CHIEF COMPLAINT: s/p renal transplant over 20 years ago, now failed, ESRD,
here for renal transplant

PRESENT ILLNESS: Pt is a 48 year old male s/p renal transplant over 20 years ago.
The native kidney failed [**2-11**] glomerulonephritis. The
transplanted
kindey failed 3 - 4 years ago since which time patient has been
on hemodialysis three times a week, Tue/Thr/Sat. He is dialyzed
through right upper arm AV fistula.

MEDICAL HISTORY: -h/o fistula s/p repair, c/b seizures and cord compression
-Hypertension
-Dyslipidemia
-History of gloerulonephritis, then received cadaveric renal
transplant, ~20 yrs ago, on immunosuppressants in past,
transplant failed 2 years ago and now on hemodialysis.
-[**2182-8-15**] renal transplant
-Anemia
-Coagulase negative staphylococcal bacteremia
-Community-acquired pneumonia
-Duodenal ulcers status post thermal therapy/injection
-Pericardial effusion
-Obesity
-Osteopenia

MEDICATION ON ADMISSION: metoprolol 50 mg qday
nephrocaps 1 tab qday
minocycline 50mg [**Hospital1 **]
omeprazole 20mg qday (?[**Hospital1 **])
renagel 800mg tid
warfarin 8mg qday
fish oil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: WD/WA, NAD
HEENT: PERRL, EOMI, non-icteric
CV: RRR, nl S1, S2, [**3-15**] ejection murmur appreciated
pulm: CTA B
abd: obese, NT/ND, NBS, soft
neuro: deferrred, pt with generalized weakness on L side

FAMILY HISTORY: No history of seizure or stroke

SOCIAL HISTORY: Has lived with his mother and children in the past, now living
with sons.  Former businessman, not working because he remains
on
dialysis.  He denies use of tobacco, alcohol or using illicit
substances, though a he has had toxicology screens positive for
cocaine and opioids in the past.
Complications of transplanted kidney,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Other iatrogenic hypotension,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Anemia in chronic kidney disease
Compl kidney transplant,End stage renal disease,Hyp kid NOS w cr kid V,Nephritis NOS,Iatrogenc hypotnsion NEC,Abn react-org transplant,Accid in resident instit,Anemia in chr kidney dis
Admission Date:  [**2182-8-15**]              Discharge Date:   [**2182-8-21**]

Date of Birth:  [**2133-12-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
s/p renal transplant over 20 years ago, now failed, ESRD,
here for renal transplant


Major Surgical or Invasive Procedure:
[**2182-8-15**] renal transplant


History of Present Illness:
Pt is a 48 year old male s/p renal transplant over 20 years ago.
The native kidney failed [**2-11**] glomerulonephritis. The
transplanted
kindey failed 3 - 4 years ago since which time patient has been
on hemodialysis three times a week, Tue/Thr/Sat. He is dialyzed
through right upper arm AV fistula.


Past Medical History:
-h/o fistula s/p repair, c/b seizures and cord compression
-Hypertension
-Dyslipidemia
-History of gloerulonephritis, then received cadaveric renal
transplant, ~20 yrs ago, on immunosuppressants in past,
transplant failed 2 years ago and now on hemodialysis.
-[**2182-8-15**] renal transplant
-Anemia
-Coagulase negative staphylococcal bacteremia
-Community-acquired pneumonia
-Duodenal ulcers status post thermal therapy/injection
-Pericardial effusion
-Obesity
-Osteopenia

Social History:
Has lived with his mother and children in the past, now living
with sons.  Former businessman, not working because he remains
on
dialysis.  He denies use of tobacco, alcohol or using illicit
substances, though a he has had toxicology screens positive for
cocaine and opioids in the past.


Family History:
No history of seizure or stroke

Physical Exam:
gen: WD/WA, NAD
HEENT: PERRL, EOMI, non-icteric
CV: RRR, nl S1, S2, [**3-15**] ejection murmur appreciated
pulm: CTA B
abd: obese, NT/ND, NBS, soft
neuro: deferrred, pt with generalized weakness on L side


Pertinent Results:
[**2182-8-21**] 05:32AM BLOOD WBC-5.7 RBC-3.09* Hgb-9.6* Hct-28.6*
MCV-93 MCH-31.1 MCHC-33.7 RDW-15.7* Plt Ct-148*
[**2182-8-21**] 05:32AM BLOOD PT-16.6* INR(PT)-1.5*
[**2182-8-21**] 05:32AM BLOOD Glucose-102 UreaN-44* Creat-2.7* Na-142
K-4.0 Cl-107 HCO3-26 AnGap-13
[**2182-8-15**] 10:14AM BLOOD ALT-24 AST-25 AlkPhos-155* TotBili-0.5
[**2182-8-20**] 06:17AM BLOOD tacroFK-9.5

Brief Hospital Course:
On [**2182-8-15**], Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] performed a renal transplant into
the left iliac fossa with placement of a 6-French double-J
stent. Please refer to operative note for details. Induction
immunosuppression was administered (solumedrol, cellcept, ATG).
Postop, urine output was on the low side averaging 6-25cc per
hour. SBP was on the low side (80s). Two units of prbc were
administered for hct 28.6. He was transferred to the SICU for
management. He was started on low dose neo for BP support, but
this was quickly weaned off. Hemodialysis was done on postop day
1 for hyperkalemia and volume overload.

