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

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    Vučičević-Trobok Jadranka

    2002-01-01

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

  2. Treatment of osteoporosis in renal insufficiency

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    Schipper, L.G.; Fleuren, H.W.; Bergh, J.P. van den; Meinardi, J.R.; Veldman, B.A.; Kramers, C.

    2015-01-01

    Patients with osteoporosis often have chronic kidney disease (CKD). CKD is associated with bone and mineral disturbances, renal osteodystrophy, which like osteoporosis leads to a higher risk of fractures. Bisphosphonates are first-line therapy for osteoporosis; however, these are contra-indicated in

  3. Prevalence of renal insufficiency in individuals with obesity

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    Vasiljević Nađa; Zuković Milica; Žakula Dejan; Živadinović Nenad; Žarković Boris; Živković Bojana; Zlatić Nataša; Zogović Jovana; Ležaić Višnja

    2011-01-01

    Introduction. The association of obesity with renal function disorders has been demonstrated by some studies. Objective. The aim of this study was to assess the prevalence of renal insufficiency (RI), measured as glomerular filtration rate (GFR) <60 ml/min and impact of weight loss on kidney function in a cohort of 109 obese patients (body mass index - BMI >25 kg/m2), without previous kidney disease, and who underwent the dietician’s treatment. Methods. According to body mass inde...

  4. Renal and suprarenal insufficiency secondary to familial Mediterranean fever associated with amyloidosis: a case report

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    Sari Nagehan

    2011-08-01

    Full Text Available Abstract Introduction Familial Mediterranean fever is an autosomal recessive disease that predominantly affects people of the Mediterranean coast. One of the most frequent complications of the disease is amyloidosis. This clinical entity is known as secondary (also called AA amyloidosis. Case presentation In this report, we describe the case of a 33-year-old Turkish man with familial Mediterranean fever and chronic renal insufficiency. He was admitted to our clinic with symptoms of suprarenal insufficiency. The patient died three months later as a result of cardiac arrest. Conclusion Our aim is to make a contribution to the literature by reporting a case of combined insufficiency due to the accumulation of renal and adrenal amyloid in a patient with familial Mediterranean fever, which has very rarely been described in the literature. We hope that adrenal insufficiency, which becomes fatal if not diagnosed and treated rapidly, will come to mind as easily as chronic renal failure in clinical practice.

  5. Renovascular hypertension due to insufficient collateral flow in segmental artery occulusion

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    Park, Y. H.; Lee, S. Y.; Kim, S. H.; Sohn, H. S.; Chung, S. K. [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2001-07-01

    We report a case in which a 33-year-old woman with renovascular hypertension due to insufficient collateral flow in segmental renal artery occlusion demonstrated abnormality on captopril renal scintigram. Baseline renal scintigram with DTPA showed normal perfusion and excretion in left kidney and captopril renal scintigram with DTPA showed a focal area of decreased perfusion and delayed clearance in lower half of left kidney, suggesting segmental renal artery stenosis. Selective left renal arteriography showed complete obstruction in proximal portion of anterior segmental artery with multiple small collateral vessels from posterior segmental artery and capsular artery and delayed opacification in lower half of left kidney. These findings are suggestive of segmental hypoperfusion due to insufficient collateral blood flow resulting to positive captopril response. Patient's blood pressure have been controlled well with ACE (angiotensin converting enzyme) inhibitor and calcium channel blocker for 2 year. Follow-up baseline renal scintigram with MAG3 showed normal perfusion and excretion in left kidney and captopril renal scintigram with MAG3 showed a focal area of decreased perfusion and delayed clearance in lower lateral portion of left kidney, which was smaller size than that of previous renal scintigram. And captopril renal scintigram with DMSA demonstrated a small area of decreased DMSA uptake on this lesion compared to baseline DMSA scintigram.

  6. Atherosclerosis in elderly patients with renal insufficiency

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    Sandeep S. Soman

    2005-01-01

    @@ Introduction As people age,cardiovascular structure and function change and this is superimposed on by specific pathophysiologic disease mechanism.In addition to lipid levels,diabetes,sedentary lifestyle,and genetic factors that are known risks for coronary disease,hypertension,and stroke - the quintessential cardiovascular (CV) diseases related to atherosclerosis within our society - advancing age unequivocally confers the major risk.(Fig.1) Mortality due to cardiovascular disease is more than any other disease and creates enormous costs for the health care system.The main underlying problem in cardiovascular disease is atherosclerosis,a process that obstructs major arteries with lipid deposits and cell accumulation.1 Decreased kidney function (estimated GFR<70 mL/min/1.73 m2) is an independent risk factor for cardiovascular disease and all-cause mortality in the general population.2

  7. Safety and tolerability of voriconazole in patients with baseline renal insufficiency and candidemia.

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    Oude Lashof, A.M.L.; Sobel, J.D.; Ruhnke, M.; Pappas, P.G.; Viscoli, C.; Schlamm, H.T.; Rex, J.H.; Kullberg, B.J.

    2012-01-01

    Acutely ill patients with candidemia frequently suffer from renal insufficiency. Voriconazole's intravenous formulation with sulfobutylether beta-cyclodextrin (SBECD) is restricted in patients with renal insufficiency. We evaluated the use of intravenous voriconazole formulated with SBECD in candide

  8. Safety and tolerability of voriconazole in patients with baseline renal insufficiency and candidemia.

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    Oude Lashof, A.M.L.; Sobel, J.D.; Ruhnke, M.; Pappas, P.G.; Viscoli, C.; Schlamm, H.T.; Rex, J.H.; Kullberg, B.J.

    2012-01-01

    Acutely ill patients with candidemia frequently suffer from renal insufficiency. Voriconazole's intravenous formulation with sulfobutylether beta-cyclodextrin (SBECD) is restricted in patients with renal insufficiency. We evaluated the use of intravenous voriconazole formulated with SBECD in

  9. Pharmacokinetics and pharmacodynamics of roxatidine in patients with renal insufficiency.

    OpenAIRE

    1995-01-01

    1. Roxatidine acetate, a new histamine H2-receptor antagonist, was administered in the evening (75 mg p.o.) to eight patients with renal insufficiency (CLCR 8-17 ml min-1) for 12 days and plasma drug concentrations were measured. 2. Ambulatory intragastric pH was monitored following the last dose and values were compared with those on day 1 when all patients received a placebo. 3. The terminal elimination half-life (mean +/- s.d.) of roxatidine was 10.8 +/- 2.4 h and its oral clearance was 17...

  10. Piperazine side-effects in a patient with pre-existing renal insufficiency

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    Majid Malaki

    2014-01-01

    Full Text Available Piperazine as an antihelminth has many adverse effects, especially on patients with renal insufficiency. We report the use of piperazine in a girl with a moderately severe kidney disease due to Biedl Bardet syndrome. She developed coma and acute kidney injury due to acute interstitial nephritis (AIN, anemia and thrombocytopenia. The presence of fever, proteinuria, acidosis, anemia, sterile pyuria and non-oliguric renal failure strongly suggested AIN. Her problems abated mostly by discontinuing of piperazine and supportive therapy, except anemia and thrombocytopenia.

  11. Acute adrenal insufficiency due to primary antiphospholipid antibody syndrome

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    Kishore Kumar Behera

    2013-01-01

    Full Text Available Introduction: We report a case of acute adrenal insufficiency (AAI in a patient with antiphospholipid syndrome (APS. Case Report: A 44-year-old female patient presented to us with acute abdominal pain associated with recurrent vomiting and giddiness. On examination, her blood pressure was 80/50 mm Hg. Systemic examination was normal. Further evaluation revealed hypocortisolemia with elevated plasma adrenocorticotropin hormone indicative of primary adrenal insufficiency. Her abdominal computed tomography scan showed features of evolving bilateral adrenal infarction. Etiological work-up revealed prolonged activated thromboplastin time, which didn′t correct with normal plasma, her anti-cardiolipin antibody and lupus anticoagulant were also positive. She was diagnosed to have APS with adrenal insufficiency and she was started on intravenous steroids and heparin infusion. Conclusion: AAI due to the APS can present with acute abdominal pain followed by hypotension. A high index of suspicion is needed to make the correct diagnosis and to initiate appropriate treatment.

  12. Drug administration in patients with renal insufficiency. Minimising renal and extrarenal toxicity.

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    Matzke, G R; Frye, R F

    1997-03-01

    Renal insufficiency has been associated with an increased risk of adverse effects with many classes of medications. The risk of some, but not all, adverse effects has been linked to the patient's degree of residual renal function. This may be the result of inappropriate individualisation of those agents that are primarily eliminated by the kidney, or an alteration in the pharmacodynamic response as a result of renal insufficiency. The pathophysiological mechanism responsible for alterations in drug disposition, especially metabolism and renal excretion, is the accumulation of uraemic toxins that may modulate cytochrome P450 enzyme activity and decrease glomerular filtration as well as tubular secretion. The general principles to enhance the safety of drug therapy in patients with renal insufficiency include knowledge of the potential toxicities and interactions of the therapeutic agent, consideration of possible alternatives therapies and individualisation of drug therapy based on patient level of renal function. Although optimisation of the desired therapeutic outcomes are of paramount importance, additional pharmacotherapeutic issues for patients with reduced renal function are the prevention or minimisation of future acute or chronic nephrotoxic insults, as well as the severity and occurrence of adverse effects on other organ systems. Risk factors for the development of nephrotoxicity for selected high-risk therapies (e.g. aminoglycosides, nonsteroidal anti-inflammatory drugs, ACE inhibitors and radiographic contrast media) are quite similar and include pre-existing renal insufficiency, concomitant administration of other nephrotoxins, volume depletion and concomitant hepatic disease or congestive heart failure. Investigations of prophylactic approaches to enhance the safety of these agents in patients with renal insufficiency have yielded inconsistent outcomes. Hydration with saline prior to drug exposure has given the most consistent benefit, while sodium

  13. Role of Soluble ST2 as a Prognostic Marker in Patients with Acute Heart Failure and Renal Insufficiency.

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    Kim, Min-Seok; Jeong, Tae-Dong; Han, Seung-Bong; Min, Won-Ki; Kim, Jae-Joong

    2015-05-01

    This study sought to assess the relationship between serum concentrations of the soluble ST2 (sST2) and B-type natriuretic peptide (BNP) and investigate the role of sST2 as a prognosticator in patients hospitalized with acute heart failure (HF) and renal insufficiency. sST2 was measured at admission and discharge in 66 patients hospitalized with acute decompensated HF and renal insufficiency (estimated glomerular filtration rate [eGFR] renal insufficiency (eGFR renal function, even though BNP level was much higher in patients with severe renal insufficiency. During 3 month follow-up, 9 (13.6%) died and 16 (24.2%) were readmitted due to HF aggravation.On multivariate analysis, sST2 at discharge was independently associated with death or HF readmission during 3 months after discharge (hazard ratio, 1.038; 95% confidence interval, 1.011-1.066, P = 0.006). In conclusion, sST2 is not affected by renal function compared with BNP in acute HF patients. The measurement of predischarge sST2 can be helpful in predicting short-term outcomes in acute decompensated HF patients with renal insufficiency.

