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Sample records for anuria

  1. Reflex anuria: a rare cause of acute kidney injury

    OpenAIRE

    Dhakarwal, Pradeep; Adediran, Samuel

    2014-01-01

    Background: Acute Kidney Injury results from pre renal, post renal or intrinsic renal causes. Reflex anuria is a very rare cause of renal impairment which happens due to irritation or trauma to one kidney or ureter, or severely painful stimuli to other nearby organs.Case Presentation: Here we present a case of acute kidney injury secondary to reflex anuria in a patient who underwent extensive gynecological surgery along with ureteral manipulation which recovered spontaneously.Conclusion: Refl...

  2. Acute anuria after a family vacation to Corsica/France.

    Science.gov (United States)

    Richter, Joachim; Holtfreter, Martha; Mouahid, Gabriel; Moné, Hélène

    2016-04-01

    A 12-year-old male patient suffered hematuria. Histopathology of a biopsy showed granulomata suspicious for schistosomiasis. The patient had never travelled outside Europe during his entire lifetime. He had taken frequent bathes in various rivers during his last family holidays 5 months earlier in Corsica. Microfiltration of urine revealed viable ova of Schistosoma haematobium with alterated size and shape. Ultrasonography showed a large focal echopoor mass attached to the bladder roof. Four days after antihelminthic therapy, the patient suffered inferior abdominal pain and acute anuria. Ultrasound revealed an approximately 5-cm mass in the bladder lumen suspicious for a large blood clot. After taking non-invasive measures such as drinking high amounts of fluid and treating the lower abdomen with a warm water bag and massage, the clot was excreted with urine and symptoms subsided. The further course was uneventful until 11 months later when hematuria recurred. This time, parasitological urine examination confirmed non-viable schistosome ova. Hematuria was likely due to erosion of the bladder mucosa by calcified non-viable ova. PMID:26852123

  3. 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.

  4. Investigating the mechanism for maintaining eucalcemia despite immobility and anuria in the hibernating American black bear (Ursus americanus).

    Science.gov (United States)

    Seger, Rita L; Cross, Randal A; Rosen, Clifford J; Causey, Robert C; Gundberg, Caren M; Carpenter, Thomas O; Chen, Tai C; Halteman, William A; Holick, Michael F; Jakubas, Walter J; Keisler, Duane H; Seger, Richard M; Servello, Frederick A

    2011-12-01

    Ursine hibernation uniquely combines prolonged skeletal unloading, anuria, pregnancy, lactation, protein recycling, and lipolysis. This study presents a radiographic and biochemical picture of bone metabolism in free-ranging, female American black bears (Ursus americanus) that were active (spring bears and autumn bears) or hibernating (hibernating bears). Hibernating bears included lactating and non-lactating individuals. We measured serum calcium, albumin, inorganic phosphate, creatinine, bone specific alkaline phosphatase (BSALP), CTX, parathyroid hormone, insulin-like growth factor-I (IGF-l), leptin, 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D] and sclerostin from 35 to 50 tranquilized hibernating bears and 14 to 35 tranquilized spring bears. We compared metacarpal cortical indices (MCI), measured by digital X-ray radiogrammetry, from 60 hunter-killed autumn bears and 79 tranquilized, hibernating bears. MCI was greater in autumn than winter in younger bears, but showed no seasonal difference in older bears. During hibernation eucalcemia was maintained, BSALP was suppressed, and CTX was in the range expected for anuria. During hibernation 1,25(OH)(2)D was produced despite anuria. 1,25(OH)(2)D and IGF-I were less in hibernating than spring bears. In a quarter of hibernating bears, sclerostin was elevated. Leptin was greater in hibernating than spring bears. In hibernating bears, leptin correlated positively with BSALP in non-lactating bears and with CTX in lactating bears. Taken together the biochemical and radiographic findings indicate that during hibernation, bone turnover was persistent, balanced, and suppressed; bone resorption was lower than expected for an unloaded skeleton; and there was no unloading-induced bone loss. The skeleton appears to perceive that it was loaded when it was actually unloaded during hibernation. However, at the level of sclerostin, the skeleton recognized that it was unloaded. During hibernation leptin

  5. Successful Management of Repetitive Urinary Obstruction and Anuria Caused by Double J Stent Calculi Formation after Renal Transplantation

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    Zongyao Hao

    2014-01-01

    Full Text Available This report firstly describes an extremely rare case of repetitive double J stent calculi formation after renal transplantation caused by the antihyperparathyroidism (HPT drug calcitriol. In 2012, a woman initially presented to our hospital for anuria with lower abdominal pain. She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements. Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3 administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease. After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up. Our novel findings may provide an important clue and approach to managing formidable repetitive double J stent calculi formation in the clinical trial.

  6. Resolution of refractory hypotension and anuria in a premature newborn with loss-of-function of ACE.

    Science.gov (United States)

    Richer, Julie; Daoud, Hussein; Geier, Pavel; Jarinova, Olga; Carson, Nancy; Feberova, Jana; Ben Fadel, Nadya; Fadfel, Nadya Ben; Unrau, Jennifer; Bareke, Eric; Khatchadourian, Karine; Bulman, Dennis E; Majewski, Jacek; Boycott, Kym M; Dyment, David A

    2015-07-01

    We present the investigation and management of a premature, hypotensive neonate born after a pregnancy complicated by anhydramnios to highlight the impact of early and informed management for rare kidney disease. Vasopressin was used to successfully treat refractory hypotension and anuria in the neonate born at 27 weeks of gestation. Next generation sequencing of a targeted panel of genes was then performed in the neonate and parents. Subsequently, two compound heterozygous deletions leading to frameshift mutations were identified in the angiotensin 1-converting enzyme gene ACE; exon 5:c.820_821delAG (p.Arg274Glyfs*117) and exon24: c.3521delG (p.Gly1174Alafs*12), consistent with a diagnosis of renal tubular dysgenesis. In light of the molecular diagnosis, identification, and treatment of associated low aldosterone level resulted in further improvement in renal function and only mild residual chronic renal failure is present at 14 months of age. Truncating alterations in ACE most often result in fetal demise during gestation or in the first days of life and typically as a result of the Potter sequence. The premature delivery, and serendipitous early treatment with vasopressin, and then later fludrocortisone, resulted in an optimal outcome in an otherwise lethal condition. PMID:25899979

  7. A successful pregnancy and parturition in a patient with anuria undergoing maintenance hemodialysis for 6 years: a case report of a 3-year-follow-up

    OpenAIRE

    Yu, Panxi; Diao, Wenqi; Tang, Qionglan; JIANG, XUEFENG

    2015-01-01

    Background Pregnancies in hemodialysis patients are uncommon and difficult to study. Although the chance of a successful pregnancy and parturition in hemodialysis women has increased over the years, it still remains extremely low with a high maternal and fetal mortality and morbidity rate. Case presentation We reported a case of successful pregnancy and parturition in a 22-year-old Chinese female in uremic stage of chronic renal failure and undergoing maintenance hemodialysis (three sessions ...

  8. 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.

  9. 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%

  10. Spectrum of mutations in the renin-angiotensin system genes in autosomal recessive renal tubular dysgenesis

    DEFF Research Database (Denmark)

    Gribouval, Olivier; Morinière, Vincent; Pawtowski, Audrey;

    2012-01-01

    Autosomal recessive renal tubular dysgenesis (RTD) is a severe disorder of renal tubular development characterized by early onset and persistent fetal anuria leading to oligohydramnios and the Potter sequence, associated with skull ossification defects. Early death occurs in most cases from anuri...

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

    DEFF Research Database (Denmark)

    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...

  12. Acute kidney injury after cardiac arrest

    OpenAIRE

    Tujjar, Omar; Mineo, Giulia; Dell’Anna, Antonio; Poyatos-Robles, Belen; Donadello, Katia; Scolletta, Sabino; Vincent, Jean-Louis; Taccone, Fabio Silvio

    2015-01-01

    Introduction The aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients. Methods We reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output

  13. Renal failure as a result of mesenteric cyst.

    Science.gov (United States)

    Cain, William C; Kennedy, Shalyn; Evans, Neil; Goldthorne, Jane; Tsikouris, James; Anuras, Julia; Varma, Surendra; Meyerrose, Gary E

    2004-09-01

    The authors report a rare case of renal failure secondary to abdominal cyst in a newborn girl. The clinical presentation was one of a largely distended abdomen coupled with anuria. The histopathologic and clinical findings suggest mesenteric cyst causing renal failure by mass effect. PMID:15359411

  14. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013.