He was transferred out of the SICU as BP stabilized. Urine
output increased daily and creatinine trended down each day to
2.7 by postop day 6 ([**8-21**]). A total of 3 doses of ATG were
given. Prograf was started and increased to 6mg [**Hospital1 **] with trough
reaching a level of 12.7 by postop day 6. Steroids were weaned
off and cellcept 1 gram [**Hospital1 **] was well tolerated.

The foley was removed without incident. The incision remained
clean, dry and intact. JP was removed.

Coumadin (for h/o cva [**1-18**]) was resumed at home dose (8mg qd) on
[**8-19**]. INR was 1.5 on [**8-21**]. Coumadin had been managed previously
by nephrology at his dialysis unit. This will be managed by
[**Hospital1 18**] Transplant nephrology until he acquires a PCP. [**Name10 (NameIs) **] will
be drawn every Monday and Thursday per transplant protocol.

PT was consulted and felt that he was safe to go home. PT
recommended resumption of outpatient PT that he had been doing
as long as no straining or heavy lifting was involved.

ID saw him post transplant for h/o cervical osteo [**11-16**]
recommending continuing minocycline as previously taken. A f/u
appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 106886**] was to be arranged.


Medications on Admission:
metoprolol 50 mg qday
nephrocaps 1 tab qday
minocycline 50mg [**Hospital1 **]
omeprazole 20mg qday (?[**Hospital1 **])
renagel 800mg tid
warfarin 8mg qday
fish oil


Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
6. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
7. Minocycline 50 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
8. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO once a
day.
9. Warfarin 4 mg Tablet Sig: Two (2) Tablet PO once a day.
10. Tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
11. Tacrolimus 1 mg Capsule Sig: One (1) Capsule PO twice a day.

12. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*1*
13. Outpatient Physical Therapy
OK to resume previous outpatient PT 3-4x/week to improve
strength left side.
no heavy lifting/no straining. has RLQ incision


Discharge Disposition:
Home

Discharge Diagnosis:
esrd
s/p renal transplant
h/o cva
h/o cervical osteo


Discharge Condition:
good


Discharge Instructions:
Please call the Transplant Office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, increased abdominal distension, decreased
urine output, weight gain of 3 pounds in a day, edema,  incision
redness/bleeding/drainage.
[**Telephone/Fax (1) **] every Monday and Thursday at [**Last Name (NamePattern1) 439**], [**Location (un) 86**]
[**Month (only) 116**] shower
No heavy lifting
No driving while taking pain medication

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] TRANSPLANT SOCIAL WORK
Date/Time:[**2182-8-27**] 10:30
Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2182-8-27**] 11:20



Completed by:[**2182-8-21**]
{'Complications of transplanted kidney,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Other iatrogenic hypotension,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Anemia in chronic kidney disease'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: s/p renal transplant over 20 years ago, now failed, ESRD,
here for renal transplant

PRESENT ILLNESS: Pt is a 48 year old male s/p renal transplant over 20 years ago.
The native kidney failed [**2-11**] glomerulonephritis. The
transplanted
kindey failed 3 - 4 years ago since which time patient has been
on hemodialysis three times a week, Tue/Thr/Sat. He is dialyzed
through right upper arm AV fistula.

MEDICAL HISTORY: -h/o fistula s/p repair, c/b seizures and cord compression
-Hypertension
-Dyslipidemia
-History of gloerulonephritis, then received cadaveric renal
transplant, ~20 yrs ago, on immunosuppressants in past,
transplant failed 2 years ago and now on hemodialysis.
-[**2182-8-15**] renal transplant
-Anemia
-Coagulase negative staphylococcal bacteremia
-Community-acquired pneumonia
-Duodenal ulcers status post thermal therapy/injection
-Pericardial effusion
-Obesity
-Osteopenia

MEDICATION ON ADMISSION: metoprolol 50 mg qday
nephrocaps 1 tab qday
minocycline 50mg [**Hospital1 **]
omeprazole 20mg qday (?[**Hospital1 **])
renagel 800mg tid
warfarin 8mg qday
fish oil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: WD/WA, NAD
HEENT: PERRL, EOMI, non-icteric
CV: RRR, nl S1, S2, [**3-15**] ejection murmur appreciated
pulm: CTA B
abd: obese, NT/ND, NBS, soft
neuro: deferrred, pt with generalized weakness on L side

FAMILY HISTORY: No history of seizure or stroke

SOCIAL HISTORY: Has lived with his mother and children in the past, now living
with sons.  Former businessman, not working because he remains
on
dialysis.  He denies use of tobacco, alcohol or using illicit
substances, though a he has had toxicology screens positive for
cocaine and opioids in the past. 

### Response:
{'Complications of transplanted kidney,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Other iatrogenic hypotension,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Anemia in chronic kidney disease'}