  14. Prevalence of renal insufficiency in individuals with obesity

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    Vasiljević Nađa

    2011-01-01

    Full Text Available Introduction. The association of obesity with renal function disorders has been demonstrated by some studies. Objective. The aim of this study was to assess the prevalence of renal insufficiency (RI, measured as glomerular filtration rate (GFR <60 ml/min and impact of weight loss on kidney function in a cohort of 109 obese patients (body mass index - BMI >25 kg/m2, without previous kidney disease, and who underwent the dietician’s treatment. Methods. According to body mass index (BMI, the patients were classified as overweight (25-29.9 kg/m2, 25 patients, obesity grade I (30-34.9 kg/m2, 37 patients, obesity grade II (35 to 39.9 kg/m2, 23 patients, and obesity grade III (>40 kg/m2, 24 patients. Data on hypertension, cardiovascular diseases, diabetes, family illness history on diabetes, obesity and hypertension, smoking and medications, lipid profile, serum creatinine (sCr measured before and after diet, and urine examination were collected from the patients’ records. GFR was estimated using MDRD formula (modification of diet in renal disease. Results The patients groups were similar in age and co-morbidities, lipids, and sCr values. In comparison to other obese patients, blood pressure was the highest in obesity grade III patients (p=0.0001. Mean GFR rate before diet was satisfactory in all studied groups. RI was present in 12.8% patients. After diet nine patients still had GFR < 60ml/min, while lipids decreased in all groups. Patients with the highest decrease of BMI also showed best improvement in GFR. The risk for the development of decreased GFR was higher in elderly patients (estimated rate: -0.434, p<0.0001. Conclusion. Obesity is a potentially reversible risk factor for the development of decreased GFR. The relationship between obesity and decreased GFR may be mediated by the presence of known cardiovascular risk factors. In order to clarify the obesity influence on renal functioning, further studies are needed.

  15. Pharmacokinetics and pharmacodynamics of roxatidine in patients with renal insufficiency.

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    Gladziwa, U; Wagner, S; Sieberth, H G; Klotz, U

    1995-02-01

    1. Roxatidine acetate, a new histamine H2-receptor antagonist, was administered in the evening (75 mg p.o.) to eight patients with renal insufficiency (CLCR 8-17 ml min-1) for 12 days and plasma drug concentrations were measured. 2. Ambulatory intragastric pH was monitored following the last dose and values were compared with those on day 1 when all patients received a placebo. 3. The terminal elimination half-life (mean +/- s.d.) of roxatidine was 10.8 +/- 2.4 h and its oral clearance was 178 +/- 43 ml min-1. 4. During roxatidine treatment gastrin levels increased slightly (median 189 vs 289 ng l-1) and the hyperparathyroid status of the patients was almost normalized (parathyroid hormone levels: median 199 vs 132 ng l-1). 5. The mean latency to a gastric pH of at least 4 was 4.3 +/- 1.4 h. The duration of action (intragastric pH > 4) was 10.6 +/- 3.9 h. 6. As in a pilot study with six patients (CLCR 4 for more than 6 h, daily nocturnal intake of 75 mg roxatidine acetate appears appropriate to elevate gastric pH > 4 for a sufficient period of time.

  16. Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications.

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    Cunha, B A; Cunha, C B; Lam, B; Giuga, J; Chin, J; Zafonte, V F; Gerson, S

    2017-02-02

    Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl urinary tract infections. Urinary isolated susceptibility testing was done by micro broth dilution (MBD). Treatment duration was 5-7 days. Cure was defined as eradication of the uropathogen and failure was defined as minimal/no decrease in urine colony counts. Of 26 evaluable patients with renal insufficiency (CrCl < 60 ml/min), nitrofurantoin eradicated the uropathogen in 18/26 (69%) of patients, and failed in 8/26 (31%). Of the eight failures, five were due to intrinsically resistant uropathogens, e.g., Proteus sp., and one failure was related to an alkaline urine. Of the treatment failures, only two were due to renal insufficiency, i.e., CrCl < 30 ml/min. Since there are few oral antibiotics available to treat AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).

  17. Upper Digestive Endoscopic Findings in Patients with Chronic Renal Insufficiency in Phase of Dialysis

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    Marcos Félix Osorio Pagola

    2009-12-01

    Full Text Available Background: Patients with chronic renal insufficiency in phase of dialysis present clinical manifestations that can include different symptoms. Morbidity due to gastric, esophageal and duodenal disturbances is significant and constitutes a considerable risk before, while and after a renal transplant. Objective: To identify the most frequent disturbances of the upper digestive tract in patients with chronic renal insufficiency who require dialysis. Methods: An observational, descriptive and retrospective study was carried out in this search. The universe was composed by all the patients with a diagnosis of chronic renal insufficiency in a dialysis phase, who had been included in the Hemodialysis Program at the University Hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos and who had undergone an upper digestive endoscopy from January to May, 2008. The patient’s health record was studied to get information for the variables under study. Results: the average age was 46,7 years and the most affected patients were males. The mean value for serum creatinine was 929,7 mMol/L, for serum urea 21,4 mMol/L and for hemoglobin 8,4 g/L. The most frequent cause of chronic nephropathy was High Blood Pressure in 25 patients (56,8 %, followed by Diabetes Mellitus in 9 patients (20,5 %. 52,3 % of the patients were asymptomatic, but the most frequent symptoms reported by the patients were flatulence (25 % and nausea (15,9 %. Endoscopy revealed normal results in most of the patients (40,9 %. Conclusions: Antral erythematous endoscopic gastritis was the most frequent endoscopic diagnosis followed by duodenal ulcer

  18. Renal insufficiency after heart transplantation: a case-control study

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    T. van Gelder (Teun); R. Zietse (Bob); C.J. Hesse (Cees); W. Weimar (Willem); A.H.M.M. Balk (Aggie); B. Mochtar (Bas)

    1998-01-01

    textabstractBACKGROUND: In Rotterdam 304 heart transplants have been performed since 1984. End-stage renal failure, necessitating renal replacement therapy, has developed in 24 patients (8%) after an interval of 25-121 months (median 79 months). After starting renal rep

  19. Mieloma Múltiplo e insuficiência renal Multiple Myeloma and renal insufficiency

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    Angelo Maiolino

    2007-03-01

    Full Text Available A insuficiência renal (IR é uma complicação freqüente em pacientes com mieloma múltiplo (MM podendo estar presente em 35% dos pacientes ao diagnóstico e em mais de 50% durante a evolução da doença. O mecanismo mais freqüente de IR é o assim chamado "rim do mieloma" decorrente da excreção de cadeias leves provocando um dano tubular. Outros mecanismos de IR são o depósito tissular de cadeias leves e a Síndrome de Fanconi Adquirida. Determinados fatores podem precipitar e agravar a IR tais como a hipercalcemia, hiperuricemia, desidratação, hiperviscosidade e drogas nefrotóxicas. O tratamento de suporte deve ser feito em todos os pacientes e nos casos em que a função renal não possa ser revertida deve ser considerado o tratamento dialítico. O tratamento específico do MM em pacientes com IR tem papel importante e impacto na sobrevida. A quimioterapia inicial mais adequada é VAD ou combinação de ciclofosfamida e dexametasona. Quimioterapia em altas doses e transplante autólogo podem ser considerados para pacientes com idade inferior a 60 anos e um bom performance status (PS.Renal insufficiency is a frequent complication in patients with Multiple Myeloma (MM. It occurs in 35% of newly diagnosed patients and in more than 50% during the evolution of the disease. The most frequent mechanism of renal failure is the so-called "myeloma kidney", which is the renal tubular damage caused by the excretion of light chains. Other mechanisms of renal damage are light chain tissue deposition and acquired Fanconi's syndrome. This renal impairment might be aggravated by precipitating factors such as hypercalcemia, hyperuricemia, dehydration, hyperviscosity, and nephrotoxic drugs. Supportive measures must be taken for all patients; for those with an irreversible renal function, dialysis must be considered. Specific myeloma treatment has an important prognostic value for patients with renal impairment. The recommendation of induction

  20. Amantadine neurotoxicity in a pediatric patient with renal insufficiency.

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    Strong, D K; Eisenstat, D D; Bryson, S M; Sitar, D S; Arbus, G S

    1991-11-01

    Amantadine hydrochloride, a dopamine agonist with antiviral and antiparkinsonism properties, is used for the prevention and treatment of influenza A respiratory infections in high-risk populations. The occurrence of amantadine-induced hallucinations and tremors is described in a young, renal transplant patient with declining renal function. Following discontinuation of amantadine, plasma amantadine concentrations were correlated with central nervous system toxicity. In view of the usage of amantadine in renal transplant recipients and the elderly, clinicians must be alert to the possibility of amantadine-induced neurotoxicity in patients with changing renal function.

  1. Shunt insufficiency due to knot formation in the peritoneal catheter.

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    Fekete, Gábor; Nagy, Andrea; Pataki, István; Bognar, László; Novák, László

    2013-07-30

    The authors report a rare case of the peripheral obstruction of a ventriculoperitoneal shunt. Premature baby was operated on hydrocephalus due to germinal matrix bleeding. After two months of implantation of venticuloperitoneal shunt peripheral insufficiency of the system was emerged. During the shunt revision extensive knot formation became visible. We simply cut the catheter above the knot and the working shunt was replaced into the abdominal cavity. The postoperative course was uneventful and the baby was free of complaints for more than one year. The pathomechanism of knot formation is not clear thus the discovery of the problem during the operation is an unexpected event. In our opinion tight knot cannot be spontaneously formed intraabdominally. Loose knots can be developed and can reduce the capacity of liquor flow. We think that the knot tightens during pulling out. Longer peritoneal catheters can precipitate multiple looping and/or axial torquations and increase the peripheral resistance of the shunt. In such cases when the pulling out is challenged conversion to laparotomy is suggested.

  2. Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

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    Kim Chang Seong

    2011-10-01

    Full Text Available Abstract Background Diabetes mellitus and renal dysfunction are prognostic factors after acute myocardial infarction (AMI. However, few studies have assessed the effects of renal insufficiency in association with diabetes in the context of AMI. Here, we investigated the clinical outcomes according to the concomitance of renal dysfunction and diabetes mellitus in patients with AMI. Methods From November 2005 to August 2008, 9905 patients (63 ± 13 years; 70% men with AMI were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR and were categorized into 4 groups: Group I (n = 5700 had neither diabetes nor renal insufficiency (glomerular filtration rate [GFR] ≥ 60 ml/min/1.73 m2, Group II (n = 1730 had diabetes but no renal insufficiency, Group III (n = 1431 had no diabetes but renal insufficiency, and Group IV (n = 1044 had both diabetes and renal insufficiency. The primary endpoints were major adverse cardiac events (MACE, including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after 1-year clinical follow-up. Results Primary endpoints occurred in 1804 (18.2% patients. There were significant differences in composite MACE among the 4 groups (Group I, 12.5%; Group II, 15.7%; Group III, 30.5%; Group IV, 36.5%; p p = 0.001; and HR, 2.42; 95% CI, 1.62-3.62; p Conclusions Renal insufficiency, especially in association with diabetes, is associated with the occurrence of composite MACE and indicates poor prognosis in patients with AMI. Categorization of patients with diabetes and/or renal insufficiency provides valuable information for early-risk stratification of AMI patients.

  3. Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.

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    Keogh, J B; McGeeney, K F; Drury, M I; Counihan, T B; O'Donnell, M D

    1978-12-01

    Pancreatic and salivary amylase/creatinine clearance ratios in patients with various degrees of renal impairment were compared with those obtained for control subjects. In chronic renal insufficiency (mean GFR 30 ml/min +/- 15 SD; n = 13) the clearance ratios for pancreatic (mean 3.5 +/- 1.85 SD) and salivary (mean 2.3 +/- 1.3 SD) amylase were significantly higher (P less than 0.05) than those in controls. Corresponding control values (n = 26) were 2.64 +/- 0.86 (pancreatic) and 1.64 +/- 0.95 (salivary). Three patients showed values above the normal limit. In the diabetic group (mean GFR 41 ml/min +/- 22 SD; n = 10) salivary amylase/creatinine clearance ratios (mean 2.36 +/- 1.55 SD) were significantly higher than in controls (P less than 0.05). Three patients showed raised values. Pancreatic amylase clearance was raised in only one of these patients. Three patients with terminal disease (mean GFR 10 ml/min) showed markedly raised (two- to threefold) clearance ratios for both salivary and pancreatic amylase. Of a total of 26 patients, eight had increased total amylase/creatinine clearance ratios. Pancreatic amylase/creatinine clearance was increased in seven patients, while nine patients showed raised salivary amylase/creatinine ratios. Patients with raised clearance ratios did not have clinical evidence of pancreatitis. We suggest that, in the presence of impaired renal function, a high amylase/creatinine clearance ratio need not be indicative of pancreatic disease.

