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Sample records for anuria

  1. [Obstructive anuria. Thirty cases].

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    Bennani, S; Debbagh, A; Joual, A; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology.

  2. Reflex anuria affecting both kidneys following hysterectomy

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    Gholyaf Mahmoud

    2009-01-01

    Full Text Available In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA and acute renal failure (ARF. Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruc-tion. She was managed with hemodialysis, control of hypertension and correction of fluid and elec-trolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum crea-tinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

  3. [Urogenital lymphoma presenting with obstructive anuria].

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    Rabii, Redouane; Mezzour, Mohamed Hicham; Guessous, Hicham; Essaki, Hicham; Joual, Abdenbi; Rachid, Mohamed; Quessar, Asmaa; Benchekroun, Said; El Mrini, Mohamed

    2004-02-01

    The authors report a case of urogenital lymphoma with multiple sites in a patient presenting with oligo-anuria. Clinical examination revealed a hard hypogastric and prostatic mass and an enlarged left scrotum. Abdominopelvic and scrotal ultrasound demonstrated a prostatic tumour, a hypogastric mass, hepatic nodular lesions and coeliac lymphadenopathy with bilateral ureterohydronephrosis and a heterogeneous intrascrotal mass in contact with the lower pole of the left testis. The laboratory assessment revealed severe renal failure. After a haemodialysis session and ultrasound-guided right percutaneous nephrostomy, pelvic magnetic resonance imaging (MRI) showed a very large pelvic mass between the bladder and the rectum and transrectal biopsy of the mass confirmed the diagnosis of high-grade malignant non-Hodgkin's lymphoma (NHL) with a type B lymphoblastic phenotype. Treatment consisted of chemotherapy according to the LMB 93 protocol. The course was favourable with return of normal renal function and complete remission 1 month after induction. The patient is currently in complete remission with a follow-up of 12 months. In the light of this case and a review of the literature, the authors discuss the diagnostic, therapeutic and prognostic aspects of this rare site of lymphoma.

  4. [Calculus-induced anuria. Apropos of 25 cases].

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    Joual, A; Dakir, M; el Mrini, M; Benjelloun, S

    1997-01-01

    The objective of this study was to analyse the clinical and therapeutic aspects of stone-induced anuria based on the analysis of 25 cases. The mean age of the patients was 51 years. The stones were bilateral in 54% of cases, and consisted of uric acid stones in 52% of cases. The diagnosis was based on laboratory and radiological findings. Dialysis was indicated in eight patients because of major metabolic disorders. Urinary diversion was performed by insertion of a ureteric catheter or percutaneous nephrostomy. The medium- to long-term prognosis was favourable in two-thirds of cases, but 3 immediate deaths were observed due to delayed diagnosis.

  5. SAFETY AND EFFICACY OF PERCUTANEOUS NEPHROLITHOTOMY IN INFANTS PRESENTING WITH OBSTRUCTIVE RENAL CALCULI AND ANURIA

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    Yugesh

    2015-04-01

    Full Text Available BACKGROUND : Urolithiasis in infancy is rare but important health issue. Etiology is multi factorial . Optimal management of pediatric stone disease is still evolving . Infants with bilateral obstructive renal stones are unique group of patients in whom prompt evaluation and management is necessary. AI MS AND OBJECTIVE: To evaluate safety and efficacy of PCNL in infants presenting with bilateral obstructive renal calculi and anuria . MATERIALS AND METHOD S: From N ov . 2012 to M arch 2014, 18 renal units with calculi in 9 infants (6 boys, 3 girls were treated with PCNL ( P ercutaneous N ephrolithotomy at our institution. All infants presented with anuria, rised serum creatinin (mean 6.1mg/dl and uremic symptoms due to bilateral obstructive renal calculi. All patients managed initially with peritoneal dialysis a t nephrology u nit, followed by bilateral DJ (D ouble J stenting, then bilateral PCNL performed in two sittings. Mean age 8.5 months (4m to 12m, mean stone burden 1.7 cm (0.6cm to 3.0 cm, 20 F pediatric nephroscope through 22F percutaneous access was used . Stones were fragmented with pneumatic lithotripter. RESULTS: Mean operative time was 60.22 mins (30 mins to 90 mins. Complete stone clearance was done in all cases without need for second look PCNL. Mean post op serum creatinin is 0.6 mg/dl. No patient r equired blood transfusion, developed urosepsis, or had a procedure related complications. CONCLUSION: When performed by experienced urologists, PCNL is safe and effective procedure in infants presenting with bilateral obstructive renal calculi and anuria, provided these patients managed preoperatively with peritoneal dialysis and DJ stenting to optimise renal function and to relieve sepsis.

  6. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

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    Anuj D Dangi

    2015-01-01

    Full Text Available A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.

  7. Massive gastric dilatation and anuria resolved with naso-gastric tube decompression.

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    Peces, Ramón; Vega, Cristina; Peces, Carlos; Trébol, Julio; González, Juan A

    2010-09-01

    We report for the first time a case of acute kidney injury associated with severe gastric distention after a laparoscopic Nissen-Rossetti fundoplication of the stomach for hiatal hernia. An abdominal compartment syndrome secondary to intra-abdominal hypertension was suspected. Naso-gastric tube decompression resulted in immediate resaturation of the diuresis and progressive recovery of renal function.

  8. [Complications of urinary calculi].

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    Joual, A; Fekak, H; Rabii, R; el Moussasoui, A; Benjelloun, S

    1996-01-01

    Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

  9. [Acute kidney failure due to kidney cortex necrosis. 2 clinical cases of surviving patients].

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    Fuenzalida, E

    1991-07-01

    A 22 year old female developed preeclampsia with fetal death in utero. After cesarean section she developed uterine inertia and acute hemorrhagic anemia complicated by sepsis, disseminated intravascular coagulation and total anuria for 4 weeks. She was treated with hemodialysis. The second patient, a 49 year old man developed sepsis and intravascular coagulation after a dog bite. Acute renal failure with a 3 week total anuria followed. He was initially treated with peritoneo dialysis. Renal biopsy showed evidence of renal cortical necrosis in both patients.

  10. Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse

    DEFF Research Database (Denmark)

    Schäfer, Carolyn; Guldager, Helle Skov; Jørgensen, H L

    2011-01-01

    and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency...

  11. A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion : case report

    NARCIS (Netherlands)

    Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H.; Yaghi, Aktham

    2014-01-01

    The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum.Initial laboratory tests revealed 40%

  12. Post appendectomy acalculus bilateral ureteric obstruction: A rare entity in children

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    Vipul Gupta

    2013-01-01

    Full Text Available Bilateral acalculus ureteric obstruction is described as rare sequelae of acute appendicitis in two paediatric patients aged 6 and 11 years presented with features of anuria. Imaging and endoscopic evaluation confirmed bilateral ureteric obstruction secondary to bladder wall oedema as an inflammatory reaction to appendix. Both cases recovered following bilateral ureteric stenting and are doing well.

  13. [Severe Haemophilus influenzae b infection in healthy male adult

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    Vilmar, A.C.; Gjorup, I.; David, Kim Peter

    2008-01-01

    Haemophilus influenzae b (Hib) can be the cause of serious infections, and is mainly observed affecting children and immuno-compromised patients. We report a case of a healthy 49-year old male with a severe Hib infection complicated by septicaemia, meningitis and anuria. The risk of invasive Hib...

  14. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment.

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    Chung, J; Caumartin, Y; Warren, J; Luke, P P W

    2008-06-01

    The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

  15. Neurogenic bladder decompressing via a spontaneous colovesical fistula--a case report.

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    Karl, Sampath; Sen, Sudipta; Chacko, Jacob; Thomas, Gordon

    2007-10-01

    A 3-year-old girl with operated meningomyelocele and urinary incontinence presented with recurrent attacks of watery diarrhea and anuria, which were relieved by urethral catheterization. Investigations revealed a poorly compliant neurogenic bladder that periodically decompressed via a spontaneously developed colovesical fistula. The fistula was repaired with concomitant bladder augmentation. To our knowledge, this is the only report of such a complication from neurogenic bladder in childhood.

  16. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    OpenAIRE

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya

    2016-01-01

    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urina...

  17. [Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].

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    da Gama, A Dinis; Nunes, J Silva; Cunha e Sá, Diogo; Pedro, Luís Mendes

    2003-01-01

    The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.

  18. Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse

    DEFF Research Database (Denmark)

    Schäfer, Carolyn; Guldager, Helle Skov; Jørgensen, H L

    2011-01-01

    and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency......, and was transferred to the ICU. After manometric monitoring on the patient's upper arms proved difficult, invasive blood pressure monitoring was used and revealed that the patient was in a state of hypertensive crisis. This case of multi-organ dysfunction was possibly caused by multi-substance-induced hypercalcemia....

  19. Intensive chromic acid burns and acute chromium poisoning with acute renal failure

    Institute of Scientific and Technical Information of China (English)

    XIANG Jun; SUN Zhen; HUAN Jing-ning

    2011-01-01

    In this case report, we describe our experience of managing a patient with chemical burns caused by hot chromic acid that covered over 60% of the patient's body. The patient developed anuria 48 hours after injury. Early excision of burn eschars and hemodialysis were carried out. The patient survived after a series of comprehensive treatments, including allografting and autografting. In patients burned by hot chromic acid, excision of affected skin down to the muscle fascia should be carried out as soon as possible after injury. Dialysis to remove circulating chromium in the first 24 hours after injury is also recommended.

  20. [Bilateral renal vein thrombosis and acute renal failure due to inferior vena cava filter thrombosis. Report of one case].

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    Vega, Jorge; Díaz, Rienzi

    2014-11-01

    Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.

  1. Results of an isotopic treatment of a thyroid cancer associated to an anuric end-stage renal disease (E.S.R.D.); Resultats d'un traitement isotopique d'un cancer thyroidien associe a une insuffisance renale terminale anurique

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    Mansouri, F.; Bali, I.; Slougui, F.; Boughaba, S. [CHU Dr-Benbadis, Service de medecine nucleaire, Constantine (Algeria); Bouafia, S. [CHU Dr-Benbadis, Service de medecine interne, Constantine (Algeria); Aboua, A. [EHS Daksi, service de nephrologie, Constantine (Algeria)

    2010-07-01

    Purpose: The metastatic differentiated thyroid cancer represents an indication of isotopic treatment by an ablative dose of iodine 131, but the coexistence of an anuric renal failure poses very serious problems and requires adequate logistics. Conclusions: Surgical treatment is the rule, isotope treatment is less in a number of cases. The initial staging of the disease of our patient has imposed an additional treatment based on {sup 131}I, but complicated by anuria which is the elimination path. Interdisciplinary cooperation allowed to stabilize the case of this patient. (N.C.)

  2. Joint Influence of Protein Supplements, Soft Drinks and Extreme Physical Activity on the Development of Acute Renal Failure and Hypokalaemia.

    Science.gov (United States)

    Djordjevic, S; Kitic, D; Kostic, M; Apostolovic, B; Brankovic, S; Ciric, I M; Velickovic-Radovanovic, R

    2015-11-13

    We present a case of a 33-year old man who complained of weakness, fever and decreased urinating. A personal history revealed a consumption of creatine, protein supplements, soft drinks containing caffeine and stevia, and extreme physical activity which included lifting of heavy weights. The patient developed anuria, uraemia, fatigue, rhabdomyolysis and paradoxical hypokalaemia. After the patient had seven successive dialysis treatments, normal kidney function was restored. The report presents the first case of acute renal failure followed by hypokalaemia due to the combined action of the excessive consumption of supplements, soft drinks with stevia and caffeine, and extreme physical activity.

  3. Operation for rumperet abdominalt aorta-aneurisme. Stoar resultaterne mål med indsatsen?

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T V; Sørensen, Steffen;

    1991-01-01

    During 1979-1988 218 patients were operated on for ruptured abdominal aortic aneurysm. On admission 110 patients (50%) were in shock. Patients with a systolic blood pressure less than 100 mmHg, anuria on admission, peroperative bleeding of more than five litres and aged more than 70 years had...... an increased mortality. The intraoperative mortality was 15% and the postoperative mortality 21%. The perioperative mortality decreased from 45% in 1979 to 32% in 1988. The most frequent complications were renal failure and respiratory insufficiency, both were associated with a mortality of more than 50...

  4. Malaria induced acute renal failure: A single center experience

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    Kanodia K

    2010-01-01

    Full Text Available Malaria has protean clinical manifestations and renal complications, particularly acute renal failure that could be life threatening. To evaluate the incidence, clinical profile, out-come and predictors of mortality in patients with malarial acute renal failure, we retrospectively studied the last two years records of malaria induced acute renal failure in patients with peripheral smear positive for malarial parasites. One hundred (10.4% (63 males, 37 females malaria induced acute renal failure amongst 958 cases of acute renal failure were evaluated. Plasmodium (P. falciparum was reported in 85%, P. vivax in 2%, and both in 13% patients. The mean serum creatinine was 9.2 ± 4.2 mg%, and oligo/anuria was present in 82%; 78% of the patients required hemodialysis. Sixty four percent of the patients recovered completely, 10% incompletely, and 5% developed chronic kidney failure; mortality occurred in 21% of the patients. Low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coa-gulation, and high serum creatinine were the main predictors of mortality. We conclude that ma-laria is associated with acute renal failure, which occurs most commonly in plasmodium falci-parum infected patients. Early diagnosis and prompt dialysis with supportive management can reduce morality and enhance recovery of renal function.

  5. Severe loin pain following renal biopsy in a high-risk patient: A case report of a rare combination of pseudoaneurysm and arterio-venous fistula

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    Desai Madhav

    2011-01-01

    Full Text Available We report a 50-year-old male patient with diabetes mellitus and hypertension who presented with low-grade fever, anuria and renal failure. He had no prior history of nephropathy and retinopathy. Since anuria persisted, a renal biopsy was performed using automated gun, under ultrasound guidance. Two hours after the renal biopsy was performed, the patient developed severe left loin pain that required analgesics and sedatives. Ultrasound of the abdomen performed immediately, two hours and four hours after the biopsy, did not reveal any hematoma. The hemoglobin was stable when the patient developed loin pain, but after eight hours decreased to 9.1 g/dL, and computed tomography scan of the abdomen revealed a big peri-nephric hematoma around the left kidney. He was managed with blood transfusions and a selective angiogram was done. It revealed a pseudoaneurysm and arterio-venous fistula from the segmental artery of lower pole of the left kidney; both were closed by using microcoils and liquid embolic agent N-butyl-cyanoacrylate (NBCA. The only risk factor the patient had at the time of renal biopsy was severe renal failure. Our case suggests that severe loin pain immediately after renal biopsy in a patient with renal failure warrants careful follow-up of hemoglobin and imaging, even if initial imaging is normal. Further fall of hemoglobin necessitates early evaluation with angiogram, which helps in diagnosing the treatable, although rare, complications like pseudoaneurysm and arterio-venous fistula.

  6. Imipenem-induced clostridium difficile diarrhea in a patient with chronic renal failure

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    R Enríquez

    2011-01-01

    Full Text Available An 80-year-old man was diagnosed to have pneumonia and advanced chronic kidney disease. He presented with anuria and hemodialysis, by temporary femoral catheter, was initiated. He was empirically treated with imipenem/cilastatin 500 mg/24 h after hemodialysis. After 10 days of antibiotic intake, he developed severe diarrhea. Diagnosis of Clostridium difficile (CD-associated diarrhea was confirmed by detection of the toxins A and B in his stool. Imipenem therapy was discontinued; Vancomycin 500 mg orally every 6 h and 1000 mg per rectum every day was added. After two weeks of this treatment, the patient reported complete resolution of the diarrhea and stool samples were negative for Clostridium toxin. In this case, the most possible cause of CD colitis was considered to be imipenem because of the temporal relationship between exposure to the drug and onset of symptoms.

