#End-stage kidney disease

[drforambhuta]

Challenges in Re-Kidney Transplantation:

Re-kidney transplantation presents distinct challenges compared to initial kidney transplants. The development of antibodies against Human Leukocyte Antigens (HLA) due to sensitization from the first transplant escalates the risk of hyper-acute or acute rejection during re-transplantation. The presence of pre-existing HLA antibodies, known as donor-specific antibodies (DSA), makes finding a compatible donor more difficult and serves as a major obstacle to successful re-kidney transplantation. Furthermore, re-kidney transplantation can give rise to surgical challenges as patients may have adhesions or altered anatomy from the previous surgery. This can complicate the procedure, necessitating specialized techniques or experienced kidney transplant surgeons' involvement to address these complexities. Moreover, achieving the right balance in immunosuppressive regimens becomes crucial to prevent rejection while minimizing the risk of infection and other side effects. Both under-suppression and over-suppression of the immune system carry potential risks, respectively leading to acute rejection and graft failure or increased susceptibility to infections and malignancies.

Graft Survival in Re-Kidney Transplantation:

The success of re-kidney transplantation depends on various factors such as recipient and donor age, HLA matching, pre-transplant sensitization, and the duration between the first and second transplant. Notably, studies indicate that graft survival rates in re-kidney transplantation generally fall below those in primary kidney transplantation. However, advancements in immunosuppressive therapies, improved donor-recipient matching, and enhanced post-transplant care have positively impacted outcomes over time. Recent developments in transplantation have seen a growing emphasis on personalized medicine, wherein individual patient characteristics are considered when tailoring immunosuppressive regimens for optimal results. Additionally, progress in organ preservation techniques and the utilization of marginal or extended criteria donors have broadened the donor pool, providing greater access to kidney transplantation for patients seeking re-kidney transplantation.

There are some of the best doctors and hospitals in Bangalore available for the procedure of re-kidney transplantation. The total cost of kidney transplant in Bangalore will depend on a number of factors, like the doctor and hospital chosen for treatment, the reason for the failure of the previous kidney transplant, the health of the patient, and the type of donor used for kidney transplantation.

[txhospitals123]

Peritoneal Dialysis: Definition, Types, and Benefits | TX Hospital Hyderabad

Peritoneal dialysis is a medical treatment for end-stage kidney disease. Learn about the two types of peritoneal dialysis, CAPD and APD, and their benefits over hemodialysis. TX Hospital Hyderabad offers state-of-the-art technology and top nephrologists to provide safe and effective peritoneal dialysis treatment options.

[alifeoutloud]

I started dialysis a few months ago, after ending up in hospital with a creatinine of 15.4.

And I’m sitting here, looking at this machine that leashes me each evening, and it’s a little miracle of science that I’m alive, that I can continue to be alive, in the comforts of my own home, with a dedicated team of professionals available 24/7 to support me: I have doctors, nurses, a dietitian, a social worker, a finance/insurance coordinator…and then the transplant team is even bigger. It’s wild. Truck drivers who come into the house and stack boxes for me, even.

And in the U.S. it’s covered immediately with Medicare, by federal law. Because I’d die without it.

So it can be done. This could be how we handle diabetes. Cancers. This could extend to others, who will die without intervention.

So I am so very lucky(?) to have a terminal chronic disease that is handled like this. Don’t get me wrong, having any chronic illness is exhausting, and there are nights when I feel burdened at the thought of hooking up, but then I remind myself how damn lucky I am (for both the technology and the supports) and then I am enraged that it isn’t common sense for a government to not let its population just die from treatable things…

[superflaminggayelmo]

Frustrated by lack of relatable ESRD posts

I really really wish there were more posts about End Stage Renal Disease and everything related to it from other people who also live with it. Stuff about our experiences with kidney failure and dialysis and doctors and the diets they put us on and co-morbid illnesses and just everyday mundane stuff and what it's like to live with this condition. Cause most of the time when I'm looking up ESRD, I just find stuff about pets who have it, or posts from doctors or medical institutes or some study about some supposedly innovative thing in the nephrology world. I crave more relatable content from other humans who have ESRD, because it feels like there's hardly enough out there and I'm tired of it

[whatevenisthiscrap]

nsaids go to your kidneys not your liver that’s why drinking with them isn’t advised bc of your stomach. tylenol causes a buildup of a metabolite when drinking that is actually toxic.

Every time I see another ibuprofen post on this site I'm like STOP

STOP

Stop.

Take that after a meal. Take it with a big glass of water. Don't take it on an empty stomach EVER. Don't take it with alcohol. You will destroy your stomach. You will end up with an ulcer. You will vomit blood. I'm not exaggerating.

Yes, you. Yes, it will happen to cute little you. With your cute little bottle of miracles. Ibuprofen really does that to your body.