  4. Reversible Renal Insufficiency Secondary to Extrinsic Splenic Compression of the Kidney in a Patient with Chronic Lymphocytic Leukemia

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    Miriam Hadj-Moussa

    2010-01-01

    Full Text Available While increased renal venous and direct renal parenchymal pressure may cause renal insufficiency, there are no prior reports of hypersplenism secondary to chronic lymphocytic leukemia (CLL doing so. This first report of massive splenomegaly leading to marked compression of the left kidney associated with renal insufficiency that resolved after splenectomy illustrates that profound extrinsic renal compression from splenomegaly may significantly compromise left renal function and splenectomy should be considered in this situation.

  5. X-ray changes of children with chronic renal insufficiency

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    Ponhold, W.; Balzar, E. (Vienna Univ. (Austria). Kinderklinik)

    1983-01-01

    The typical changes of renal osteopathy are shown in the X-rays of 7 children with end-stage renal disease treated with chronic intermittent hemodialysis. The exact evaluation of the granular structural changes of the cranium, the evidence of osteomalacia because of the hazy appearance of the vertebrae and the broadening of the sacroilical joints depend highly on subjective judgement and the technical X-ray procedures used. Unmistakable radiological diagnoses can be made when a broadening of the metalphyseal zones, epiphysioloysis as well as characteristic changes in the finder phalanges (acroosteolyses, spiculae, tunnelation) are present.

  6. [Hyperparathyroidism secondary to renal insufficiency. Physiopathology, clinicoradiological aspects and treatment].

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    Ben Hamida, F; Ghazali, A; Boudzernidj, M; Amar, M; Morinière, P; Westeel, P; Fournier, A

    1994-01-01

    Stimulation of PTH secretion and synthesis in chronic renal failure involves direct and indirect factors. The indirect ones are those contributing to a decrease of plasma ionized calcium concentration which stimulates the release of PTH (1) primarily the negative calcium balance due to the iatrogenic reduction of dietary calcium intake associated with an inadequate synthesis of calcitriol, this latter being explained by a reduction in the nephronic mass, the phosphate retention, the acidosis and the retention of uremic toxins (2) more accessorily, the physicochemical dysequilibrium induced by the late occurring hyperphosphatemia. The factors acting directly on the parathyroid gland stimulating synthesis of prepro PTH at its transcription level: not only hypocalcitriolemia but also hypocalcemia and hyperphosphatemia. The clinicoradiological manifestations appear late, mostly only after the patient has been put on dialysis. The most precocious sign is the subperiosteal resorption assessed on the hand X-rays. Therefore diagnosis of hyperparathyroidism relies mainly on the measurement of plasma concentration of intact PTH. In dialysis patients the optimal range corresponding to the best bone histology is between 1 an 3 times the upper limit of normal. No such data exist for predialysis patients. Medical treatment of hyperparathyroidism should primarily be preventive, probably in predialysis lipin patient as soon as plasma intact PTH is greater than the normal upper limit. This treatment is based primarily on the prevention of phosphate retention, of negative calcium balance and acidosis by the use of oral alkaline salts of calcium given with the meals in association with appropriate dietary protein and phosphate restriction. Native vitamin D depletion should also be prevented but use of 1 alpha OH vitamin D3 metabolites in controversial: it is reasonable to administer them only when plasma intent PTH is above 3-7 the normal upper limit and when plasma phosphate is

  7. Segmental Renal Infarction due to Blunt Trauma.

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    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald

    2016-05-01

    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  8. Association of high blood pressure with renal insufficiency: role of albuminuria, from NHANES, 1999-2006.

    Directory of Open Access Journals (Sweden)

    Ping Yan

    Full Text Available BACKGROUND: The relationship between hypertension and kidney disease is complicated. Clinical trials found intense blood pressure control was not associated with alterations in glomerular filtration rate (GFR in all patients but did slow the rate of GFR decline among those with a higher baseline proteinuria. However, the underlying mechanism has been unclear. METHODS: We tested the hypothesis that the association between high blood pressure and renal function is modified by albuminuria status by conducting analyses in a cross-sectional study with 12,440 adult participants without known kidney diseases, diabetes or cardiovascular diseases, participating in the National Health and Nutrition Examination Survey (NHANES 1999-2006. RESULTS: 1226 out of 12440 were found to have unknown high blood pressure and 4494 were found to have reduced renal function. Overall, a moderate association was found between high blood pressure and renal function insufficiency in all participants analyzed. However, among participants with albuminuria, the prevalence of moderate-severe renal insufficiency substantially and progressively increased from normal subjects to prehypertensive and undiagnosed hypertensive subjects (1.43%, 3.44%, 10.96%, respectively, P for trend<0.0001; on the other hand, the prevalence of undiagnosed hypertension was also significantly higher among subjects with moderate-severe renal insufficiency than those with mild renal insufficiency (35.54% Vs 19.09%, P value <0.05, supporting an association between hypertension and renal function damage. In contrast, no association between hypertension and renal insufficiency was observed among those without albuminuria in this population. Similar findings were observed when the CKD-EPI equation was used. CONCLUSIONS: The association between high blood pressure and reduced renal function could be dependent upon the albuminuria status. This finding may provide a possible explanation for results observed in

  9. [Acute renal insufficiency: nutrition disorders and therapeutic consequences].

    Science.gov (United States)

    Canaud, B; Leblanc, M; Leray-Moragues, H; Delmas, S; Klouche, K; Vela, C; Béraud, J J

    1998-01-01

    Catabolism is usually enhanced in acute renal failure (ARF). Its magnitude varies from one patient to another and can change significantly in the same patient from day to day, reflecting its clinical course. It depends on the severity of the ARF, the underlying process, the associated co-morbidity, and therapeutic approach. The detection of patients at high risk for malnutrition is extremely important; nutritional markers and indexes of caloric and protein requirements are useful to adapt renal replacement and nutritional support to ARF patients. Various biochemical parameters (namely, serum albumin and prealbumin), anthropometic measures, indirect calorimetry, urea and creatinine kinetics are all useful tools to evaluate metabolic status and requirements nutritional. Commonly, the caloric requirements are nearly 35 kcal/kg/24 h with correction factors applied for certain clinical situations: carbohydrates account for 50 to 60% of those needs whereas lipids account for the rest. The total amount of fluid administered has to be adapted to the possible ultrafiltration achieved by dialysis. Daily dialysis sessions and continuous renal replacement therapy allow larger volumes and thus facilitate nutritional support. Protein needs frequently exceed 1.2 g/kg/24 h to maintain the nitrogen balance, with a calorie to protein ration close to 150 kcal per g of nitrogen. Sufficient amounts of vitamins and oligo-elements are necessary. Stimulating anabolism by exogenous mediators, such as androgenic hormones or growth factors (rh-IGF1, rh-GH) is an avenue that deserves better definition in critically ill ARF patients.

  10. Establishment of a model of renal impairment with mild renal insufficiency associated with atrial fibrillation in canines.

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    Zhuo Liang

    Full Text Available Chronic kidney disease and occurrence of atrial fibrillation (AF are closely related. No studies have examined whether renal impairment (RI without severe renal dysfunction is associated with the occurrence of AF.Unilateral RI with mild renal insufficiency was induced in beagles by embolization of small branches of the renal artery in the left kidney for 2 weeks using gelatin sponge granules in the model group (n = 5. The sham group (n = 5 underwent the same procedure, except for embolization. Parameters associated with RI and renal function were tested, cardiac electrophysiological parameters, blood pressure, left ventricular pressure, and AF vulnerability were investigated. The activity of the sympathetic nervous system, renin-angiotensin-aldosterone system, inflammation, and oxidative stress were measured. Histological studies associated with atrial interstitial fibrosis were performed.Embolization of small branches of the renal artery in the left kidney led to ischemic RI with mild renal insufficiency. The following changes occurred after embolization. Heart rate and P wave duration were increased. Blood pressure and left ventricular systolic pressure were elevated. The atrial effective refractory period and antegrade Wenckebach point were shortened. Episodes and duration of AF, as well as atrial and ventricular rate during AF were increased in the model group. Plasma levels of norepinephrine, renin, and aldosterone were increased, angiotensin II and aldosterone levels in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced after 2 weeks of embolization in the model group.We successfully established a model of RI with mild renal insufficiency in a large animal. We found that RI with mild renal insufficiency was associated with AF in this model.

  11. The influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with renal insufficiency

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    Stolić Radojica

    2007-01-01

    Full Text Available Introduction/Aim. Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. Methods. The examination was organized as a prospective, clinical study and involved 68 patients − 33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. Results. The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4±11.1 vs. 65.4±12.3 years; p = 0.014. There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03, hiatal hernia (p = 0.008, gastroesophageal reflux disease (p = 0.007, and duodenal ulcer (p = 0.002. Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal τB = -0.523; p = 0.003 and hiatal hernia (Kendal τB = 0.403; p = 0.021, while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal τB = 0.350; p = 0.044. Conclusion. Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency.

  12. The relationship between heart rate variability and prostaglandin E2 in patients with renal insufficiencies

    Institute of Scientific and Technical Information of China (English)

    陈伊伦; 朱建华; 胡申江; 王磊; 赵力; 陈宝仙

    2003-01-01

    Objective To investigate the relationship between heart rate variability (HRV) and prostaglandin E2 (PGE2) in patients with renal insufficiencies. Methods HRV blood and 24-hour urine prostagladin E2 (PGE2) detection were detected in the following 4 groups of people: group A was a control group comprised of 20 normal individuals; group B had 20 patients with renal disease but exhibiting normal renal function; group C contained 20 patients with renal disease and compensatory renal function; group D had 20 patients demonstrating renal insufficiencies. The indices standard deviation of all NN intervals (SDNN), index of standard deviation of the averages of NN intervals (SDANN), mean of the standard deviation of all NN intervals performed on all 5-minute segments of the entire recording (SDNNindex), square root of the mean of the sum of the squares of differences between adjacent NN intervals (rMSSD) and NN50 count divided by the total number of all NN intervals (PNN50) were used to evaluate HRV, blood and 24-hour urine were determined by specific radioimmunoassay (RIA). Results PGE2 in blood and urine and HRV exactly within 24 hours in patients with renal insufficiencies, negatively correlated with worsening damage to renal function. There was a slight or moderate correlation between blood and urine PGE2 and the SDNNindex, SDANNindex, SDNN, rMSSD and PNN50 indices (P<0.05). Conclusions HRV and cardiac autonomic regulatory functions are decreased in the patients with renal insufficiencies, while lower levels of PGE2 may be a related factor.

  13. Amylase-creatinine clearance ratios and serum amylase isoenzymes in moderate renal insufficiency.

    Science.gov (United States)

    Banks, P A; Sidi, S; Gelman, M L; Lee, K H; Warshaw, A L

    1979-12-01

    Both the amylase-creatinine clearance ratio (normal 1.55%) and proportion of pancreatic isoamylase in serum (normal 41.0%) increase in acute pancreatitis, and are therefore useful measurements to support that diagnosis. Whether renal insufficiency interferes with the accuracy and specificity of these tests has been debated. Our study indicates that even moderate renal insufficiency (creatinine clearance 30.5 ml/minute) raises the amylase-creatinine clearance ratio (3.23%) close enough to values characteristic of acute pancreatitis (4.41%) to cause potential diagnostic confusion. The fraction of pancreatic isoamylase in serum is also increased (69.9%), but not to the levels of acute pancreatitis (91.0%). We therefore caution against the use of the amylase-creatinine clearance ratio for the diagnosis of acute pancreatitis in patients with moderate renal insufficiency.