    Science.gov (United States)

    Hochedez, Patrick; Theodose, Rafaelle; Olive, Claude; Bourhy, Pascale; Hurtrel, Guillaume; Vignier, Nicolas; Mehdaoui, Hossein; Valentino, Ruddy; Martinez, Roland; Delord, Jean-Marie; Herrmann, Cécile; Lamaury, Isabelle; Césaire, Raymond; Picardeau, Mathieu; Cabié, André

    2015-12-01

    To identify factors associated with disease severity, we examined 102 patients with quantitative PCR-confirmed leptospirosis in Martinique during 2010-2013. Associated factors were hypotension, chest auscultation abnormalities, icterus, oligo/anuria, thrombocytopenia, prothrombin time <68%, high levels of leptospiremia, and infection with L. interrogans serovar Icterohaemorrhagiae/Copenhageni. PMID:26583702

  15. Is Postrenal Acute Renal Failure Possible in the Absence of Hydronephrosis?

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    Mustafa YAPRAK

    2014-09-01

    Full Text Available Acute renal failure (ARF is a clinical situation that renal functions deteriorate suddenly within hours to days. Postrenal causes are responsible for a small part of ARF. In this article, we presented a case gone to left nephrectomy priorly, with a right ureter stone led to complete obstruction, ARF, and treated by ureterorenoscopy (URS. A seventy year old male patient was sent to Emergency Department because of anuria for 48 hours. In ultrasonographic exam; there wasn’t hydronephrosis of right kidney. A right lower ureter stone was seen in the non-contrast spiral abdominal computed tomography. The lower ureter stone was removed by URS and JJ catheter was replaced. He was discharged with normal renal function tests. In conclusion, postrenal ARF must be ruled out in patients with acute anuria, especially zero urine, even if hydronephrosis delinea. If postrenal ARF is diagnosed and treated quickly, the outcomes will be excellent.

  16. Waardenburg syndrome with familial unilateral renal agenesis: a new syndrome variant?

    Science.gov (United States)

    Webb, Katie M; Smith, Alisha J; Dansby, Linda M; Diskin, Charles J

    2015-06-01

    A 64-year-old man with Waardenburg syndrome presented with anuria and was subsequently discovered by renal ultrasound to have unilateral renal agenesis. The patient is one of three generations with incidental finding of renal agenesis also marked by the presence of Waardenburg syndrome. To our knowledge, there has been no mention elsewhere in the scientific literature of a variant of Waardenburg syndrome with associated renal agenesis. PMID:25402868

  17. Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

    OpenAIRE

    Son, Jungmin; Lee, Dong Won; Seong, Eun Young; Song, Sang Heon; Lee, Soo Bong; Kang, Jin; Yang, Byeong Yun; Lee, Su Jin; Choi, Jong-Ryeol; Lee, Kyu-Sup; Kwak, Ihm Soo

    2010-01-01

    The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data wer...

  18. Incidence of tumor lysis syndrome in children with advanced stage Burkitt's lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase.

    Science.gov (United States)

    Wössmann, W; Schrappe, M; Meyer, U; Zimmermann, M; Reiter, A

    2003-03-01

    To evaluate the clinical benefit of the prophylactic use of urate oxidase in children with non-Hodgkin's lymphoma (NHL), we analyzed the incidence and complications of tumor lysis syndrome (TLS) in children with B-cell acute lymphoblastic leukemia (B-ALL) or stage III/IV Burkitt's lymphoma and a lactate dehydrogenase (LDH) level > or =500 U/l before and after the introduction of a protocol amendment to use urate oxidase for the prophylaxis of TLS. Data from 1791 children with NHL enrolled in the two subsequent multicenter studies NHL-BFM 90 and 95 were evaluated. The presence of the side effects TLS, anuria, sepsis, and other complications during the first 2 weeks after admission were registered. Until March 1996, no urate oxidase was used (period 1). From November 1997 all children with B-ALL or stage III and IV B-NHL and LDH > or =500 U/l should receive urate oxidase prophylactically (period 3). In between (period 2), urate oxidase was given in a minority of hospitals therapeutically. Initial chemotherapy was identical. Altogether, 78 children (4.4%) developed a TLS. Patients with B-ALL had the highest risk to develop a TLS (26.4%) followed by B-ALL/Burkitt's lymphoma and a LDH > or =500 U/l (14.9%). In period 1, 16.1% and 9.2% of the latter children developed a TLS or anuria, respectively, compared to 12.3% and 6.2% in period 3 ( p=NS). The incidence of sepsis remained unchanged (5.0% vs 4.6%). In children with B-ALL the differences in the incidence of TLS and anuria between period 3 and period 1 were more pronounced, reaching significance for anuria (15.4% vs 3.8%, p=0.03). Our results suggest that patients with the highest risk to develop a TLS might benefit from the prophylactic use of urate oxidase. PMID:12634948

  19. Spontaneous Rupture of Bladder in Puerperium without Uterine Rupture

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    Subrat Panda

    2012-11-01

    Full Text Available Objective: we report a case of intraperitoneal urinary bladder rupture I week following normal delivery ina primigravida, who presented with huge urinary ascites, anuria and renal failure. Abdominalparacentesis and exploratory laparotomy was done and a diagnosis of intraperitoneal bladder rupturewas made. The rent was repaired in layers. This may be preventable if adequate precaution in the formof evacuating the bladder before the patient goes into second stage of labor is undertaken.

  20. Early Diagnosis of Leptospirosis

    OpenAIRE

    Andrea Babic-Erceg; Diana Karlovic-Martinkovic; Marija Santini; Zdenka Persic; Tatjana Vilibic-Cavlek

    2014-01-01

    A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume r...

  1. Aortic Dissection and Renal Failure in a Patient with Severe Hypothyroidism

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    Valerie Brooke

    2012-01-01

    Full Text Available Acute aortic dissection (AAD is a life-threatening condition associated with high morbidity and mortality. The most important recognized acquired cause that leads to dissection is chronic arterial hypertension. With respect to the anuria and renal failure, aortic dissection is not something that is always considered and is still not a very common presentation unless both renal arteries come off the false lumen of the dissection. However, when present, preoperative renal failure in patients with acute type B dissection has been noted to be an independent predictor of mortality. Early recognition and diagnosis is the key and as noted by previous studies as well, almost a third of these patients are initially worked up for other causes until later when they are diagnosed with aortic dissection. Here we present a case of a patient presenting with severe hypothyroidism, long-standing hypertension, and anuria. Through the case, we highlight the importance of having aortic dissection as an important differential in patients presenting with anuria who have a long standing history of uncontrolled hypertension. Pathophysiology relating to severe hypothyroidism-induced renal dysfunction is also discussed.

  2. 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.

  3. [Transurethral prostate resection prior to kidney transplantation leading to urethral cicatricial tissue].

    Science.gov (United States)

    Schou-Jensen, Katrine; Mohammad, Wael

    2015-01-26

    In Denmark, kidney transplantations in patients above 50 years have increased during the last decade. Consequently, the number of patients with lower urinary tract symptoms due to prostate hypertrophy increases accordingly. We describe two patients, who both had a resection of the prostate while having anuria and waiting for a kidney transplantation from a deceased donor. In both cases it was impossible to place a urethral catheter during the following transplantation due to total urethral occlusion, so a suprapubic catheter was inserted until the scar tissue was dilated or resected by a later transurethral intervention. PMID:25612989

  4. Successful Clinical management of Uraemic toxaemia in a bitch

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    A.M. Rode,V.E. Mahajan

    2009-08-01

    Full Text Available Uraemic toxemia is a condition resulting due to the retention of toxic waste metabolite of urine like urea, creatinine etc. in the blood. Which may prove fatal many a times. The retention of urine may be a sequelee of severe dehydration leading to oliguria followed by anuria or due to the nephritis in a animals. It has been observed that nephritis is oftenly associated with pyometra also. In the present study the elevated levels of urea and creatinine were alarmingly elevated and was life threatening also. However the timely diagnosis & surgical intervention could save and prolong the life of bitch. [Vet. World 2009; 2(4.000: 146-147

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

    International Nuclear Information System (INIS)

    Malaria has protean clinical manifestations and renal complications, particularly acute renal failure that could be life threatening. To evaluate the incidence, clinical profile, ou 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 coagulation, and high serum creatinine were the main predictors of mortality. We conclude that malaria is associated with acute renal failure, which occurs most commonly in plasmodium falciparum infected patients. Early diagnosis and prompt dialysis with supportive management can reduce morality and enhance recovery of renal function (Author).

  6. Acute Renal Failure in a Renal Center, Iraq

    International Nuclear Information System (INIS)

    We evaluated retrospectively the etiology and outcome of acute renal failure (ARF) in 84 patients in Rasheed Renal Center in Baghdad, Iraq from June 1998 through March 1999. They were 82 males and 2 females with ages that ranged between 5 and 80 years. Prerenal ARF was the commonest type found in 45 (53.6%) patients followed by renal ARF in 33 (39.3%) patients and acute obstructive uropathy six (7.1%) patients. Clinically, 74 patients presented with oligo-anuria, while 10 patients presented with non-oliguria. Of the oligo-anuria group, 61 ( 82.4%) patients required required renal replacement therapy (RRT) and 50 (67.6%) had complete recovery. The mortality rate was 25.67% in the oliguric group, while none in the non-oliguric group required RRT and the complete recvery rate was 100%. The overall survival in both groups was (77.4%). The patterns of ARF in our center were mostly compatible with the previous reports from the region. (author)

  7. 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.