Love, an adult person over 35 who can't take NSAIDs anymore

[artisticdivasworld]

Compassionate Care for Chronic Kidney Disease: A Nursing Perspective

Chronic Kidney Disease (CKD) is a progressive loss of kidney function over time. Managing CKD is not just about slowing the progression of the disease but also about enhancing the quality of life for those affected. Nurses play a crucial role in this process, providing care that is as compassionate as it is competent. This blog post will explore the nursing interventions and desired outcomes that…

[superflaminggayelmo]

Autism, GERD, neurogenic bladder, and End Stage Renal Disease, among other things

Autism: dx'ed by a pediatric psych in 2004, so I've known about that for a long time. GERD: figured it out after online research then told someone at an urgent care (iirc??) and they dx'ed me. This would've been around 2015 I think. Neurogenic bladder was dx'ed by a urologist sometime in the early 2000s but I don't remember the exact year. Got my ESRD diagnosis in late 2020 after landing in the hospital with all of the kidney failure symptoms. Started dialysis in December of that year, just before turning 30 3. Lots of meds. Lexapro, phosphate binders, and Pepcid are a godsend 4. Yup to both!

5. Yeaahhh. My bladder issues are part of the reason my kidneys failed. 6. I'm struggling to figure that out tbh. 7. Renal and GERD diets and how restrictive they can get. Honestly renal failure and dialysis need to be talked about more in general, and not just in terms of transplants, pets, or scientist talk. Another thing I wish was talked about more is sensory-seeking autism. 8. I want to travel more but because of money and how difficult it is to find an accommodating kidney center in another town, it's been a lot harder to accomplish 9. spoons 10. I'm cooking a lot more than before the kidney failure, if that counts. 11. hmm I'd say low-medium 12. I haven't figured out anything specific yet

13. All the people who went "OmG i'M sO SoRrY!" or "but you're so young!!" after learning about my kidneys. Also the doc who made a backhanded comment about my diet, lack of exercise, and weight about two months ago. And the person who, upon learning of my kidney shit, proceeded to tell me twice that I'm "so brave" 14. Possibly? I found a few other sensory seeking autistic people on Twitter. But then again I might've just misread the question. 15. Good question! I guess it's saying that this is my life, it's how my body is, also there's no shame in being autistic. These things aren't going to change or "get better". Oh and I'm more than just my dead kidneys 16. Renal doctors and techs need to stop shaming or scolding patients for eating things that aren't part of the renal diet. They need to listen to us more in general. We are human beings and deserve to still live our lives and enjoy them while we can, and also our needs and voices matter too. Oh and if we decide to refuse transplant, RESPECT OUR DECISION. There's probably a good reason why we made that choice

disability pride ask game

I'm so sleepy but I have persisted anyway bc i am so brave

feel free to reblog, try and send an ask to the person you're reblogging from so the game doesn't die, and absolutely never be pressured to answer anything that feels too personal--this is about/inspiration for what you Want to share about disability and experiences being disabled, not what you feel like you have to! (also: this ask game is PRO SELF DX.)

what disability/ies do you have? (and are they mental, physical, or both?)

how long have you known you're disabled? does that match up with diagnosis?

what, if any, disability aids do you use? (mobility aids, sensory aids, braces, communicative devices, IVs, etc. meds also count here). do you customize them/their containers/outsides?

do you know any disabled people irl? what about online?

if you have multiple disabilities: do they affect each other? how?

what's something good that's come out of being disabled?

what's a struggle you wish more people talked about?

does your disability affect how you experience other parts of your identity? (gender, queerness, culture, even hobbies/life goals you're very passionate about)

how do you measure your energy? (spoons, battery, something else?)

whats something youve come up with or integrated into your life that makes disability easier, besides typical aids?

how would you label your support needs?

what's something (a struggle, a symptom, a weird phenomenon, or even a funny experience) people don't realize about your disability?

whats the most Abled Person Thing someone has said to you?

has there ever been a time where you felt solidarity/community with another disabled person in a situation with you?

what does disability pride mean to you?

free space to talk about whatever disability issue or experience you want !

[scientia-rex]

I also spend a lot of time trying to convince people to prevent problems, because prevention still works better than cures. Don't fucking smoke! I would instantly become the best doctor who ever lived if I could just convince all my patients to quit smoking. Avoid alcohol! Don't do meth! Don't do fentanyl! Things that are poisons will poison you in ways you understand, in the short term, but also ways you can't really understand until you've watched dozens of people die from it thirty years later, struggling to breathe from their COPD or weak and nauseated beyond bearing from their end-stage liver disease. I watched a man take 3 weeks in the ICU to die from what meth did to his heart. Your heart isn't meant to beat 145 times a minute for weeks on end. Your liver isn't meant to metabolize 5 shots of gin a day. You aren't going to be able to use denial and willpower to repair the damage your own habits did.

I drink a lot less now than I did before I went into medicine. Lot of different reasons, including that I'm older and more settled. But I can't look at it the same way I used to; I can't brush off as a "fun quirk" what I know is alcohol use on a level that risks withdrawal seizures if they were to suddenly stop, like some of my family members do, nervously asking me about their loved one's drinking when we're alone because beneath the jokes they know it's a problem.