  7. The cause of P.I. Tchaikovsky's (1840-1893) death: cholera, suicide, or both?

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    Kornhauser, Pavle

    2010-01-01

    The death of P. I. Tchaikovsky (1840 - 1893) excites imagination even today. According to the "official scenario", Tchaikovsky had suffered from abdominal colic before being infected with cholera. On 2 November 1893, he drank a glass of unboiled water. A few hours later, he had diarrhoea and started vomiting. The following day anuria occured. He lost consciousness and died on 6 November (or on 25 Oktober according to the Russian Julian calendar). Soon after composer's death, rumors of forced suicide began to circulate. Based on the opinion of the musicologist Alexandra Orlova, the main reason for the composer's tragic fate lies in his homosexual inclination. The author of this article, after examining various sources and arguments, concludes that P. I. Tchaikovsky died of cholera.

  8. A rare entity of acute bilateral cortical renal necrosis following acute pancreatitis

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    Kruti D Dave

    2015-01-01

    Full Text Available Acute bilateral renal cortical necrosis following acute pancreatitis is extremely rare condition. Among all cases of acute renal failure, the incidence of renal cortical necrosis was 3.8% in one of the study in North India. Till date, only eight cases of bilateral cortical necrosis following acute pancreatitis were reported in the literature. We report a case of a 27-year-old male patient with abdominal pain, nausea and vomiting since 2 days duration and anuria since 24 h. Serum amylase and lipase were raised, and elevated serum creatinine was noted on admission. Contrast-enhanced computed tomography scan of the abdomen revealed changes of acute pancreatitis with hypoenhancement of renal cortex compared to medulla on both sides (reverse rim sign-stronger enhancement of the renal medulla compared to cortex, suggest an acute renal cortical necrosis.

  9. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery.

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    Baheti, Vidyasagar H; Wagaskar, Vinayak G; Patwardhan, Sujata K

    2015-10-01

    Bladder rupture following caesarian section is well documented complications. Intraperitoneal bladder rupture following normal vaginal delivery is very rare. Hereby, we present a case report of intraperitoneal bladder rupture presented late following normal vaginal delivery. We report a case of spontaneous intraperitoneal urinary bladder rupture following uneventful outlet forceps delivery in a 22-year-old primi gravid woman with gestational diabetes mellitus and fetal macrosomia who presented with large urinary ascites, anuria and renal failure. Emergent exploratory laparotomy with repair of the intraperitoneal bladder rupture helped to prevent its potential complications. Postpartum patients who undergo episiotomy or perineal repair may land up in unnoticed urinary retention which may rarely terminate in spontaneous urinary bladder rupture. Awareness of its manifestations amongst emergency physician would help to initiate appropriate timely management.

  10. Infarction of renal transplant with extrarenal excretion of Tc-99m MAG{sub 3} demonstrated by renal scintigraphy

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    Lim, Seok Tae; Kim, Min Woo; Sohn, Myung Hee [Chonbok National University Medical School, Chonju (Korea, Republic of)

    2003-06-01

    A 38-year-old woman with end stage renal disease received a living related donor-renal transplant to the right iliac fossa. She developed anuria a week later. Tc-99m MAG{sub 3} renal scintigraphy demonstrated no perfusion, uptake, or excretion of the radioactive tracer from the renal transplant. The expected area of the renal allograft appeared as a photopenic area with increased rim activity. The gallbladder and bowel activities were observed on delayed images at 24 hours. There was no blood flow within the renal artery on renal doppler examination. This case shows total absence of perfusion and function in the infarcted renal transplant with extrarenal excretion of Tc-99m MAG{sub 3} caused by acute renal artery thrombosis.

  11. Fatal non-accidental alpha-lipoic acid intoxication in an adolescent girl.

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    Hadzik, B; Grass, H; Mayatepek, E; Daldrup, T; Hoehn, T

    2014-09-01

    The aim of our report is to increase awareness that the antioxidant alpha-lipoic acid, which is marketed primarily as weight loss and energy supplement, has potentially lethal effects. A 14-year-old girl ingested in suicidal intention a large amount of alpha-lipoic acid, which led to multiorgan failure and subsequent death within 24 h. Multiorgan failure consisted of decreased myocardial contractility, seizures, anuria, thrombocytopenia, and coagulopathy. Therapy consisted of ventilation, anticonvulsive treatment and circulatory support with high-dose catecholamines. According to alpha-lipoic acid serum levels following ingestion the girl must have ingested a minimum of 10 alpha-lipoic acid tablets of 600 mg each. This is the first report on a fatal case of alpha-lipoic acid ingestion, which is intended to inform physicians, pharmacists and patients about critical side effects of this allegedly innocuous drug.

  12. Gadolinium-based contrast media may be nephrotoxic even at approved doses

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    Thomsen, Henrik S. [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, 2730, Herlev (Denmark)

    2004-09-01

    It is generally believed that gadolinium-based contrast media are not nephrotoxic at the approved doses for MR (<0.3 mmol/kg body weight). Recently, a patient with diabetic nephropathy required dialysis because of anuria 6-7 days after MR angiography with 0.14 mmol/kg body weight gadolinium-DTPA-BMA to assess renal artery stenosis. No special precautions (e.g., hydration) had been taken. The serum creatinine levels had been within 200 and 300 {mu}mol/l for the last 3 years with a very slow increase. This case highlights that gadolinium-based contrast media can cause contrast medium-induced nephropathy even at doses below 0.2 mmol/kg body weight in patients with multiple risk factors. (orig.)

  13. Acute kidney injury as the first sign of spontaneous renal vein thrombosis: report of 2 cases.

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    Shumei, Shi; Ling, Xu; Yanxia, Wang; Lei, Zhang; Yuanyuan, Sun

    2012-01-01

    Spontaneous renal vein thrombosis (RVT) is very rare in the absence of nephrotic syndrome. It is more common in newborns and infants. RVT should always be included in the differential diagnosis of flank pain and hematuria, and because RVT can induce acute renal injury. A 19-year-old man was admitted to our hospital because he complained of right flank pain and oliguria for 3 days. Another patient, a 24-year-old man, complained of a severe and sudden onset of bilateral flank pain and anuria for a day. They were both healthy before they developed the described symptoms and had different levels of decrease in renal function when they visited the hospital. Color Doppler ultrasonography revealed RVT in both the patients. The patients received therapy, including anticoagulation and thrombolysis, following their diagnoses, and they recovered in a few days.

  14. Neonatal renal vein thrombosis: role of anticoagulation and thrombolysis--an institutional review.

    Science.gov (United States)

    Bidadi, Behzad; Nageswara Rao, Amulya A; Kaur, Dominder; Khan, Shakila P; Rodriguez, Vilmarie

    2016-02-01

    Neonatal renal vein thrombosis (NRVT) is a rare thromboembolic complication in the neonatal period, and sequelae from renal dysfunction can cause significant morbidity. The authors retrospectively reviewed 10 patients with NRVT treated at their institution. The majority of the cohort were male (n = 9), preterm (n = 6), and had unilateral NRVT (n = 6). Six patients received thrombolysis and/or anticoagulation, and 4 patients received supportive care only. Two of the 6 patients treated with anticoagulation who had bilateral NRVT and anuria received thrombolysis with low-dose tissue plasminogen activator. Thrombolysis was not associated with any major adverse events, and both patients had marked improvement of renal function. Eight patients subsequently developed renal atrophy (3 received anticoagulation, 2 received thrombolysis with anticoagulation, and 3 received supportive care). Anticoagulation/thrombolysis did not appear to prevent renal atrophy. The role of thrombolysis needs to be further studied and considered in the setting of bilateral NRVT and acute renal failure.

  15. Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse: case report and review of literature.

    Science.gov (United States)

    Schäfer, C N; Guldager, H; Jørgensen, H L

    2011-01-01

    A 26-year-old male bodybuilder was admitted to the surgical department of a Danish community hospital for hematemesis. During the clinical interview, he revealed that he had recently finished a course of anabolic steroids and erythropoietin. The patient also had a previous history of infections and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency, and was transferred to the ICU. After manometric monitoring on the patient's upper arms proved difficult, invasive blood pressure monitoring was used and revealed that the patient was in a state of hypertensive crisis. This case of multi-organ dysfunction was possibly caused by multi-substance-induced hypercalcemia.

  16. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    Science.gov (United States)

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya

    2016-01-01

    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urinary tuberculosis, ureteral stricture can deteriorate and result in ureteral obstruction during anti-tuberculosis treatment. Pre-emptive administration of corticosteroids may be beneficial for preventing such stricture in patients with a pre-existing ureteral lesion. PMID:27904125

  17. Malarial acute kidney injury: Prognostic markers

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    Ruhi Khan

    2013-01-01

    Full Text Available Background: Malaria has protean clinical manifestations and acute kidney injury (AKI is one of its serious and life threatening complications. This study was carried out to describe the clinical characteristics, and factors associated with adverse outcomes, in patients with malarial AKI. Materials and Methods: Data of 100 patients with AKI and smear positive malaria was retrospectively analyzed to evaluate the incidence, clinical profile, outcome and predictors of mortality among all cases presented to us at the Nephrology unit of Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh between November 2010 to October 2011. Results were expressed as mean, standard deviation (SD and range. Results: One hundred (22.1% (68 males, 32 females cases of malaria induced AKI, amongst 452 total cases of AKI, were evaluated. The mean age (± SD was 30 ± 11.23 years. Male to female ratio was 3.3:1. Plasmodium falciparum was reported in 76%, P. vivax in 11%, and both in 13% patients. The mean serum creatinine was 8.7 ± 3.7 mg%, and oligo/anuria was present in 84% of the patients. 78% of the patients required hemodialysis. 67% of the patients recovered completely, 12% did not show full recovery, and 6% developed chronic kidney failure. Mortality occurred in 15% of the patients. Conclusion : Malarial AKI most commonly occurs in patients infected by Plasmodium Falciparum. Falciparum malaria associated with AKI is a life threatening condition. Prolonged disease duration, low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coagulation, and high serum creatinine were the main predictors of mortality in our study.

  18. Anuric renal failure in a dog after red-bellied black snake (Pseudechis porphyriacus) envenomation.

    Science.gov (United States)

    Heller, J; Bosward, K L; Hodgson, D R; Pottie, R

    2006-05-01

    A case of Red-bellied Black snake envenomation resulting in intravascular haemolytic anaemia, rhabdomyolysis and anuric renal failure is described in the dog. A 12-year-old female desexed Golden Retriever was presented with a 15 hour history of profuse salivation, progressive lethargy, obtundence, inappetence and collapse. Significant findings on clinical examination were pallor, icterus, tachypnoea and dyspnoea with increased respiratory sounds and crackles in all lung fields. Generalised abdominal and muscular pain was apparent and dark red-brown urine was present around the perineal region. A diagnosis of Red-bellied Black snake (Pseudechis porphyriacus) envenomation was made and the dog was treated with intravenous fluid therapy, Tiger/Brown snake antivenom, packed red cell transfusions and Intermittent Positive Pressure Ventilation. Continued clinical deterioration occurred and a diagnosis of acute renal failure secondary to myohaemoglobinuric pigmenturia was made 12 hours after admission. Intensive treatment was attempted with diuresis and volume expansion. Oliguria and subsequent anuria ensued and the dog was euthanased due to a grave prognosis and lack of clinical response to treatment. Necropsy examination revealed muscular necrosis, accumulation of fluid in the thoracic and peritoneal cavities, and marked renal tubular necrosis with intraluminal occlusion secondary to pigmentary casts.

  19. Surgical salvage of acute renal artery occlusion in the setting of a solitary kidney.

    Science.gov (United States)

    Stone, Patrick; Mossalllati, Adam S; Schlarb, Haley; Schlarb, Chris

    2014-04-01

    Management of acute renal artery occlusion in patients with a solitary kidney has a poorly defined prognosis. Loss of renal function is reported by some when acute warm ischemia reaches 2 hours. We report a unique case of a patient that had a 24-hour onset of anuria and acute renal failure upon arrival to the hospital. Nuclear imaging showed trace uptake of the right kidney, without evidence of excretion. Conventional digital subtraction angiography was performed; however, evidence of nephrogram or distal filling of the renal artery was not demonstrated. Secondary to conflicting studies, a computed tomography of the abdomen and pelvis with intravenous contrast revealed only minimal cortical perfusion despite complete occlusion of the previously grafted right renal artery. Patient was taken for urgent hepatorenal bypass surgery. Intraoperative return of urine output occurred immediately after completion of the bypass. Hemodialysis, which was required preoperatively, was stopped after renal salvage, the patient has maintained a normal glomerular filtration rate and patency of her bypass by duplex follow-up.

  20. Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

    Directory of Open Access Journals (Sweden)

    Kostakoglu Lale

    2010-10-01

    Full Text Available Abstract Background The differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak. Case Presentation A 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall. Conclusions Renal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly.

  1. Tube cystostomy for management of obstructive urolithiasis in ruminants

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    P. Tamilmahan

    2014-04-01

    Full Text Available Aim: The aim of this study was to evaluate the simple tube cystostomy procedure for management of urethral obstruction cases in ruminants. Materials and Methods: Tube cystostomy was used to treat a total of 58 ruminants, which included 35 buffalo calves and 23 goats. Diagnosis of the disease was made with the history of anuria, clinical signs, and physical examinations. Physical parameters like heart rate, respiratory rate, rectal temperature dehydration status of animals by skin tenting test, and intraoperative findings were compared. Results: Young ruminants were most commonly affected and the mean age was 4-5 months in both species. Only male were considered for the study in which buffalo calves were not castrated but in goat's 73.91% animal were castrated and 34.7% not castrated. Rupture of bladder was more common in buffalo calves as compared to goats. The confirmed cases of obstructive urolithiasis were selected for tube cystostomy with Foley's catheter. Postoperatively all cases were administered with broad spectrum antibiotic, anti-inflammatory agent, and caliculolytic agents like ammonium chloride. Postoperative complications recorded only in 10 animals and remaining 48 animals had an uneventful recovery. Conclusion: Tube cystostomy is a simple and effective procedure particularly in intact urinary bladder, which can be adopted at field level.

  2. Percutaneous Renal Biopsy : A Report of 200 Caces

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    M. Bahadori

    1966-01-01

    Full Text Available In the diffuse medical diseases of kidney, percutaneous renal biopsy is a valuable, safe and hazardless procedure. With the aid of this nearly new technique renal pathology, the natural history of renal diseases and the response of renal diseases to therapy, as well as the prognosis of renal disorders can be evaluated."nWe have analysed 210 percutaneous biopsies in Tehran. Complications were observed in 13% of cases, there is no mortality and no patient required drastic therapeutic intervention. Anuria, peri-renal colic and peri-renal hematoma were the only serious complications, which were seen in 4 patients, and were. readily controled with simple measures We obtained renal tissue in 95% cases of our patients and in 9 I% of them the tissue was adequate for c'ear diagnosis."nLike other authors, we believe that the procedure, when properly performed, can give a far more valuable informations about the patients without any realy dangerous risk.