  8. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery.

    Science.gov (United States)

    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. PMID:26557563

  9. Cystic uterus masculinus in the dog: six case history reports

    International Nuclear Information System (INIS)

    Radiographic, historical, clinical signs, and surgical and histopathologic findings of six dogs with diagnosed cystic uterus masculinus are given. The condition was seen in aged dogs between 4 and 15 years (mean of 8.8 years). There was no breed predisposition, although the larger breeds were involved in this study. The predominant clinical signs were constipation, dysuria and anuria. Lateral survey recumbent abdominal radiographs coupled with negative-or positive-contrast cystography were useful in delineating the bladder and the urethra, thus revealing the smooth-contoured, asymmetrical fluid-filled viscus in the caudal abdomen. The bi-horned cysts were connected to the dorsal urethra through a short blind-ending pedicle. The nonseptic, aspermic, cystic fluid averaged 146.7 ml (range of 100–200 ml). The predominant epithelial lining cells seen were simple columnar to pseudostratified columnar

  10. Use of a Boari flap and renal descensus as treatment for proximal ureteral rupture in a cat.

    Science.gov (United States)

    Gordo, Inês; Mestrinho, Lisa A; Minderico, Maria M; Leal, Nuno M; Hamaide, Annick J

    2016-08-15

    CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Lethargy, mydriasis, bradycardia, abdominal distension, and signs of pain on abdominal palpation were observed. Abdominal ultrasonography revealed moderate urinary bladder distension without evidence of free abdominal fluid; hematologic evaluation revealed leukocytosis with high BUN and serum creatinine concentrations. TREATMENT AND OUTCOME The patient was hospitalized, medical stabilization was attempted, and an indwelling urinary catheter was placed. Urinary output was cat was free of clinical signs, and results of ultrasonography, CBC, and serum biochemical analysis were unremarkable. CLINICAL RELEVANCE Results suggested that a Boari flap procedure with renal descensus could be a feasible alternative in the management of proximal ureteral rupture in cats, but research is needed in this area. PMID:27479285

  11. The clinician's guide to diagnostic imaging: Cost effective pathways

    International Nuclear Information System (INIS)

    This book presents logical, step-by-step imaging sequences for 47 medical, surgical, and pediatric problems. Topics considered include breast cancer screening, acute spinal trauma, search for primary cancer of unknown origin, acute anuria, blunt chest trauma, new onset seizures, and spinal cord compression from metastases. Other chapters have been rewritten to enhance the clarity of presentation and to incorporate new techniques such as magnetic resonance imaging, dipyridamole stress testing, and single photon emission computed tomography. The book highlights the expanding role of CT in evaluation of thoracic and abdominal problems, the emergence of magnetic resonance imaging as a vital diagnostic tool for the central nervous system, and the clinical utility of many newly developed radiopharmaceuticals

  12. 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.

  13. Infarction of renal transplant with extrarenal excretion of Tc-99m MAG3 demonstrated by renal scintigraphy

    International Nuclear Information System (INIS)

    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 MAG3 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 MAG3 caused by acute renal artery thrombosis

  14. 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.

  15. Prognostic factors in neonatal acute renal failure

    International Nuclear Information System (INIS)

    Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations greater than 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow less than 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 +/- 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 +/- 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis

  16. Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit

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    Rajeev A Annigeri

    2016-01-01

    Full Text Available Aim: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT in acute kidney injury (AKI in Intensive Care Unit (ICU. We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. Subjects and Methods: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93 were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT, early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT instead of lactate buffer. The primary study outcome was 28-day hospital mortality. Results: The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%. The overall mortality was high (68% but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006. Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality. Conclusions: Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis.

  17. 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.

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

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    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.

  19. 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.

  20. Urethropexy for the management of urethral sphincter mechanism incompetence in the bitch.

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    White, R N

    2001-10-01

    Urethropexy was performed on 100 bitches for the management of urethral sphincter mechanism incompetence (SMI). The dogs ranged in age from 12 months to nine years (mean 4.5 years). Diagnosis of the condition was based upon clinical, laboratory and contrast radiographic examinations, and clinical response to medical management. In all bitches, incontinence developed in the adult individual and in the majority (89 bitches) after spaying. Radiographic findings were unremarkable in 22 bitches, apart from the presence of an intrapelvic bladder neck. Follow-up periods ranged from 12 months to seven years (mean 2.9 years). Fifty-six bitches were completely cured by surgery, 27 became less incontinent and 17 either failed to respond (nine animals) or showed an initial improvement in urinary function, but then relapsed (eight animals). Nine of these 17 animals underwent a second urethropexy procedure, resulting in a cure in six and an improvement in three cases (follow-up 12 to 41 months, mean 22.2 months). A deterioration in the response rate was observed over time. Postoperative complications were seen in 21 bitches and included an increased frequency of micturition (14 bitches), dysuria (six bitches) and anuria (three bitches). PMID:11688522

  1. 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.

  2. Adverse effects of drugs on the immature kidney.

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    Guignard, J P; Gouyon, J B

    1988-01-01

    The immature kidney may be adversely affected by a variety of vasoactive or diuretic drugs, either administered to the mother during pregnancy, or to the neonate. Inhibitors of the angiotensin-converting enzyme administered to the hypertensive pregnant woman can severely and sometimes definitely impair renal function in the fetus, leading to postnatal anuria. Pathogenesis involves interference with the renin-angiotensin system and the prostaglandins. Beta-adrenergic agents administered during labor depress glomerular filtration rate transiently. Tolazoline, an alpha-adrenergic blocking agent useful in the treatment of persistent pulmonary hypertension of the neonate induces intense renal vasoconstriction with consequent hypoperfusion. Indomethacin, a prostaglandin synthetase inhibitor used for the pharmacological closure of a patent ductus arteriosus, also increases renal vascular resistance, and decreases urine output. Furosemide, the drug most often used in oliguric neonates, may also adversely affect the newborn infant. Its use has been associated with an increase in the incidence of patent ductus arteriosus, hypercalciuria, nephrocalcinosis and secondary hyperparathyroidism. These observations demonstrate that the proper use of drugs requires that the therapeutic endpoint be clearly defined and the predictable side effects be anticipated. PMID:2901276

  3. Special considerations in the pediatric use of radionuclides for kidney studies

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    Ash, J.M.; Antico, V.F.; Gilday, D.L.; Houle, S.

    1982-10-01

    Radionuclide renal studies are particularly well suited to pediatrics as renal problems in children usually are part of a dynamic process which requires serial assessment. The absence of side-effects and the low radiation dose has added to their popularity in pediatrics. A number of different renal parameters can be evaluated using the appropriate radiopharmaceutical and method of analysis. The renal study is of value to assess patients with hydronephrosis both pre-operatively and for serial follow-up post-operatively, as well as to distinguish obstructive from non-obstructive uropathy. Perfusion to the kidney may be assessed and ischemic areas detected in children with hypertension or trauma. The renal scan commonly is used in patients with congenital anomalies such as ectopic and duplex kidneys, nonvisualized kidney on IVP and in children with oliguria or anuria secondary to diseases such as acute tubular necrosis, hemolytic uremic syndrome, and renal vein thrombosis. It frequently is done as an emergency procedure in neonates. In conjunction with the IVP and ultrasound, the renal study is useful in some cases of abdominal mass to distinguish between hydronephrosis, cystic kidneys and tumors.

  4. Special considerations in the pediatric use of radionuclides for kidney studies

    International Nuclear Information System (INIS)

    Radionuclide renal studies are particularly well suited to pediatrics as renal problems in children usually are part of a dynamic process which requires serial assessment. The absence of side-effects and the low radiation dose has added to their popularity in pediatrics. A number of different renal parameters can be evaluated using the appropriate radiopharmaceutical and method of analysis. The renal study is of value to assess patients with hydronephrosis both pre-operatively and for serial follow-up post-operatively, as well as to distinguish obstructive from non-obstructive uropathy. Perfusion to the kidney may be assessed and ischemic areas detected in children with hypertension or trauma. The renal scan commonly is used in patients with congenital anomalies such as ectopic and duplex kidneys, nonvisualized kidney on IVP and in children with oliguria or anuria secondary to diseases such as acute tubular necrosis, hemolytic uremic syndrome, and renal vein thrombosis. It frequently is done as an emergency procedure in neonates. In conjunction with the IVP and ultrasound, the renal study is useful in some cases of abdominal mass to distinguish between hydronephrosis, cystic kidneys and tumors

  5. [Acute tubulointerstitial nephritis following adenovirus and respiratory syncytial virus infection].