If you're having more than one, maybe two drinks a day on average, over a long period of time, you are damaging your body in ways you don't understand. You're setting up a permanent heightened inflammatory state. Your heart cells don't like alcohol; Google "alcohol-induced cardiomyopathy." Your esophagus and stomach respond to incessant bathing in poison by first developing wounds and then cancer. Your liver, of course, doesn't like it. Your liver not only converts poisons to harmless substances you can excrete, it also makes your platelets, so your blood can clot. It makes albumin, a protein that's essentially for keeping water in your blood vessels and not letting it leach into your tissues. So people who are dying of liver failure are in pain and weak and tired and sad the whole fucking time! And the only solution, a liver transplant, will come with a lifetime of medication and specialist check-ups and the knowledge that if you fuck up and kill this liver, too, no one is going to be eager to give you another try.

I don't guilt-trip my alcoholic patients with liver disease. I don't guilt-trip my smokers with COPD. They chose to cope with substances for reasons, even if I disagree with their reasons, even if those reasons are opaque to me. They will suffer the natural consequences of those actions whether I guilt-trip them or not. I want them to continue to see me, I want them to be honest with me. Other people will lay enough guilt on them. And nothing I can say or do would ever compare to the physical and mental suffering that goes with those diseases.

But if you can prevent these diseases in yourself, prevent them. Quit smoking. Do it now. Your lungs are going to look better starting almost immediately, with positive changes continuing for many years. Drink less alcohol. Sure, it's fun, sure, it's a longstanding human tradition, but it is also unfortunately a straight up poison and your body knows that no matter how persuasively you argue about the obvious failure of Prohibition. You can't argue with a cell. You can't convince your kidneys that high blood pressure shouldn't damage them. They are a system; they do what they do; they existed long before prefrontal cortex existed to justify what we want to do but know to be harmful.



[reasonsforhope]

"For the first time, genetically modified pig kidneys provided “life-sustaining kidney function” during the course of a planned seven-day clinical study—a first step in addressing the critical crisis worldwide of kidney donor organ shortage.

The University of Alabama’s pre-clinical human study at Birmingham also advances the science and promise of xenotransplantation as a therapy to potentially cure end-stage kidney disease—just as a human-to-human transplants can.

“It has been truly extraordinary to see the first-ever preclinical demonstration that appropriately modified pig kidneys can provide normal, life-sustaining kidney function in a human safely and be achieved using a standard immunosuppression regimen,” said UAB transplant surgeon scientist Jayme Locke, M.D., director of UAB’s Comprehensive Transplant Institute and lead author of the paper...

The peer-reviewed findings published last month in JAMA Surgery describes the pioneering pre-clinical human research performed on a recipient experiencing brain death...

The pre-clinical human brain death model developed at UAB can evaluate the safety and feasibility of pig-to-human kidney xenografts, or transplants, without risk to a living human. It is named for transplant pioneer Jim Parsons, an organ donor whose family generously donated his body to advance xenotransplant kidney research, like the latest patient did.

A Critical Need

Kidney disease kills more people each year than breast or prostate cancer, while more than 90,000 people are on the transplant waiting list. More than 800,000 Americans are living with kidney failure and 240 Americans on dialysis die every day. The wait for a deceased donor kidney can be as long as five to 10 years, and almost 5,000 people per year die waiting for a kidney transplant.

Groundbreaking Study Details

The 52-year-old study subject for this research lived with hypertension and stage 2 chronic kidney disease, which affects more than one in seven U.S. adults, or an estimated 37 million Americans. As part of this study, the subject had both of his native kidneys removed and dialysis stopped, followed by a crossmatch-compatible xenotransplant with two 10 gene-edited pig kidneys, or UKidney.

The transplanted pig kidneys made urine within four minutes of re-perfusion and produced more than 37 liters of urine in the first 24 hours. The pig kidneys continued to function as they would in a living human for the entirety of the seven-day study. Also, the kidneys were still viable at the time the study was concluded.

“In the first 24 hours these kidneys made over 37 liters of urine,” said Dr. Locke. “It was really a remarkable thing to see.” ...

Gene editing in pigs to reduce immune rejection has made organ transplants from pigs to humans possible. The natural lifespan of a pig is 30 years, they are easily bred, and they have organs of similar size to humans. Genetically modified pig kidneys have been extensively tested in non-human primates, and the addition of UAB’s preclinical human research model—the Parsons Model—now provides important information about the safety and efficacy of kidneys in human transplant recipients."

-via Good News Network, September 17, 2023

[drforambhuta]

Understanding Dialysis:

Dialysis stands as a remarkable medical intervention, effectively mimicking the essential functions of the kidneys by removing waste products, excess fluid, and toxins from the bloodstream. This process is vital for maintaining the body's overall health and preventing the accumulation of harmful substances that can lead to severe complications. Broadly categorized into hemodialysis and peritoneal dialysis, each approach offers distinct advantages and considerations, catering to the diverse needs and preferences of patients.