  3. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    Science.gov (United States)

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  4. Urinary Ascites in the Young Infants:Analysis of 9 Cases%小婴儿尿腹(附9例报告)

    Institute of Scientific and Technical Information of China (English)

    黄澄如; 陈幼容

    1989-01-01

    我院共收治9例小婴儿尿腹,其中8例并发于下尿路梗阻(7例证实为后尿道瓣膜症),1例并发于肾盂输尿管连接部梗阻.全组均为男婴,年龄为5日~3个月.临床特点是腹大,均经腹腔穿刺抽出尿性液.经尿路引流、电灼瓣膜等治疗,4例治愈,3例好转出院,2例治疗不当死亡.%Nine infants,aged 5 days to 3 months,with urinary ascites were admitted to Beijing Children's Hospital.8 of them had posterior urethral valve while the other had pelvic ureteral junction obstruction.All were males.The most common symptom was gradual distention of abdomen since birth. One had history of anuria for 5 days after birth,5had urinary dribbling,and two came in with ureterostomy or eystostomy done in other hospitals.A lot of pus cells in the ascitie fluid was found in 2 cases among the 8 cases.4 cases cured,3 improved nnd 2 died of improper management.The etiology,iagnosis,management and prognosis of the urinary ascites were discussed in the paper.

  5. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients.

    Science.gov (United States)

    Schiffl, Helmut

    2014-01-01

    Dialysis-related amyloidosis (DRA) is a unique type of amyloidosis (beta-2 microglobulin) predominantly in end-stage renal disease. Its clinical manifestations add to increased morbidity and reduced quality of life. There seems to be a relative risk reduction in DRA manifestations when hemodialysis (HD) patients are treated with advanced HD technology, but changes of the course of DRA are uncertain. The aim of our investigation was to evaluate the prevalence and severity of carpal tunnel syndrome (CTS) in long-term dialysis patients receiving either conventional or high-flux, online-produced ultrapure dialysis fluid. The cross-sectional study included 147 HD patients (at least 10 years). The definitive diagnosis of CTS was made histologically or by the coexistence of CTS with other radiological DRA manifestations (bone cysts, arthropathies). The two HD patient groups did not differ significantly in age at start of HD, gender, major co-morbid diseases, anuria, and dialysis vintage. The conventional HD group had significantly higher circulating beta-2 microglobulin and C-reactive protein (CRP) levels. The prevalence of DRA was 68% for the conventional HD group and 28% for the advanced HD group. Duration of dialysis treatment was the only significant risk factor for the development of clinical DRA manifestations in both study groups, but CTS, bone cysts, or arthropathies occurred significantly earlier in conventional HD patients. The prevalence and severity of DRA have decreased with advances in dialysis technology during the last two decades, although its occurrence is simply delayed.

  6. Percutaneous nephrostomy or double J stenting, which is better modality for obstructive uropathy-a descriptive study

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    Vinamra Mittal

    2016-08-01

    Results: Two comparable groups of PCN and DJS were formed with a mean age of 45.5 years and 47.9 years. Male to female ratio was 1.5:1 and 1.2:1 respectively. Pain with oliguria or anuria was the major presentation. The urine output levels showed a sudden increase postoperatively with a subsequent trend towards normal value in both the groups. Creatinine however showed a normalizing trend from a mean 6.46 mg/dl preoperatively to 1.01mg/dl postoperatively in PCN group whereas in DJS group 5.38mg/dl preoperatively to 2.75mg/dl with a rising trend from POD 15 requiring conversion to PCN in 20% of patients with subsequent normalization of creatinine levels to 0.95 mg/dl. Statistically we found no difference in the outcome when both the groups were compared in view of serum creatinine and urine output levels whereas there is a significant difference in the pre and post operative outcome of both the groups. Conclusions: Our results thus support that though there is no significant difference among both the procedures, ureteral stents are associated with intolerable lower urinary tract symptoms owing to conversion to secondary percutaneous Nephrostomy. Hence percutaneous nephrostomy is superior to ureteral stents for diversion of urine in patients with ARF due to obstructive uropathy. [Int J Res Med Sci 2016; 4(8.000: 3486-3491

  7. Angiotensin II receptor blockade does not protect against progressive loss of residual renal function in hemodialysis patients: A randomized controlled trial (SAFIR study)

    DEFF Research Database (Denmark)

    Kjærgaard, Krista Dybtved; Peters, Christian Daugaard; Jespersen, Bente;

    Background: Glomerular filtration rate (GFR) declines during chronic dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve renal function in hemodialysis (HD). Methods...... centers and randomized to placebo or the angiotensin II receptor blocker irbesartan 300 mg daily. Target systolic blood pressure (BP) was 140 mmHg. Outcomes were GFR measured as the mean of creatinine and urea renal clearance, urine volume and time to anuria. Results: Of the 82 patients randomized...... in both groups and BP did not differ significantly between groups over time. Adverse event rates were similar. GFR declined by 1.7 (1.2 to 2.3) (mean (95% CI)) mL/min/1.73m2/year in the placebo group and by 1.8 (1.1 to 2.4) mL/min/1.73m2/year in the irbesartan-treated group. Mean difference (baseline-12...

  8. 神农化石丹治疗泌尿系结石的临床观察

    Institute of Scientific and Technical Information of China (English)

    陶修翠; 叶婷婷

    2005-01-01

    Objective Observing the curative effect and safety of shennong Calculi - stopping Bolus for treating the calculi in the urinary system.Method Choosing 160 patients of the calculi in the urinaruy system,who are divided randomly in two groups,in which,the curative group thkes orally the Shennong Calculi - removal granule. The period of treatment is three months. Symptom sign, ealculi removal and clinic comprehensive curative effect after observing and treating. Results Total effective rate of curative group and control group is separately up to 93.59% and 80% ,the comparing diffetenee of two groups is obvious,the curative effect ot curative group is obviously higher than control group(P < 0.05). The curative effect of creative group is better than control group on symptom sign and calculi removal for improving the dull pain of lumbar region, anuria, macroscopic hematuria, real region pain by tapping and so on. The serious untoward reaction dpes not occur. Conclusion The curative effect of Shennong Calculistopping Bolus is obvious and its safety is excellent.

  9. Acute Glomerulonephritis: A 7 Years Follow up of Children in Center of Iran

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    Mohsen Akhavan Sepahi

    2011-06-01

    Full Text Available Acute glomerulonephritis (AGN is a type of renal disease which indicates the inflammation of glomerulus and nephrons. This study was carried on 94 children, <15 years old with the diagnosis of AGN who were admitted to Qom and Yazd's hospitals between 2000 and 2006. Data were collected using hospital records on admission, progression notes and outpatient follow up. Among 94 patients, 55.3% were male and 44.6% were female. Mean age of patients was 8.2±2.7 years old. Acute post streptococcal glomerulonephritis (APSGN was reported in 92.5%, membranoproliferative glomerulonephritis in 4.2%, hemolytic uremic syndrome in 2.1% and IgA nephropathy in 1.06%. There was no significant differences between GN types and gender (P=0.54. Clinical manifestation included edema in 68.8%, oliguria in 36.3%, gross hematuria in 69.1%, HTN in 61.7% and anuria in 1.06%. Microscopic hematuria was detected in all patients. In the time of follow up none of patients had hypertension, 3.1% had proteinuria and 6.3% had microscopic hematuria. APSGN is the most common causes of AGN in Qom and Yazd's children. Early diagnosis and treatment of APSGN may protect children from long term morbidity and mortality and improve quality of life.

  10. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

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    Vučičević-Trobok Jadranka

    2002-01-01

    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  11. Successful Salvage of a Renal Allograft after Acute Renal Vein Thrombosis due to May-Thurner Syndrome

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    Omkar U. Vaidya

    2012-01-01

    Full Text Available A 68-year-old Caucasian female with a past medical history of a deceased donor kidney transplant four months prior was admitted with a two-day history of anuria and acute kidney injury. A renal ultrasound demonstrated thrombus in the transplanted kidney's renal vein that extended into the left iliac vein as well as into the left femoral venous system. Catheter-guided tissue thrombolytics were infused directly into the clot. Within twelve hours of initiating thrombolytic infusion, there was brisk urine output. Interval venography demonstrated decreasing clot burden. At the time of discharge her creatinine was 0.78 mg/dL, similar to her baseline value prior to presentation. The patient was noted to have May-Thurner syndrome on intravascular ultrasound (IVUS. Angioplasty followed by stent placement was done. Unique to our case report was the timing of the presentation of renal vein thrombosis (four months after transplant and the predisposing anatomy consistent with May-Thurner syndrome, which was diagnosed with IVUS and successfully treated with local thrombolytics.

  12. Comparative study of obstructive urolithiasis and its sequelae in buffalo calves

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    Yasmin H. Bayoumi

    2017-02-01

    Full Text Available Aim: The present work was designed to study the incidence of obstructive urolithiasis and to apply comparative diagnosis to urine retention cases. Materials and Methods: A total of 78 non-castrated buffalo calves aging 3-11 months were included in this study, 68 calves were admitted to the Veterinary Teaching Hospital, Zagazig University, Egypt, during the study period with a history of anuria, and they were classified into three groups; intact bladder group (19 calves, uroperitoneum group (45 calves, and ruptured urethra group (4 calves. 10 apparently healthy calves were used for comparison. On the basis of history, clinical, laboratory, and ultrasonographic findings diagnosis was achieved. Results: There was a marked increase in the incidence of obstructive urolithiasis in winter season, especially in winter months of 2016. Calves within the age of 3-4 months and 6-8 months were mostly affected. Inappetence to anorexia, restlessness or depression, and abdominal distension were the most observed signs in the diseased calves. Laboratory findings revealed hemoconcentration and a significant increase in blood urea nitrogen and serum creatinine levels in all diseased groups. Hyperproteinemia, hypocalcemia, and hyperphosphatemia with electrolytes imbalance were recorded in the uroperitoneum group. Ultrasonographically, distended urinary bladder with distal acoustic enhancement revealed obstructive urolithiasis with intact bladder while anechoic fluid in abdominal cavity indicates uroperitoneum. Conclusion: On the basis of all findings, calves with intact bladder were in superior condition than those with a ruptured urethra and both were better than those with uroperitoneum.

  13. Phytochemical profile of sugarcane and its potential health aspects

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    Amandeep Singh

    2015-01-01

    Full Text Available Sugarcane (Saccharum officinarum Linn. is an important perennial grass of Poaceae family, indigenous to tropical South Asia and Southeast Asia. It is cultivated worldwide due to the economical and medicinal value of its high yielding products. Sugarcane juice is well known as a raw material for the production of refined sugar and its wax is considered as a potential substitute for the expensive carnauba wax, which is of cosmetic and pharmaceutical interest. Refined sugar is the primary product of sugarcane juice, but during its processing, various other valuable products are also obtained in an unrefined form, such as, brown sugar, molasses, and jaggery. Sugarcane juice is widely used in India in the treatment of jaundice, hemorrhage, dysuria, anuria, and other urinary diseases. Herein, we have summarized the different phytoconstituents and health benefits of sugarcane and its valuable products. The phytochemistry of sugarcane wax (obtained from the leaves and stalks of sugarcane, leaves, juice, and its products has revealed the presence of various fatty acid, alcohol, phytosterols, higher terpenoids, flavonoids, -O- and -C-glycosides, and phenolic acids. The future prospective of some of the sugarcane products has been discussed, which needs a phytopharmacological study and has a great potential to be a valuable medicinal product.

  14. Obstructive Uropathy in Sudanese Patients

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    El Imam M

    2006-01-01

    Full Text Available In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66% patients presented with chronic obstruction and 175 (34% with acute obstruction. Of the study patients, 210 (40% presented with significant renal impairment; 50 (23% of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

  15. Sequential MRI, SPECT and PET in respiratory syncytial virus encephalitis

    Energy Technology Data Exchange (ETDEWEB)

    Hirayama, K.; Sakazaki, Hiromi; Murakami, Seiko; Yonezawa, Sumiko [Department of Paediatrics, Izumi Municipal Hospital, Osaka (Japan); Fujimoto, Keiji [Dept. of Radiology, Izumi Municipal Hospital, Osaka (Japan); Seto, Toshiyuki; Tanaka, Katsuji; Hattori, Hideji; Matsuoka, Osamu [Dept. of Paediatrics, Osaka City University Medical School, Osaka (Japan); Murata, Ryosuke [Children`s Medical Centre, Osaka City General Hospital, Osaka (Japan)

    1999-04-01

    We report on a 3-year-old girl with respiratory syncytial virus (RSV) encephalitis manifested by disturbance of consciousness, conjugate eye deviation, anuria, truncal ataxia and intention tremor. T2-weighted magnetic resonance imaging (MRI) showed hyperintense areas in the cerebellar cortex. No lesion was detected in the cerebral cortex, pons or spinal cord. The hyperintense areas in the cerebellar cortex diminished with recovery from the clinical manifestations and had resolved 2 months after onset. The MRI lesions in the cerebellum were considered to be due to oedema. SPECT and positron emission tomography (PET), performed 3 months after onset, disclosed areas of hypoperfusion and hypometabolism at the same sites. One year after onset, MRI showed mild atrophy of the cerebellum. Hypoperfusion on SPECT and hypometabolism on PET remained. Neuroimaging showed that ataxia and tremor in this case were the result of cerebellitis. The patient has no neurological deficit except for mild truncal ataxia. This patient is a rare example of RSV encephalitis. (orig.) With 4 figs., 16 refs.

  16. Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy

    Institute of Scientific and Technical Information of China (English)

    LI Sha-dan; WANG Qing-tang; CHEN Wei-guo

    2011-01-01

    Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy (ESWL). Two patients had stones sized <0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone (1.2 cm), which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.

  17. Acute aortic dissection: be aware of misdiagnosis

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    Asteri Theodora

    2009-02-01

    Full Text Available Abstract Background Acute aortic dissection (AAD is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. Methods From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT, transthoracic echocardiography (TTE and coronary angiography. Results Initial misdiagnosis occurred in fifteen patients (31% later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients. Conclusion Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.

  18. Survival of a very low-birthweight infant with Potter sequence on long-term hemodialysis.

    Science.gov (United States)

    Miyahara, Jun; Yamamoto, Masaki; Motoshige, Kyoko; Fujita, Naoya; Ohki, Shigeru

    2016-07-01

    Recent advances in neonatal cardiorespiratory management and neonatal renal replacement therapy have led to occasional reports of favorable short-term and long-term outcomes for Potter sequence, once thought to be fatal. The present patient was a girl born at a gestational age of 34 weeks 4 days with a birthweight of 1398 g. She was diagnosed with Potter sequence complicated by pulmonary hypoplasia due to left renal agenesis and small right kidney. Hemodialysis was started because anuria persisted even after persistent pulmonary hypertension receded and cardiorespiratory status improved. Peritoneal dialysis during the clinical course failed to achieve stability because of pericatheter leakage and frequent obstruction of the peritoneal dialysis catheter; in the meantime, hemodialysis was also performed. Once bodyweight passed 3.5 kg, peritoneal dialysis became more feasible with stability; the patient was discharged at 9 months and at the time of writing was on peritoneal dialysis at home, and renal transplantation was planned.

  19. The patterns of peripheral plasma renin concentration in the early post-renal-transplant period.

    Science.gov (United States)

    Kornerup, H J

    1979-01-01

    Serial determinations of peripheral plasma renin concentration (PRC) were performed in 11 kidney transplant recipients during the early post-transplant period. In 5 recipients with late onset of graft function, PRC values were increased during the anuric phase and, subsequently, PRC values declined in every during restoration of graft function. In 4 recipients with an acute renal allograft reaction, PRC values were increased at the onset of the allograft reaction in 3 with hypertension whereas PRC values were normal in one normotensive recipient. Subsequently, PRC normalized in the hypertensives coincident with increasing body weights. In 2 recipients with an uncomplicated course and with a normal graft function immediately after transplantation and throughout the study period, PRC values were constantly normal. The results indicate that acute anuria in the early phase after kidney transplantation is associated with an increased release of renin. The results also suggest that an increased activity of the renin-angiotensin system may be counterbalanced by sodium and fluid retention in hypertension following an acute renal allograft reaction.