  14. Serum amylase determinations and amylase to creatinine clearance ratios in patients with chronic renal insufficiency.

    Science.gov (United States)

    Tedesco, F J; Harter, H R; Alpers, D H

    1976-10-01

    Patients with severe chronic renal failure may have significant hyperamylasemia in the absence of clinical symptoms or signs of acute pancreatitis. Amylase to creatinine clearance (CA/CC) ratios were usually elevated in patients with chronic renal failure and were not helpful in evaluating the possibility of acute pancreatitis. The mean amylase to creatinine clearance ratio for the controls with normal renal function was 1.24 +/- 0.13. In patients with chronic renal failure, it was 3.17 +/- 0.42 (P less than 0.001). Serum amylase isoenzyme patterns revealed no difference in salivary to pancreatic isoenzyme ratios between normals (1.04 +/- 0.12) and patients with severe renal insufficiency without evidence of pancreatic disease (1.07 +/- 0.13). The isoenzymes were helpful in excluding the diagnosis of pancreatic in 1 renal failure patient whose hyperamylasemia was primarily salivary in origin and in confirming the diagnosis in another who had only a pancreatic band.

  15. Effectiveness of theophylline prophylaxis of renal impairment after coronary angiography in patients with chronic renal insufficiency.

    Science.gov (United States)

    Huber, Wolfgang; Schipek, Chrysantha; Ilgmann, Kathrin; Page, Michael; Hennig, Michael; Wacker, Annette; Schweigart, Ursula; Lutilsky, Leopoldo; Valina, Christian; Seyfarth, Melchior; Schömig, Albert; Classen, Meinhard

    2003-05-15

    Contrast media can lead to renal impairment that results in longer hospitalization and increased mortality. Adenosine is a crucial mediator of contrast-induced nephropathy (CIN; an increase in serum creatinine of >or=0.5 mg/dl within 48 hours). Therefore, it was the purpose of our study to investigate whether the adenosine antagonist theophylline reduces the incidence of CIN after coronary angiography. We also characterized risk factors for CIN after coronary angiography. One hundred patients with serum creatinine concentrations of >or=1.3 mg/dl randomly received 200 mg IV theophylline or placebo 30 minutes before coronary angiography (amount of contrast medium >or=100 ml). Patients who received theophylline and the controls were comparable with regard to baseline creatinine levels (means +/- SD) (1.65 +/- 0.41 vs 1.72 +/- 0.69 mg/dl) and the amount of contrast medium received (235 +/- 89 vs 261 +/- 139 ml). Theophylline significantly reduced the incidence of CIN (4% vs 20%, p = 0.0138). With placebo, creatinine significantly increased at 12 (1.82 +/- 0.79 mg/dl, p = 0.0057), 24 (1.90 +/- 0.86 mg/dl, p = 0.0001), and 48 hours (1.90 +/- 0.89 mg/dl, p = 0.0007) after administration of contrast medium. With pretreatment with theophylline, mean creatinine only increased 24 hours after contrast medium administration (1.70 +/- 0.40 mg/dl, p = 0.029), but was stable 12 hours (1.65 +/- 0.43 mg/dl, p = 0.99) and 48 hours after contrast medium administration (1.65 +/- 0.41 mg/dl, p = 0.99). The following parameters were significantly associated with contrast-induced renal impairment: Cigarroa quotient >5 (contrast medium [milliters] x serum creatinine/body weight [kg]), elevated troponin T, >300 ml of contrast medium, and emergency angiography. In conclusion, theophylline reduces the incidence of CIN in patients with chronic renal insufficiency undergoing coronary angiography. It should be used especially in patients receiving large amounts of contrast medium, and in

  16. Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Ryusuke; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Yoshida, Tamiko; Okazaki, Emi; Kumita, Shin-ichiro; Owan, Chojin [Nippon Medical School, Department of Radiology, Graduate School of Medicine, Tokyo (Japan)

    2012-10-15

    To evaluate the safety of contrast-enhanced MDCT in patients with renal impairment. We conducted a retrospective review of 938 patients with stable renal insufficiency (eGFR between 15 and 60 ml/min) who underwent contrast-enhanced MDCT. SCr levels were measured at baseline and 48-72 h after contrast medium administration. The incidence of contrast-induced nephropathy (CIN) in the total study population was assessed. As a control group, 1,164 separate patients with renal insufficiency who did not receive contrast medium for CT were also reviewed. The overall incidence of CIN in the patient population with renal insufficiency was 6.1 %; the incidence was 4.4 %, 10.5 % and 10.0 % for patients whose eGFR was 45-60, 30-45 and {<=}30 ml/min, respectively (P < 0.01). In the control group, 5.8 % of patients showed an increase in the SCr level from the baseline. The increase in the SCr level showed no significant difference between the patients who received CM and those who did not (P = 0.82) The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appeared to be low, and there was no significant difference in the incidence of CIN in comparison with patients who did not receive CM. (orig.)

  17. Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency.

    Science.gov (United States)

    Yu, S; Paetau-Robinson, I

    2006-05-01

    Oxidative stress may contribute to the progression of chronic renal failure. In this study, cats with spontaneous renal insufficiency were fed a dry cat food supplemented with the antioxidants vitamins E and C, and beta-carotene for 4 weeks. When compared with healthy cats, cats with renal insufficiency had a tendency to oxidative stress. The antioxidant supplements significantly reduced DNA damage in cats with renal insufficiency as evidenced by reduced serum 8-OHdG and comet assay parameters. Therefore, supplements of vitamins E and C and beta-carotene as antioxidants may be beneficial to cats with renal disease.

  18. [Adrenal cortex insufficiency in children due to inhaled corticosteroids

    NARCIS (Netherlands)

    Eijkemans, M.C.J.; Otten, B.J.; Yntema, J.L.

    2011-01-01

    A 3-year-old boy was treated for asthmatic symptoms with fluticasone inhalations. Due to a flattening growth curve Cushing's syndrome was suspected and the dosage of fluticasone was gradually decreased after which the boy became less active and his appetite decreased. Another patient, a 7-year-old b

  19. [Respiratory insufficiency due to duplications of the oesophagus].

    Science.gov (United States)

    Luoma, Reijo

    2015-01-01

    Duplications of the oesophagus are uncommon congenital malformations with possible occurrence in any part of the gastrointestinal tract. The duplications may be cysts, diverticula or tubular-shaped. Cysts may even occur further away from the gastrointestinal tract, not necessarily having contact with it. I present a patient case, in which a 13-month-old child was brought to the emergency room due to gradually increasing dyspnea. The child made a full recovery after the surgical procedure.

  20. [Features of episodes of mental disorders in chronic renal insufficiency (clinico-morphologic study)].

    Science.gov (United States)

    Korkina, M V; Tsivil'ko, V S; Tsivil'ko, M A

    1976-01-01

    The authors studied the traits of psychotic attacks in 40 patients with terminal stages of chronic renal insufficiency. They were expressed in atypical delirious, delirio-amentive and amentive conditions. 8 cases were studied morphologically. The pathological process in the brain was characterized as toxico-dyshomeostatic encephalopathy. The pathogenesis of such disorders is discussed.

  1. The predictive value of mild renal insufficiency on the prognosis of patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    张建华

    2014-01-01

    Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome(ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate(eGFR),patients were divided into two groups,normal

  2. Sirolimus conversion efficacy for graft function improvement and histopathology in renal recipients with mild to moderate renal insufficiency.

    Science.gov (United States)

    Joo, Dong Jin; Yang, Chul Woo; Jeong, Hyeon Joo; Lim, Beom Jin; Huh, Kyu Ha; Chung, Byung Ha; Choi, Yeong Jin; Kang, Shin-Wook; Kim, Yu Seun

    2014-08-01

    This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.

  3. Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency

    Science.gov (United States)

    Ye, Ziliang; Lu, Haili; Su, Qiang; Guo, Wenqin; Dai, Weiran; Li, Hongqing; Yang, Huafeng; Li, Lang

    2017-01-01

    of Scr after operation, including Scr of postoperative 24 hours (standardized mean difference [SMD] −0.30, 95% CI −0.51, −0.09, P = 0.005), Scr of postoperative 48 hours (SMD −0.66, 95% CI −1.23, −0.10, P = 0.022), and Scr of postoperative 7 days (SMD −0.74, 95% CI −1.36, −0.11, P = 0.021). However, the Scr of postoperative 72 hours between TMZ group and control group has no statistical significance (P = 0.362). Conclusion: Our study showed that when comparing with conventional hydration, TMZ can significantly reduce the incidence of CIN and the level of postoperative Scr. Therefore, we could suggest that TMZ was superior to conventional hydration for the treatment of CIN in patients with renal insufficiency. However, due to the restriction of quality and number of included articles, it still needs to carry out multicenter, randomized, double-blind clinical trials to confirm this conclusion in the future. PMID:28248861

  4. [Assessment and characteristics of chronic renal insufficiency in France].

    Science.gov (United States)

    Bongard, V; Dallongeville, J; Arveiler, D; Ruidavets, J-B; Cottel, D; Wagner, A; Ferrières, J

    2012-08-01

    Chronic kidney disease (CKD) is a major public health issue. In France, few studies have evaluated CKD prevalence. The objective of the MONA LISA study was to estimate and to characterize CKD in three representative cross-sectional surveys in subjects aged 35-74.9 years. CKD was defined as subjects having MDRD glomerular filtration rate lower than 60 mL/min/1.73 m(2). Prevalence of CKD in MONA LISA was standardized according to the French population. A multiple logistic regression analysis was performed in order to find independent factors associated to CKD. The French estimate of CKD prevalence was 8.2% (95% confidence interval: 7.4-8.9%), that is 2,454,548 (95% confidence interval: 2,215,080-2,664,082) subjects aged 35-74.9 years. Factors significantly and independently associated to CKD were older age, hypertension and dyslipidemias. In conclusion, the MONA LISA study evaluated for the first time in France CKD prevalence in subjects aged 35-74.9 years. This prevalence probably underestimates the real CKD size due to selection bias present in every representative cross-sectional survey. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  5. Dislocation after Hemiarthroplasty due to Insufficiency Fracture of the Superior Acetabulum: A Case Report

    OpenAIRE

    Masahiko Nozawa; Takashi Nishiura; Katsuhiko Maezawa; Keiji Matsuda; Hidenori Morio

    2009-01-01

    Insufficiency fracture of the superior part of the acetabulum after hemiarthroplasty has not been reported before. Here we report a case of dislocation after hemiarthroplaty due to insufficiency fracture of the acetabulum. In our patient, insufficiency fracture of the ilium immediately above the acetabulum produced obvious evidence of compression and collapse that led to dislocation of the outer head of the femoral component. This patient had subsequently been treated with a cementless socket...

  6. Acute renal failure due to rhabdomyolyisis

    Directory of Open Access Journals (Sweden)

    Nieto-Ríos, John Fredy

    2016-04-01

    Full Text Available Acute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of severe uremia, metabolic acidosis, hiperkalemia or fluid overload it is necessary to start renal replacement therapy. As a rule, kidney function is completely recovered, but these patients have higher risk of future chronic kidney disease.

  7. Dislocation after Hemiarthroplasty due to Insufficiency Fracture of the Superior Acetabulum: A Case Report

    Directory of Open Access Journals (Sweden)

    Masahiko Nozawa

    2009-01-01

    Full Text Available Insufficiency fracture of the superior part of the acetabulum after hemiarthroplasty has not been reported before. Here we report a case of dislocation after hemiarthroplaty due to insufficiency fracture of the acetabulum. In our patient, insufficiency fracture of the ilium immediately above the acetabulum produced obvious evidence of compression and collapse that led to dislocation of the outer head of the femoral component. This patient had subsequently been treated with a cementless socket inserted into the fractured acetabulum. We should remember the possibility of insufficiency fracture of the superior acetabulum after hemiarthroplasty, particularly in elderly patients suffering from chronic postoperative pain and disability.