Hemodialysis:

Hemodialysis represents a widely utilized form of renal replacement therapy, involving the extracorporeal circulation of blood through a specialized machine known as a hemodialyzer. This sophisticated apparatus functions as an artificial kidney, facilitating the removal of waste products and excess fluid from the blood while restoring electrolyte balance. Hemodialysis sessions typically occur several times a week at designated dialysis centers, necessitating the establishment of reliable vascular access through arteriovenous fistulas, grafts, or central venous catheters.

The procedural intricacies of hemodialysis encompass a comprehensive array of considerations, including blood flow rates, dialysate composition, and ultrafiltration targets. Despite its efficacy in achieving adequate clearance of metabolic waste, hemodialysis may pose certain challenges such as the risk of hypotension, muscle cramps, and vascular access-related complications. Furthermore, adherence to a strict dietary regimen and fluid restriction is essential to optimize treatment outcomes and minimize potential adverse effects.

Peritoneal Dialysis:

In contrast to hemodialysis, peritoneal dialysis harnesses the permeable nature of the peritoneal membrane lining the abdominal cavity to facilitate the exchange of solutes and fluids. This modality entails the instillation of a sterile dialysis solution into the peritoneal cavity via a surgically implanted catheter, allowing for the passive diffusion of waste products and excess fluid across the peritoneal membrane. Subsequently, the spent dialysate is drained from the abdomen, completing a cycle of peritoneal dialysis.

The versatility and convenience of peritoneal dialysis render it an attractive option for many patients, offering greater autonomy and flexibility in managing their treatment regimen. Home-based peritoneal dialysis affords individuals the opportunity to undergo therapy while maintaining their daily routines and minimizing disruptions to their lifestyle. Nevertheless, meticulous attention to infection control practices, including proper catheter care and aseptic technique during exchanges, is imperative to mitigate the risk of peritonitis and other infectious complications.

Doctors suggest undergoing a full body health checkup at regular intervals in case of dialysis patients to check the side effects associated with dialysis, its impact on the general health of the patient, and early management of the complications associated with the procedure.

[gremlins-hotel]

Post headcanons abt Arthur and his first baby you coward, you fool. The audience arrived, we are here, yet you stay silent upon the stage.

(Just joking ofc, tho id give you a kidney if you gave us some hcs abt their early days <3)

I know it's not a headcanon, but I hope this will still be satisfactory. A moment between a new father and his first son, to whom Arthur wishes the world.

“You coddle him,” came Rhys’ voice, blunt and teasing.

Arthur waved his brother’s words away. They were meaningless like wayward flecks of spume against the broad side of a ship in the face of the treasure held tight to his chest. Sleepless nights, tears, and the terror of the unknowing life. He had watched his son like a hawk for years, and the boy now grew blessedly stronger. Each time little Alfred grabbed his finger, the babe’s grip was vicelike, and Arthur knew the little chubby squish of pain was worth all his toils.

Alfred burbled up at Arthur, seeing his father’s watchful eyes glimmer, a mostly toothless smile scrunching his small face with joy.

Heart squeezing and eyes wide, Arthur knew he would endure it all again as long as that babe was laughing. Hugging the heavy bundle tighter to his chest, Arthur bounced the boy gently as he fiddled with a pocket of his coat. Life was difficult when one-handed, but he hated putting Alfred down. The troubles a baby could get into with any degree of autonomy he did not wish to imagine, not after famine and disease and blood. Alfred seemed determined to bind the world with his gums if his father allowed him, in any case, and to grab it without hesitation. There were dangers on the floor that the boy approached fearlessly. That determination. It was a good thing to have, Arthur knew, but woeful for life still so seemingly fragile.

A faint jingle answering his seeking fingers told the man he’d found his quarry. Arthur whisked the trinket from his pocket in a closed fist, the toy’s chain hanging from between two fingers. The near-sterling silver rings tinkled prettily against one another as he shook his fist above Alfred’s head. Curiosity lit the deep skies held in his son’s face like stars and Arthur couldn’t keep the soft smile from turning the corners of his mouth, shaking the chain again. Skies and stars indeed, for he had never observed someone to watch the heavens so closely at such a young age. Silently he praised the boy’s curiosity; one day it might have its questions answered if Arthur had anything to say about it. He would give that lad the sky and the seas.

Short, squishy fingers reached up for the chain, seeking the noisemaker with excitement. Arthur raised it away from his baby’s reach and took delight in seeing him try again. So he played the cat-and-mouse, jerking the prize just inches from Alfred’s grasp when he waved his hands skyward. Alfred laughed uproariously each time the toy made its metallic clinking and at seeing the smile on his father’s face. Arthur opened his fingers to reveal the rest of the shining silver toy and raised it to his mouth. One end was a sweet little whistle, which he blew quietly in the face of the babe. A high, windy note spiraled out into the air between them and Alfred laughed again, his entire face bright and bold. It made the boy redouble his efforts.