    Science.gov (United States)

    de Suremain, A; Somrani, R; Bourdat-Michel, G; Pinel, N; Morel-Baccard, C; Payen, V

    2015-05-01

    Acute tubulointerstitial nephritis (TIN) is responsible for nearly 10% of acute renal failure (ARF) cases in children. It is mostly drug-induced, but in a few cases viruses are involved, probably by an indirect mechanism. An immune-competent 13-month-old boy was admitted to the intensive care unit for severe ARF with anuria in a context of fever, cough, and rhinorrhea lasting 1 week. The kidney biopsy performed early brought out tubulointerstitial damage with mild infiltrate of lymphocytes, without any signs of necrosis. There were no virus inclusion bodies, no interstitial hemorrhage, and no glomerular or vascular damage. Other causes of TIN were excluded: there was no biological argument for an immunological, immune, or drug-induced cause. Adenovirus (ADV) and respiratory syncytial virus (RSV) were positive in respiratory multiplex polymerase chain reaction (PCR) in nasal aspirate but not in blood, urine, and renal tissue. The patient underwent dialysis for 10 days but the response to corticosteroid therapy was quickly observed within 48 h. The mechanism of TIN associated with virus infection is unknown. However, it may be immune-mediated to be able to link severe renal dysfunction and ADV and/or RSV invasion of the respiratory tract. PMID:25842199

  6. 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.

  7. 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.

  8. The clinician's guide to diagnostic imaging: Cost-effective pathways. Second edition

    International Nuclear Information System (INIS)

    The authors developed a cost-effective approach to imaging studies, based on initial selection of an exam that best addresses the specific clinical problem and obviates the need for additional diagnostic tests. Tightly reasoned arguments compare available imaging options with respect to diagnostic yield, feasibility, risk, and cost. To aid the clinician in making cost comparisons, each paper of the Second Edition lists the dollar cost of relevant imaging studies. The Second Edition has been thoroughly revised to reflect the important advances in diagnostic imaging of the past three years, highlighting CT's expanding role in thoracic and abdominal problems, magnetic resonance imaging as a spectacular diagnostic tool for the central nervous system, and the clinical application of many newly-developed radiopharmaceuticals. New chapters cover breast cancer screening, acute spinal trauma, search for primary cancer of unknown origin, acute anuria, blunt chest trauma, new onset seizures, and spinal cord compression from metastases. Other papers have been rewritten for greater clarity and to incorporate new techniques, like dipyridamole stress testing. A glossary and an introduction define and explain the capabilities and limitations of current techniques

  9. Endovascular Repair of a Type III Thoracoabdominal Aortic Aneurysm in a Patient with Occlusion of Visceral Arteries

    International Nuclear Information System (INIS)

    The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneus transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft

  10. New aspects for nuclear renal diagnosis

    International Nuclear Information System (INIS)

    Non-invasive nuclear methods of examination have gained great importance in renal diagnosis because they can be carried out without discomfort to the patient. Unilateral clearance is valuable in cases of unilateral renal damage where the impaired functioning of one kidney may be mashed by the compensatory action of the other, contralateral kidney. This is offen the case with chronic pyelonephritis, ureteral stenosis, and nephrolithiasis. In ectactic renal pelves, unilateral clearance should be obligatory, as functional assessment on the basis of the excretory urogram is impossible. The pathological X-ray picture often leads to false conclusions in this type of disease. Due to the low radiation exposure involved, close-meshed control examinations are possible which indicate functional changes early enough for the necessary therapy. The emphasis in scintiscanning has shifted to dynamic investigations. The main fields of application for sequential scintiscanning are unilateral and segmental renal diseases, differential diagnosis of anuria, traumatic changes, and emergency diagnoses in infants. Suspected growing and displacing processes are only an indirect indication for scintiscanning today. (orig.)

  11. 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%.

  12. Anti-Inflammatory Effects of Melandrii Herba Ethanol Extract via Inhibition of NF-κB and MAPK Signaling Pathways and Induction of HO-1 in RAW 264.7 Cells and Mouse Primary Macrophages

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    Yun Hee Jeong

    2016-06-01

    Full Text Available Melandrii Herba (MH is a traditional Asian medicinal herb used to treat breast cancer, anuria, and diseases of lactation. However, its biological properties and molecular mechanisms have not been fully elucidated. The purpose of this study was to investigate the anti-inflammatory activity and underlying molecular mechanism of MH ethanol extract (MHE on the lipopolysaccharide (LPS-mediated inflammatory response in macrophages. MHE cytotoxicity was determined using a cell counting kit (CCK assay. The effects of MHE on the production of NO, inflammatory cytokines, and related proteins and mRNAs were determined using the Griess test, ELISA, Western blotting, and real-time RT-PCR, respectively. In addition, intracellular signaling pathways, such as NF-κB, MAPK, and HO-1, were analyzed using Western blotting. Our results revealed that MHE treatment significantly inhibited the secretion of NO and inflammatory cytokines, including TNF-α, IL-6, and IL-1β in macrophages, at sub-cytotoxic concentrations. Furthermore, MHE treatment inhibited iNOS expression and induced HO-1 expression. Finally, the transcriptional activities of NF-κB and MAPK activation were significantly suppressed by MHE in LPS-stimulated macrophages. The results indicate that MHE exerts anti-inflammatory effects by suppressing inflammatory mediator production via NF-κB and MAPK signaling pathways inhibition and induction of HO-1 expression in macrophages. Therefore, our results suggest the potential value of MHE as an inflammatory therapeutic agent developed from a natural substance.

  13. Anti-Inflammatory Effects of Melandrii Herba Ethanol Extract via Inhibition of NF-κB and MAPK Signaling Pathways and Induction of HO-1 in RAW 264.7 Cells and Mouse Primary Macrophages.

    Science.gov (United States)

    Jeong, Yun Hee; Oh, You-Chang; Cho, Won-Kyung; Lee, Bohyoung; Ma, Jin Yeul

    2016-01-01

    Melandrii Herba (MH) is a traditional Asian medicinal herb used to treat breast cancer, anuria, and diseases of lactation. However, its biological properties and molecular mechanisms have not been fully elucidated. The purpose of this study was to investigate the anti-inflammatory activity and underlying molecular mechanism of MH ethanol extract (MHE) on the lipopolysaccharide (LPS)-mediated inflammatory response in macrophages. MHE cytotoxicity was determined using a cell counting kit (CCK) assay. The effects of MHE on the production of NO, inflammatory cytokines, and related proteins and mRNAs were determined using the Griess test, ELISA, Western blotting, and real-time RT-PCR, respectively. In addition, intracellular signaling pathways, such as NF-κB, MAPK, and HO-1, were analyzed using Western blotting. Our results revealed that MHE treatment significantly inhibited the secretion of NO and inflammatory cytokines, including TNF-α, IL-6, and IL-1β in macrophages, at sub-cytotoxic concentrations. Furthermore, MHE treatment inhibited iNOS expression and induced HO-1 expression. Finally, the transcriptional activities of NF-κB and MAPK activation were significantly suppressed by MHE in LPS-stimulated macrophages. The results indicate that MHE exerts anti-inflammatory effects by suppressing inflammatory mediator production via NF-κB and MAPK signaling pathways inhibition and induction of HO-1 expression in macrophages. Therefore, our results suggest the potential value of MHE as an inflammatory therapeutic agent developed from a natural substance. PMID:27338335

  14. Renal proximal tubular dysgenesis associated with severe neonatal hemosiderotic liver disease.

    Science.gov (United States)

    Bale, P M; Kan, A E; Dorney, S F

    1994-01-01

    We report the necropsy findings for three infants with the unusual combination of proximal renal tubular dysgenesis and severe congenital liver disease with excessive iron in several organs resembling neonatal hemochromatosis. Two of the infants were caucasian siblings and one was an Australian aborigine. One died in utero at 35 weeks of gestation and two died at 7 days. The liveborn infants presented with anuria and liver failure. The livers all showed marked loss of hepatocytes and replacement by pseudotubules in the collapsed lobules. The liveborn infants also showed giant cell transformation of hepatocytes, small regenerative nodules, cholestasis, and normal bile ducts. Absence of proximal renal convolutions was confirmed by epithelial membrane antigen positivity in nearly all tubules. In each family there was another sibling with congenital liver disease, fatal in one case, but no renal tubular dysgenesis. No infection or metabolic disease was uncovered in any of our patients, and the cause of the hepatocyte destruction was not determined. The combination in three infants of two rare congenital diseases could be genetic or acquired in utero from the same etiological agent. Alternatively, the absence of proximal convolutions could be secondary to hypoperfusion, perhaps because of shock due to extensive necrosis of hepatocytes. PMID:8066004

  15. AETIOLOGICAL PROFILE AND OUTCOME IN PATIENTS WITH ACUTE KIDNEY INJURY (AKI ADMITTED TO VIMS, BELLARY

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    Ramamurthy

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: This was a study about the various causes of ARF, in our hospital (VIMS, Bellary during a specified period, and to find out the incidence of Pre-renal, Renal and Post-renal causes by using renal failure indices and to analyze outcome of ARF pertaining to the aetiology. MATERIALS AND METHODS: 70 cases admitted at VIMS, Bellary during the period January 2012 to june 2013, with clinical evidence of acute renal failure were included in the study. They were evaluated for various etiological, prognostic factors and its outcome. RESULTS: Among the various aetiologies in our study, snake bite (28.6%, ADD (27.1%, RPGN (7.1% were the most common. Most common type of renal failure was prerenal (50%, among them ADD was the predominant cause followed by intrinsic failure (47%, among them snake bite was leading cause. Patients presenting with Anuria, late presentation to hospital, blood pressure 3mg had poor outcome. CONCLUSION: Amongst the etiological factors snake bite and ADD ranked first. Prognosis was determined by age, aetiology of renal failure, initial creatinine value, blood pressure, time of presentation to. Even though both snake bite and ADD are equally common causes, morbidity is more in snake bite and cost of treatment also more in snake bite as many of them require dialysis.