  8. The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency.

    Science.gov (United States)

    Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng

    2016-01-01

    The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

  9. The effect of bacterial lipopolysaccharide on gastric emptying in rats suffering from moderate renal insufficiency

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    Rigatto S.Z.P.

    1998-01-01

    Full Text Available The objective of the present study was to evaluate the response of rats suffering from moderate renal insufficiency to bacterial lipopolysaccharide (LPS, or endotoxin. The study involved 48 eight-week-old male SPF Wistar rats (175-220 g divided into two groups of 24 animals each. One group underwent 5/6 nephrectomy while the other was sham-operated. Two weeks after surgery, the animals were further divided into two subgroups of 12 animals each and were fasted for 20 h but with access to water ad libitum. One nephrectomized and one sham-treated subgroup received E. coli LPS (25 µg/kg, iv while the other received a sterile, pyrogen-free saline solution. Gastric retention (GR was determined 10 min after the orogastric infusion of a standard saline test meal labeled with phenol red (6 mg/dl. The gastric emptying of the saline test meal was studied after 2 h. Renal function was evaluated by measuring the plasma levels of urea and creatinine. The levels of urea and creatinine in 5/6 nephrectomized animals were two-fold higher than those observed in the sham-operated rats. Although renal insufficiency did not change gastric emptying (median %GR = 26.6 for the nephrectomized subgroup and 29.3 for the sham subgroup, LPS significantly retarded the gastric emptying of the sham and nephretomized groups (median %GR = 42.0 and 61.0, respectively, and was significantly greater (P<0.01 in the nephrectomized rats. We conclude that gastric emptying in animals suffering from moderate renal insufficiency is more sensitive to the action of LPS than in sham animals

  10. Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

    Science.gov (United States)

    El-Menyar, Ayman A.; Al Suwaidi, Jassim; Holmes, David R.

    2010-01-01

    Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of RI on the pathogenesis of coronary artery disease and outcomes after percutaneous coronary intervention in the form of drug-eluting stent (DES) implantation in these high-risk patients. We searched the English-language literature indexed in MEDLINE, Scopus, and EBSCO Host research databases from 1990 through January 2009, using as search terms coronary revascularization, drug-eluting stent, and renal insufficiency. Studies that assessed DES implantation in patients with various degrees of RI were selected for review. Most of the available data were extracted from observational studies, and data from randomized trials formed the basis of a post hoc analysis. The outcomes after coronary revascularization were less favorable in patients with RI than in those with normal renal function. In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease. PMID:20118392

  11. Congestive heart failure and converting enzyme inhibition: failure of current prognostic criteria for predicting subsequent renal insufficiency.

    OpenAIRE

    1991-01-01

    Angiotensin-1-converting enzyme inhibitors have an effective and established role in the treatment of patients with congestive heart failure. However, a small number of such patients will subsequently develop renal insufficiency. These patients may be identified prior to, or shortly after, commencement of therapy by recognized criteria. This report describes 4 patients with congestive heart failure who developed severe renal insufficiency secondary to either enalapril or captopril therapy in ...

  12. Renal injury due to hepatic hydatid disease.

    Science.gov (United States)

    Altay, Mustafa; Unverdi, Selman; Altay, Fatma Aybala; Ceri, Mevlüt; Akay, Hatice; Ozer, Hüseyin; Kiraç, Halil; Denizli, Nazim; Yilmaz, Bilal; Güvence, Necmettin; Duranay, Murat

    2010-08-01

    Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease. Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining. Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%). Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.

  13. Use of sofosbuvir-based direct-acting antiviral therapy for hepatitis C viral infection in patients with severe renal insufficiency.

    Science.gov (United States)

    Hundemer, Gregory L; Sise, Meghan E; Wisocky, Jessica; Ufere, Nneka; Friedman, Lawrence S; Corey, Kathleen E; Chung, Raymond T

    2015-01-01

    Sofosbuvir-based direct-acting antiviral therapy revolutionized the treatment of hepatitis C virus (HCV) infection. However, sofosbuvir use is not approved for patients with severe renal insufficiency (estimated glomerular filtration (eGFR) rate below 30 ml/min) or end-stage renal disease (ESRD) based on concerns raised during premarket animal testing over hepatobiliary and cardiovascular toxicity in this population. We report the first published data on use of sofosbuvir-based regimens in patients with severe renal insufficiency and ESRD, focusing on clinical efficacy and safety. Six patients were treated with full dose sofosbuvir; three received sofosbuvir and simeprevir, two received sofosbuvir and ribavirin, and one received sofosbuvir, ribavirin, and interferon. Three of the patients had cirrhosis. On-treatment viral suppression was 100% and sustained virological response (SVR) rate at 12 weeks was 67%. One patient had to discontinue antiviral therapy early due to side effects. No hepatobiliary or cardiovascular toxicity was reported.

  14. Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement: A Propensity Score Matching Analysis

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Chen, Yung-Chang; Lee, Hsiu-An; Chen, Shao-Wei; Liu, Kuo-Sheng; Lin, Pyng-Jing

    2016-01-01

    Abstract Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency. From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group. Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P 72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05). Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or

  15. Retinopathy and Chronic Kidney Disease in the Chronic Renal Insufficiency Cohort Study (CRIC)

    Science.gov (United States)

    Grunwald, Juan E.; Alexander, Judith; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker, Candace; McWilliams, Kathleen; Lo, Joan C.; Go, Alan; Townsend, Raymond; Gadegbeku, Crystal A.; Lash, James P.; Fink, Jeffrey C.; Rahman, Mahboob; Feldman, Harold; Kusek, John W.; Xie, Dawei; Jaar, Bernard G.

    2013-01-01

    Objectives Retinal vascular and anatomic abnormalities caused by diabetes, hypertension, and other conditions can be observed directly in the ocular fundus and may reflect severity of chronic renal insufficiency. The purpose of this study was to investigate the association between retinopathy and chronic kidney disease (CKD). Methods In this observational, cross-sectional study, 2605 participants of the Chronic Renal Insufficiency Cohort (CRIC) study, a multi-center study of CKD, were offered participation. Non-mydriatic fundus photographs of the disc and macula in both eyes were obtained in 1936 of these subjects. Photographs were reviewed in a masked fashion at a central photograph reading center using standard protocols. Presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed by trained graders and a retinal specialist using protocols developed for large epidemiologic studies. Kidney function measurements and information on traditional and non-traditional risk factors for decreased kidney function were obtained from the CRIC study. Results Greater severity of retinopathy was associated with lower estimated glomerular filtration rate (eGFR) after adjustment for traditional and non-traditional risk factors. Presence of vascular abnormalities usually associated with hypertension was also associated with lower eGFR. We found no strong direct relationship between eGFR and average arteriolar or venular calibers. Conclusions Our findings show a strong association between severity of retinopathy and its features and level of kidney function after adjustment for traditional and non-traditional risk factors for CKD, suggesting that retinovascular pathology reflects renal disease. PMID:22965589

  16. Renal infarction due to lupus vasculopathy.

    Science.gov (United States)

    Varalaxmi, B; Sandeep, P; Sridhar, A V S S N; Raveendra, P; Kishore, C Krishna; Ram, R; Kumar, V Siva

    2015-08-01

    In the ISN/RPS 2003 classification of lupus nephritis (LN) renal vascular lesions are not mentioned. We present a patient with postpartum lupus vasculopathy. The renal biopsy in our patient showed concentric intimal thickening with narrowed lumen. No inflammatory changes were found. It also revealed immunoglobulin and complement deposition on the wall of the arteriole. These changes indicate lupus vasculopathy. The glomeruli revealed diffuse proliferative glomerulonephritis, with wire loops and cellular crescent in one glomerulus. The patient showed improvement with immunosuppression.

  17. [A case of cryptococcal meningitis with nephrotic syndrome and renal insufficiency under immunosuppressive therapy].

    Science.gov (United States)

    Tsuchida, Hiroki; Ichikawa, Daisuke; Shima, Yoshinori; Yasuda, Takashi; Sato, Takeo; Kimura, Kenjiro

    2007-01-01

    A 76 year-old woman was admitted to our hospital because of pyrexia and fatigue. One year earlier, she was diagnosed as nephrotic syndrome(NS) caused by focal segmental glomerulosclerosis and immunosuppressive therapy was started with marked amelioration of proteinuria. Thereafter, her renal function worsened, but only supportive treatment was continued. After admission, a cerebrospinal fluid (CSF) examination revealed Cryptococcus neoformans (C. neoformans) by india ink staining and a subsequent CSF culture confirmed C. neoformans infection. Accordingly, we made the diagnosis of cryptococcal meningitis and immediately started multiple anti fungal drugs with dosage modification according to her impaired renal function. Immunosuppressive therapy for NS was temporarily terminated. The inflammatory signs and symptoms soon were markedly improved, but the anti cryptococcal antibody titer in the serum and CSF remained high. Immunosuppressive therapy was started again at a low dosage because urinary protein had increased again. One hundred and eight days from admission, she was discharged with a regimen of multiple anti fungal drugs. Proteinuria and renal insufficiency was almost stable during hospitalization. Most fungal infection develops in patients in an immunosuppressive state induced by immunosuppressive drugs, HIV infection and so on. Patients with NS are frequently in an immunosuppressive state because of urinary loss of immunoglobulins and the use of immunosuppressive drugs. Therefore, it should be remembered that patients with NS are at a high risk of suffering from fungal infection.

  18. [Respiratory and renal insufficiency as risk factors of surgical treatment of patients with aortic aneurysm of the infrarenal segment].

    Science.gov (United States)

    Iaitskiĭ, N A; Bedrov, A Ia; Martynenko, G I; Vrabiĭ, A A; Moiseev, A A

    2013-01-01

    Retrospective analysis of data in 188 patients showed, that chronic nonspecific pulmonary disease was diagnosed in 65.4% of all. Disorders of bronchial patency of different degrees of manifestation were noted in 61.2% and 19.7% of patients had a hypoxemia. Renal diseases were found in 59% of patients, resulting in the development of chronic renal insufficiency in 17%. The data obtained indicate, that the presence of coexisting pulmonary pathology directly influences the frequency and severity of respiratory complications after surgery, which can be the cause of fatal outcome. The presence of renal diseases results in three times higher risk of the development of postoperative renal complications.

  19. Renal infarct: a rare disease due to a rare etiology

    Science.gov (United States)

    Akshintala, Divya; Bansal, Saurabh K.; Emani, Vamsi Krishna; Yadav, Manajyoti

    2015-01-01

    Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan. PMID:26091657

  20. Renal infarct: a rare disease due to a rare etiology

    Directory of Open Access Journals (Sweden)

    Divya Akshintala

    2015-06-01

    Full Text Available Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan.