  20. Hemiresective reconstruction of a redundant ileal conduit with severe bilateral ileal conduit-ureteral re fl ux.

    Science.gov (United States)

    Fujimura, Tetsuya; Minowada, Shigeru; Kishi, Hiroichi; Hamasaki, Kimihisa; Saito, Kiyoshi; Kitamura, Tadaichi

    2005-10-01

    A 58-year-old man was referred to our hospital with high fever and anuria. Since undergoing a total pelvic exenteration due to bladder-invasive sigmoid colon cancer, urinary tract infections had frequently occurred. We treated with the construction of a bilateral percutaneous nephrostomy (PCN), and chemotherapy. Although we replaced the PCN with a single J ureteral catheter after an improvement of infection, urinary infection recurred because of an obstruction of the catheter. Urological examinations showed that an ileal conduit-ureteral reflux caused by kinking of the ileal loop was the reason why frequent pyelonephritis occurred. We decided to resect the proximal segment to improve conduit-ureteral reflux for the resistant pyelonephritis. After the surgery, the excretory urogram showed improvement and the urinary retention at the ileal conduit disappeared. Three years after the operation, renal function has been stable without episodes of pyelonephritis. Here we report a case of open repair surgery of an ileal conduit in a patient with severe urinary infection.

  1. Vibrio vulnificus infection in Southern Brazil - Case report Infecção por Vibrio vulnificus no sul do Brasil - Relato de caso

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    João César Beenke França

    2013-06-01

    Full Text Available The genus Vibrio is a member of the family Vibrionaceae, and among their disease-causing species, Vibrio vulnificus, a lactose-positive gram-negative bacillus, is one of the most virulent pathogen of the noncholerae vibrios. We describe the case of a 39-year-old male patient, who was using immunosuppressive therapy, admitted to the hospital for liver transplantation. Twelve hours later, the patient presented high fever, myalgia, anuria and erythematous plaques on lower limbs, of rapid growth and proximal progression. The patient was treated with ceftriaxone, meropenem and oxacillin, however he expired within 30 hours. Blood cultures showed growth of a gram-negative bacillus, which was later identified as Vibrio vulnificus.O gênero Vibrio é membro da família Vibrionaceae, e entre as espécies patogênicas, Vibrio vulnificus, bacilo gram negativo lactose positivo, tem sido frequentemente citado. Descrevemos o caso de um paciente masculino de 39 anos, em uso de medicação imunossupressora, admitido no hospital para transplante hepático. Doze horas após a internação, o paciente evoluiu com febre, mialgias, anúria e placas eritematosas em membros inferiores, com rápido crescimento e evolução proximal. O paciente foi tratado com ceftriaxona, meropenem e oxacilina sem melhora, evoluindo para óbito em 30 horas. Hemocultura mostrou crescimento de bacilo gram negativo posteriormente identificado como Vibrio vulnificus.

  2. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    Science.gov (United States)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  3. Combination of oral activated charcoal plus low protein diet as a new alternative for handling in the old end-stage renal disease patients

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    Musso C

    2010-01-01

    Full Text Available Chronic dialysis is a valid therapeutic option in very elderly ESRD patients, even though the decision to dialyze or not has little impact on survival. Additionally, very old patients usually do not agree with starting chronic dialysis. Even though, activated charcoal is a cheap treatment for working as adsorbent for nitrogenous products its utility is very limited. We studied the combination of a low protein diet and oral activated charcoal to reduce serum urea and crea-tinine levels in very old ESRD patients who had refused to start chronic dialysis. Nine lucid, very old > 80 years, ESRD patients who had refused to start dialysis were prescribed a treatment based on a combination of a very low protein diet and oral activated charcoal (30 gram/day. None of the patients had anuria, oliguria, edema, significant metabolic acidosis or hyperkalemia. None of them had significant gastrointestinal symptoms. After one week and ten months of charcoal use signi-ficant decrease in blood urea and creatinine levels was observed and none of them required emer-gency dialysis during this time. In conclusion, in patients more than 80 years of age low protein diet and oral activated charcoal may control the uremic symptoms effectively.

  4. Combination of oral activated charcoal plus low protein diet as a new alternative for handling in the old end-stage renal disease patients.

    Science.gov (United States)

    Musso, C G; Michelangelo, H; Reynaldi, J; Martinez, B; Vidal, F; Quevedo, M; Parot, M; Waisman, G; Algranati, L

    2010-01-01

    Chronic dialysis is a valid therapeutic option in very elderly ESRD patients, even though the decision to dialyze or not has little impact on survival. Additionally, very old patients usually do not agree with starting chronic dialysis. Even though, activated charcoal is a cheap treatment for working as adsorbent for nitrogenous products its utility is very limited. We studied the combination of a low protein diet and oral activated charcoal to reduce serum urea and creatinine levels in very old ESRD patients who had refused to start chronic dialysis. Nine lucid, very old > 80 years, ESRD patients who had refused to start dialysis were prescribed a treatment based on a combination of a very low protein diet and oral activated charcoal (30 gram/day). None of the patients had anuria, oliguria, edema, significant metabolic acidosis or hyperkalemia. None of them had significant gastrointestinal symptoms. After one week and ten months of charcoal use significant decrease in blood urea and creatinine levels was observed and none of them required emergency dialysis during this time. In conclusion, in patients more than 80 years of age low protein diet and oral activated charcoal may control the uremic symptoms effectively.

  5. Ureteroscopic holmium laser lithotripsy in treatment of patients with acute obstructive renal impairment%输尿管镜钬激光碎石术治疗急性梗阻性肾功能衰竭

    Institute of Scientific and Technical Information of China (English)

    段永顺; 倪少滨; 陈起引; 赵忠山

    2011-01-01

    目的 探讨上尿路结石引起的急性梗阻性肾衰的治疗方法.方法 采用输尿管镜直视下取石、钬激光碎石或将结石推入肾盂,体外冲击渡碎石(ESWL)治疗急性梗阻性肾衰32例(62侧).所有患者输尿管镜检查术前未曾放置输尿管支架或肾盂引流管.结果 30例输尿管中下段结石经输尿管镜直视下取碎石成功,碎石成功率93.7%.2例输尿管上段结石被推入肾盂,行ESWL治疗后1个月,结石排净.术后患者肾功能恢复正常或接近正常,尿量恢复,结石排净率100%.结论 输尿管镜下取石、钬激光碎石治疗结石引起的急性梗阻性肾衰是一种安全、有效、创伤小、术后恢复快且可同时处理双侧输尿管的手术方式,可作为上尿路梗阻并发急性肾功能衰竭的首选治疗方法.%Objective To evaluate the efficacy and safety of holmium laser for treatment ureteric stones in patients with acute obstructive renal impairment.Methods Thirty-two patients were included in this study.None of the patients had a ureterie stent or nephrostomy tube before the ureteroseopy.All patients were treated with holmium laser.Results 30 patients with ureter stones in middle and inferior segment were free of stones by ureteroscopic lithotripsy.The success rate for treatment of ureteral stones lithotripsy and calculus removal was 93.7%.Ureter stones located in superior segment in two patients were sent back pelvis.Extracorporeal shock-wave lithotripsy were performed.The two patients were free of any stone fragmens a month later.In all patients, including the five with obstructive anuria,the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine.100% of the patients were free of any stone fragments postoperatively.Conclusion A holmium laser was a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria.It also had merits of small

  6. 维持性血液透析患者不宁腿综合征的横断面研究%A cross-sectional study of restless legs syndrome in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    肖成根; 梁馨苓; 李锐钊; 蔡璐; 许德珍

    2013-01-01

    目的 了解维持性血液透析患者中不宁腿综合征(restless legs syndrome,RLS)的发病率及其影响因素.方法 入选2012年9月1-30日在广东省人民医院血液净化中心行维持性血液透析的375例患者,收集相关实验室和透析指标数据,应用多元logistic回归分析对相关危险因素进行统计分析.结果 RLS的发病率为13.3%,严重程度评分为(18.69±0.95)分,多元logistic回归分析显示无尿(OR0.292,95% CI 0.114~0.750)和β2微球蛋白升高(OR 1.023,95% CI 1.003~1.044)是维持性血液透析患者发生RLS的危险因素,而体重指数、血红蛋白、血清铁、甲状旁腺素等与RLS无相关性.结论 维持性血液透析患者RLS发病率高,其发生危险因素为无尿和β2微球蛋白升高,故保存残余肾功能,提高透析充分性,特别是清除中分子毒素,可降低不宁腿的发生率进而改善透析患者的生活质量.%Objective To explore the incidence and possible risk factors of restless legs syndrome (RLS) in the maintenance hemodialysis patients.Methods A total of 375 maintenance hemodialysis patients were enrolled in this study from September 1 to 30 in 2012.The diagnosis and assessment of severity were based on the International Restless Leg Syndrome Study Group (IRLSSG) standard.The relevant laboratory parameters and dialysis indicators were collected,such as hemoglobin,serum ferritin,parathyroid hormone,blood flow and dialysis mode.The clinical data were analyzed by multivariate logistic regression method.Results The incidence of RLS was 13.3% with the severity score of 18.69 ± 0.95.The logistic regression analysis showed that anuria (OR 0.292,95% CI 0.114-0.750) and β2 microglobulin(OR 1.023,95%C1 1.003-1.044) were the risk factors for RLS in the maintenance hemodialysis patients,while hemoglobin,serum iron and parathyroid hormone were not correlated with RLS.Conclusions The incidence of RLS is high in the maintenance hemodialysis patients

  7. Urothelial Defects from Targeted Inactivation of Exocyst Sec10 in Mice Cause Ureteropelvic Junction Obstructions.

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    Ben Fogelgren

    Full Text Available Most cases of congenital obstructive nephropathy are the result of ureteropelvic junction obstructions, and despite their high prevalence, we have a poor understanding of their etiology and scarcity of genetic models. The eight-protein exocyst complex regulates polarized exocytosis of intracellular vesicles in a large variety of cell types. Here we report generation of a conditional knockout mouse for Sec10, a central component of the exocyst, which is the first conditional allele for any exocyst gene. Inactivation of Sec10 in ureteric bud-derived cells using Ksp1.3-Cre mice resulted in severe bilateral hydronephrosis and complete anuria in newborns, with death occurring 6-14 hours after birth. Sec10 FL/FL;Ksp-Cre embryos developed ureteropelvic junction obstructions between E17.5 and E18.5 as a result of degeneration of the urothelium and subsequent overgrowth by surrounding mesenchymal cells. The urothelial cell layer that lines the urinary tract must maintain a hydrophobic luminal barrier again urine while remaining highly stretchable. This barrier is largely established by production of uroplakin proteins that are transported to the apical surface to establish large plaques. By E16.5, Sec10 FL/FL;Ksp-Cre ureter and pelvic urothelium showed decreased uroplakin-3 protein at the luminal surface, and complete absence of uroplakin-3 by E17.5. Affected urothelium at the UPJ showed irregular barriers that exposed the smooth muscle layer to urine, suggesting this may trigger the surrounding mesenchymal cells to overgrow the lumen. Findings from this novel mouse model show Sec10 is critical for the development of the urothelium in ureters, and provides experimental evidence that failure of this urothelial barrier may contribute to human congenital urinary tract obstructions.

  8. Urothelial Defects from Targeted Inactivation of Exocyst Sec10 in Mice Cause Ureteropelvic Junction Obstructions.

    Science.gov (United States)

    Fogelgren, Ben; Polgar, Noemi; Lui, Vanessa H; Lee, Amanda J; Tamashiro, Kadee-Kalia A; Napoli, Josephine Andrea; Walton, Chad B; Zuo, Xiaofeng; Lipschutz, Joshua H

    2015-01-01

    Most cases of congenital obstructive nephropathy are the result of ureteropelvic junction obstructions, and despite their high prevalence, we have a poor understanding of their etiology and scarcity of genetic models. The eight-protein exocyst complex regulates polarized exocytosis of intracellular vesicles in a large variety of cell types. Here we report generation of a conditional knockout mouse for Sec10, a central component of the exocyst, which is the first conditional allele for any exocyst gene. Inactivation of Sec10 in ureteric bud-derived cells using Ksp1.3-Cre mice resulted in severe bilateral hydronephrosis and complete anuria in newborns, with death occurring 6-14 hours after birth. Sec10 FL/FL;Ksp-Cre embryos developed ureteropelvic junction obstructions between E17.5 and E18.5 as a result of degeneration of the urothelium and subsequent overgrowth by surrounding mesenchymal cells. The urothelial cell layer that lines the urinary tract must maintain a hydrophobic luminal barrier again urine while remaining highly stretchable. This barrier is largely established by production of uroplakin proteins that are transported to the apical surface to establish large plaques. By E16.5, Sec10 FL/FL;Ksp-Cre ureter and pelvic urothelium showed decreased uroplakin-3 protein at the luminal surface, and complete absence of uroplakin-3 by E17.5. Affected urothelium at the UPJ showed irregular barriers that exposed the smooth muscle layer to urine, suggesting this may trigger the surrounding mesenchymal cells to overgrow the lumen. Findings from this novel mouse model show Sec10 is critical for the development of the urothelium in ureters, and provides experimental evidence that failure of this urothelial barrier may contribute to human congenital urinary tract obstructions.

  9. Black water fever associated with acute renal failure among Congolese children in Kinshasa

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    Joseph M Bodi

    2014-01-01

    Full Text Available Acute renal failure (ARF is reported in some severe forms of malaria such as black water fever (BWF. It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics′ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8% had severe malaria (39 with BWF and 5 with cerebral malaria. The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%. Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively. Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate <15 mEq/L in 61.5% and hyponatremia (<130 mEq/L in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%, including 20 on dialysis, fully recovered and 14 died (22.2%, including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.

  10. A Case of Fibrillary Glomerulonephritis Associated with Thrombotic Microangiopathy and Anti-Glomerular Basement Membrane Antibody

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    Akishi Momose

    2015-02-01

    Full Text Available We present the first report of a case of fibrillary glomerulonephritis (FGN associated with thrombotic microangiopathy (TMA and anti-glomerular basement membrane antibody (anti-GBM antibody. A 54-year-old man was admitted to our hospital for high fever and anuria. On the first hospital day, we initiated hemodialysis for renal dysfunction. Laboratory data revealed normocytic-normochromic anemia with schistocytes in the peripheral smear, thrombocytopenia, increased serum lactate dehydrogenase, decreased serum haptoglobin, and negative results for both direct and indirect Coombs tests. Based on these results, we diagnosed TMA. Assays conducted several days later indicated a disintegrin-like and metalloprotease with a thrombospondin motif 13 (ADAMTS13 activity of 31.6%, and ADAMTS13 inhibitors were negative. We started plasma exchange using fresh frozen plasma and steroid pulse therapy. Anti-GBM antibody was found to be positive. Renal biopsy showed FGN. Blood pressure rose on the 46th hospital day, and mild convulsions developed. Based on magnetic resonance imaging of the head, the patient was diagnosed with reversible posterior leukoencephalopathy syndrome. Hypertension persisted despite administration of multiple antihypertensive agents, and the patient experienced a sudden generalized seizure. Computed tomography of the head showed multiple cerebral hemorrhages. However, his blood pressure subsequently decreased and the platelet count increased. TMA remitted following 36 plasma exchange sessions, but renal function was not restored, and maintenance hemodialysis was continued. The patient was discharged on the 119th day of hospitalization. In conclusion, it was shown that TMA, FGN and anti-GBM antibody were closely related.

  11. Urolithiasis in renal transplantation: Diagnosis and management

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    Elisa Cicerello

    2014-12-01

    Full Text Available Obiectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Patients and Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10% of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL. Three patients were treated by ureteroscopy (URS and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS. Conclusions: The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.