  16. A sheep survived for 48 days with the biventricular bypass type total artificial heart.

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    Senoo,Yoshimasa

    1991-08-01

    Full Text Available A biventricular bypass type total artificial heart (BVB-TAH utilizing two pusher-plate pumps was developed and implanted in a sheep for 48 days with excellent results. A Hall effect sensor was utilized to operate each pump independently with a full stroke at variable rates (VR. With this system, the animal's hemodynamics was kept physiologically, and all metabolic parameters except hemoglobin and hematocrit returned to normal three weeks after implantation. However, signs of infection appeared on the forty-second day, and consequently the animal fell into a state of shock. Even at that time the BVB-TAH maintained circulation by increasing pumping rate automatically. On the forty-eighth day, the animal could not stand and suffered from anuria; the experiment was then terminated after 1,140 h pumping. At autopsy, there was an enlarged heart with an atrophic change, 1,900 ml of pleural effusion, and 3,100ml of ascites fluid. Blood culture taken on the forty-seventh day yielded Acinetobacter calcoaceticus. The BVB-TAH operated in an independent VR mode maintained entire circulation, and has a capability of substituting the native heart function in any situation.

  17. 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.

  18. Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation

    Directory of Open Access Journals (Sweden)

    Sara Querido

    2015-01-01

    Full Text Available A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS. A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.

  19. Envenoming after a snakebite from the Northeast African saw-scaled viper Echis pyramidum: prolonged therapy upon failed treatment by antivenom.

    Science.gov (United States)

    Valenta, J; Stach, Z; Kolář, M

    2011-01-01

    A reptile holder based in the Czech Republic was bitten into his hand and foot by the Northeast saw-scaled viper (Echis pyramidum). The person arrived at the health institution after twenty hours for anuria. Despite the antivenom against the Asian Echis carinatum - the Echis pyramidum's close relative - was readily available and administered repeatedly, the envenoming continued to develop with subsequent coagulopathy, hepatopathy and respiratory failure. The effects of plasmapheresis and symptomatic therapy were positive, but only temporary. Continual renal replacement therapy and plasmapheresis were complicated by thrombotic occlusions of the device tubing set. A turning point arrived following repeated application of imported antivenom containing antigens against venom components of another African saw-scaled viper species, Echis leucogaster (the antivenom containing E. pyramidum antigens was not available). The clinical status, including complications, resolved following 30 days of hospitalization. The case further validates the geographical specifics of immunogenicity of venom components with similar clinical action in snakes of the same genus. PMID:21978783

  20. Comparative study of unilateral renal tubule function using 131I-o-hippuran and sup(99m)Tc-dimercaptosuccinic acid with regard to renal depth and excretion relations

    International Nuclear Information System (INIS)

    Good agreement was found between sonographic and nuclear renal depth data. In patients with undisturbed postrenal urodynamics, the data of unilateral renal clearance obtained by DMSA and OIH are in good agreement after depth correction. With OIH, the activity measured for unilateral congestion kidneys was higher than with DMSA. However, both methods may overestimate unilateral congestion kidneys. The OIH method should be favoured in nuclear renal diagnostics. In patients with mobile kidneys, the lower function calculated for the ptotic kidney can be evaluated only after depth correction. To reduce the radiation exposure, renal depth data required for depth correction should be determined by sonographic methods. The peak/scatter method of renal depth determination cannot be employed in practice in the 131J hippurane test; in the sup(99m)Tc-DMSA test, sufficient agreement between peak/scatter quotient and renal depth is only obtained after background correction. The result does not warrant the tedious procedure. DMSA studies of the kidneys are appropriate in the following cases: 1. Emergency studies of unilateral renal function in cases of acute anuria due to postrenal stoppage. 2. Assessment of unilateral parenchymal function in patients with mobile kidneys if the ptotic kidney cannot be imaged by sonographic processes. 3. Search for extremely displaced renal tissue. 4. Unilateral renal function studies in patients with unilateral kidney diseases if the postrenal situation and the global renal function can be assessed by other methods. (orig./MG)

  1. 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.

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

    International Nuclear Information System (INIS)

    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. 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. 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

  3. Role of radiopharmaceutical renal function studies in the medical surveillance of patients with transplanted kidneys

    International Nuclear Information System (INIS)

    In a study group of 35 patients having received a total of 37 kidneys 204 renal function scintiscans were obtained following administration of 99mTc DTPA and analysed with regard to the question as to whether radiopharmaceutical investigations using a gamma camera are a useful auxiliary tool to detect and diagnose functional disorders in the transplant that occur soon after surgery. In all of 13 patients showing complications in the form of prolonged anuria or oliguria during a period of up to 14 days following surgical intervention, the renal function scintiscans either permitted as firm diagnosis to be established or revealed conclusive findings that pointed to the necessity of further specific tests. Long-term follow-up studies carried out in 33 individuals failed or were slow to reveal acute or chronic rejection processes in one quarter of the patients, whereas the renal function scintiscans gave the earliest warning of functional disorders, unfavourable developments and complications in another quarter of patients; in the remaining part, the test results were in keeping with the clinical findings. Renal function scintiscans were thus judged to be a valuable diagnostic tool to ascertain and identify disorders occurring soon after surgery as well as to detect the early signs of functional disorders in the transplant during long-term follow-up studies. In view of the fact, however, that the sensitivity of the method in this field of application only is of the order of 75%, further research work appears to be required here. (TRV)

  4. Sequential Scintigraphy in Renal Transplantation

    International Nuclear Information System (INIS)

    Based on experience gained from more than 1600 patients with proved or suspected kidney diseases and on results on extended studies with dogs, sequential scintigraphy was performèd after renal transplantation in dogs. After intravenous injection of 500 μCi. 131I-Hippuran scintiphotos were taken during the first minute with an exposure time of 15 sec each and thereafter with an exposure of 2 min up to at least 16 min.. Several examinations were evaluated digitally. 26 examinations were performed on 11 dogs with homotransplanted kidneys. Immediately after transplantation the renal function was almost normal arid the bladder was filled in due time. At the beginning of rejection the initial uptake of radioactive Hippuran was reduced. The intrarenal transport became delayed; probably the renal extraction rate decreased. Corresponding to the development of an oedema in the transplant the uptake area increased in size. In cases of thrombosis of the main artery there was no evidence of any uptake of radioactivity in the transplant. Similar results were obtained in 41 examinations on 15 persons. Patients with postoperative anuria due to acute tubular necrosis showed still some uptake of radioactivity contrary to those with thrombosis of the renal artery, where no uptake was found. In cases of rejection the most frequent signs were a reduced initial uptake and a delayed intrarenal transport of radioactive Hippuran. Infarction could be detected by a reduced uptake in distinct areas of the transplant. (author)

  5. Early Diagnosis of Leptospirosis

    Science.gov (United States)

    Babic-Erceg, Andrea; Karlovic-Martinkovic, Diana; Santini, Marija; Persic, Zdenka; Vilibic-Cavlek, Tatjana

    2014-01-01

    A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume restitution. Renal failure soon ensued. Consequently continuous venovenous hemodiaphiltration therapy was performed. Due to acute respiratory distress syndrome, the patient was mechanically ventilated. The patient’s condition gradually improved and he recovered fully from multi-organ failure. Diagnosis was confirmed by a microscopic agglutination test (MAT) covering 15 leptospira serovars and real-time polymerase-chain reaction (PCR). The first serum sample taken on day 6 tested negative for leptospira, while PCR showed positive results for leptospiral DNA. The second serum sample taken on day 13 tested positive for serovar Canicola serogroup Canicola, serovar Patoc, serovar Grippotyphosa serogroup Grippotyphosa and serovar Tarassovi serogroup Tarassovi (titre 4000, 4000, 1000 and 2000, respectively), while PCR was negative. This report highlights the benefits of combining MAT and PCR methods in early diagnosis of leptospirosis. PMID:25002958

  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. 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.

