這是一位64歲的阿伯，之前因為腎病症候群，所以短暫洗腎一段子，後來改善了，一年未來洗腎。後來，他又出現在診所，說醫院交待要安排每週一次的血液透析，問一下病況，才知道他近來才從死神的手中逃出，以下是他的出院病摘：
1. Acute NSTEMI Killip I
2. Coronary artery disease, left main and triple vessel disease s/p CABG with patent LIMA to LAD, critical stenosis at SVG-RCA and SVG-OM, total occulsion of SVG-diagnoal s/p PTCA with Percusurge distal balloon protection to SVG-RCA (Biomatrix
3.5*18mm drug eluting stent) and SVG-OM (Biomatrix 2.75*18mm DES) and PTCA with bail-out stent to RCA-PDA distal to SVG, PDA anastomosis site (Integrity 2.75 *18mm BMS).
Because of refractory VTs with shock, requiring ECMO and IABP support. Because of deteriorating renal function ( chronic on acute), hemodialysis was done.
Cardiac cath. with coronary angio. was done again on 2013/01/12 and concluded:
1. Sustained ventricular tachycardia post cardioversion and CPCR
2. Status post extracorporal membrane oxygenation support
3. Left main and triple vessels coronary artery disease s/p CABG with patent LIMA to LAD, prior stent (Biomatrix 3.5x18mm) to SVG-RCA, bail-out stent (Integrity 2.75x18mm) to RCA-PDA and stent (Biomatrix 2.75x18mm) to SVG-OM without significant stenosis.
Removal of V-A ECMO was done on 2012/1/18.
Removal of IABP (open method) and Removal of Double lumen catheter were done on 2013/1/19.
Implantation of AICD (automated implantable cardioverter-defibrillator , Medtronic Protecta CT VR) (via left subclavian vein, puncture method) on 2013/1/23.
His condition was improveing and he was transferred to the ordinary ward on 2013/01/25.
除了放心臟內支架外，也裝上了ECMO、IABP和AICD，幾乎把心臟內科的極限都發揮上了。看了患者現在自行走進來診所，滿臉笑容，現代醫學進步，真是救了很多人，出院花了多少錢？10多萬新台幣。
然而，腎臟是沈默的器官，在這些極度的血流動力學不穩的狀況下，強心劑的副作用，顯影劑的的腎毒性下，腎臟功能惡化，目前又回復至需要每週一次的血液透析。然而，若不是之前的極力搶救，現在就沒有這個人了，所以心臟科就先救心臟，腎臟呢？沒關係，心臟科都說，心臟停了不行，但是腎壞了，還可以洗腎。
這台灣洗腎的族群這麼大，是腎臟科醫護不力所造成的嗎？還是老話一句，腎臟是沈默的器官啊！那麼多加害它的因子，怎麼是腎臟科醫護單方面可以阻擋的？