  12. Hypertonic saline solution and high-dose furosemide infusion in cardiorenal syndrome: our experience

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    Francesco Ventrella

    2013-03-01

    Full Text Available Introduction Heart failure is frequently complicated by renal failure, and this association is a negative prognostic factor. These patients sometimes present oligo-/anuria and resistance to high-dose furosemide, a condition referred to as the cardiorenal syndrome (CRS. Acute or chronic reductions in left ventricular function result in decreased blood flow, with reduction of renal perfusion and activation of several neurohormonal systems, which cause resistance to diuretic therapy. This condition often requires ultrafiltration, which is an effective, but invasive and expensive procedure. Infusions of hypertonic saline solution (HSS and high-dose furosemide can be an effective alternative. Materials and methods From November 2009 through May 2010, our team treated 20 patients with CRS and resistance to iv boluses of high-dose furosemide. These patients were treated with small-volume (150-250 mL infusions of HSS (NaCl 1.57 – 4.5%, depending on serum Na values and high-dose furosemide twice a day. The aim of this treatment is to modify renal hemodynamics and the water-saline balance in the kidney by counteracting the extracellular fluid accumulation and eliminating symptoms of congestion. Results In 18 patients (90%, urine output was restored and renal function improved during the first hours of treatment. Clinical improvement was evident from the first day of therapy, and there were no adverse events. Two patients (10% did not respond to the treatment: one (who had been in critical condition since admission died; the other required regular sessions of ultrafiltration. Conclusions HSS combined with high-dose furosemide is a safe, effective, low-cost approach to the treatment of CRS that is resistant to diuretic therapy.

  13. Intoxicação por enrofloxacina em um cão da raça Pinscher Miniatura: relato de caso Enrofloxacin poisoning in a Miniature Pinscher: a case report

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    H.H.A. Barcellos

    2006-02-01

    Full Text Available Uma cadela da raça Pinscher Miniatura foi medicada pelo proprietário com enrofloxacina, na dose de 50mg/kg, uma vez ao dia, por dois dias (dose diária 10 vezes maior que a prescrita. Ao exame clínico o animal apresentou-se deprimido, em cifose lombar, hipotérmico, com mucosas pálidas, dispnéia, sialorréia, vômitos e anúria, evoluindo para parada respiratória, convulsões e coma. Foi realizado tratamento sintomático. O fluxo urinário retornou ao normal em 12 horas e as convulsões foram controladas, mas o animal permaneceu em coma, morrendo 72 horas após o início do tratamento. A necropsia e o histopatológico confirmaram insuficiência renal e hepática agudas, e choque hipovolêmico, compatível com intoxicação por enrofloxacina.A Miniature Pinscher bitch was treated by the owner with enrofloxacin at dose of 50 mg/kg, once a day, for two days (daily dose rate 10 times greater than prescribed. Physical examination showed depression, lumbar cifosis, hipotermia, pale mucosa, dispneia, drewling, vomiting and anuria, followed by respiratory failure, seizures, and coma. Symptomatic treatment was performed, and the urinary flow returned to normal in 12 hours, and seizures were controlled. However, the animal stayed in coma, and died 72 hours after the beginning of the treatment. Acute renal and hepatic failure, and hipovolemic shock, compatible with enrofloxacin intoxication, were observed through necropsia and histopatology.

  14. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: A single-center study from India

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    Suraj M Godara

    2014-01-01

    Full Text Available Acute kidney injury (AKI is one of the most challenging and serious complications of pregnancy. We present our experience on the clinical profile and outcome of 57 patients with pregnancy-related AKI, of a total of 580 patients with AKI seen during the study period. This is a prospective single-center study in a civil hospital conducted from January to December 2010. The most common age group of the study patients was 20-25 years; 43.8% of the patients had received antenatal care. AKI was observed in the puerperium (n = 34, early pregnancy (n = 10 and late pregnancy (n = 13. The cause of AKI included puerperal sepsis (63.1%, pregnancy-induced hypertension (PIH (33.33%, post-abortion (22.80%, ante-partum hemorrhage (APH (14% and post-partum hemorrhage (PPH (8%. Complete, partial and no renal recovery was observed in 52.64%, 21.05% and 26.31% of the patients, respectively. Low platelet count and plasma fibrinogen and high bilirubin, D-dimer and activated partial throm-boplastin time were observed more commonly in patients with partial recovery. Of the 57 patients, 50 received hemodialysis, three received peritoneal dialysis and seven patients were managed conserva-tively. A total of 13 patients developed cortical necrosis that was associated with sepsis in six, PPH and pre-eclampsia/eclampsia in three patients each and APH in one. Nine patients died, and the cause of death was septicemia in four, pre-eclampsia in three and APH and PPH in one patient each. In our study, puerperal sepsis was the most common etiological factor for pregnancy-related AKI. Prolonged oliguria or anuria were bad prognostic factors for renal recovery. Sepsis, thrombocytopenia, disseminated intra-vascular coagulation and liver involvement were associated with increased mortality.

  15. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India.

    Science.gov (United States)

    Godara, Suraj M; Kute, Vivek B; Trivedi, Hargovind L; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Gumber, Vandana M

    2014-07-01

    Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy. We present our experience on the clinical profile and outcome of 57 patients with pregnancy-related AKI, of a total of 580 patients with AKI seen during the study period. This is a prospective single-center study in a civil hospital conducted from January to December 2010. The most common age group of the study patients was 20-25 years; 43.8% of the patients had received antenatal care. AKI was observed in the puerperium (n = 34), early pregnancy (n = 10) and late pregnancy (n = 13). The cause of AKI included puerperal sepsis (63.1%), pregnancy-induced hypertension (PIH) (33.33%), post-abortion (22.80%), ante-partum hemorrhage (APH) (14%) and post-partum hemorrhage (PPH) (8%). Complete, partial and no renal recovery was observed in 52.64%, 21.05% and 26.31% of the patients, respectively. Low platelet count and plasma fibrinogen and high bilirubin, D-dimer and activated partial thromboplast in time were observed more commonly in patients with partial recovery. Of the 57 patients, 50 received hemodialysis, three received peritoneal dialysis and seven patients were managed conservatively. A total of 13 patients developed cortical necrosis that was associated with sepsis in six, PPH and pre-eclampsia/eclampsia in three patients each and APH in one. Nine patients died, and the cause of death was septicemia in four, pre-eclampsia in three and APH and PPH in one patient each. In our study, puerperal sepsis was the most common etiological factor for pregnancy-related AKI. Prolonged oliguria or anuria were bad prognostic factors for renal recovery. Sepsis, thrombocytopenia, disseminated intra-vascular coagulation and liver involvement were associated with increased mortality.

  16. RECONSTRUCTION OF THE FRAGMENT OF HISTORY OF GRAMMATICAL NORM OF THE CHURCH SLAVONIC LANGUAGE (ON THE MATERIAL OF “COLLECTION” BY NILUS OF SORA

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    Karavaeva Polina Yuryevna

    2014-12-01

    Full Text Available The article presents some results of the research that are aimed at identifying specific realization of grammatical norms of the Church Slavonic language (Russian edition of the XV – beginning of XVI century. In Hagiography 'Life of Saint Anuria of the Desert', which is included into "Sobornik of the Greek Saints' lives" by St. Nilus of Sora, functional-semantic specificity of the forms of the past tense is defined. It is established that in the Hagiography all possible preterit forms are used: aorist, imperfect, perfect, pluperfect. On the example of aorist and imperfect forms' usage it is proved that they implement not only the original semantics, but also the meanings, that are characteristic of other preteritum. Due to the context the aorist form can express the following aeristhesia meanings: specifically factual (when referring to a specifically singled undifferentiated actions attributable to the past and without any connection with reality, specifically processional (if the characteristic of a specific condition or process is associated with a specific moment in the past, and perfect (in case of designating condition at the moment of speech, which was the result of actions in the past, pluscuamperfecto (when referring to actions that preceded another past action and imperfective (when referring to either long-term, continuous or repeated action in the past. The imperfect is used not only in its original meaning (long-term, repeated action or state, but also in the meanings of other preterito, in particular of the aorist. The mixture of past tense forms indicates a change in the nature of strict grammatical rules and the emergency of new grammatical rules of the Church Slavonic language (Russian edition.

  17. PROSPECTIVE STUDY OF TAMSULOSIN IN THE MANAGEMENT OF CALCULI IN LOWER THIRD OF URETER

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    Arunabha

    2015-04-01

    Full Text Available INTRODUCTION: Urinary calculus disease is one of the 3 most common urological diseases . It affects about 12 % of the world population and has become a worldwide health problem . Of all the urinary tract stones 20% are ureteral stones , of which 70% are found in the lower third of ureter . Patients with ureteric calculi have wide range of complications which includes acute pain necessitating hospitalization , urinary tract infection , anuria , acute renal failure , chronic renal failure , hydronephrosis , pyonephrosis , pyelonephritis . The objective of the study is , t o study the effect of Tamsulosin in the passage of calculi in the lower one third of the ureter compared to NSAIDs and oral and IV fluids . MATERI AL AND METHOD: This study included a total of 82 patients between the study period from Nov 20 10 to May 201 3 . 42 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs ( Diclofenac sodium and the other 40 patients w ere treated with Tamsulosin ( alpha blocker 0 . 4mg HS for one month along with oral fluids and NSAIDs ( Diclofenac sodium . RESULTS: Majority of the patients were in the age group of 20 - 40 yrs . The mean size of the calculus was 6 . 62 cms on the right side and 6 . 07 cms on the left side . Out of the 40 patients who were on alpha 1 blocker ( Tamsulosin 31 patients had passed the calculi and 9 patients had no results with a success rate of 77 . 5% . In the 42 patients who were not on Tamsulosin , 8 patients passed the calculi and 34 patients did not pass the calculi . 9 patients among the 42 underwent ureterorenoscopy ( URS . CONCLUSION : Tamsulosin is an effective and safe drug in the management of calculi in the lower 1/3 rd of the ureter . Most patients with ureteric calc uli were rendered stone free with endourological procedures if conservative treatment failed .

  18. [Etiology, pathophysiology and clinical significance of hereditary fructose intolerance].

    Science.gov (United States)

    Fauth, U; Halmágyi, M

    1991-10-01

    Due to repeatedly described incidents in patients with undiscovered hereditary fructose intolerance, the application of fructose and sorbit-containing parenteral solutions is a topic vehemently discussed. This paper presents a survey of the literature dealing with the inborn defect of fructose-1-phosphate aldolase. The physiology and pathophysiology of fructose metabolism are described as well as the clinical appearance and diagnostic possibilities. The acute course of a fructose incompatibility is determined by a threatening decrease in the blood glucose level, which is attributed to the inhibition of several enzymes of glycolysis and gluconeogenesis by an intracellular accumulation of fructose-1-phosphate. Within hours a global functional breakdown of organs, which normally have the enzyme, occurs. The impairment of the liver function finds expression in a severe coagulopathy, the damage of the kidney leads to anuria. In chronic oral fructose supply, damage of the liver and small intestinal mucosa with corresponding gastrointestinal symptoms determine the clinical course. Concerning diagnosis, contrary to the liver biopsy and the fructose tolerance test, the mucosal biopsy with determination of fructose-1-phosphate aldolase activity has the advantage of greater specificity and is better tolerated by the patient. A total abstinence to fructose and sorbitol-containing solutions is not considered to be necessary when the rarity of the illness is taken into account and certain precautions are taken. These include a specific anamnesis of nutrition as well as a total abstinence from fructose and sorbitol in infants and in the unconscious patient. For clinical routine a simple fructose tolerance test is suggested.

  19. Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study

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    Kristiansson, Mattias; Nyman, Ulf [Lasarettet Trelleborg, University of Lund, Department of Diagnostic Radiology, Trelleborg (Sweden); Holmquist, Fredrik [Malmoe University Hospital, University of Lund, Department of Diagnostic Radiology, Malmoe (Sweden)

    2010-06-15

    To analyse 80-kVp 16-MDCT in patients with clinically suspected pulmonary embolism (PE) and diminished renal function after a reduction in dose of contrast medium (CM) from 200 to 150 mg I/kg. Fifty patients with suspected PE and glomerular filtration rate (GFR) less than 50 mL/min underwent 80-kVp 16-MDCT with 150 mg I/kg. Mean density/image noise (1 standard deviation) was measured in a region of interest in the left pulmonary artery (LPA) and a lower lobe segmental artery (LLSA), and the contrast-to-noise ratio (CNR) was calculated. The values of LPA and LLSA were averaged. Median values/2.5-97.5 percentiles were: age 84/67-96 years, weight 65/43-84 kg, GFR 36/21-45 mL/min, CM dose 9.6/6.4-12 g of iodine, PA density 353/164-495 HU and CNR 11/4.4-20. PE incidence was 16%, and 8% and 12% of the examinations were regarded suboptimal by observer 1 and 2, respectively. Density/CNR values were within ranges reported for common 120-kVp MDCT protocols. None of 32 patients with plasma-creatinine follow-up within 1 week experienced a rise of more than 44.2 {mu}mol/L and none of 50 patients had oliguria/anuria or dialysis. None of 40 patients with a negative CT/no anticoagulation had thromboembolism during follow-up. 80-kVp MDCT combined with individualised ultralow CM doses may provide satisfactory diagnostic quality, which should be to the benefit of patients at risk of contrast medium-induced nephropathy. (orig.)

  20. Venomic and pharmacological activity of Acanthoscurria paulensis (Theraphosidae) spider venom.

    Science.gov (United States)

    Mourão, Caroline Barbosa F; Oliveira, Fagner Neves; e Carvalho, Andréa C; Arenas, Claudia J; Duque, Harry Morales; Gonçalves, Jacqueline C; Macêdo, Jéssica K A; Galante, Priscilla; Schwartz, Carlos A; Mortari, Márcia R; Almeida Santos, Maria de Fátima M; Schwartz, Elisabeth F

    2013-01-01

    In the present study we conducted proteomic and pharmacological characterizations of the venom extracted from the Brazilian tarantula Acanthoscurria paulensis, and evaluated the cardiotoxicity of its two main fractions. The molecular masses of the venom components were identified by mass spectrometry (MALDI-TOF-MS) after chromatographic separation (HPLC). The lethal dose (LD(50)) was determined in mice. Nociceptive behavior was evaluated by intradermal injection in mice and the edematogenic activity by the rat hind-paw assay. Cardiotoxic activity was evaluated on in situ frog heart and on isolated frog ventricle strip. From 60 chromatographic fractions, 97 distinct components were identified, with molecular masses between 601.4 and 21,932.3 Da. A trimodal molecular mass distribution was observed: 30% of the components within 500-1999 Da, 38% within 3500-5999 Da and 21% within 6500-7999 Da. The LD(50) in mice was 25.4 ± 2.4 μg/g and the effects observed were hypoactivity, anuria, constipation, dyspnea and prostration until death, which occurred at higher doses. Despite presenting a dose-dependent edematogenic activity in the rat hind-paw assay, the venom had no nociceptive activity in mice. Additionally, the venom induced a rapid blockage of electrical activity and subsequent diastolic arrest on in situ frog heart preparation, which was inhibited by pretreatment with atropine. In the electrically driven frog ventricle strip, the whole venom and its low molecular mass fraction, but not the proteic one, induced a negative inotropic effect that was also inhibited by atropine. These results suggest that despite low toxicity, A. paulensis venom can induce severe physiological disturbances in mice.

