CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 65 year-old
woman with end stage renal disease, secondary to malignant
hypertension. She was started on dialysis in [**2174-2-7**].  She currently was on peritoneal dialysis and appears
to be doing well.  She has a history of gastric angiectasia
which she requires endoscopy. She was admitted on [**2175-5-30**] for
a scheduled living donor kidney transplant by her son, who is
the donor.  She does have a donor specific antibody (B-51)
and will have a final T & B cell class match prior to
transplantation.

MEDICAL HISTORY: End stage renal disease, secondary to
malignant hypertension on dialysis.  History of anemia
following gastric angiectasia.  She has no known history for
coronary artery disease for diabetes.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married, lives with her husband.  She has a
history of a half pack of cigarettes per day for 20 years.
Occasional alcohol.
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Peripheral vascular complications, not elsewhere classified,Anemia, unspecified,Disorders of phosphorus metabolism,Personal history of tobacco use
Hyp kid NOS w cr kid V,Surg comp-peri vasc syst,Anemia NOS,Dis phosphorus metabol,History of tobacco use
Admission Date: [**2175-5-30**]        Discharge Date:  [**2175-6-15**]

Date of Birth:                    Sex:  F

Service:


ADMISSION DIAGNOSIS:  End stage renal disease, admitted for
transplant surgery.

HISTORY OF PRESENT ILLNESS:  The patient is a 65 year-old
woman with end stage renal disease, secondary to malignant
hypertension. She was started on dialysis in [**2174-2-7**].  She currently was on peritoneal dialysis and appears
to be doing well.  She has a history of gastric angiectasia
which she requires endoscopy. She was admitted on [**2175-5-30**] for
a scheduled living donor kidney transplant by her son, who is
the donor.  She does have a donor specific antibody (B-51)
and will have a final T & B cell class match prior to
transplantation.

PAST MEDICAL HISTORY:  End stage renal disease, secondary to
malignant hypertension on dialysis.  History of anemia
following gastric angiectasia.  She has no known history for
coronary artery disease for diabetes.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Unknown.

SOCIAL HISTORY:  Married, lives with her husband.  She has a
history of a half pack of cigarettes per day for 20 years.
Occasional alcohol.

PHYSICAL EXAMINATION:  The patient was afebrile.  Vital signs
were stable. Blood pressure was 124/58; heart rate 76; weight
160 pounds. Abdomen soft and nontender.  She has a peritoneal
dialysis catheter in the right lower quadrant. She has good
femoral pulses bilaterally. Mild pedal edema.

HOSPITAL COURSE:  On [**2175-5-30**], the patient went to the
operating room for living donor kidney transplant, performed
by Dr. [**Last Name (STitle) **] and assisting by Dr. [**Last Name (STitle) **]. Please see details
of this surgery in operating room note. Also during her
operating room time, the patient also had a right iliac
artery thrombosis.  It was noted that at the end of the
completion of the procedure, that she had an ischemic
appearing right foot and absence of a right femoral pulse. In
the operation, there was some difficulty with arterial
anastomosis, renal artery to the left iliac artery and Dr.
[**Last Name (STitle) **] came to assist Dr. [**Last Name (STitle) **].  Again, please see
details of that operation in the operative report.

Postoperatively, the patient went to the Intensive Care Unit.
The patient had an A line, a central line, Foley. She was
placed on a heparin drip to keep PTT between 45 and 50.  The
patient's dressing was clean, dry and intact. The patient had
2 [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains in place.  Good femoral pulse and good
dorsalis pedis pulse.  These pulses were palpable.  The
patient was making good urine output postoperatively.  Renal
was consulted and made recommendations.  Postoperatively, the
patient had a renal ultrasound demonstrating an unremarkable
renal transplant ultrasound with normal size and appearance
of the transplanted kidney and normal arterial wave forms and
resistive disease, ranging from 0.63 to 0.75 throughout.

On postoperative day number one, the patient had another
ultrasound secondary to her hematocrit decreasing and they
wanted to rule out hematoma. The ultrasound demonstrated that
there was no hematoma seen adjacent to the transplanted
kidney. The transplanted kidney is minimally changed from
yesterday which was on [**2175-5-30**] with a small amount of pelvic
ectasis.  Relatively unchanged resistive indices.  The
patient did get multiple transfusions for her low hematocrit.
Her heparin was discontinued on [**2175-6-1**]. The patient received
1/2 cc per cc of replacement and on [**6-1**], Tacrolimus was
started.  On [**2175-6-2**], the patient had some complaint of right
foot numbness. Lower extremity ultrasound was obtained to
rule out deep venous thrombosis and this showed no evidence
of right lower extremity deep venous thrombosis.  On [**2175-6-2**],
WBC was 2.9, hematocrit of 35.2. Also on [**6-2**], PT was 13.5,
PTT was 36.7, INR of 1.2.  Sodium that day was 129 and 4.4,
100 BUN, creatinine of 69 and 6.2 with a glucose of 96.