  1. Renal Osteodystrophy

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    Aynur Metin Terzibaşoğlu

    2004-12-01

    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  2. Coronary stenting does not improve the long-term cardiovascular outcome of patients with mild to moderate renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    XIE Di; HOU Yu-qing; HOU Fan-fan; ZHANG Wei-ru; LI Yong; GUO Zhi-gang; GUO Zhi-jian; ZHANG Xun

    2009-01-01

    Background Several studies have shown that coronary stenting reduces the frequency of clinical and angiographic restenosis in patients with mild to moderate renal insufficiency. However, less is known about the long-term benefits of stent use in this population. This study was aimed to determine the impact of coronary stenting on extended (5 years) long-term outcomes of patients with chronic renal insufficiency. Methods The study included 602 consecutive patients who underwent successful percutaneous coronary intervention with stenting. Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml·min-1·1.73 m-2. The major adverse cardiac events were compared for patients with (n=160) and without (n=442) renal insufficiency. Results After the third year of follow-up, nonfatal myocardial infarction and revascularization rates were significantly increased in patients with renal insufficiency compared with those without renal dysfunction (16.9% vs 7.7%, P=0.001; 29.4% vs 15.8%, P <0.001). In patients who had recurrent cardiovascular events, a significantly higher rate of de novo stenosis revascularization was found in patients with renal insufficiency than without renal insufficiency (57.7% vs 22.7%, P <0.001), while there was no significant difference in target lesion revascularization between the groups (51.9% vs 43.6%, P=0.323). Multivariate analysis demonstrated an independent impact of the presence of renal insufficiency on the major adverse cardiac events (hazard ratio: 1.488, 95% confidence interval: 1.051-2.106, P=0.025) and de novo stenosis (hazard ratio: 5.505, 95% confidence interval: 2.151-14.090, P <0.001 ). Conclusions The late major adverse cardiac events, after successful coronary stenting, is increased in patients with an estimated glomerular filtration rate <60 ml·min-1·1.73 m2. This might be associated with increased risk of de novo stenosis in this population.

  3. Predictors of ertapenem therapeutic efficacy in the treatment of urinary tract infections (UTIs) in hospitalized adults: the importance of renal insufficiency and urinary pH.

    Science.gov (United States)

    Cunha, B A; Giuga, J; Gerson, S

    2016-04-01

    In hospitalized adults acute uncomplicated cystitis (AUC) and catheter associated bacteriuria (CAB) may be treated with oral antibiotics. With AUC or CAB due to extended spectrum ß-lactamase (ESBL) + Gram negative bacilli (GNB) physicians often use intravenous therapy, e.g., ertapenem. We reviewed our recent experience in hospitalized adults with AUC and CAB treated with ertapenem. Therapeutic efficacy of ertapenem was assessed by decreased pyuria/bacteriuria, and elimination of the uropathogen. The effectiveness of ertapenem in the presence of renal insufficiency (CrCl 3 days) in patients with decreased renal function and alkaline urinary pH. We reviewed 45 hospitalized adults with AUC or CAB to determine if renal insufficiency and or alkaline urinary pH affected ertapenem efficacy. In the 33 adult hospitalized patients with AUC and 12 with CAB, we found that ertapenem was consistently effective in eliminating the GNB bacteriuria. In hospitalized adults, the presence of renal insufficiency and acid urine, bacteriuria was eliminated in  3 days which has not been previously reported.

  4. A rare case of acute renal infarction due to idiopathic renal arterial thrombosis

    Institute of Scientific and Technical Information of China (English)

    FU Zhi-fang; ZHANG Zhi-gang; LIU Xin-min

    2008-01-01

    @@ Because of the lack of specific clinical signs and symptoms,acute renal infarction is apt to be missed in diagnosis and hence has a"low"incidence.In this report,a case of acute renal infarction due to idiopathic renal arterial thrombosis is presented.

  5. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial

    OpenAIRE

    Sahmeddini, M. A.; Janatmakan, F.; Khosravi, M. B.; Ghaffaripour, S.; Eghbal, M. H.; Nickeghbalian, S.; Malek-Hosseini, S. A.

    2014-01-01

    Background: Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. Objective: To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. Methods: In this randomized clinical study, 67 adult patients with en...

  6. Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

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    Murakami, Ryusuke, E-mail: rywakana@nms.ac.jp; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

    2013-10-01

    Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

  7. The predictive role of histopathological findings in renal insufficiency and complete remission in Iranian adults with primary focal segmental glomerulosclerosis

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    Diana Taheri

    2010-01-01

    Full Text Available Objectives: to identify the histopathological findings that may act as possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis (FSGS. Methods: In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patient’s identities or outcomes. We divided the patients based on their histopathological findings, and compared the outcomes (renal insufficiency and complete remission among these groups. Results: There were significant differences in the complete remission in subject with and without mesangial hypercellularity (p<0.05, and in patients with and without hyalinosis (p<0.05. According to the cut off points based on ROC curve analysis for the quantitative data, there was significant difference in renal insufficiency between the patients with and without global scars more than 12% (p<0.05.Also multiple logistic regression analysis strongly suggest the association of mesangial hypercellularity and global scar with no complete remission and progression to renal insufficiency, respectively. Conclusion: In the studied patients, presence of mesangial hypercellularity and hyalinosis have been suggested as prognostic factors for lower remission rate. According to multivariate analysis, only the presence of mesangial hypercellularity and global scar were found as independent prognostic predictors to lower complete remission rate and progression to renal insufficiency in patients with FSGS, respectively.

  8. The relationship of H-type hypertension and renal insufficiency in coronary heart disease patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    郑卫峰

    2014-01-01

    Objective To discuss the relationship between Htype hypertension and renal insufficiency in patients with coronary atherosclerotic heart disease(CHD)and chronic heart failure(CHF).Methods 100 CHD patients with both hypertension and CHF were chosen in our hospital from January 2011 to July 2013.Left ventricular ejection fraction(LVEF)was measured with echocardiography and estimated glomerular filtration rate(e GFR)was calculated with the simplified modification of diet in renal

  9. Chronic renal insufficiency among Asian Indians with type 2 diabetes: I. Role of RAAS gene polymorphisms

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    Chandra T Satish

    2006-05-01

    Full Text Available Abstract Background Renal failure in diabetes is mediated by multiple pathways. Experimental and clinical evidences suggest that renin-angiotensin-aldosterone system (RAAS has a crucial role in diabetic kidney disease. A relationship between the RAAS genotypes and chronic renal insufficiency (CRI among type 2 diabetes subjects has therefore been speculated. We investigated the contribution of selected RAAS gene polymorphisms to CRI among type 2 diabetic Asian Indian subjects. Methods Twelve single nucleotide polymorphisms (SNPs from six genes namely-renin (REN, angiotensinogen (ATG, angiotensin converting enzyme I (ACE, angiotensin II type 1 receptor (AT1 and aldosterone synthase (CYP11B2 gene from the RAAS pathway and one from chymase pathway were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP method and tested for their association with diabetic CRI using a case-control approach. Successive cases presenting to study centres with type 2 diabetes of ≥2 years duration and moderate CRI diagnosed by serum creatinine ≥3 mg/dl after exclusion of non-diabetic causes of CRI (n = 196 were compared with diabetes subjects with no evidence of renal disease (n = 225. Logistic regression analysis was carried out to correlate various clinical parameters with genotypes, and to study pair wise interactions between SNPs of different genes. Results Of the 12 SNPs genotyped, Glu53Stop in AGT and A>T (-777 in AT1 genes, were monomorphic and not included for further analysis. We observed a highly significant association of Met235Thr SNP in angiotensinogen gene with CRI (O.R. 2.68, 95%CI: 2.01–3.57 for Thr allele, O.R. 2.94, 95%CI: 1.88–4.59 for Thr/Thr genotype and O.R. 2.68, 95%CI: 1.97–3.64 for ACC haplotype. A significant allelic and genotypic association of T>C (-344 SNP in aldosterone synthase gene (O.R. 1.57, 95%CI: 1.16–2.14 and O.R. 1.81, 95%CI: 1.21–2.71 respectively, and genotypic association of

  10. NSAID nephrotoxicity revisited: acute renal failure due to parenteral ketorolac.

    Science.gov (United States)

    Perazella, M A; Buller, G K

    1993-12-01

    The success of ketorolac as a nonnarcotic analgesic is likely to propagate its widespread use to control moderate to severe postoperative pain. Indeed, of the patients treated with ketorolac and described in the medical literature, nearly 90% had had a major surgical procedure. Since any such procedure may be associated with significant third-spacing of the fluid and result in renal hypoperfusion, care must be taken in administering ketorolac. Close attention to urine output and parameters of renal function must be maintained. Moreover, postoperative ketorolac therapy should be avoided in patients who have conditions that predispose to NSAID nephrotoxicity (as in our Case 1). Likewise, in nonsurgical patients the same degree of caution should be used with ketorolac as with any oral NSAID. Finally, since ketorolac is excreted almost entirely by the kidney, either elderly patients or patients with underlying renal insufficiency must have an adjustment of the dosing interval, or this medication should be avoided in such patients altogether.

  11. Genome-Wide Association of CKD Progression: The Chronic Renal Insufficiency Cohort Study.

    Science.gov (United States)

    Parsa, Afshin; Kanetsky, Peter A; Xiao, Rui; Gupta, Jayanta; Mitra, Nandita; Limou, Sophie; Xie, Dawei; Xu, Huichun; Anderson, Amanda Hyre; Ojo, Akinlolu; Kusek, John W; Lora, Claudia M; Hamm, L Lee; He, Jiang; Sandholm, Niina; Jeff, Janina; Raj, Dominic E; Böger, Carsten A; Bottinger, Erwin; Salimi, Shabnam; Parekh, Rulan S; Adler, Sharon G; Langefeld, Carl D; Bowden, Donald W; Groop, Per-Henrik; Forsblom, Carol; Freedman, Barry I; Lipkowitz, Michael; Fox, Caroline S; Winkler, Cheryl A; Feldman, Harold I

    2017-03-01

    The rate of decline of renal function varies significantly among individuals with CKD. To understand better the contribution of genetics to CKD progression, we performed a genome-wide association study among participants in the Chronic Renal Insufficiency Cohort Study. Our outcome of interest was CKD progression measured as change in eGFR over time among 1331 blacks and 1476 whites with CKD. We stratified all analyses by race and subsequently, diabetes status. Single-nucleotide polymorphisms (SNPs) that surpassed a significance threshold of P<1×10(-6) for association with eGFR slope were selected as candidates for follow-up and secondarily tested for association with proteinuria and time to ESRD. We identified 12 such SNPs among black patients and six such SNPs among white patients. We were able to conduct follow-up analyses of three candidate SNPs in similar (replication) cohorts and eight candidate SNPs in phenotype-related (validation) cohorts. Among blacks without diabetes, rs653747 in LINC00923 replicated in the African American Study of Kidney Disease and Hypertension cohort (discovery P=5.42×10(-7); replication P=0.039; combined P=7.42×10(-9)). This SNP also associated with ESRD (hazard ratio, 2.0 (95% confidence interval, 1.5 to 2.7); P=4.90×10(-6)). Similarly, rs931891 in LINC00923 associated with eGFR decline (P=1.44×10(-4)) in white patients without diabetes. In summary, SNPs in LINC00923, an RNA gene expressed in the kidney, significantly associated with CKD progression in individuals with nondiabetic CKD. However, the lack of equivalent cohorts hampered replication for most discovery loci. Further replication of our findings in comparable study populations is warranted.

  12. Post-renal acute renal failure due to a huge bladder stone.

    Science.gov (United States)

    Celik, Orcun; Suelozgen, Tufan; Budak, Salih; Ilbey, Yusuf Ozlem

    2014-06-30

    A 63-year old male was referred to our emergency unit due to acute renal failure. The level of serum renal function tests levels, blood urea nitrogen (BUN)/creatinine, were 63 mmol/L/848 μmol/L. CT (Computarised Tomography) scan showed a huge bladder stone (5 cm x 6 cm x 5 cm) with increased bladder wall thickness. Post-renal acute renal failure due to bilateral ureterohydronephrosis was diagnosed. The huge bladder stone was considered to be the cause of ureterohydronephrosis and renal failure. The patient was catheterised and received haemodialysis immediately. He received haemodialysis four times during ten days of hospitalization and the level of serum renal function tests levels (BUN/ creatinine) decreased 18 mmol/L/123 μmol/L. After improvement of renal function, we performed cystoscopy that demonstrated normal prostatic urethra and bladder neck and bilaterally normal ureteral orifices. Bladder wall was roughly trabeculated and Bladder outlet was completely obstructed by a huge bladder stone. After cystoscopy open, cystolithotomy was performed to remove calcium phosphate and magnesium ammonium phosphate stone weighing 200 g removed. Four days after operation the patient was discharged uneventfully and urethral catheter was removed on the seventh day. Post-renal acute renal failure due to large bladder stones is rare in literature. According to the our knowledge; early diagnosis of the stone avoid growth to large size and prevent renal failure.

