CHIEF COMPLAINT: Polycystic kidneys requiring removal due to size and pain

PRESENT ILLNESS: 62 y/o female with end-stage kidney disease secondary to
polycystic kidney
disease. She has recently started hemodialysis. Her chief
complaint is that the kidneys are painful, causing discomfort
and they interfere with her breathing and make it difficult to
get around. She has been advised to have the kidneys removed.

MEDICAL HISTORY: PMHx:
- [**Month/Day/Year 93249**] (autosomal dominant w renal/liver involvement, c/b [**Doctor Last Name **]
aneurysmal bleed and ESRD)
- multiple liver cysts
- ESRD [**1-1**] [**Month/Day (2) 18048**]
- subarachnoid hemorrhage 2/2 L MCA [**Doctor Last Name **] aneurysm s/p surgical
clipping c/b peri-operative hemorrhagic stroke resulting in
right hemiparesis([**2136**])
- HTN
- secondary hyperparathyroidism
- anemia
- acidosis
- nephrolithiasis
- stress fracture of the right ankle.
- seizure disorder
.
PSHx:
- s/p appy,
- s/p hysterectomy,
- s/p rectal prolapse repair,
- urethral elevation,
- tonsillectomy as a child,
- eye surgeries,
- aneurysmal repair

MEDICATION ON ADMISSION: renagel 800"', levothyroxine 88', nifedipine 30', metoprolol
50', nephrocaps

ALLERGIES: Iodine; Iodine Containing / Trileptal / Dilantin

PHYSICAL EXAM: POst Op;
VS: 97.3, 85, 110/60, 15, 100% (intubated)
General: Intubated and sedated
Card: RRR
Lungs: on CMV
Abd: significant hapatomegaly, soft, no peritoneal signs,
appropriately tender
Extr: No edema

FAMILY HISTORY: Father and son with [**Name (NI) 18048**].
F - died in his 80s, [**Name (NI) 18048**] and prostate cancer
M - died at [**Age over 90 **] yrs of old age
Sister w [**Name (NI) 11398**].

SOCIAL HISTORY: Lives w husband in [**Name (NI) 86**]. Ambulates w cane. Worked as a city
planner.
Smoking: denies
EtOH: 1 glass of wine/day
Drugs: denies
Polycystic kidney, autosomal dominant,Secondary hyperparathyroidism (of renal origin),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Congenital cystic disease of liver,Other ascites,Umbilical hernia without mention of obstruction or gangrene,End stage renal disease,Cirrhosis of liver without mention of alcohol,Anemia in chronic kidney disease,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Polycyst kid-autosom dom,Sec hyperparathyrd-renal,Hyp kid NOS w cr kid V,Hyposmolality,Cong cystic liver dis,Ascites NEC,Umbilical hernia,End stage renal disease,Cirrhosis of liver NOS,Anemia in chr kidney dis,Iatrogenc hypotnsion NEC,Abn react-renal dialysis
Admission Date:  [**2148-5-17**]              Discharge Date:   [**2148-6-5**]

Date of Birth:  [**2085-7-5**]             Sex:   F

Service: SURGERY

Allergies:
Iodine; Iodine Containing / Trileptal / Dilantin

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
Polycystic kidneys requiring removal due to size and pain

Major Surgical or Invasive Procedure:
[**2148-5-17**]:  Bilateral nephrectomy for polycystic kidney disease
with repair of umbilical hernia.


History of Present Illness:
62 y/o female with end-stage kidney disease secondary to
polycystic kidney
disease. She has recently started hemodialysis. Her chief
complaint is that the kidneys are painful, causing discomfort
and they interfere with her breathing and make it difficult to
get around. She has been advised to have the kidneys removed.

Past Medical History:
PMHx:
- [**Month/Day/Year 93249**] (autosomal dominant w renal/liver involvement, c/b [**Doctor Last Name **]
aneurysmal bleed and ESRD)
- multiple liver cysts
- ESRD [**1-1**] [**Month/Day (2) 18048**]
- subarachnoid hemorrhage 2/2 L MCA [**Doctor Last Name **] aneurysm s/p surgical
clipping c/b peri-operative hemorrhagic stroke resulting in
right hemiparesis([**2136**])
- HTN
- secondary hyperparathyroidism
- anemia
- acidosis
- nephrolithiasis
- stress fracture of the right ankle.
- seizure disorder
.
PSHx:
- s/p appy,
- s/p hysterectomy,
- s/p rectal prolapse repair,
- urethral elevation,
- tonsillectomy as a child,
- eye surgeries,
- aneurysmal repair


Social History:
Lives w husband in [**Name (NI) 86**]. Ambulates w cane. Worked as a city
planner.
Smoking: denies
EtOH: 1 glass of wine/day
Drugs: denies


Family History:
Father and son with [**Name (NI) 18048**].
F - died in his 80s, [**Name (NI) 18048**] and prostate cancer
M - died at [**Age over 90 **] yrs of old age
Sister w [**Name (NI) 11398**].


