CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 40-year-old male
with a history of diabetes, status post haplotype living
donor kidney transplant in [**2164-4-10**] in good function
(creatinine 1.3 to 1.5) until this summer (creatinine 2.6 to
2.8).  The patient had a biopsy prior to admission that
showed fibrosis consistent with ischemia.  MRA confirmed
stenosis of the apical renal artery.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Complications of transplanted kidney,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of renal artery,Dissection of renal artery,Background diabetic retinopathy
Compl kidney transplant,DMI renl nt st uncntrld,Abn react-org transplant,Renal artery atheroscler,Dissection renal artery,Diabetic retinopathy NOS
Admission Date:  [**2166-10-29**]       Discharge Date:  [**2166-11-4**]

Date of Birth:   [**2126-7-1**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:   Status post exploratory laparotomy and
renal artery repair.

DISCHARGE DIAGNOSIS:   Status post exploratory laparotomy and
renal artery repair.

HISTORY OF THE PRESENT ILLNESS:  This is a 40-year-old male
with a history of diabetes, status post haplotype living
donor kidney transplant in [**2164-4-10**] in good function
(creatinine 1.3 to 1.5) until this summer (creatinine 2.6 to
2.8).  The patient had a biopsy prior to admission that
showed fibrosis consistent with ischemia.  MRA confirmed
stenosis of the apical renal artery.

HOSPITAL COURSE:  The patient presented to the hospital for a
renal angiogram of the transplanted kidney and possible
stent.  Angiogram was performed on [**2166-10-29**] that
showed virtuosity of the proximal renal artery with focal
moderate stenosis centrally and 35 mmHg systolic gradient.  A
5.35 by 11 mm balloon stent was displayed at the stenosis.
However, the procedure was complicated by dissection a branch
of the renal artery distal to the stent.  Post stent
arteriogram showed intimal flap of large second order vessel
consistent with flow-limiting dissection distal to the stent.


The patient was taken emergently to the OR on [**2166-10-29**] where
an exploratory laparotomy, division of branch of transplanted
renal artery and reimplantation of the transplanted artery to
the external iliac artery were performed without any
complications.

The patient was taken to the PACU and from there to the SICU
for stabilization.  In the SICU, the patient received 1 unit
of packed RBCs for low hematocrit, at least 1 unit of RBCs,
and was also started on an insulin drip for better control of
his blood glucose.  A renal ultrasound on postoperative day
number one showed good perfusion of the kidney.  Serial
creatinine levels were measured and showed a gradual increase
consistent with nonoliguric ATN.  The patient was well
hydrated and his hemodynamic status was very closely
monitored and regulated by the SICU Team and the Renal
Service along with Transplant Surgery.

A central line was placed and the patient was started on
perioperative antibiotics (Cephazolin) times six.  He was
started on immunosuppressive medications on postoperative day
number one .................... 3 mg q.d., prednisone 5 mg
q.d., and mycophenolate 1 gram b.i.d.

On postoperative day number three, the patient was stable
enough to be transferred to the floor and he quickly advanced
from clears to a diabetic diet without any problems.  The
patient's creatinine has been followed serially throughout
the days.  His creatinine on admission was 2.6 and increased
on postoperative day number one to 4.5 slowly plateauing at
7.8 on discharge, postoperative day number five.

The patient's pain was well controlled with PCA Dilaudid that
was changed to Percocet on postoperative day number three.
On postoperative day five, the central line was discontinued.
The patient was afebrile.  The vital signs were stable.  He
was ambulatory, tolerating a regular diet.  His
immunosuppressive medications remained stable with no changes
since admission.

The patient has been making adequate urine throughout his
stay.  The patient was discharged on postoperative day number
five with instructions to follow-up with Dr. [**First Name (STitle) **] and Dr.
.................... at the Transplant Center with
instructions also to take his immunosuppressive medications.
No antibiotics were prescribed.



                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 23784**]
MEDQUIST36

D:  [**2166-11-4**]  05:34
T:  [**2166-11-4**]  18:16
JOB#:  [**Job Number 23785**]
{'Complications of transplanted kidney,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of renal artery,Dissection of renal artery,Background diabetic retinopathy'}


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: This is a 40-year-old male
with a history of diabetes, status post haplotype living
donor kidney transplant in [**2164-4-10**] in good function
(creatinine 1.3 to 1.5) until this summer (creatinine 2.6 to
2.8).  The patient had a biopsy prior to admission that
showed fibrosis consistent with ischemia.  MRA confirmed
stenosis of the apical renal artery.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Complications of transplanted kidney,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of renal artery,Dissection of renal artery,Background diabetic retinopathy'}