  13. Fournier's gangrene (necrotising fasciitis) complicated by renal and respiratory insufficiency: a case report.

    Science.gov (United States)

    Frisman, E; Rácz, O; Beck, J; Firment, J; Bodnárová, L

    2016-01-01

    A case report of a 68-year-old male obese diabetic patient with an abscess of left femoral region, and diffuse inflammation of abdominal wall and genital region developing sepsis, respiratory and renal failure. At admission in the regional hospital a diagnosis of polymicrobial necrotising fasciitis with suspected sepsis was declared. The patient was transferred to the special intensive care unit (SICU) of Burns and reconstructive surgery at the Kosice-Saca. The patient was treated surgically, with hyperbaric oxygen and pharmacologically to control his diabetes. The main aetiological agent of the condition was identified as Stenotrophomonas maltophilia. In addition to respiratory and metabolic acidosis and gastric bleeding occurred. Due to acute renal failure (day 38) the patient was transferred to clinic of anaesthesiology and the intensive care medicine at the University Hospital in Kosice. The patient was treated by continuous veno-venous haemodialysis, mechanical ventilation and nasogastric nutritional support. On day 48 the conscious sub-febrile patient with healed wounds was transferred back to the regional hospital with ventilation support and continuous renal replacement therapy. His diabetes was uncontrolled, and only kidney parameters remained pathological. The survival of this patient with an extremely poor prognosis was achieved through prompt transfer to a specialised centre, early identification of the aetiological agent and immediate appropriate antibiotic treatment as a result of good cooperation between surgeons and laboratory specialists.

  14. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data.

    Science.gov (United States)

    Damman, Kevin; Tang, W H Wilson; Felker, G Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J V

    2014-03-11

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients with (severe) renal dysfunction. The benefit of these evidence-based therapies in this high-risk patient group is largely unknown. This paper reviews data from randomized clinical trials in systolic heart failure and the interactions between baseline renal dysfunction and the effect of randomized treatment. It highlights that most evidence-based therapies show consistent outcome benefit in patients with moderate renal insufficiency (stage 3 CKD), whereas there are very scarce data on patients with severe (stage 4 to 5 CKD) renal insufficiency. If any, the outcome benefit might be even greater in stage 3 CKD compared with those with relatively preserved renal function. However, prescription of therapies should be individualized with consideration of possible harm and benefit, especially in those with stage 4 to 5 CKD where limited data are available.

  15. Diabetes Insipidus and Anterior Pituitary Insufficiency Due to Breast Cancer Metastasis

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    Ayşe Arduç

    2016-03-01

    Full Text Available Metastases from breast cancer to the pituitary gland are uncommon. We present a 35-year-old woman with diabetes insipidus and anterior pituitary insufficiency resulting from breast cancer metastases to the pituitary gland. The patient presented with reduced consciousness, fatigue, polyuria, and polydipsia. Hypernatremia (sodium: 154 mmol/L, hypostenuria (urine density: 1001, and hypopituitarism were present on laboratory evaluation. Magnetic resonance imaging (MRI revealed heterogeneous pituitary gland, thickened pituitary stalk (8mm, and loss of normal hyperintense signal of the posterior pituitary. Based on the clinical, laboratory, and MRI findings, the patient was diagnosed with diabetes insipidus and anterior pituitary insufficiency due to pituitary metastases from breast cancer. She received desmopressin, L-thyroxine, and prednisolone, which resulted in improvement of her symptoms and laboratory results. The patient, who also received Gamma Knife radiosurgery and chemotherapy, died six months later due to disseminated metastases. Although pituitary metastasis is rare, it should be kept in mind in patients with breast cancer since early detection and treatment can improve symptoms of patients.

  16. Efficacy and Toxicity of Mammalian Target Rapamycin Inhibitors in Patients with Metastatic Renal Cell Carcinoma with Renal Insufficiency: The Korean Cancer Study Group GU 14-08

    Science.gov (United States)

    Kim, Ki Hyang; Kim, Joo Hoon; Lee, Ji Young; Kim, Hyo Song; Heo, Su Jin; Kim, Ji Hyung; Kim, Ho Young; Rha, Sun Young

    2016-01-01

    Purpose We evaluated the efficacy and toxicity of mammalian target rapamycin inhibitors in Korean patients with metastatic renal cell carcinoma (mRCC) with chronic renal insufficiency not requiring dialysis. Materials and Methods Korean patients with mRCC and chronic renal insufficiency not requiring dialysis treated with everolimus or temsirolimus between January 2008 and December 2014 were included. Patient characteristics, clinical outcomes, and toxicities were evaluated. Overall survival (OS) and progression-free survival (PFS) durations were evaluated according to the degree of renal impairment. Results Eighteen patients were considered eligible for the study (median age, 59 years). The median glomerular filtration rate was 51.5 mL/min/1.73 m2. The best response was partial response in six patients and stable disease in 11 patients. The median PFS and OS durations were 8 months (95% confidence interval [CI], 0 to 20.4) and 32 months (95% CI, 27.5 to 36.5), respectively. The most common non-hematologic and grade 3/4 adverse events included stomatitis, fatigue, flu-like symptoms, and anorexia as well as elevated creatinine level. Conclusion Mammalian target rapamycin inhibitors were efficacious and did not increase toxicity in Korean patients with mRCC and chronic renal insufficiency not requiring dialysis. PMID:26875195

  17. Renal uptake of /sup 67/Ga-citrate in renal amyloidosis due to Familiar Mediterranean Fever

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    Banzo-Marraco, J.; Abos-Olivares, M.D.; Iribar-Ibabe, M.C.; Prats-Rivera, E.; Banzo-Marraco, J.I.; Teijeiro-Vidal, J.; Nerin-Mora, E.; Nerin de la Puerta, I.

    1981-06-01

    Renal uptake of /sup 67/Ga-citrate is described in a patient with biopsy-proven amyloidosis of the kidneys, due to Familiar Mediterranean Fever. After administration 150 MBq (4mCi) /sup 67/Ga-citrate, scans were done at 48, 72, and 120 h. Intense uptake was noted in both kidneys. A renal biopsy done 5 days after the /sup 67/Ga-citrate scan revealed a pattern typical of amyloidosis. Gallium scanning can be useful in patients with fever of unknown origin. Renal amyloidosis can be considered when renal uptake of /sup 67/Ga-citrate associated with nephrotic syndrome is observed.

  18. NSS for an RCC in a patient with renal insufficiency after heart transplant because of right ventricular tumor.

    Science.gov (United States)

    Prokopowicz, Grzegorz; Zyczkowski, Marcin; Nowakowski, Krzysztof; Bryniarski, Piotr; Paradysz, Andrzej

    2013-01-01

    The effect of the immunosuppressive therapy on the development of neoplasms has become the object of an ever increasing interest for clinicians all over the world. The literature on neoplasms development in the course of therapy following transplants has confirmed a considerable increase in the incidence of neoplasms of the skin and lymph nodes. Organ neoplasms developing in patients after transplants are characterized by increased progression, poor cellular diversification and a more unfavorable prognosis than in the general population The aim of the study is to present the case of a nephron-sparing surgery of a renal tumor (NSS) without any intraoperative ischaemia in a 55-year-old female patient with an orthotopic heart transplant and renal insufficiency following a prolonged immune suppression. It is estimated that the patients at the highest risk of neoplasm development are those in the first months after transplant, especially heart transplant. They require maximum doses of immunosuppressive drugs. In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle. The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

  19. Towards a rational screening strategy for albuminuria: results from the unreferred renal insufficiency trial.

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    Arjan van der Tol

    Full Text Available BACKGROUND: There remains debate about the screening strategies for albuminuria. This study evaluated whether a screening strategy in an apparently healthy population based on basic clinical and biochemical parameters could be more effective than a strategy where screening for albuminuria is performed unselectively. METHODOLOGY/PRINCIPAL FINDINGS: The Unreferred Renal Insufficiency (URI Study is a cross-sectional study on the prevalence of metabolic risk factors in Belgian workers, volunteering to be screened during a routine yearly occupational check-up. Subjects (n = 295 with treated hypertension, known diabetes, treated dyslipidaemia, cardiovascular and renal disease were excluded. Among 1,191 apparently healthy subjects, 23% had unknown hypertension, 13% had impaired glucose tolerance, 15.4% had normoalbuminuria, 4.2% had microalbuminuria and 0.4% had macroalbuminuria. Subjects with resting heart rate ≥85 bpm, plasma glucose ≥5.6 mmol/L and blood pressure ≥140/90 mmHg were associated with albuminuria of any degree. A strategy where only subjects with at least one of these risk factors (n = 431 were screened for albuminuria, would identify all subjects with macroalbuminuria (5/5, 64% of those with microalbuminuria (32/50, and less than half of those with normoalbuminuria (81/183. An alternative strategy whereby subjects were first screened for presence of albuminuria, and additional cardiovascular risk factors were only measured in subjects positive for albuminuria (n = 238, would identify only 27% (118/431 of the subjects with additional and potentially modifiable cardiovascular risk factors. On the other hand, half of the subjects in this study with albuminuria (120/238, of which 102 had normoalbuminuria, had no additional cardiovascular risk factor at all. CONCLUSIONS: Screening an apparently healthy population directly for albuminuria will result in a high percentage of false positives, mostly measured in the normal

  20. Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort

    Science.gov (United States)

    Isakova, Tamara; Anderson, Cheryl A. M.; Leonard, Mary B.; Xie, Dawei; Gutiérrez, Orlando M.; Rosen, Leigh K.; Theurer, Jacquie; Bellovich, Keith; Steigerwalt, Susan P.; Tang, Ignatius; Anderson, Amanda Hyre; Townsend, Raymond R.; He, Jiang; Feldman, Harold I.; Wolf, Myles

    2011-01-01

    Background. Secondary hyperparathyroidism is a common complication of chronic kidney disease (CKD) that is associated with bone disease, cardiovascular disease and death. Pathophysiological factors that maintain secondary hyperparathyroidism in advanced CKD are well-known, but early mechanisms of the disease that can be targeted for its primary prevention are poorly understood. Diuretics are widely used to control volume status and blood pressure in CKD patients but are also known to have important effects on renal calcium handling, which we hypothesized could alter the risk of secondary hyperparathyroidism. Methods. We examined the relationship of diuretic treatment with urinary calcium excretion, parathyroid hormone (PTH) levels and prevalence of secondary hyperparathyroidism (PTH ≥ 65 pg/mL) in a cross-sectional study of 3616 CKD patients in the Chronic Renal Insufficiency Cohort. Results. Compared with no diuretics, treatment with loop diuretics was independently associated with higher adjusted urinary calcium (55.0 versus 39.6 mg/day; P < 0.001), higher adjusted PTH [67.9, 95% confidence interval (CI) 65.2–70.7 pg/mL, versus 52.8, 95% CI 51.1–54.6 pg/mL, P < 0.001] and greater odds of secondary hyperparathyroidism (odds ratio 2.1; 95% CI 1.7–2.6). Thiazide monotherapy was associated with lower calciuria (25.5 versus 39.6 mg/day; P < 0.001) but only modestly lower PTH levels (50.0, 95% CI 47.8–52.3, versus 520.8, 95% CI 51.1–54.6 pg/mL, P = 0.04) compared with no diuretics. However, coadministration of thiazide and loop diuretics was associated with blunted urinary calcium (30.3 versus 55.0 mg/day; P <0.001) and odds of hyperparathyroidism (odds ratio 1.3 versus 2.1; P for interaction = 0.05) compared with loop diuretics alone. Conclusions. Loop diuretic use was associated with greater calciuria, PTH levels and odds of secondary hyperparathyroidism compared to no treatment. These associations were attenuated in patients who were coadministered