  8. Obstetrical acute renal failure: a challenging medical complication

    International Nuclear Information System (INIS)

    Acute renal failure (ARF) is a syndrome characterised by rapid decline in glomerular filtration rate and retention of nitrogenous waste products such as urea and creatinine. The objective of this study was to study the prevalence, risk and outcome of women with obstetrical renal failure. Methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital, Hyderabad, Pakistan from October 2009 to September 2010. Thirty-five patients with obstetrical acute renal failure were included in the study, patients with chronic renal diseases, hypertension, diabetes mellitus and renal stones were excluded from the study. A detailed history was followed by thorough examination and investigation. Their clinical history, physical examination and intake/urine output was recorded. Routine laboratory investigations were done related to each case and specialised investigations like renal scan, renal ultrasonography and renal biopsies were performed in selected cases where recovery was delayed for more than 3 weeks. Results: Total numbers of admissions in obstetric ward were 3,285. Pregnancy related acute renal failure was found in 35 (1.065%) women. Age ranged from 18-40 years. Most of the women belonged to age group 30-35. Out of 35 women 31.42% had postpartum haemorrhage. Ante partum haemorrhage was found in 25.71%, Eclampsia in 17.14%, DIC in 14.28%, and sepsis in 11.42%. Anuria was observed in 25 patients, remaining presented with oliguria (28.57%). Haemodialysis was done in 75% of patients, others were managed conservatively. Complete recovery was observed in 53% cases. Maternal mortality was 25.71% and foetal mortality was 22.85%. Conclusion: Pregnancy related ARF is one of the most common causes of ARF, it is a dangerous complication of pregnancy which carries very high mortality and morbidity. (author)

  9. Acute glomerulonephritis in children of the Niger Delta region of Nigeria

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    G I McGil Ugwu

    2015-01-01

    Full Text Available A three-year retrospective study was conducted to determine the incidence, pattern of presentation and other clinical and biochemical features as well as outcome of treatment of patients admitted with acute glomerulonephritis at the Delta State University Teaching Hospital, Oghara and GN Children′s Clinic, Warri. The case notes of all the children who presented with renal diseases from January 2010 to December 2012 were retrieved and those with acute glomerulonephritis were analyzed. A total of 20 patients (13 male and seven female with acute glomerulonephritis were seen during the three-year period under review. Twelve patients (60% were from the low socioeconomic class, six (30% from the middle class and only two (10% were from the high-income group. The presentation of the illness was most common between October and January. The age range of the patients was three to 13 years, with an average age of eight years. Seventeen (85% of the patients were in the school-going age group (>5 years to 10 years. The most common symptom/sign noted was anemia in 90% of the patients, followed by oliguria/anuria and edema seen in 80% of the patients. Seventy percent of the patients had cola-colored urine, while 55% had hypertension. Some patients gave a history suggestive of previous streptococcal infection. More patients had sore throat (25% than skin infection (10%. All the patients had proteinuria, while 90% had hematuria. The most common complication was acute kidney injury, seen in eight (40% of the patients, followed by hypertensive encephalopathy, which occurred in three (15% patients. Most patients (60% were hospitalized for one to two weeks. The outcome of the management of these patients showed 14 (70% of the patients recovered fully while three (15% had persistent hematuria and two (10% had persistent proteinuria. Ninety-five percent of the patients recovered from the acute illness and one patient (5%, a boy aged nine years old, died.

  10. Acute glomerulonephritis in children of the Niger Delta region of Nigeria.

    Science.gov (United States)

    McGil Ugwu, G I

    2015-09-01

    A three-year retrospective study was conducted to determine the incidence, pattern of presentation and other clinical and biochemical features as well as outcome of treatment of patients admitted with acute glomerulonephritis at the Delta State University Teaching Hospital, Oghara and GN Children's Clinic, Warri. The case notes of all the children who presented with renal diseases from January 2010 to December 2012 were retrieved and those with acute glomerulonephritis were analyzed. A total of 20 patients (13 male and seven female) with acute glomerulonephritis were seen during the three-year period under review. Twelve patients (60%) were from the low socioeconomic class, six (30%) from the middle class and only two (10%) were from the high-income group. The presentation of the illness was most common between October and January. The age range of the patients was three to 13 years, with an average age of eight years. Seventeen (85%) of the patients were in the school-going age group (>5 years to 10 years). The most common symptom/sign noted was anemia in 90% of the patients, followed by oliguria/anuria and edema seen in 80% of the patients. Seventy percent of the patients had cola-colored urine, while 55% had hypertension. Some patients gave a history suggestive of previous streptococcal infection. More patients had sore throat (25%) than skin infection (10%). All the patients had proteinuria, while 90% had hematuria. The most common complication was acute kidney injury, seen in eight (40%) of the patients, followed by hypertensive encephalopathy, which occurred in three (15%) patients. Most patients (60%) were hospitalized for one to two weeks. The outcome of the management of these patients showed 14 (70%) of the patients recovered fully while three (15%) had persistent hematuria and two (10%) had persistent proteinuria. Ninety-five percent of the patients recovered from the acute illness and one patient (5%), a boy aged nine years old, died. PMID:26354592

  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. 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.

  13. 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. PMID:26046524

  14. 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.

  15. Enterohemorrhagic E. coli and hemolytic uremic syndrome in Georgia.

    Science.gov (United States)

    Vashakidze, E; Megrelishvili, T; Pachkoria, E; Tevzadze, L; Lashkarashvili, M

    2010-09-01

    It is important to consider that between Jul-October 2009 in the pathologic center of infectious diseases (Tbilisi State Medical University Department of Infectious Diseases) among hospitalized patients with hemorrhagic colitis 25 patients developed HUS syndrome. Most of patients were rural residents 20 (80%), only 5 (20%) were urban. 11 (44%) patients were children, 14 (56%) were adults. Male and female rate was equal. All the patients related the onset of the disease with the consumption of notwashed raw fruits or vegetables, nonpasteurized dairy products, food from street vendors, soft cheeses made from raw milk and untreated water in areas lacking adequate chlorination. The onset of the disease was not acute: low grade fever (37,5-37,8(0)C), severe diffuse pain in abdomen accompanied with cramps, frequent bowel movement with loose, watery stools 5-6 times a day. On the 2-3rd days of disease condition was worsened by increased of intoxication and frequent bowel movement with bloody stools about 10-15-20 times a day. On the 3-4 rd days of the onset of the diarrhea developed oliguria, anuria, edema. Among other complications important were: polyserosit - 8 (32%), encephalopathy - 2 (8%), disseminated intravascular coagulation - 3 (14%), ileus -1 (4%,) acute reactive phsycosis - 1 (4)%. In 15 (60%) cases became necessary to carry out hemodialysis. died 5 patients, lethality is - 5 (20%). Treatment options included: pathogenetic and symptomatic. Thus, increased rate of patients in the recent years indicates to circulation of shiga-toxin producing E.Coli in Georgia. PMID:20972274

  16. 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

  17. Acute renal failure in pregnancy: Tertiary centre experience from north Indian population

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    Munna Lal Patel

    2013-01-01

    Full Text Available Background: Obstetrical acute renal failure ARF is now a rare entity in the developed countries but still a common occurrence in developing countries. Delay in the diagnosis and late referral is associated with increased mortality. This study aimed to evaluate the contributing factors responsible for pregnancy-related acute kidney failure, its relation with mortality and morbidity and outcome measures in these patients. Materials and Methods: Total 520 patients of ARF of various aetiology were admitted, out of these 60 (11.5% patients were pregnancy-related acute renal failure. Results: ARF Acute renal failure occurred in 32 (53.3% cases in early part of their pregnancy, whereas in 28 (46.7% cases in later of the pregnancy. Thirty-two (53.3% patients had not received any antenatal visit, and had home delivery, 20 (33.4% patients had delivered in hospitals but without antenatal care and eight (13.3% patients received antenatal care and delivered in the hospitals. Anuria was observed in 23 (38.3% cases, remaining 37 (61.7% cases presented with oliguria. Septicemia was present in 25 (41.7%, hypertensive disorder of pregnancy in 20 (33.3%, haemorrhage in eight (13.3%, abortion in 5 (8.3%, haemolysis elevated liver enzymes low platelets counts (HELLP syndrome in one (1.67% and disseminated intravascular coagulation in one (1.67%. (61.7% patients were not dialyzed, 33 (55% recovered normal renal function with conservative treatment. Complete recovery was observed in 45 (75% patients, five (8.4% patients developed irreversible renal failure. Maternal mortality was nine (15% and foetal loss was 25 (41.7%. Conclusion: Pregnancy-related ARF is usually a consequence of obstetric complications; it carries very high morbidity and mortality.

  18. 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.

  19. 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 .

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

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    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. PMID:24969215

  1. 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.