Arthur finally acquiesced, lowering his hand enough for those ferocious fingers to grip the tiny silver rings and tug. Once more Alfred’s burgeoning strength shot a bolt of pride through the man’s chest. With reluctant fingers he allowed the toy to drop into his son’s happy hands. Little curved talons, blunt by youth, curled around the moon-bright metal like a hunting bird content with its catch. The babe brought the whistle end to his soft mouth and immediately made to teethe on the silver. Tiny puffs of breath made the whistle sing and stutter, and Alfred’s eye glimmered happily, gazing up at Arthur as though he’d hung the heavens. Quickly he slobbered on the toy, but Arthur couldn’t help but feel enraptured by his son, drool or not.

Having forgotten the watching eyes beside him, it was Rhys’ voice that broke his reverie. “You ordered the coral, after all? No measure too small.”

Arthur blinked, looking up and away, then back to the toy in his son’s burbling mouth. The opposite end of the whistle had a stub of red, red coral from lands far away, polished to a beautiful shine. It was worth it to him. Anything to keep winding spirits and the fey away from his boy who had already suffered enough. No measure too small.

“Someday he will not need it, I hope.”

[macgyvermedical]

Let's Talk ESRD and Dialysis

Have you thanked your kidneys today? Do you feel grateful when you pee? How about when you eat a little too much potassium or drink a little too much water, do you really enjoy feeling confident that your kidneys will just dispose of the excess?

If so, you probably know the alternative.

About 10% of the world's population has a condition called Chronic Kidney Disease, or CKD. About 2 million of those people are in End Stage Renal Disease (ESRD) and require dialysis or a kidney transplant to live.

Your kidneys are amazing things. They are two organs that sit outside of the sac that hold the rest of the abdominal organs, called the peritoneum. They take in blood from the body, determine the levels of electrolytes, water, and waste products in that blood, and remove the waste products and excess electrolytes and water.

They also have secondary tasks. They monitor the amount of red blood cells in your blood and send out hormones that entice the bone marrow to make more when we're low. They also monitor blood pressure and release hormones that raise that blood pressure when it gets low.

Lots of things can hurt the kidneys. For example, poorly controlled high blood pressure and poorly controlled diabetes are among the top reasons why kidneys fail. Additionally, being dehydrated while engaging in strenuous exercise or taking medications like ibuprofen or naproxen (any NSAIDs) can cause kidney damage.

We measure how well the kidneys are working via the Glomerular Filtration Rate, or GFR. This is a measure of (essentially) how much blood in milliliters the kidneys filter per minute. 90 or higher is normal, while a GFR of 15 or lower is considered ESRD.

So let's say someone has a GFR of less than 15 and the decision is made to start them on dialysis and put them on the kidney transplant list. What options do they have?

Well, they need to figure out if they want to do hemodialysis or peritoneal dialysis.

In hemodialysis, the patient is hooked up to a machine that runs their blood across a special membrane. On the other side of the membrane, a solution called dialysate draws excess water, electrolytes, and waste products from the blood. Hemodialysis is usually done at a dialysis center for 3-5 hours, 3 times per week.

Hemodialysis is better for patients who have either failed home peritoneal dialysis or can't or aren't comfortable with doing the technical part of the job by themself at home. There is also a social component, where dialysis is a chance to meet and interact with other people who are going through the same things they are.

People who undergo hemodialysis have to have some kind of "access", or a way for the blood to come out of their body, go through a machine, and go back into their body. For some people, this is a dialysis catheter that is inserted into the person's chest and looks like this:

It can also be a fistula. A fistula is the surgical connection between a vein and an artery in the arm or leg. Over time, this connection becomes large and rubbery, and each time dialysis is done, two needles (one to remove blood, and one to return it) are placed in the fistula. A fistula often looks like this:

In peritoneal dialysis, the patient instills the dialysate directly into the sac that holds their abdominal organs. The sac itself acts as the membrane, and dialysate draws the electrolytes, water, and waste directly through the sac wall. They then wait a certain number of hours, and drain the dialysate. This can be done manually by the patient during the day, or at night while the patient sleeps with a machine called an automatic cycler. Usually peritoneal dialysis is done every day, with 2-4 cycles of 4 hours per cycle.

People using peritoneal dialysis also need a form of access, but instead of it being to their blood stream, it is to their peritoneum. Here's what that looks like:

The catheter is placed surgically into the peritoneum, and stays there all the time, even in between dialysis sessions.

Someone using peritoneal dialysis has to be very careful when they are accessing their dialysis catheter. This is because the biggest problem with peritoneal dialysis is the risk of a life threatening infection called peritonitis. Someone who gets peritonitis too many times may need to switch to hemodialysis.