Physical Exam:
POst Op;
VS: 97.3, 85, 110/60, 15, 100% (intubated)
General: Intubated and sedated
Card: RRR
Lungs: on CMV
Abd: significant hapatomegaly, soft, no peritoneal signs,
appropriately tender
Extr: No edema

Pertinent Results:
On Admission: [**2148-5-17**]
WBC-6.0 RBC-2.73* Hgb-8.5*# Hct-25.8*# MCV-94# MCH-31.3
MCHC-33.1 RDW-17.6* Plt Ct-205
PT-18.1* PTT-36.1* INR(PT)-1.6*
Glucose-147* UreaN-25* Creat-3.1* Na-140 K-3.6 Cl-112* HCO3-18*
AnGap-14
ALT-207* AST-254* AlkPhos-38* TotBili-0.8
Albumin-3.0* Calcium-8.6 Phos-4.0 Mg-1.7

Brief Hospital Course:
62 y/o female with known polycystic kidney disease who presented
for bilateral nephrectomy. On [**2148-5-17**] she underwent bilateral
nephrectomy with repair of umbilical hernia. Surgeon was Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**]. Per Dr.[**Name (NI) 1381**] operative note, the kidneys were quite
large and difficult to remove. Ascites was noted and there was a
significant amount of oozing as her INR was 1.8. She received
FFP and DDAVP during the case. 2 Drains were placed. She also
has a small umbilical hernia that was primarily repaired.

She was not extubated prior to transfer to the PACU. She did
remain on Levophed and received albumin for volume resusciation.
Additional FFP and cryo were administered. She was able to be
extubated about 4 hours later and received an additional 2 units
pRBCs post op.

She was transferred for overnight stay in the SICU. Renal was
consulted and she received hemodialysis  via her AVG. On [**5-18**],
she was transferred out of the SICU to the med-surgical unit
where her diet was advanced and tolerated. Hemodialysis was
continued, but was frought with hypotension secondary to volume
loss from high JP drain outputs. Therefore, extravolume was
unable to be removed.

JP drain outputs were high (4000-1000cc/day of ascitic fluid).
She received IV fluid replacements for this.  On [**5-20**], she was
noted to be orthostatic during PT evaluation.  Nifedipine was
stopped given orthostasis and nephrology adjusted hemodialysis
to prevent excess fluid removal. Lopressor was also stopped.

On [**2148-5-29**], she became hypotensive in dialysis necessitating IV
fluid boluses (3800cc)to maintain sbp in high 70s. She was
transferred to the SICU after having an ABD CT for management.
CT demonstrated fluid collections in both postoperative beds
containing locules of air. There were no findings to suggest
definite abscess at the sites.  Innumerable cystic structures
resulting in near complete obliteration of
normal liver parenchyma and architectural distortion from known
polycystic kidney disease. The main portal, left and right
portal veins were patent. There was hyperenhancement of the
gallbladder mucosa, gastric mucosa, and small bowel mucosa.
Hyperenhancement of bilateral adrenal glands may reflect
hypovolemic state. There was hypoenhancement of the
normal-appearing liver parenchyma at the inferior left tip of
the liver. On [**5-30**] fluid was sent from the JP for culture. This
grew vancomycin sensitive enterococcus (also sensitive to
ampicillin and PCN). Cell count revealed wbc count of 110 with
70 polys. Levaquin was started. She completed a seven day course
finishing on [**6-5**].

While in the SICU, she was started on IV albumin 25grams of 5%
every 8 hours, midodrine 5mg [**Hospital1 **], fluid replacements and sodium
chloride tablets (1gram [**Hospital1 **]). Blood pressure stabilized. She
transferred out of the SICU back to the med-[**Doctor First Name **] unit where BP
remained relatively stable. The JP was removed on [**6-2**] -2 weeks
after bilateral nephrectomies. A small amount of ascitic
drainage was noted initially, but this became scant. Albumin was
stopped on [**6-3**] with BP remaining stable. She was ambulating
without complaints of dizziness.