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

    Science.gov (United States)

    Bodi, Joseph M; Nsibu, Célestin N; Aloni, Michel N; Lukute, Guy N; Kunuanuna, Thomas S; Tshibassu, Pierre M; Pakasa, Nestor

    2014-11-01

    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. PMID:25394465

  3. The profile of patients with obstructive uropathy in Cameroon: case of the Douala General Hospital

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    Halle, Marie Patrice; Toukep, Linda Njonkam; Nzuobontane, Samuel Ekane; Ebana, Hermine Fouda; Ekane, Gregory Halle; Priso, Eugene Belley

    2016-01-01

    Introduction Obstructive uropathy can lead to irreversible kidney damage. The etiology largely determined by the patient's age can be benign or malignant. This study aimed at determining the profile and outcome of patients with obstructive uropathy in Cameroon. Methods A cross sectional study carried out in the urology unit of the Douala General Hospital, including patients with a diagnosis of obstructive uropathy seen from January 2004 to December 2013. Clinical profile, treatment and outcome data were obtained from patients records. Results Of the 229 patients included 69% were men, mean age 50 ±18 years. Associated comorbidities were hypertension, diabetes, and HIV. Mean haemoglobin 8,40±2,4g/dl, mean GFR 10,3 ±10ml/min, 94 (41%) patients needed emergency dialysis. Symptoms at presentation: asthenia (57%), anorexia (55%), loin pain (37%), vomiting (28%), oedema (20%), and anuria (15%). Urinary tract infection was present in 33 patients. Main aetiologies of obstruction: urolithiasis (35%), begnin prostatic hypertrophy (27%), prostatic cancer (12%), cervical cancer (16%), and congenital malformations (5%). Drainage was effective in 102 (45%) patients, 63 (28%) recovered completely, 91 (41%) were loss to follow up, 49 (22%) died and more women (p = 0.02). Mortality was associated with prostatic cancer (p = 0.000), cervical cancer (p = 0.004) and radiotherapy (p = 0.03). Conclusion Patients with obstructive uropathy presented with significant impaired renal function. Main causes were urinary stones, prostatic hypertrophy, prostatic and cervical cancers. Renal recovery was poor, loss to follow up and mortality high. Specific strategies to target improvement in renal recovery and patient's survival are needed in this patient's group.

  4. 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.

  5. Renal and post-renal causes of acute renal failure in children

    International Nuclear Information System (INIS)

    Objective: To identify the causes of acute renal failure (ARF) in pediatric population along with the identification of the age and gender most affected by the failure. Subjects and Methods: The study included children under the age of 12 years who presented with signs and symptoms suggestive of ARF (oliguria/anuria, vomiting, acidotic breathing etc.) along with raised blood urea nitrogen (BUN) serum creatinine and metabolic acidosis as shown by arterial blood gases (ABGs). Patients were divided into two group on the basis of age; group A consisting of 0-2 years and group B from >2 years. Patients presenting with transient pre-renal azotaemia were excluded from the study. After providing initial emergency cover, detailed history, physical examination and investigations were carried out according to a proforma specially designed to ascertain the cause of ARF. Patients were managed for ARF as per standard recommendations and investigations completed or repeated as and when required. Results: A total of 119 patients with ARF were admitted in the ward over a period of two years constituting 1.36% of the total admissions and 16.39% of the admissions due to renal pathology. Mean age of presentation was 4.5 years 16.7% of the patients under the age of 5 years. Male predominance was noted in all ages with an overall male to female ratio of 2.3:1. Most common cause leading to ARF in younger age group was found to be hemolytic uremic syndrome [25(54.34%)] followed by septicemia [7(15.21 %)]. In older patients renal calculus disease was the most common [22(30.13%)] underlying pathology followed by pre-existing, undiagnosed chronic renal failure [16(21.91 %)]. Conclusion: ARF is fairly cotton in children especially under the age of 5 years showing a male predominance. More than 90% of the cases can be prevented by improving primary health care and by early and prompt treatment of infections. (author)

  6. Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report.

    Science.gov (United States)

    Pothuri, Pallavi; Ahuja, Keerat; Kumar, Viki; Lal, Sham; Tumarinson, Taisiya; Mahmood, Khalid

    2016-01-01

    BACKGROUND Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. CONCLUSIONS As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute

  7. Angiotensin I-converting enzyme Gln1069Arg mutation impairs trafficking to the cell surface resulting in selective denaturation of the C-domain.

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    Sergei M Danilov

    Full Text Available BACKGROUND: Angiotensin-converting enzyme (ACE; Kininase II; CD143 hydrolyzes small peptides such as angiotensin I, bradykinin, substance P, LH-RH and several others and thus plays a key role in blood pressure regulation and vascular remodeling. Complete absence of ACE in humans leads to renal tubular dysgenesis (RTD, a severe disorder of renal tubule development characterized by persistent fetal anuria and perinatal death. METHODOLOGY/PRINCIPAL FINDINGS: Patient with RTD in Lisbon, Portugal, maintained by peritoneal dialysis since birth, was found to have a homozygous substitution of Arg for Glu at position 1069 in the C-terminal domain of ACE (Q1069R resulting in absence of plasma ACE activity; both parents and a brother who are heterozygous carriers of this mutation had exactly half-normal plasma ACE activity compared to healthy individuals. We hypothesized that the Q1069R substitution impaired ACE trafficking to the cell surface and led to accumulation of catalytically inactive ACE in the cell cytoplasm. CHO cells expressing wild-type (WT vs. Q1069R-ACE demonstrated the mutant accumulates intracellularly and also that it is significantly degraded by intracellular proteases. Q1069R-ACE retained catalytic and immunological characteristics of WT-ACE N domain whereas it had 10-20% of the nativity of the WT-ACE C domain. A combination of chemical (sodium butyrate or pharmacological (ACE inhibitor chaperones with proteasome inhibitors (MG 132 or bortezomib significantly restored trafficking of Q1069R-ACE to the cell surface and increased ACE activity in the cell culture media 4-fold. CONCLUSIONS/SIGNIFICANCE: Homozygous Q1069R substitution results in an ACE trafficking and processing defect which can be rescued, at least in cell culture, by a combination of chaperones and proteasome inhibitors. Further studies are required to determine whether similar treatment of individuals with this ACE mutation would provide therapeutic benefits such as

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

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    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.

  9. Bilateral renal cortical necrosis with end-stage renal failure following envenoming by Proatheris superciliaris: a case report.

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    Pourreau, François; Pinsard, Michel; Goyffon, Max; Plasse, Florent; Desport, Estelle; Thierry, Antoine; Touchard, Guy; Bridoux, Frank

    2014-06-01

    Acute bilateral renal cortical necrosis (BRCN) has been reported following envenoming by exotic venomous snakes. Proatheris superciliaris is a rare viper with restricted distribution in east Africa. Very little information is available on envenoming by this species. We herein describe the case of a 60-year-old professional wildlife photographer who was bitten on his thumb while photographing an adult specimen of P. superciliaris that he held at home in France. On admission, physical examination revealed severe hypertension and bruising with edema at the bite site. Within the following 24 h, he developed vomiting, diarrhea, acute lumbar pain and anuria. Laboratory tests showed acute kidney injury (serum creatinine 4.6 mg/dL), with thrombocytopenia, anemia and severe coagulopathy. Contrast-enhanced computed tomography scan revealed hypodense areas in the cortex of both kidneys consistent with diffuse BRCN. As no appropriate antivenom existed, only symptomatic care was given to the patient. Coagulation tests returned to normal within 48 h. The patient was placed on chronic hemodialysis, until he underwent successful kidney transplantation 18 months later. In developed countries, severe complications provoked by snake bites tend to be more frequent with the number of trendy exotic pets. Acute kidney injury, including BRCN, is a classic complication of viper bites. The present case of end-stage renal failure related to diffuse BRCN illustrates the potentially devastating effects of envenoming by P. superciliaris. Clinicians in developed countries should be informed about renal disorders and other potentially fatal complications of venomous snake bites and seek urgent expert advice for optimizing clinical management. Education and coaching of envenomed patients and exotic snake owners is mandatory to prevent dramatic accidents. PMID:24709757

  10. Computerized technique for evaluating renal transplant function

    International Nuclear Information System (INIS)

    This investigation was undertaken to improve the assessment of renal transplant function in the early post-operative period when the usual measures of renal function afford little useful information. A simplified mathematical model of I-131 hippurate transport allows separation of renal uptake and excretion. Uptake (U) is defined as the fraction of I-131 hippurate in the plasma picked up by the kidney per minute, and excretion (E), the fraction of I-131 hippurate in the kidney excreted into the bladder per minute. Scintillation camera data from the region of the renal allograft are framed at 4/min by a computer system for up to 30 minutes post injection. After regions of interest are flagged over the kidney, bladder and background regions, the activity-time curves are analyzed, and values for U and E are output in a report updated through punched paper tape for any values from previous studies. The entire analysis of a patient study requires about 5 minutes of technologist time. Over 150 studies on 24 patients have been analyzed using the above technique. In the immediate post-operative state when anuria or severe oliguria is often present, sequential estimation of U was found to be a sensitive measure of renal transplant viability. In the period beyond one week reductions in U and E appeared to be sensitive measures of rejection, while increases in U and E heralded amelioration of the rejection episode. Changes in U and E appeared to be more sensitive measures of changes in renal function than routine qualitative scintiphotographic analysis. This technique has proven useful in following the renal function status of the kidney transplant recipient through acute tubular necrosis and rejection episodes and has been a significant adjunct to routine scintigraphy

  11. 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

  12. Clinical parameters, postmortem analysis and estimation of lethal dose in victims of a massive intoxication with diethylene glycol.