Here is what a manual exchange looks ilke:

Someone may choose to do peritoneal dialysis over hemodialysis because it affords more freedom to keep a job or do daily tasks like keeping house. People who do PD also don't have to find rides to the dialysis center. However, they do have to take on more of the responsibility for making sure they do treatments correctly and be able to keep accurate records of the treatments they give themselves. Peritoneal dialysis also tends to be less taxing on the body, and have fewer side effects than hemodialysis when done correctly.

[superflaminggayelmo]

I have a headache and I wish I could take naproxen instead of useless Tylenol

[cardiacreports2]

Autopsy Report

Case Number: 2024-1125-01 Decedent Name: Chad Evanston Age: 19 Sex: Male Height: 5’11” Weight: 154 lbs (estimated lean build) Race/Ethnicity: Caucasian Date of Death: November 24, 2024 Time of Autopsy: November 25, 2024, 9:00 AM Pathologist: Dr. Robert Linfield

I. External Examination

General Appearance: The decedent is a well-developed, lean, and athletic-appearing 19-year-old male, weighing approximately 154 pounds. He has brown hair, approximately 3 inches in length, and brown eyes. Skin is pale but otherwise unremarkable, with no evidence of external trauma or defensive injuries. Fingernails are clean and well-trimmed.

Clothing: The decedent was found dressed in athletic attire, including a blue baseball cap, black athletic shorts, a running watch on the left wrist, and well-worn running shoes. The clothing was damp due to environmental exposure but showed no tears or stains of significance beyond expected post-mortem findings.

Identifying Marks: A faint scar measuring 2 cm is present on the left knee, consistent with prior minor trauma or surgery. No tattoos or other distinguishing marks.

II. Internal Examination

Cardiovascular System: The heart is notably abnormal upon inspection. Weighing 390 grams (upper end of normal for the decedent's size and build), the heart exhibits significant thickening of the left ventricle (left ventricular hypertrophy). The mitral valve shows marked structural abnormalities, including:

Fibrotic thickening of the leaflets.

Mild calcification at the annulus.

Evidence of prolapse of the posterior leaflet, causing incomplete coaptation during closure. This structural defect resulted in significant mitral regurgitation, which would have led to reduced cardiac efficiency during exertion.

Examination of the coronary arteries reveals no signs of atherosclerosis or narrowing. However, microscopic examination identifies mild interstitial fibrosis in the ventricular myocardium, particularly in the left ventricle. These findings are consistent with chronic strain and early-stage cardiomyopathy, likely exacerbated by prolonged high-intensity physical activity.The conduction system shows mild scarring near the sinoatrial node, likely the origin of the arrhythmias detected on the decedent's running watch.

Lungs: The lungs weigh 520 grams (right) and 480 grams (left), with mild congestion. Examination shows no emboli or aspirated material.

Abdominal Organs: All abdominal organs, including the liver, spleen, kidneys, and gastrointestinal tract, appear normal in size and morphology.

Brain: Examination of the brain reveals no hemorrhages, infarcts, or structural abnormalities.

III. Microscopic Findings

Heart Tissue: Histological examination of the heart confirms chronic myocardial fibrosis and focal areas of myocyte disarray. These findings are indicative of longstanding structural abnormalities and stress-induced cardiac remodeling.

Lung Tissue: Pulmonary alveoli appear congested but otherwise unremarkable.

Valvular Tissue: Fibrosis and calcification of the mitral valve tissue are evident, along with cellular degeneration, consistent with a congenital or acquired valvular defect exacerbated over time.

IV. Toxicology Report

Testing for substances, including recreational drugs, alcohol, and common stimulants, returned negative results.

V. Cause of Death

Sudden cardiac arrest secondary to severe mitral valve dysfunction and associated arrhythmia.

Detailed Analysis of Cardiac Findings

The decedent's heart exhibited chronic and progressive mitral valve disease. The fibrotic and calcified changes in the mitral valve likely originated from an undiagnosed congenital defect, aggravated over time by physical exertion. The incomplete closure of the mitral valve resulted in backflow of blood (regurgitation) during systole, progressively overloading the left atrium and left ventricle. Over time, this stress led to the observed hypertrophy and scarring of the myocardium.

The combination of myocardial fibrosis and conduction system scarring predisposed the decedent to severe arrhythmias. The running watch data corroborates this, showing prolonged arrhythmic episodes throughout the decedent's final run.

The sustained stress of a nine-mile run caused the decedent’s heart to become electrically unstable, leading to ventricular fibrillation—a fatal arrhythmia resulting in sudden cardiac arrest. The autopsy findings, supported by wearable device data, confirm that this event was precipitated by his preexisting cardiac abnormalities.

Despite being otherwise healthy and athletic, the decedent’s heart was structurally compromised, making high-intensity exercise particularly dangerous. The mitral valve's dysfunction was significant enough that even mild to moderate exertion may have posed a risk over time.

Conclusion: Chad Evanston’s death was due to undiagnosed and progressive cardiac pathology exacerbated by prolonged physical exertion. This case highlights the critical need for screening individuals engaging in high-intensity activities for underlying heart conditions.