  1. Rationale and design of the balANZ trial: A randomised controlled trial of low GDP, neutral pH versus standard peritoneal dialysis solution for the preservation of residual renal function

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    Clarke Margaret

    2010-09-01

    Full Text Available Abstract Background The main hypothesis of this study is that neutral pH, low glucose degradation product (GDP peritoneal dialysis (PD fluid better preserves residual renal function in PD patients over time compared with conventional dialysate. Methods/Design Inclusion criteria are adult PD patients (CAPD or APD aged 18-81 years whose first dialysis was within 90 days prior to or following enrolment and who have a residual GFR ≥ 5 ml/min/1.73 m2, a urine output ≥ 400 ml/day and an ability to understand the nature and requirements of this trial. Pregnant or lactating patients or individuals with an active infection at the time of enrolment, a contra-indication to PD or participation in any other clinical trial where an intervention is designed to moderate rate of change of residual renal function are excluded. Patients will be randomized 1:1 to receive either neutral pH, low GDP dialysis solution (Balance® or conventional dialysis solution (Stay.safe® for a period of 2 years. During this 2 year study period, urinary urea and clearance measurements will be performed at 0, 3, 6, 9, 12, 18 and 24 months. The primary outcome measure will be the slope of residual renal function decline, adjusted for centre and presence of diabetic nephropathy. Secondary outcome measures will include time from initiation of peritoneal dialysis to anuria, peritoneal small solute clearance, peritoneal transport status, peritoneal ultrafiltration, technique survival, patient survival, peritonitis rates and adverse events. A total of 185 patients has been recruited into the trial. Discussion This investigator-initiated study has been designed to provide evidence to help nephrologists determine the optimal dialysis solution for preserving residual renal function in PD patients. Trial Registration Australian New Zealand Clinical Trials Registry Number: ACTRN12606000044527

  2. Recipient Related Prognostic Factors for Graft Survival after Kidney Transplantation. A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Alina Daciana ELEC

    2012-09-01

    Full Text Available Background and Aim. Advanced chronic kidney disease (CKD severely impairs life expectancy and quality of life in affected patients. Considering its benefits, renal transplantation currently represents the optimal treatment solution for end stage kidney disease patients. Pre-transplant assessment aims to maximize the graft and patient survival by identifying potential factors influencing the post-transplant outcome. The aim of this study has been to analyze recipient related prognostic factors bearing an impact on graft survival. Material and Methods. We analyzed the graft outcomes of 426 renal transplantations performed at the Clinical Institute of Urology and Renal Transplantation of Cluj-Napoca, between January 2004 and December 2008. Variables related to recipient and to potential donor/recipient prognostic factors were studied using univariate and multivariate analysis. Results. Graft survivals at 1, 3, 5 and 7 years were 94.01%, 88.37%, 82.51% and 78.10%, respectively. Chronic rejection (41.11% and death with a functioning graft (18.88% were the main causes of graft loss. In uni and multivariate analysis the recipient related variables found to influence the renal graft outcome were: peritoneal dialysis, pre transplant residual diuresis, grade I hypertension, severe iliac vessel atheromatosis, ischemic heart disease, stroke history, dyslipidemia and denutrition. The worst graft outcomes have been found for recipients on peritoneal dialysis, with anuria, hypotension, severe iliac atheromatosis, ischemic heart disease, stroke history, dyslipidemia and a poor nutritional status. Conclusion. The type of dialysis, the pre transplant residual diuresis, recipient arterial blood pressure, iliac vessel atheromatosis, ischemic heart disease, stroke history, dyslipidemia and denutrition significantly influence graft survival.

  3. 急性HBV感染合并肾功能衰竭及多器官损害1例%Acute hepatitis B combined with renal failure and multiple organ dysfunction: one case report

    Institute of Scientific and Technical Information of China (English)

    陈晓红; 单蕾; 付成涛; 刘佳; 刘成林

    2011-01-01

    急性乙型肝炎并发肾功能衰竭十分少见,其肝外表现通常为血清病样表现,包括发热、皮疹和多动脉炎.我们报道1位男性34岁患者,诊断为急性HBV感染,临床表现为肝脏和肝外多器官的损害,以肾功能衰竭为突出的表现,推测是由循环免疫复合物沉积在肾小球血管壁,导致膜性肾小球肾炎而引起的.患者接受了血液透析和持续性血液滤过治疗、常规的护肝和对症治疗及恩替卡韦抗病毒治疗,最后痊愈.%Acute hepatitis B is often accompanied by serum-sickness-like syndrome, including fever, rash and polyarteritis. Acute renal failure in acute hepatitis B is extremely rare. A 34-year-old male presented to our hospital, with initial laboratory values showing acute hepatitis B virus infection. The clinical feature indicated hepatitis and extrahepatic impairments of kidney, myocardium and platelet, and renal failure was the prominent manifestation which appeared early in the day 3 of onsetting, including 19 days of oliguria and 6 days of anuria. Kidney impairment was presumed owing to deposition of immune complex which resulted in membranous glomerulonephritis. The patient accepted hemodialysis and continuous renal replacement therapy, and entecavir was applied to depress HBV DNA copying and may have shortened the course of the disease. At 2-month follow up, the patient healed completely.

  4. Blood purification therapy in treatment of acute renal failure in infants with melamine-induced stones

    Institute of Scientific and Technical Information of China (English)

    SHEN Ying; LIU Xiao-rong; ZHANG Gui-ju; ZHOU Nan

    2009-01-01

    , comparable to that of the two control groups treated with catheterization with a cystoscope or by medication. There was no significant difference in the recovery time of renal function among the three groups (P>0.05).Conclusions Melamine-contaminated milk formula may cause urinary stones and obstructive acute renal failure in infants. Dialysis is suggested to treat life-threatening complications such as hyperkalemia, oliguria or anuria if surgical intervention fails. If possible, hemodialysis or peritoneal dialysis can be performed early. Blood purification is feasible to help the infants overcome the critical stage of acute renal failure. Surgical measures can be taken to remove the obstruction if necessary.

  5. 6例食用含三聚氰胺奶粉中毒死亡患儿的法医学分析%Forensic Analysis of Melamine-tainted Milk Powder Poisoning:Six Fatal Cases

    Institute of Scientific and Technical Information of China (English)

    赵杰; 李红涛

    2015-01-01

    目的:通过分析食用含三聚氰胺的奶粉中毒死亡患儿的病历材料,为此类中毒案件的法医学鉴定提供参考。方法选取6例因食用某品牌含三聚氰胺的奶粉中毒死亡患儿的病历材料,从中毒症状、影像学和血生化检查以及转归情况进行归纳分析。结果中毒患儿年龄在8个月左右,主要因泌尿系统结石梗阻尿路引起少尿、无尿等中毒症状,最终因急性肾功能衰竭或其他并发症导致死亡,血清BUN和Cr均异常升高。结论结合三聚氰胺的毒理作用,推断6例患儿的死亡与三聚氰胺中毒有关。%Objective To analyze the m edical records of poisoned children to provide references for the forensic identification ofmelam ine-tainted milk pow der poisoning. Methods M edical records of six fatal cases of consum ing som e brandmelam ine-tainted milk pow der w ere studied, specifically the poisoning sym ptom s, m edical im aging, blood biochem ical tests, treatm ent and prognosis. Results The m ajor m edical problems of these eight-m onth sick infants w ere urinary tract obstruction caused by urinary tract calculi. The poisoned infants developed oliguria, anuria and other sym ptom s, eventually, acute renal failure or other com plications leaded to death. The serum BUN and Crabnorm ally increased. Conclusion B y con-sidering the toxicological effects of melam ine, it was concluded that the deaths of these sick infants w ere related to themelam ine poisoning.

  6. Clinical features, laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease

    Institute of Scientific and Technical Information of China (English)

    LUO Ming-yue; LIN Bing-liang; GAO Zhi-liang

    2009-01-01

    Background There was a hospital outbreak of venous diethylene glycol poisoning in Guangzhou, China. It is the only massive episode of venous diethylene glycol poisoning in history. Here we report its clinical features, laboratory findings, and imaging appearances.Methods The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized. Their laboratory findings and imaging appearances were comparatively analyzed before and after poisoning.Results All poisoned patients presented with oliguric acute renal failure with anuria after a mean of 6 days. Carbon dioxide combination power of 13 patients dropped after a mean of 9 days with valley value on the 10th day, when metabolic acidosis developed. Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days. Neurological system impairment was observed in 10 patients after a mean of 14 days. Seven patients had low fever after a mean of 6 days. Causes of death of 14 patients included multiple organ dysfunction syndrome, severe lung infection and massive haemorrhage of digestive tract. Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value on the 11th and 14th days, respectively. Serum calcium had no obvious change, and phosphorus was distinctively increased. Liver functions did not change significantly. Poisoned patients had higher white blood cell counts, but lower red blood cell counts and hemoglobin value. Of the 7 patients who exhibited mild, moderate or severe patchy consolidation shadowing in the lung, 2 manifested mild or severe gaseous distention and dilation of gastroenteric tract.Conclusions Main features of venous diethylene glycol poisoning in patients with liver disease include oliguric acute renal failure, metabolic acidosis, gastroenteric symptoms or aggravation of gastroenteric symptoms, neurological system impairment and low fever, with a mortality rate of 93

  7. [Sodium azide--clinical course of the poisoning and treatment].

    Science.gov (United States)

    Łopaciński, Bogdan; Kołacinski, Zbigniew; Winnicka, Renata

    2007-01-01

    Sodium azide poisonings occur very rarely. The mechanism of sodium azide toxic effect has not yet been fully explained. Despite the lack of an explicit procedure for the cases of sodium azide poisonings, in vitro tests and rare case reports suggest that treatment with antidotes for cyanide poisoning victims can be effective. This study describes two cases of suicidal sodium azide ingestion. Case 1. 30-year-old male ingested ca. 180 mg of sodium azide. On admission to hospital, within 4 hours from poisoning, the man complained of dizziness and anxiety. Physical examination revealed horizontal nystagmus, flapping tremor, HR 135/min. In laboratory tests, higher blood concentration of lactates (3 mmol/l) was detected, as well as lower potassium concentration (3.4 mmol/L) and increased transaminase activity (ALT 74 U/l, AST 90 U/l). Electrocardiographic tests showed a negative T wave in limb lead III. Other results were within normal. As the patient ingested a toxic dose of sodium azide, he was treated according to the therapy prescription for cyanide poisoning (amyl nitrite inhalation followed by intravenous administration of sodium nitrite and sodium thiosulphate). ECG record of the last day of hospitalization (7th day of treatment) showed negative T waves in lead III, V4-V6. He was discharged from hospital in good condition. Case 2.23-year-old male ingested 10 g of sodium azide 1.5 hours prior to admission to hospital. At the beginning, the patient's condition was good, but it changed to critical state within the first hours of hospitalization. He developed a deep coma, respiratory and circulatory insufficiency, metabolic acidosis, cardiac dysrrhythmias and anuria. Cardiac activity monitoring showed alternating tachycardia (140 beats per minute) and bradycardia (48 beats per minute), numerous additional supraventricular and ventricular extrasystoles and sinus dysrrhythmia. Cardiac arrest (asystolia) occurred twice, the second incident with fatal outcome. The patient

  8. Application of ultrafiltration during extracorporeal membrane oxygenation%体外膜肺氧合期间超滤技术的应用

    Institute of Scientific and Technical Information of China (English)

    赵成秀; 李彤; 段大为; 胡晓旻; 张强; 吴鹏; 稂与恒; 侯跃龙

    2011-01-01

    OBJECTIVE To introduce the connection and effect of extracorporeal memhrane oxygenation ( ECMO ) combination with ultrafiltration in extracorporeal circulation. METHODS 3 severe heart disease patients with anuria and tissue oedema,whose age ranged from 57 years to 78 years ( average 69 years ) and body weight ranged from 63 kg to 89 kg ( average 73. 6 kg ) were treated with Medtronic ECMO circuit to assist cardiac function. The ultrafiltration devise with idio - designed methods was connected at the three - way joint of ECMO circuit and negative pressure site of centrifugal pump. RESULTS The ultrafiltration volume during ECMO assisting ranged from 5 750 ml to 14 850 ml of the three patients. After ECMO assisting combination with ultrafiltration for 36 hours and 42 hours. urinary production of two patients were recovery, who weaned off ECMO after cardiac function recovery and discharged. Another patient gave up treatment after ECMO assisting for 48 hours and left hospital. CONCLUSION For ECMO combination with ultrafiltration in extracorporeal circulation, the conjunction was simple , deflation was thorough and convenient, the effect of filtration was well and safe. Ultrafiltration was fitted for ECMO assist homeochronously.%目的 总结体外膜肺氧合(ECMO)中结合超滤一体化连接方法及应用效果.方法 3例重症心脏病患者,年龄57~78(69)岁,体重63~89(73.6)kg.采用Medtronic ECMO管路行ECMO心功能支持,ECMO前及ECMO期间无尿、组织脏器水肿,在ECMO管路三通板处与离心泵接负压处连接超滤.结果 3例患者在ECMO过程中滤水5 750~14 850 ml,2例患者经过ECMO辅助联合超滤治疗后36 h、42 h尿量逐渐恢复,心功能恢复后撤除ECMO,后康复出院,另1例患者ECMO辅助48 h,家属放弃治疗自动出院.结论 ECMO中结合超滤连接方法简便,排气方便彻底,滤水效果良好、安全,适合ECMO过程中同期使用.

  9. Débito cardíaco diminuído: revisão sistemática das características definidoras Débito cardíaco disminuído: revisión sistemática de las características definidoras Decreased cardiac output: a systematic review of the defining characteristics

    Directory of Open Access Journals (Sweden)

    Vanessa de Souza

    2011-01-01

    Full Text Available OBJETIVOS: Caracterizar os artrigos científicos relacionados ao diagnóstico de enfermagem débito cardíaco diminuído. Verificar os artigos que descrevem o comportamento das características definidoras deste diagnóstico, identificando aquelas que ocorrem com maior frequência. MÉTODOS: Trata-se de uma revisão sistemática realizada nas bases de dados: Lilacs, SciELO, Embase, Medline, Pubmed e Cochrane, no período de 1985 a 2008. RESULTADOS: Foram selecionados 13 artigos, identificando 50 características definidoras, sendo dez com maior frequência: alteração da frequência/ritmo cardíaco, dispneia, labilidade da pressão arterial, estertores, oligúria anúria, edema, pele fria, fadiga/fraqueza, diminuição dos pulsos periféricos e diminuição da perfusão periférica. CONCLUSÃO: A temática vem sendo pouco explorada. Constatou-se a importância do exame físico, a utilização de técnicas menos invasivas e a necessidade de rever as características definidoras propostas a fim de proporcionar clareza e objetividade na identificação desse diagnóstico de enfermagemOBJETIVOS: Caracterizar los artículos científicos relacionados al diagnóstico de enfermería débito cardíaco disminuído. Verificar los artículos que describen el comportamiento de las características definidoras de este diagnóstico, identificando aquellas que ocurren con mayor frecuencia. MÉTODOS: Se trata de una revisión sistemática realizada en las bases de datos: Lilacs, SciELO, Embase, Medline, Pubmed y Cochrane, en el período de 1985 al 2008. RESULTADOS: Fueron seleccionados 13 artículos, identificando 50 características definidoras, siendo diez con mayor frecuencia: alteración de la frecuencia/ritmo cardíaco, disnea, labilidad de la presión arterial, estertores, oliguria anuria, edema, piel fría, fatiga/debilidad, disminución de los pulsos periféricos y disminución de la perfusión periférica. CONCLUSIÓN: La temática viene siendo poco

  10. Diagnosis and Treatment for a Cardio-Pulmonary Resuscitation (PCR) Patient with HELLP Syndrome (PRS) after Cesarean Section-The Discussion on Clinical Thinking of Post-Resuscitation Syndrome%HELLP综合征剖宫产术后发生心肺复苏后综合征一例分析——兼论复苏后综合征的临床思维