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    Ferrari, Luis A; Giannuzzi, Leda

    2005-10-01

    This work analyzes a massive intoxication that occurred in 1992 in Argentina as a result of the use of propolis syrup as a popular upper respiratory infection medicinal agent. The intoxicating agent was diethylene glycol (DEG), which caused metabolic acidosis, anuria, renal failure and death in 15 out of the 29 studied victims. DEG poisoning cases were classified in three groups according to survival time: Group 1-patients that survived up to 3 days; Group 2-patients that survived between 4 and 5 days; Group 3-patients that survived between 6 and 21 days. Patients from Group 1 showed the highest values of anion gap, the lowest measures of base excess (BE) and more severe clinical manifestations. Correlation between pH and BE was r(2) = 0.68, 0.99 and 0.55 for Groups 1, 2 and 3, respectively. A methanolic extraction was performed on the fatal victims' viscera and blood, with subsequent concentration and purification. The semi-crystalline fraction obtained retained DEG by means of co-dissolution and adsorption as demonstrated by thin lay chromatography/flame ionisation detection (TLC/FID). In 3 out of the 15 fatal cases (from Group 1), DEG was isolated from viscera and blood (femoral venous), between 48 and 72 h post ingestion. The concentration relation (DEG)viscera/(DEG)blood ranged from 1.45 to 1.55 with a coefficient correlation r(2)=0.96 (n=3). In the other victims, DEG could not be detected. The reason for this could be the long survival period of the victims after their ingestion of the syrup. Additionally, putrefying mechanisms could have been operating. Samples of the propolis syrup of each victim were studied by means of nuclear magnetic resonance (NMR) and quantified by gas chromatography/flame ionisation detection (GC/FID). Results showed that syrup samples contained 65.0% (w/v) of diethylene glycol (DEG) and 32.0% (w/v) of propylene glycol (PG). A good correlation between the amount of DEG ingested and the anion gap (r(2)=0.63) for the 15 victims studied

  13. 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.

  14. Unbounded 131I elimination by means of hemodialysis after papillary thyroid cancer radioiodine therapy in patients with terminal renal failure: 3 case reports

    International Nuclear Information System (INIS)

    Full text of publication follows. Background and objectives: after its administration for therapeutic purposes, unbounded and circulating 131I should be eliminated from the body, as it can cause adverse effects to non-thyroid/tumor tissue. If a patient is anuric or severely oliguric, the only way for unbound radioiodine to get eliminated is via hemodialysis. However, the effectiveness of this process is questionable, and furthermore, the patient is not allowed to leave the controlled radiation zone until the radioactivity in their body drops below 400 MBq. Methods: 3 patients (two males and one female, 35, 53 and 66 years of age) with terminal renal failure accompanied by anuria/severe oliguria, who had previously undergone papillary thyroid cancer surgery (pT1NxMx/CSI), received therapeutic doses of 1915, 1880 and 1850 MBq of 131I, respectively. Prior to this, the patients had received chronic hemodialysis (4 hours every other day) over a 6-month period. Twenty-four hours after the oral administration of radioiodine, each patient was hemo-dialysed in the controlled zone (veno-venous hemo-dia-filtration for 4 hours, via MultiFILTRATE device, Fresenius Medical Care). Upon the completion of dialysis, venous blood was sampled from the patients every hour for 4 hours. Moreover, the dialysis effluent was collected hourly, its value was measured and it was sampled. The radioactivity of blood and dialysis effluent samples was measured by means of gamma-counter using peak of 131I energy. Results: the total radioactivity measured in the dialysis effluent after 4 hours amounted to 31.61% of the administered dose. Within the first hour following the dialysis, the radioactivity decreased by 8.31%, whereas after the 2., 3. and 4. hour it decreased by 7.23%, 7.77% and 8.30%, respectively. In other words, one hour after the dialysis the radioactivity of blood samples was 91.33% of the pre-dialysis value. After 2, 3 and 4 hours it was 83.34%, 75.23% and 69.88 % respectively

  15. Peritoneal dialysis in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery%腹膜透析治疗婴幼儿复杂先天性心脏病术后急性肾功能不全30例

    Institute of Scientific and Technical Information of China (English)

    卢琳; 吴锡阶; 陈良万

    2013-01-01

    Objective To analyse peritoneal dialysis(PD) in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery,sum up the clinical experience of PD therapy infants and children with acute renal insufficiency after complex congenital heart disease surgery.Methods The clinical records of 30 infants and children during January 2010 to June 2012 were analysed retrospectively,with 23 male and 7 female,aged from 7 days to 18 months[average (8.28 ± 5.17) months],weight 2.5-14 kg[average (5.15 ± 3.89) kg].The reasons for PD:7 cases because of oliguria (urine < 1 ml · h-1 · kg-1,duration > 4 h) and the other 23 cases because of anuria.Results One case with total anomalous pulmonary venous connection(TAPVC) died of left heart failure,1 case with transposition of the great arteries died of multiple organ failure,and the other 28 cases were all cured,cure rate 93.33%.Conclusion PD is easy,safe and low-cost,has definite curative effect in infants and children with acute renal insufficiency after complex congenital heart disease surgery,worth to popularize.%目的 回顾性分析30例婴幼儿复杂先天性心脏病术后合并急性肾功能不全行腹膜透析治疗的资料,总结腹膜透析治疗婴幼儿复杂先心病术后合并肾功能不全的临床经验.方法 分析2010年1月至2012年6月,30例复杂先天性心脏病术后合并急性肾功能不全行腹膜透析治疗患婴(儿)的的临床资料,男23例,女7例;年龄7天~18个月,平均(8.28±5.17)个月;体质量2.5 ~14.0 kg,平均(5.15 ±3.89) kg.7例因少尿(每小时尿量<1ml/kg,持续时间>4h)、组织水肿行腹膜透析,23例因无尿行腹膜透析.结果 死亡2例,1例完全型肺静脉异位引流患儿因左心室小、左心衰竭而死亡,1例完全型大动脉转位因多器官功能衰竭而死亡;28例(93.33%)治愈.结论 腹膜透析操作简单方便、安全性高、费用低,治疗复杂先天性心脏病术后合

  16. 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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. Clinical analysis of 18 cases with acute tumor lysis syndrome in children with B-cell lymphoma%儿童成熟B细胞淋巴瘤并发急性肿瘤溶解综合征18例临床分析

    Institute of Scientific and Technical Information of China (English)

    黄爽; 杨菁; 张蕊; 段彦龙; 张永红

    2011-01-01

    Objective To investigate risk factors associated with acute tumor lysis syndrome (ATIS) in children with B-cell lymphoma and to explore feasible means for the prophylaxis and treatment.Method Data from 18 children with ATLS in B-cell lymphoma were collected to assess their tumor burden at diagnosis and before chemotherapy. Evaluation was performed at the 8th day, 3 month, and the end of chemotherapy and follow up. The incidence of ATLS in B-cell lymphoma, and the relationship between the incidence of ATLS and whether the kidney was involved and large tumor burden were analyzed respectively.All patients received hydration, alkalinization and received allopurinol routinely. Urate oxidase and hemodialysis treatment were administered in some cases. Result Of the 103 children with B-cell lymphoma, 18 were diagnosed as having ATLS (17.5%). All the 18 cases with ATLS were histopathologically confirmed as having Burkitt's lymphoma. All the patients were at stage Ⅲ or Ⅳ and all had large tumor sizes, and 7 were found to have blasts in the bone marrow > 25% ( 38. 9% ). Lactate dehydrogenase (LDH) levels ≥1000 U/L were found in 11 (61.1%) cases. All patients had developed metabolic abnormalities, including hyperuricemia, hyperphosphatemia, hypocalcemia , and uremia. In terms of clinical features and prognosis, all cases had nausea, vomiting, anorexia, oliguria, and anuria at different levels. One had gastrointestinal bleeding, 7 patients experienced seizures. The etiology in five was hypocalcemia and two had reversible posterior encephalopathy syndrome and all responded well to treatment.Nine cases of ATLS responded to supportive care, 4 required hemodialysis, and the other 4 responded to urate oxidase. Ten cases survived and 8 died. The major cause of death was severe complications and treatment was given up in 5 cases and recurrence occurred in 3 cases. Conclusion ATLS was commonly seen in Burkitt's subtype of B-cell lymphoma. Higher LDH and large tumor sizes and

  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.