Vascular surgery continued to see the patient.  It was
decided that hematocrit was stable, that heparin could be
continued. The patient was restarted on heparin.  The patient
still complained of right foot numbness but it was about the
same and not worse.  She was continued on all of her
immunosuppressive medications, including Tacrolimus, Valcyte,
Cellcept, Bactrim, Solu-Medrol.  The patient was transitioned
from heparin to Coumadin.  The patient was transferred to the
floor, continued to make excellent urine output.  The patient
had another ultrasound on [**2175-6-6**] because there was blood in
her [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drain and with the decreasing hematocrit.
Ultrasound demonstrated normal arterial and venous color,
blood flow and wave form with normal residual indices.  7.6
by 3.5 cm fluid collection, likely simply fluid, anterior to
the contrast. Focal area of heterogeneity within the lateral
aspect of the mid pole, probably which demonstrates normal
blood flow and may represent artifact; however, attention to
this area on a follow up scan is recommended to document
interval change or resolution.

On [**2175-6-9**], the patient's right lower extremity was swollen.
The patient complained of right hip and thigh pain, pitting
edema of right lower extremity greater than left lower
extremity so an ultrasound was performed which included the
right iliac artery. This demonstrated acute deep venous
thrombosis within the right common femoral and superficial
femoral veins which had developed since [**2175-6-2**]. There
is a right groin hematoma which was unchanged. The patient
continued to be anticoagulated for DVT.  One drain was
eventually removed, continued on [**2175-6-12**] with drain output of
170, afebrile, vital signs stable.  She went home with
services on the following medications:  Valcyte 450 mg q.
day, Bactrim SS 1 tab q. day, Protonix 40 mg q. day, Nystatin
5 ml suspension, 5 ml four times a day, Colace 100 mg twice a
day, Movlapine 10 mg q. day, Percocet 22 tabs q. day,
Lopressor 100 mg twice a day, MMF 500 mg q.o.d. Coumadin 2 mg
q. day.  This should be monitored to keep the INR between 2
and 3. Reglan 10 mg four times a day before meals and at
bedtime.  Tacrolimus 10 mg p.o. twice a day. Potassium sodium
phosphate, one packet q. day and Compazine 10 mg q. 6 hours
prn.  The patient has a follow up appointment with Dr.
[**Last Name (STitle) **], please call [**Telephone/Fax (1) 673**] for an appointment.  The
patient needs to change dressings on her wound twice a day
located on her groin, place a dry gauze between the wound and
her skin.  No heavy lifting of greater than 10 pounds for the
first 6 weeks after surgery.

DIAGNOSES:  End stage renal disease, status post renal
transplant.
Arterial thrombosis.
Deep venous thrombosis.
Resolving hypertension.



                        [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 55494**]

Dictated By:[**Last Name (NamePattern1) 4835**]
MEDQUIST36
D:  [**2175-9-15**] 16:39:51
T:  [**2175-9-15**] 17:14:46
Job#:  [**Job Number 55495**]
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Peripheral vascular complications, not elsewhere classified,Anemia, unspecified,Disorders of phosphorus metabolism,Personal history of tobacco use'}


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: 

PRESENT ILLNESS: The patient is a 65 year-old
woman with end stage renal disease, secondary to malignant
hypertension. She was started on dialysis in [**2174-2-7**].  She currently was on peritoneal dialysis and appears
to be doing well.  She has a history of gastric angiectasia
which she requires endoscopy. She was admitted on [**2175-5-30**] for
a scheduled living donor kidney transplant by her son, who is
the donor.  She does have a donor specific antibody (B-51)
and will have a final T & B cell class match prior to
transplantation.

MEDICAL HISTORY: End stage renal disease, secondary to
malignant hypertension on dialysis.  History of anemia
following gastric angiectasia.  She has no known history for
coronary artery disease for diabetes.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married, lives with her husband.  She has a
history of a half pack of cigarettes per day for 20 years.
Occasional alcohol. 

### Response:
{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Peripheral vascular complications, not elsewhere classified,Anemia, unspecified,Disorders of phosphorus metabolism,Personal history of tobacco use'}