    Institute of Scientific and Technical Information of China (English)

    康红军; 赵妍; 胡新; 孟庆义

    2013-01-01

    目的 探讨复苏后综合征(post-resuscitation syndrome,PRS)的临床特点及诊治要点,以提高患者生存率并改善预后.方法 对我院收治的1例PRS的临床资料进行回顾性分析.结果 本例因停经30+4周,血压升高6周,上腹痛1d入院,诊断为宫内妊娠30+4周、重度子痫前期、HELLP综合征.急诊在全麻下行剖宫取胎术,术后患者因无尿、高钾血症等转入重症监护病房(ICU),予持续床旁连续性肾脏替代治疗(CRRT)中2次出现心室颤动(室颤),予心肺复苏(cardiopumonaryresuscitation,CPR)后恢复窦性心律.复苏后患者昏迷,予脑保护、地塞米松、多巴胺及补镁等治疗,3d后患者恢复意识,四肢肌力0级,予神经营养药物、针灸等治疗.ICU共治疗46d出院,随访3个月肌力完全恢复正常.结论 PRS治疗过程中重视脑保护并运用综合手段维持血流动力学的稳定,对于切实提高CPR效果及改善患者预后有重要意义.%Objective To discuss the clinical characteristics and the key points of diagnosis and therapy for post-resuscitation syndrome (PRS) so as to improve its survival rate and prognosis. Methods A retrospective analysis was performed on clinical data of a patient with PRS in our hospital. Results The patient was admitted for menolipsis for 30 +4 weeks, elevated blood pressure for 6 weeks and epigastric pain for 1 day, and was diagnosed as having the intrauterine pregnancy (30+4 weeks ) , severe pre-eclampsia and HELLP syndrome. The emergency cesarean section with general anesthesia was performed and the patient was transferred to ICU after operation due to anuria. During the process of continuous renal replacement therapy ( CRRT), the patient suffered a sudden onset of ventricular fibrillation for twice and sinus rhythm was recovered after cardiopulmonary resuscitation (CPR) , but the patient was still in a coma. Brain protection combined with treatment of dexamethasone, dopamine and magnesium were performed. The

  11. 临床尿液标本采集及时准确率的调查分析%Analysis of timeliness and accuracy of collection of clinical urine specimen

    Institute of Scientific and Technical Information of China (English)

    马玉叶; 韦如仙

    2014-01-01

    目的:调查临床尿液标本采集的及时准确率。方法跟踪371份尿液标本的采集,由专人对没有及时准确采集的原因进行分析,提出改进措施,有效地进行临床标本采集的管理。结果330份尿液标本能及时准确采集,占88.95%;41份未能及时准确采集,占11.05%,其中10份是由于患者来月经、无尿或当日做检查需要憋尿而推迟,占2.70%,31份能够采集而没有及时准确采集,占8.35%。因患者新入院第1次留尿标本而错误采集的患者22例(91.67%);因同时留两个或两个以上标本而错误采集的患者10例(41.67%);因文化程度低由家人协助而错误采集的患者12例(50.00%)。结论尿液标本采集的及时准确率应作为一项专科护理质量监测指标,加强护士标本采集知识和质量意识的培训,协助患者留取标本,才能提高尿液标本采集的及时准确率。%Objective To investigate the timeliness and accuracy of collection of clinical urine specimen.Methods Totals of 371 collections of urine specimen were followed , the cause of not-in-time and inaccuracy was analyzed , improvement strategies were proposed , and effective collections of clinical specimen were managed .Results Totals of 330 urine specimens were collected timely and accurately , accounting for 88.95%, and 41 specimens failed, accounting for 11.05%, in which 10 were delayed because of patients'menstruation, anuria or inspection on that day (2.70%), and 31 were not collected timely or accurately (8.35%).Twenty-two urine specimens were wrongly collected because of the first urine specimen of admission (91.67%), ten were wrongly collected for leaving two or more than two urine specimens at the same time (41.67%), and twelve were wrongly collected because of family assistance due to low education level (50.00%).Conclusions The timeliness and accuracy should be listed as one of the quality

  12. Clinical analysis and nursing research of 58 cases of mannitol induced acute renal failure%甘露醇致急性肾功能衰竭58例临床分析与护理研究

    Institute of Scientific and Technical Information of China (English)

    丁华青

    2014-01-01

    Objective:To explore the pathogenesis and clinical nursing countermeasures of mannitol induced acute renal failure(ARF).Methods:58 cases with mannitol induced ARF were selected from March 2012 to May 2013. The clinical data was retrospectively analyzed.Results:After using mannitol,the proportion of occurrence of ARF was 6.48%.The male female proportion was 2.38.The average age was (59.48±12.43) years old.The occurrence proportion of cerebral infarction and cerebral hemorrhage was 74.32% .The mannitol average daily dosage of patients with ARF was (228.00 ± 26.44) g.The accumulated dose was (1233.00±123.46) g.About 80% cases had oliguria.50% had hematuria.Conclusion:The male,older than 60 years old,cerebral hemorrhage and cerebral infarction patients are easy to occur ARF after using mannitol.Oiguria.Anuria and hematuria are the most common symptoms.After occurrence of ARF,the total mortality of patients was 23.82% .It should strengthen short time, low-dose,intermittent,individualized drug management in nursing intervention.%目的:探讨甘露醇致急性肾功能衰竭(ARF)的发病机制与临床护理对策。方法:2012年3月-2013年5月收治甘露醇致 ARF 患者58例,回顾性分析临床资料。结果:使用甘露醇后发生 ARF 的比例6.48%,平均年龄(59.48±12.43)岁,脑梗死、脑出血的发生比例74.32%。发生 ARF 的患者甘露醇日平均用量(228.00±26.44) g,累积剂量(1233.00±123.46) g。约80%患者出现少尿,50%出现血尿。结论:男性、>60岁、原发病为脑出血和脑梗死者使用甘露醇后易发生ARF;少尿、无尿和血尿是最主要的临床表现;发生ARF后患者的总病死率23.82%。护理干预上加强短时间、小剂量、间歇、个体化的用药管理。

  13. The diagnosis and treatment of urolithiasis in allograftkidneys (a report of 46 cases)%移植肾尿路结石46例诊治体会

    Institute of Scientific and Technical Information of China (English)

    程海峰; 陈兴发; 陈军; 周星; 何辉; 田普训; 薛武军; 贺大林

    2012-01-01

    Objective To investigate the diagnosis and treatment of urolithiasis in allograft kidneys and to enhance the long-term survival rate. Methods Data of 46 cases of urolithiasis in allograft kidneys treated during Jan. 1980 to June 2011 were retrospectively analyzed. Results 35 cases had gross hcmaturia,10 were detected during ultrasound examination, and 1 case was acute anuria. None of the cases developed renal colic. Of the 4 6 cases,24 had renal stones and 22 urctcral stones. The stone size ranged from 0.7 to 2.2 cm. The stones developed 4 months to 15 years after surgery. 42 cases received cxtracorporc-al shock-wave lithotripsy (ESWL) ,3 of which received urctcroscopy and 1 percutaneous ncphrolithotripsy (PCNL) after ESWL failed. The other 4 cases were uric acid stones, which were discharged after the patients took potassium and sodium hydrogen citrate. During the follow-up of 3 months,the overall stone-free rate after ESWL was 88.1% (37/42). 2cascs(4.7%) had re-sidual fragments. 4 cases (7.1%) failed, were treated with endoscopy and stones were removed. The 4 patients taking potassi-um and sodium hydrogen citrate had most stones discharged. Conclusions Urolithiasis in allograft kidneys develops no typical symptom of renal colic. ESWL is safe and effective to treat lithiasis in transplanted kidneys.%目的 探讨肾移植术后尿路结石的诊断和治疗,提高长期存活率.方法 回顾性分析1980年1月至2011年6月46例移植肾结石患者的临床资料.结果 35例为肉眼血尿,10例为体检时B超发现,1例为急性无尿发病,均无肾绞痛.移植肾结石24例,移植输尿管结石22例,结石大小0.7~2.0 cm,结石发病时间为术后3.5(0.4 ~15)年.42例行体外冲击波碎石(ESWL),其中3例无效行输尿管镜下钬激光碎石术和1例行经皮肾镜取石术(PCNL),4例尿酸结石给予枸橼酸氢钾钠(友来特)药物治疗.随访3个月:42例ESWL中,结石排净36例(85.72%),结石残留2例(4.76%),4例(9.52%)无效改用

  14. Severe acute urolithiasis caused by melamine contamination infant formula milk in 28 infants and toddlers:diagnosis and therapy%三聚氰胺致婴幼儿泌尿系结石急重症诊治分析(附28例)

    Institute of Scientific and Technical Information of China (English)

    郑为; 赵夭望; 刘李; 祖建成; 何军

    2011-01-01

    [ Objective ] To understand the clinical characteristics and diagnosis of severe acute ease of pediatric urolithiasis in infants and toddlers caused by melamine contamination infant formula milk. [ Methods ] The clinical data of 28 cases was collected and analyzed. [ Results ] Total of 28 patients, Indwelling ureteral stents (D-J tube) by cystoscopy in 17 cases (60.71%), catheterization, underwent open operation to extract calculus in 5 cases (17.86%),catheterization, diuretic, anti-inflammatory, antispasmodic treatment for 4 patients (14.28%), re-open operation to extract calculus after Indwelling ureteral stents (D-J tube) by cystoscopy in 2 cases (7.14%). Finally, 23 patients had stone disappeared, and 5 patients had residual stones. In 5 cases, 3 patients with kidney stones, hydronephrosis, or to have unilateral ureteral stone caused Urinary obstruction again after the operation. [ Conclusions] Infants and toddlers' urolithiasis caused by melamine can be early formed and the onset, acute anuria, oliguria, dysuria were most common symptoms, Ultrasonic inspection is easy to examine urinary stone, CT scan can further clarify the position of the stone and the degree of dropsy, ureteral stenting via cystoscopy is a minimal trauma and has significant good prognosis.%目的 了解受三聚氰胺污染的婴幼儿配方扔粉致婴幼儿泌尿系结石急、重症的临床特点,总结其诊治经验.方法 回顾性分析28例三聚氰胺致婴幼儿泌尿系结石急、重症的临床资料.结果 行膀胱镜留置输尿管支架管术17例(60.71%),行开放手术取石术5例(17.86%),行导尿、利尿、消炎、解痉治疗4例(14.28%),行膀胱镜留置输尿管支架管术后再行开放手术取石2例(7.14%).出院时,23例患儿肾输尿管结石完全消失,5例有结石残留,其中3例患儿肾结石、肾积水或存在单侧输尿管结石从而术后再次发生尿路梗阻.结论 三聚氰胺致婴幼儿泌尿系结石可早期形成及发

  15. Atividade da gama glutamil transpeptidase urinária, dosagens séricas de uréia e creatinina como meios diagnósticos auxiliares na nefrotoxicidade induzida por aminoglicosídeo em cães Urinary gamma glutamyl transpeptidase activity, urinalysis, bun and creatinine serum dosages as a auxiliary diagnostic mean in dogs nephrotoxicity induced by aminoglycosides

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    Carla Rosane de Aguiar Hennemann

    1997-06-01

    histopathologic study. The clinical signs shown by the dogs were lethargy, anorexy, polyuria, oliguria, anuria, polydypsia, vomiting and diarrhea. Urinalysis findings were proteinuria, glucosuria, hematuria, cilindruria, celluria and decrease of urinary specific gravity and crescent values of urinary gamma glutamyl transpeptidase from 24 hours after gentamicin administration until the "end of" the experiment. Azotemia was noticed on the 12th and 14th days of the study. Acute tubular nephrosis was established in the histological evaluation. Based on the results found on this study, the measurement of the urinary gamma glutamyl transpeptidase activity might be considered a sensitive indicator of renal tubular damage allowing early diagnosis of the lesion.

  16. Five cases report of Ebola virus disease%埃博拉病毒病五例临床分析

    Institute of Scientific and Technical Information of China (English)

    郑以山; 杨永峰; 殷国平; 潘剑; 叶伟; 江浩; 程建; 张继宗; 孙丙虎; 赵伟

    2015-01-01

    gastrointestinal symptoms such as nausea ,vomiting ,diarrhea and hypovolemic shock .The patients presented with fast heart rate and shortness of breath and other inflammatory response syndrome in acute phase .One patient rapidly progressed to liver pain ,jaundice and anuria ,then died .Three severe cases recovered after treated with fluid resuscitation ,circulation maintenance and electrolyte balance in acute phase .Conclusions The early symptoms of Ebola virus disease are low fever ,joint pain and nausea .Frequent vomiting ,diarrhea , low blood pressure and electrolyte disorder indicate severe conditions .Shock and electrolyte disorder are deadly complications .Early recognition ,diagnosis and treatment are the key to improve the prognosis .

  17. Treatment of infants suffering from acute post renal failure after consumption of melamine contaminated powdered milk%婴儿食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭的治疗

    Institute of Scientific and Technical Information of China (English)

    周辉霞; 封志纯; 李爽; 萧翠萍; 郭辉; 王军; 戴世希

    2009-01-01

    目的 探讨因食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭婴儿的外科急诊处理方法 与疗效.方法 应用半硬性输尿管镜(F6.8)逆行输尿管插管冲洗术11例,开放输尿管切开取石术2例.结果 本组除1例开放输尿管切开取石术后5h患儿又出现无尿且血红蛋白持续下降,再次行切口探查和腹膜透析外,其余12例均顺利恢复.本组13例肾功能均恢复正常,无手术并发症.结论 对婴儿因食用三聚氰胺污染奶粉致上尿路结石引起的急性肾后性肾功能衰竭,在输尿管镜下逆行捕管置入输尿管导管冲洗术是一种微创、安全而又有效的治疗方法 ;对婴儿尿道狭小输尿管镜不能进入者,开放输尿管切开取石术也是一种有效的方法 ,但对有明显出血倾向者需先纠正出血倾向后再考虑开放手术解除梗阻.%Objective To evaluate the surgical emergent treatments and curative effects on in- fants suffering from acute post renal failure by consumption of powdered milk contaminated by mela- mine. Methods Eleven cases were treated with retrograded catheterizations of ureter with semi-rigid ureteroscopy (F6.8) and 2 cases were treated with. The renal function was followed up in these pa- tients. Results Only 1 patient got anuria and whose haemoglobin continued to drop postoperatively. This patient underwent a redo operation and peritoneal dialysis. The other 12 patients recovered well. The renal function of all the 13 children got back to normal without surgical complications. Conclusions The technique of retrograded catheterization of ureters under ureteroscope was a minimally invasive, safe and effective therapy for infants with post renal acute renal failure by consumption of powdered milk contaminated by melamine. For those infants whose urethras are thin and small, is also an effec- tive method, But the bleeding tendency should be corrected before open.

