Conversation: The conversation between human and AI assistant.
[|Human|] My daughter who has lupus. About a month ago, her kidneys shut down. The scleroderma attacked these ogans, she is now receiving dialysis. the big problem also is that her BP is staying very high with very bad headaches. She is on 4 medications for this. But even so, her BP remains high. Why?
[|AI|]  Dear User, scleroderma is a small vessel disease. Capillaries who were patent previously, become narrow, leading to distal ischemia. In this condition, in order to obtain the right perfusion, heart faces increased resistances, clinically evident as hypertension. At the same time, an ischemic but vital kidney still produces tons of renin that cause hypertension. Anyway, what make me nervous is still a very high pressure in a patient on dialysis. I would suggest to search hints of an ongoing TMA, such LDH, hemoglobin, bilirubin, schistocytes. Moreover, I would like to be sure that analytic dose is sufficient (e.g. is the Chat Doctor.  What about ongoing medications? Take care,