: Aspirin 75 mg once daily, ranitidine 150 mg once daily, isosorbide mononitrate 60 mg once daily, atorvastatin 40 mg once daily and amlodipine 10 mg once daily, with a calcium supplement and haematinics.