Final Manner of Death: Natural

[werebutch]

Literally what the fuck is the point of anything I’ve ever done if after all the sacrifices I’ve made for my sister end up with her telling me I’m abusing and manipulating her and that I’ll never understand her and that I make her hate herself. This goes for both my sisters but mostly my middle one who I also happen to be best friends with. The only reason I stayed alive was for them. But me and my sister go through cycles of being joined at the hip, then I have to ask her a favor and she freaks out and it turns into this huge crazy situation. I have to work on my group project but I don’t know when to have her pick me up (because of course she wants my car) and the time she has to wait around for me will probably overlap with the time she usually spends with her boyfriend. It’s always the fucking boyfriend btw, nothing can come between that time. One time she refused to drive my diabetic, stage 4 kidney disease dad to the ER because she wanted to pick up her boyfriend first. She ended up screeching in my ear the whole car ride. She still doesn’t see what’s wrong with that. Anyways so her thing is that my whole family acknowledges her selfishness, but we all realize that it’s entirely on accident and she has no idea she’s like this. Genuinely it’s just in her nature. She’s extremely sensitive about being called selfish, she’s a self described people pleaser and empath. To be honest it’s just middle child victim mentality. I don’t even know where I was going with this but what the fuck am I supposed to do because I truly don’t like hurting my sister so I avoid it most of the time unless we’re seriously in a crazy argument. And even then I still hold back because duh I love my little sister. Idk. I am not at all absolved of the hurtful stuff I’ve said and I CAN be very mean when I want to be, but my sister is the one person who I really can’t say much to. And I don’t. Calling her selfish is really the big problem here but how am I supposed to avoid it if every disagreement we have is about that 😭 everyone is selfish bcuz they’re human but my sister is a different breed. But she’s the younger cuter one who cries easy and soaks up sympathy and I’m the older sibling turned parent who doesn’t cry so I’m much less ummmmm idk. You know? So my family calls me evil and a monster and everything. And sometimes I start believing them and sometimes I think it’s bullshit but it’s probably a mix. I have the best interest of my sisters in my mind at all times and sometimes that makes me an asshole in their eyes. Im just tired of being the evil one WHICH is directly related to my mom leaving who used to be (and still is but she’s not in the house anymore so the pointed fingers are directed at me instead since I’m the closest thing to her) the scapegoat . I don’t know what I can do to make this better

[mariacallous]

On a recent Thursday afternoon, researchers Lanuza Faccioli and Zhiping Hu wheeled an inconspicuous black and white plastic cooler from an operating room at a hospital in downtown Pittsburgh. Inside was a badly scarred liver, just removed from a 47-year-old man undergoing a transplant to receive a new one from a donor.

But what if patients could avoid that fate? Faccioli and Hu are part of a University of Pittsburgh team led by Alejandro Soto-Gutiérrez attempting to revive badly damaged livers like these—as well as kidneys, hearts, and lungs. Using messenger RNA, the same technology used in some of the Covid-19 vaccines, they’re aiming to reprogram terminally ill organs to be fit and functioning again. With donor livers in short supply, they think mRNA could one day provide an alternative to transplants. The team plans to begin a clinical trial next year to test the idea in people with end-stage liver disease.

Alcohol use, hepatitis infection, and a buildup of fat in the liver can cause scarring over time. When there’s too much damage, the liver starts to fail. “Right now, if you get end-stage liver disease, it’s irreversible,” Soto-Gutiérrez says. “Well, we found that is not true. It is reversible.”

Soto-Gutiérrez and his team have been experimenting on rats and organs taken from people undergoing transplants at the University of Pittsburgh Medical Center, one of the busiest transplant centers in the US. To help design the mRNA and figure out how to deliver it to the human liver, they’ve partnered with Drew Weissman, a physician and immunologist at the University of Pennsylvania who won the 2023 Nobel Prize in Physiology or Medicine for his pioneering work on mRNA. Together, Soto-Gutiérrez and Weissman lead the Center for Transcriptional Medicine, launched in April with the goal of bringing these medicines to patients.

On the day I visited, I followed Faccioli and Hu through a maze of hallways until they deposited the freshly explanted liver at a pathology lab, where a team of scientists was anticipating the special delivery. After infusing the liver with an experimental mRNA therapy, they placed the organ in an oxygenated bath meant to maintain its function for several days.

A healthy liver is spongy and reddish-brown in color with a smooth appearance. But when the surgeons took this one out of the cooler, it was hard, marbled, and covered in bumps—evidence of cirrhosis, a type of end-stage liver disease. Over time, the man’s healthy liver cells had been replaced by scar tissue, and eventually, his liver stopped working. His only option was to get a new one.