  18. Intoxicação por veneno de cobra: necrose symetrica da cortex renal: uremia

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    A. Penna de Azevedo

    1938-01-01

    modificações do metabolismo se traduziram por alterações urinarias e sanguineas. As urinas foram emitidas em muito pequena quantidade (50 cc. em 24 horas não havendo comtudo, anuria absoluta. Cylindros hyalinos e granulosos, bem como leucocytos e cellulas renaes, associadas á albuminoria, era presentes. Os exames chimicos do sangue, revelaram: Proteinas totaes 7,61 grs. em 1000 cc.; Albumina 2,39 grs em 1000 cc.; Globulina 5,22 grs. em 1000 cc.; Uréa 6,42 grs. em 1000 cc.; Fibrinogeneo 0,324 grs. em 1000 cc.; Indican +++; Cl. plasmatico 339 mgrs. em 100 cc.; Cl. globular 170 mgrs. em 100 cc.; Cholesterol 163 mgrs. em 100 cc.; Creatinia 260 mgrs. em 100 cc.; Ph. inorganico 13,4 mgrs. em 100 cc.; Calcio 10,3 mgrs em 100 cc.; Potassio 28 mgrs. em 100 cc.; Sodio 328 mgrs. em 100 cc.. O exame hematologico revelou 11% de hemoglobina; 960.000 hematias por mm.³; e 5.200 leucocytos por mm.³. A formula leucocytaria revelou augmento dos neutrophilos, com 74% dos segmentados. A proporção entre sôro o coagulo foi 9 x 3 cc. A reacção de Wassermann no sôro sanguineo foi negativa. A insufficiencia renal se traduziu no caso em estudo, por modificações humoraes, particularmente pela azotemia elevada, pelo augmento da creatinina, do phosphoro inorganico e do indican. Em contraste com a existencia de taes modificações, o doente não apresentou os signaes clinicos observados nos casos emque a azotemia se mantem elevada, reproduzindo tal facto, o quadro clinico descripto para a necrose symmetrica da cortex renal.In a mortal case of ophidism, in an individual 15 years old, bitten by a snake (Bothrops jararaca on the external face of his right leg and who died 26 days after the accident, the AA. describe the pathologic-anatomical changes met with and the modifications of the metabolism put into evidence through chemical blood examinations. The main changes there existing are located in the kidneys, which present changes of diffused glomerulonephritis and the typic features of

  19. Trombose da artéria renal e síndrome do anticorpo antifosfolípide: um relato de caso Renal arterial thrombosis and the antiphospholipid antibody syndrome: a case report

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    Célia S. Macedo

    2001-12-01

    a history of abdominal pain, pallor, lethargy, and anuria for 36 hours. On physical examination, the patient showed malnutrition, high blood pressure, moderate edema, and hypochondrial pain. Laboratory findings included: urea=112mg/dl, serum creatinine= 4.5 mg/dl, blood pH= 7.47, blood bicarbonate= 12.8 mmol/L, K=7.2 mEq/L. Peritoneal dialysis was started and maintained for 11 days. After 7 weeks, the patient still needed anti-hypertensive drugs and the renal function was still abnormal. Renal biopsy was performed and revealed renal infarction. The result of Doppler ultrasonography revealed absent renal blood flow on the right side. Renal arteriography showed total occlusion of the right renal artery. Results for collagen diseases were negative. A right nephrectomy was performed and the blood pressure was controlled. The child was hospitalized again at 5 years and 8 months old with episodes of absence seizures and abdominal and precordial pain. Anticardiolipin antibody test was positive. The child is now 7 years old, asymptomatic, with negative anticardiolipin antibody, and has been under regular follow-up. COMMENTS: children with arterial thrombosis should be investigated for a possible association with the antiphospholipid antibody syndrome even in the absence of collagen disease.

  20. Management experience of acute renal failure induced by unilateral ureteral calculi obstruction%一侧输尿管结石梗阻致急性肾功能衰竭的治疗经验

    Institute of Scientific and Technical Information of China (English)

    谭付清; 沈柏华; 谢立平; 孟宏舟; 方丹波; 汪超军

    2013-01-01

    Objective To explore the causes and treatment options of acute renal failure induced by unilateral ureteral calculi obstruction.Methods The clinical data of 12 cases of acute renal failure induced by unilateral ureteral calculi obstruction between August 2008 and July 2012 were reviewed retrospectively.There were 5 males and 7 females with an average age of 65.7 years.Their clinical data and treatment options were retrospectively analyzed and summarized.Seven cases showed right side ureteral calculus with hydronephrosis while another 5 presented left side ureteral calculus with hydronephrosis.Serum creatinine was higher than 310 μmol/L in 12 cases.Anuria appeared in 4 cases for 1-7 days while oliguria in 8 cases for 2-10 days.High fever was present in 11 cases,the highest of whom was 40 ℃.White blood cell count increased in 10 cases (> 10 × 109/L) and decreased in 2 cases (<4 × 109/L).Results The therapeutic options included insertion of double J stent for internal drainage (n =1),percutaneous nephrostomy for external drainage (n =10) and open operation (n =1).Traditional treatments were performed to manage ureteral calculus in the above 11 cases with drainage.All cases had improved renal function after comprehensive treatment of anti-infection,antishock,rinsing stones and relieving obstruction.All 12 cases were treated successfully.Conclusions Unilateral ureteral calculus may impair contralateral renal function and cause acute renal failure due to the absorption of toxin at obstructive side.The keys of management are eliminating toxin and relieving obstruction.%目的 总结一侧输尿管结石梗阻继发急性肾功能衰竭的原因及治疗经验,提高诊治的及时性.方法 回顾性分析了浙江大学附属第一医院2008年8月至2012年7月诊治的一侧输尿管结石梗阻继发急性肾功能衰竭12例患者的临床资料,探讨其发病原因、治疗措施及转归.12例患者中,男5例,女7例,平均年龄65.7岁.其中,右

  1. 肝病患者静脉二甘醇中毒的临床特点、实验室检查及影像学表现%Clinical features,laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease

    Institute of Scientific and Technical Information of China (English)

    罗明月; 林炳亮; 高志良

    2009-01-01

    Objective To summarize and report the clinical features,laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease.Methods The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized,their laboratory findings and imaging appearances were comparative analyzed before and after poisoning.Results All poisoned patients presented oliguric acute renal failure with anuria after a mean of 6 days.Carbon dioxide combination power of 13 patients was dropped after a mean of 9 days with trough value at the 10th day,and metabolic acidosis was developed.Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days.Neurological system impairment was observed in 10 patients after a mean of 14 days.Seven patients hod low fever after a mean of 6 days.Causes of death of 14 patients included multiple organ dysfunction syndrome,severe lung infection and massive haemorrhage of digestive tract.Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value at the 11th and 14th days respectively.Serum calcium had no obvious change,and phosphorus was increased distinctly.Liver functions did not change significantly.Poisoned patients had higher white blood cell counts,lower red blood cell counts and hemoglobin value.Of the 7 patients exhibited mild,moderate and severe patchy consolidation shadowing in the lung,2 manifested mild or severe gaseous distention and dilation of gastroenteric tract.Conclusion Main features of venous diethylene glycol poisoning in patients with liver disease include oligurie acute renal failure,metabolic acidosis,gastroenteric symptoms or aggravation of gastroenteric symptoms,neurological system impairment and low fever,with a mortality of 93.33% of poisoned patients;higher white blood cell counts and anemia;patchy consolidation shadowing in the lung;gaseous distention and

  2. 初次单侧全膝关节表面置换者肾功能的变化★%Changes of renal function of patients with first unilateral total knee arthroplasty

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    张鹏; 刘军; 段圆慧; 龙刚

    2013-01-01

    BACKGROUND:Implanting prosthesis system during operation, perioperative haemodynamics changes and drugs may affect the renal function of patients receiving total knee arthroplasty. OBJECTIVE:To dynamical y assess the effect of relative treatment on the renal function in the perioperative period of total knee arthroplasty. METHODS:Forty-two patients with total knee arthroplasty were included. The serum creatinine, cystatin C and microalbuminuria levels before and after total knee arthroplasty were detected, and then renal function before and after replacement were compared. RESULTS AND CONCLUSION:Al of the total knee arthroplasty operations were successful in 42 patients, and no oliguria, anuria, amount urinary protein and renal failure or other serious kidney complications were observed within 1 month after total knee arthroplasty. There was no change in serum creatinine level, so was cystatin C in 1 week after total knee arthroplasty, but the cystatin C level was decreased significantly at 1 month after the operation. The microalbuminuria concentration was increased at 1 day after total knee arthroplasty, and began to descent on day 3, and the microalbuminuria concentration at 7 days and 1 month after total knee arthroplasty was decreased when compared with that before operation. Total knee arthroplasty only caused mild damage to patients’ renal function, while the average level of renal function was improved at 1 month later. To the patients who receive the unilateral total knee arthroplasty for the first time, active appropriate clinical treatment may al eviate the kidney damage.%  背景:全膝关节表面置换中植入假体系统、围手术期血流动力学的改变、药物等均可能对患者肾功能产生影响。  目的:动态观察膝关节表面置换术围手术期相关处理对患者肾功能的影响。  方法:纳入膝关节表面置换患者42例,检测患者置换前后血清肌酐、胱抑素C及尿微量白蛋白

  3. Clinical Analysis of Six Cases of Postpartum Hemolytic Uremic Syndrome%产后溶血性尿毒症综合征6例临床分析

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    许咏梅; 周信芳; 梁宝权

    2014-01-01

    Objective To investigate the clinic features of postpartum hemolytic uremic syndrome (PHUS)for early diagnosis,prompt therapy and better prognosis.Methods A retrospective study was conducted on clinical data of 6 PHUS patients with gestational age over 33 weeks in Suzhou Hospital Affiliated to Nanjing Medical University from January 2008 to December 2012.Clinical symptoms and signs,hemolytic uremic related indexes,ultrasonograph and peripheral blood smear of them were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suzhou Hospital Affiliated to Nanjing Medical University.Results All 6 patients had pregnancy combined with severe preeclampsia.After antispasmodic,antihypertensive treatment and promot fetal lung mature,they gave birth by cesarean section,and no neonatal death.The main symptoms were gradually oliguria and anuria without remote cause,hemolytic anemia,thrombocytopenia and sharp decline of renal function after 1-2 days of cesarean section.Through comprehensive treatment based on continuous renal replacement therapy (CRRT)and plasma exchange,the patient′s conditions were stable and improved,and all patients were discharged from hospital.After 1 year follow up ,3 cases(50.0%)were lost to follow up,1 case(16.7%) with chronic renal insufficiency.Conclusions Preeclampsia is one of the important remote causes of PHUS.It′s necessary to strengthen renal function monitoring of pregnant women with preeclampsia after childbirth,in order to make early diagnosis and give specialized treatment in time,which are significant measures to reduce maternal mortality and ensure mother′s healthy.%目的:探讨产后溶血性尿毒症综合征(PHUS)的临床特征,为该病的早期诊断、及时治疗和改善预后提供依据。方法选择2008年1月至2012年12月南京医科大学附属苏州医院收治的6例PHUS患者的病历资料为研究对象,孕龄≥33孕周。采用回顾性分析法分析其临

  4. Acute kidney injury associated with clindamycin%克林霉素导致的急性肾损伤

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    谢红浪; 陈惠萍; 胡炀琳; 许书添; 何群鹏; 柳晶; 胡伟新; 刘志红

    2011-01-01

    Objective: To investigate the clinical and pathological manifestation of acute kidney injury ( AKI) following infusion of clindamycin. Methodology: From Aug, 2008 to Mar, 2011, twenty two patients were diagnosed as the infusion of clindamycin induced AKI. All of patients met the following three criteria; ( 1 ) No previous history of underlying chronic kidney disease; (2) the AKIN critieria of AKI soon after the infusion of clindamycin; (3) No obvious other cause of AKI, e. G. Volume insufficency, septic shock, urinary obstruction, etc. The clinical and pathological manifestations of these patients were investigated. Results-.They were 13 males and 9 females, with an average of (44. 46 ±11. 53 ) ( ranged from 20 to 70 ) years old. The reasons of clindmycin therapy were upper respiratory infection, toothache, and routine anti-infection therapy after minor operation with a usual dosage of 1. 0 ~ 1. 5 g/d. The median time between administration of drug and onset of AKI was one day (0. 5h ~4d). The most frequent chief complains were nausea and vomiting( 54. 55% ), lumbodynia ( 22. 73% ) , abdominal pain ( 22. 73% ) and edema ( 13. 64% ). Oliguria was in 13(59. 09% )and anuria in 7 patients(31. 82% ). Sixteen patients(72. 73% ) had episodes of gross hematuria, while only 3 patients(13. 64% ) encountered fever and one (4. 55% ) had skin rash. Laboratory examinations revealed anemia in 16 (72. 73% ) patients,but eosinophilia was not detected. Nineteen(90. 91% ) patients were diagnosed as AKI 3 stage, the others were as AKI 1 stage on admission. Urine analysis sowed mild proteinuria (0. 44 ± 0. 35) g/24h and severe tubular function injury. Urine eosinophilic cell was positive in only one case, and uniform microscopic hematuria was positive in 3 cases. Clindamycin lymphocyte transformation assay was positive in 13/16 (81. 25% ). Renal biopsy was performed in 18 of them. The histological diagnosis of acute interstitial nephritides( AIN)in 16 patients(88. 89% ) , acute

  5. 马来酸桂哌齐特注射液致老年患者肾损伤的回顾性分析%Retrospective analysis of kidney injury induced by cinepazide maleate injection in elderly patients

    Institute of Scientific and Technical Information of China (English)

    李圣楠; 马清; 陈海平

    2013-01-01

    higher than that in patients aged between 60 to 80 years (P =0.043).The incidence of kidney injury in patients with chronic renal insufficiency was higher than that in the patients without chronic renal insufficiency (P =0.002).No cases developed the symptoms of oliguria or anuria in 14 patients.Nine patients (64.3%) had the records of dynamic monitoring of kidney function.Of them,cinepazide maleate injection was withdrawn immediately in 6 patients after developing renal damage and three patients continued to receive cinepazide maleate injection until the end of therapeutic course.The result of dynamic monitoring of kidney function showed that the levels of serum creatinine in above-mentioned 9 patients returned to the baseline level 3-12 (an average of 6 d) days after drug withdrawal.Five patients (35.7%) did not undergo the dynamic monitoring of kidney function.Of them,one patient stopped cinepazide maleate injection and four patients continued the medication.All the patients who developed kidney injury did not receive any drug treatment,did not develop irreversible kidney injury and did not bring adverse effects on the primary diseases.Conclusions Cinepazide maleate injection may cause kidney injury in elderly patients.Dynamic monitoring of kidney function should be given in patients at advanced age with chronic kidney disease.

  6. 降浊益肾汤治疗慢性肾衰的临床观察%Clinical observation of Jiangzhuo Decoction for tonifying kidney for chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    陈洪涛; 李树平

    2013-01-01

    , slow development of renal dysfunction and failure. With the improvement of living standards, living environment changes, chronic renal failure (including diabetic nephropathy) the incidence rate has been increasing, more and more young age, number of people in hemodialysis is also increasing, seriously affecting the quality of life of patients, resulting in huge economic losses to the state. In recent years, show who survey, the incidence of chronic kidney disease in the global rate gradually increased, have after cardiovascular disease, cancer, diabetes and a threat to the health of major diseases. The situation of chronic kidney disease was serious in China, according to people over the age of 40 preliminary investigation of chronic kidney prevalence rate of 8%---9%. And other hazards Compared with the major diseases to human health, performance of chronic kidney disease more insidious onset, no obvious symptoms, many patients began treatment have become chronic renal failure uremia patients with uremia until, average annual medical costs about 5----10 million yuan, high treatment cost bring a heavy burden to bear to the society and families, many so "family poverty, returning to poverty due to illness". Western medicine treatment can not only solve the early injury of kidney, urinary protein and early renal dysfunction cannot be alleviated. Traditional Chinese medicine believes that this disease is the disease for a long time is false and renal failure. Renal failure (edema) refers to kidney and renal injury by a sudden illness, or disease, caused by long, kidney failure, Qi dysfunction, wet and muddy uremic shall not be discharged, to quickly oliguria or anuria, eyelid swelling and edema of the lower extremities, lusterless complexion, depressed. Divided into renal failure early (compensatory period), Renal failure stage (decompensation and failure stage), renal failure (uremia) late. Western traditional treatment is early symptomatic treatment, advanced