PT was consulted given h/o CVA/brain aneurysm in past and
followed throughout this hospitalization. Initial
recommendations were for rehab due to orthostasis, but this
improved after the SICU stay. She was ambulating independently
and denied dizziness.

Of note, thyroid function tests were checked revealing TSH of
19, T4 6.7 and T3 of 59. Levoxyl was increased to 100mcg from
88mcg. Endocrine was consulted and agreed with plan. Repeat TFTs
were reccommended in one month.

She was discharged home in stable condition. Tolerating a renal
diet and ambulating independently. Hemodialysis was to continue
on the Tues-Thurs-Sat schedule.


Medications on Admission:
renagel 800"', levothyroxine 88', nifedipine 30', metoprolol
50', nephrocaps

Discharge Medications:
1. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
3. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO three
times a day: With meals.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Sodium Chloride 1 gram Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily) as needed for
reflux.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily): New dose. Have thyroid function tested in one month.
Disp:*30 Tablet(s)* Refills:*2*
8. Midodrine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
polycystic liver and kidney disease s/p bilateral nephrectomy
ESRD
umbilical hernia s/p repair
cirrhosis
Hypothyroid
hypotension secondary to large JP drain output (ascites)


Discharge Condition:
stable


Discharge Instructions:
Please call Dr.[**Name (NI) 1381**] office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, dizziness
No heavy lifting
[**Month (only) 116**] shower
Resume usual dialysis schedule
Have throid function tests checked in one month. Dose of thyroid
replacement was increased while in hospital

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2148-6-13**] 8:00
[**Month/Day/Year **] [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2148-9-18**] 9:00
[**Name6 (MD) 2105**] [**Name8 (MD) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2148-9-19**]
10:00



Completed by:[**2148-6-6**]
{'Polycystic kidney, autosomal dominant,Secondary hyperparathyroidism (of renal origin),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Congenital cystic disease of liver,Other ascites,Umbilical hernia without mention of obstruction or gangrene,End stage renal disease,Cirrhosis of liver without mention of alcohol,Anemia in chronic kidney disease,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Polycystic kidneys requiring removal due to size and pain

PRESENT ILLNESS: 62 y/o female with end-stage kidney disease secondary to
polycystic kidney
disease. She has recently started hemodialysis. Her chief
complaint is that the kidneys are painful, causing discomfort
and they interfere with her breathing and make it difficult to
get around. She has been advised to have the kidneys removed.

MEDICAL HISTORY: PMHx:
- [**Month/Day/Year 93249**] (autosomal dominant w renal/liver involvement, c/b [**Doctor Last Name **]
aneurysmal bleed and ESRD)
- multiple liver cysts
- ESRD [**1-1**] [**Month/Day (2) 18048**]
- subarachnoid hemorrhage 2/2 L MCA [**Doctor Last Name **] aneurysm s/p surgical
clipping c/b peri-operative hemorrhagic stroke resulting in
right hemiparesis([**2136**])
- HTN
- secondary hyperparathyroidism
- anemia
- acidosis
- nephrolithiasis
- stress fracture of the right ankle.
- seizure disorder
.
PSHx:
- s/p appy,
- s/p hysterectomy,
- s/p rectal prolapse repair,
- urethral elevation,
- tonsillectomy as a child,
- eye surgeries,
- aneurysmal repair

MEDICATION ON ADMISSION: renagel 800"', levothyroxine 88', nifedipine 30', metoprolol
50', nephrocaps

ALLERGIES: Iodine; Iodine Containing / Trileptal / Dilantin

PHYSICAL EXAM: POst Op;
VS: 97.3, 85, 110/60, 15, 100% (intubated)
General: Intubated and sedated
Card: RRR
Lungs: on CMV
Abd: significant hapatomegaly, soft, no peritoneal signs,
appropriately tender
Extr: No edema

FAMILY HISTORY: Father and son with [**Name (NI) 18048**].
F - died in his 80s, [**Name (NI) 18048**] and prostate cancer
M - died at [**Age over 90 **] yrs of old age
Sister w [**Name (NI) 11398**].

SOCIAL HISTORY: Lives w husband in [**Name (NI) 86**]. Ambulates w cane. Worked as a city
planner.
Smoking: denies
EtOH: 1 glass of wine/day
Drugs: denies 

### Response:
{'Polycystic kidney, autosomal dominant,Secondary hyperparathyroidism (of renal origin),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Congenital cystic disease of liver,Other ascites,Umbilical hernia without mention of obstruction or gangrene,End stage renal disease,Cirrhosis of liver without mention of alcohol,Anemia in chronic kidney disease,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