Livers are the second most in-demand organ. In 2023, a record 10,660 liver transplants were performed in the US, driven in part by a steadily growing number of living donors. In a living liver transplant, a piece is taken from a healthy person’s liver and transplanted into a recipient. But even with this uptick in transplants, not everyone who needs a new liver receives one. Patients may have other health problems that disqualify them from a transplant, and others may die while waiting for one. In 2022, the latest year for which data is available, the Centers for Disease Control and Prevention recorded nearly 55,000 deaths due to chronic liver disease.

Living donor transplants are possible because of the liver’s unique capacity to regenerate itself—more so than any other organ in the body. In a healthy person, the liver can regrow to its normal size even after up to 90 percent of it has been removed. But disease and lifestyle factors can cause permanent damage, rendering the liver unable to repair itself.

When Soto-Gutiérrez was studying medicine at the University of Guadalajara in Mexico, his uncle died of liver disease. From then on, he became dedicated to finding a treatment for patients like his uncle. In the early years of his medical career, he noticed that some patients with scarred livers were bound to a hospital bed waiting for a transplant, while other people with cirrhosis were walking around, seemingly living normal lives. He figured there must be cellular differences in these livers.

He teamed up with UPMC transplant surgeon Ira Fox to look for transcription factors—master regulators that can dial up or down the expression of groups of genes—that can potentially reprogram injured organs. Genes rely on transcription factors to perform many essential functions in organs. Together, Soto-Gutiérrez and Fox have analyzed more than 400 failing livers donated by transplant patients. When they compared them with dozens of normal donated livers that acted as controls, they identified eight transcription factors essential for organ development and function.

They zeroed in on one in particular, HNF4 alpha, that seems to act like a main control panel, regulating much of the gene expression in liver cells. In healthy liver cells, levels of HNF4 alpha were turned up, and so were other proteins it controls. But in the cirrhotic livers they examined, HNF4 alpha was almost nonexistent.

The team needed a way to get the transcription factor into liver cells, so they turned to mRNA technology. Used in some of the Covid-19 vaccines, mRNA is a molecule that carries instructions for making proteins, including transcription factors. In the Covid vaccines, the mRNA codes for a part of the virus known as the spike protein. When injected into a person’s arm, the mRNA enters cells and kicks off the protein-making process. The body recognizes these spike proteins as foreign and generates antibodies and other defenders against it.

The Pitt team is using mRNA instead to essentially turn back time in injured organs. “What we’re proposing to do with mRNA is use it to deliver proteins that have the capacity to repair those damaged liver cells,” Weissman says. “Our hope is that we can treat end-stage liver disease and turn the livers around, maybe forever, or at least until patients can get a transplanted organ liver.” Instead of delivering instructions for a foreign protein to generate an immune response, they’re delivering the genetic code for producing a transcription factor—HNF4 alpha.

In a paper published in 2021, the approach revived human liver cells in lab dishes. The researchers have since tested the mRNA therapy in rats with cirrhosis and liver failure. They treated a group of rats every three days for three weeks while a second group served as a control. The animals that were receiving the injection of HNF4 alpha started being more active. The untreated rats continued to decline and eventually died, the expected result at their stage of disease. Some of the treated rats were still living six weeks after receiving the mRNA medicine. Those results have not yet been published in a peer reviewed journal.

The team is also testing the mRNA infusions in human livers removed from patients undergoing transplants—the process I got to observe. Unlike live rats, explanted human livers can’t be observed for weeks on end. Livers have to be retrieved quickly and infused with the mRNA treatment soon after they’re removed from the body. They stay fresh for just four days or so in a preservation fluid. Six hours after the mRNA infusion, levels of HNF4 alpha start going up and last for two to three days. When HNF4 alpha peaks, other essential liver proteins, such as albumin, start to increase as well. That’s important, Soto-Gutiérrez says, because maintaining those protein levels could mean the difference between a patient needing a transplant or not.

Ideally, Soto-Gutiérrez says the mRNA therapy would be something patients could get once a week or every other week in an outpatient facility and go back home. But initially, they’ll need to test the experimental treatment in very sick patients, likely ones that are hospitalized, to make sure it’s safe. The team is gathering data from the rat and human liver experiments to submit a clinical trial application to the Food and Drug Administration in the coming months.

While livers are the first target, Fox thinks other injured organs may be amenable to this approach. “We’ve been wondering whether the same process might be taking place in other organs,” he says. Currently, the team is searching for similar transcription factors in lungs with chronic obstructive pulmonary disease and kidneys with chronic kidney disease.

Josh Levitsky, a liver transplant specialist at Northwestern University who isn’t involved in the work, says new treatments for chronic liver disease are sorely needed. Current therapies can help slow down scar tissue buildup and ease symptoms but don’t address the underlying disease. “The concept of reprogramming and being able to reverse liver failure could be really game changing if it were to pan out in clinical studies,” he says.

But lots of questions remain. How much damage could be reversed? Would patients need to be on the therapy indefinitely? Or would their livers rebound enough to go off it? Could a liver ever be restored back to normal?

“It certainly has a lot of promise,” Levitsky says, “but the clinical development is going to take a long time.”