  1. Indispensable but insufficient role of renal D-amino acid oxidase in chiral inversion of NG-nitro-D-arginine.

    Science.gov (United States)

    Xin, Yan-Fei; Li, Xin; Hao, Bin; Gong, Nian; Sun, Wen-Qiang; Konno, Ryuichi; Wang, Yong-Xiang

    2010-06-01

    Unidirectionally chiral inversion of N(G)-nitro-D-arginine (D-NNA) to its L-enantiomer (L-NNA) occurred in rats, and it was blocked markedly (ca. 80%) by renal vascular ligation, and entirely (100%) by the D-amino acid oxidase (DAO) inhibitor sodium benzoate, suggesting that renal DAO is essential for the inversion. However, the doses of sodium benzoate administrated were extremely high (e.g., 400 mg/kg) due to its low potency. It is thus possible that sodium benzoate-mediated blockade of D-NNA inversion might be due to its nonspecific (or non-DAO-related) effects. In addition, after D-NNA was incubated with the pure enzyme of DAO in vitro without tissue homogenates, L-NNA was not produced, even though D-NNA was disposed. We propose that this occurred because D-NNA was first converted to its corresponding alpha-keto acid by DAO and then to L-NNA by transaminase(s); however, there was no direct evidence for this process. The goal of this study is to further elucidate the process of D-NNA chiral inversion both in vivo and in in vitro tissue homogenates by comparing mutant ddY/DAO(-/-) mice that lack DAO activity entirely compared to normal ddY/DAO(+/+) mice and Swiss mice. Furthermore, the ability to produce L-NNA from D-NNA-corresponding alpha-keto acids (N(G)-nitroguanidino-2-oxopentanoic acid) produced by porcine kidney-derived DAO (pkDAO) was also studied in the DAO inhibitor-pretreated rats. We found that D-NNA chiral inversion occurred in Swiss mice and ddY/DAO(+/+) mice both in vivo and in in vitro kidney homogenates, but not in ddY/DAO(-/-) mice, correlated to their DAO activities. The alpha-keto acid (N(G)-nitro-guanidino-2-oxopentanoic acid) from D-NNA was able to produce L-NNA, and subsequent vasoconstriction and pressor responses. These results indicate that the role of renal DAO is indispensible but insufficient for chiral inversion of D-NNA and other neutral and polar D-amino acids, and unidentified aminotransferase(s) are involved in a subsequent

  2. Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants

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    Shin, Su Mi; Chai, Jee Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2016-07-15

    The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants. Among the 257 preterm infants born at <33 weeks of gestation between December 2009 and February 2014 at our institution, 35 preterm infants were diagnosed with AI. Brain ultrasonographic findings were retrospectively analyzed before and after LCD in 14 preterm infants, after exclusion of the other 21 infants with AI due to the following causes: death (n=2), early AI (n=5), sepsis (n=1), and patent ductus arteriosus (n=13). Fourteen of 257 infants (5.4%) were diagnosed with LCD due to AI. The age at LCD was a median of 18.5 days (range, 9 to 32 days). The last ultrasonographic findings before LCD occurred showed grade 1 periventricular echogenicity (PVE) in all 14 patients and germinal matrix hemorrhage (GMH) with focal cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%), grade 1 PVE with newly appearing GMH in three (21%), and increased PVE in three (21%) infants. Five infants (36%) showed new development (n=4) or increased size (n=1) of GMH. Two of three infants (14%) with increased PVE developed cystic periventricular leukomalacia (PVL) and rapid progression to macrocystic encephalomalacia. LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.

  3. Longitudinal femoral shaft due to bone insufficiency. A review of three cases.

    Science.gov (United States)

    Maraval, Anne; Grados, Franck; Royant, Valérie; Damade, Richard; Boulu, Gilles; Fardellone, Patrice

    2003-12-01

    We report three new cases of longitudinal femoral shaft fracture due to bone insufficiency and review the eight cases reported in the literature. The typical patient is a woman older than 65 years of age who present with mechanical pain in the thigh and/or groin. Palpation of the thigh may reproduce the pain. The diagnosis is often made late because the radiographs are normal initially. However, an early and consistent finding is increased radionuclide uptake along the femoral shaft. The fracture line is readily evidenced by computed tomography but may be difficult to see on magnetic resonance imaging. Use of crutches for 6 weeks to protect the bone from weight bearing ensures healing of the fracture.

  4. Unrecognized renal insufficiency and chemotherapy-associated adverse effects among breast cancer patients.

    Science.gov (United States)

    Lotan, Eyal; Leader, Avi; Lishner, Michael; Gottfried, Maya; Pereg, David

    2012-10-01

    Several studies have shown that more than half of cancer patients have unrecognized renal insufficiency (RI), which is a reduced glomerular filtration rate (GFR) with normal serum creatinine. The aim of this study was to determine whether unrecognized RI is associated with an increased risk for chemotherapy-associated adverse effects in breast cancer patients treated with combined doxorubicin and cyclophosphamide treatment. GFR was estimated for 95 breast cancer patients from January 2005 to August 2009 using the Cockcroft-Gault formula. Unrecognized RI was defined as GFR less than 75 ml/min/1.73 m and the patients were grouped according to their estimated GFR. Logistic regression models were used to assess the effect of GFR on clinical outcomes. In total, 49 (52%) patients experienced at least one of the following chemotherapy-associated adverse effects during the course of treatment: an episode of neutropenic fever with hospital admission, a delay in chemotherapy treatment for a medical reason, a need for dose adjustment because of toxicity of the chemotherapeutic drugs, and the need for use of granulocyte colony-stimulating factor. The incidence of these adverse effects occurred more frequently in patients with GFR less than 75 compared with patients with GFR at least 75 (64 vs. 42%, odds ratio 5.29, 95% confidence interval 2.10-13.33) and remained statistically significant after adjustment for age, BMI, and initial doses of chemotherapeutic drugs (odds ratio 3.56, 95% confidence interval 1.08-11.67). Neutropenic fever, dose delay, and dose adjustment as separate outcomes occurred more frequently in the GFR less than 75 group but lost statistical significance after adjustment. Our results demonstrate that unrecognized RI is associated with an increased risk for chemotherapy-associated adverse events in this patient population. Further prospective studies are required to determine whether a dose reduction in patients with unrecognized RI reduces adverse effects

  5. Estimating GFR Among Participants in the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Anderson, Amanda Hyre; Yang, Wei; Hsu, Chi-yuan; Joffe, Marshall M.; Leonard, Mary B.; Xie, Dawei; Chen, Jing; Greene, Tom; Jaar, Bernard G.; Kao, Patricia; Kusek, John W.; Landis, J. Richard; Lash, James P.; Townsend, Raymond R.; Weir, Matthew R.; Feldman, Harold I.

    2012-01-01

    Background Glomerular filtration rate (GFR) is considered the best measure of kidney function, but repeated assessment is not feasible in most research studies. Study Design Cross-sectional study of 1,433 participants from the Chronic Renal Insufficiency Cohort (CRIC) Study (i.e., the GFR subcohort) to derive an internal GFR estimating equation using a split sample approach. Setting & Participants Adults from 7 US metropolitan areas with mild to moderate chronic kidney disease; 48% had diabetes and 37% were black. Index Test CRIC GFR estimating equation Reference Test or Outcome Urinary 125I-iothalamate clearance testing (measured GFR) Other Measurements Laboratory measures including serum creatinine and cystatin C, and anthropometrics Results In the validation dataset, the model that included serum creatinine, serum cystatin C, age, gender, and race was the most parsimonious and similarly predictive of mGFR compared to a model additionally including bioelectrical impedance analysis phase angle, CRIC clinical center, and 24-hour urinary creatinine excretion. Specifically, the root mean square errors for the separate model were 0.207 vs. 0.202, respectively. The performance of the CRIC GFR estimating equation was most accurate among the subgroups of younger participants, men, non-blacks, non-Hispanics, those without diabetes, those with body mass index <30 kg/m2, those with higher 24-hour urine creatinine excretion, those with lower levels of high-sensitivity C-reactive protein, and those with higher mGFR. Limitations Urinary clearance of 125I-iothalamate is an imperfect measure of true GFR; cystatin C is not standardized to certified reference material; lack of external validation; small sample sizes limit analyses of subgroup-specific predictors. Conclusions The CRIC GFR estimating equation predicts measured GFR accurately in the CRIC cohort using serum creatinine and cystatin C, age, gender, and race. Its performance was best among younger and healthier

  6. [Efficacy of continuous ambulatory peritoneal dialysis in treatment of children with end-stage renal insufficiency].

    Science.gov (United States)

    Sahapozova, E; Ruso, B; Kuzmanovska, D; Tasić, V; Ristoska-Bojkoviska, N

    1998-01-01

    Three children (2 girls and 1 boy) with end-stage renal failure were put in program of continuous ambulatory peritoneal dialysis in the period of 2.5 years (January 1995-September 1997). The age of the children at the treatment onset was 5-12 years. One of three children died due to cardiovascular failure after six-month treatment. Two out of three children had a total of 8 episodes of peritonitis in the period of 37 months during the treatment with peritoneal dialysis. The incidence of peritonitis occurrence in our patients was one episode in 4 patients/months. Most frequent cause for peritonitis occurrence was Staphylococcus aureus in 50% of isolated bacteria. Obtained results in peritoneal equilibration test revealed that the transport and ultrafiltration rate of peritoneal membrane decreased after recurrent peritonitis episodes.

  7. Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants

    Directory of Open Access Journals (Sweden)

    Su-Mi Shin

    2016-07-01

    Full Text Available Purpose: The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD due to adrenal insufficiency (AI in preterm infants. Methods: Among the 257 preterm infants born at <33 weeks of gestation between December 2009 and February 2014 at our institution, 35 preterm infants were diagnosed with AI. Brain ultrasonographic findings were retrospectively analyzed before and after LCD in 14 preterm infants, after exclusion of the other 21 infants with AI due to the following causes: death (n=2, early AI (n=5, sepsis (n=1, and patent ductus arteriosus (n=13. Results: Fourteen of 257 infants (5.4% were diagnosed with LCD due to AI. The age at LCD was a median of 18.5 days (range, 9 to 32 days. The last ultrasonographic findings before LCD occurred showed grade 1 periventricular echogenicity (PVE in all 14 patients and germinal matrix hemorrhage (GMH with focal cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%, grade 1 PVE with newly appearing GMH in three (21%, and increased PVE in three (21% infants. Five infants (36% showed new development (n=4 or increased size (n=1 of GMH. Two of three infants (14% with increased PVE developed cystic periventricular leukomalacia (PVL and rapid progression to macrocystic encephalomalacia. Conclusion: LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.

  8. Association of TGFβ1, TNFα, CCR2 and CCR5 gene polymorphisms in type-2 diabetes and renal insufficiency among Asian Indians

    Directory of Open Access Journals (Sweden)

    Gupta Arvind

    2007-04-01

    polymorphisms tested, allele 59029A of CCR5 gene is significantly associated with diabetic renal insufficiency among Asian Indians. Result obtained for 59029G>A SNP of CCR5 gene is in conformity with reports from a Japanese population but due to sub-optimal power of the sample, replication in larger sample set is warranted.

  9. CERTIFY: prophylaxis of venous thromboembolism in patients with severe renal insufficiency.

    Science.gov (United States)

    Bauersachs, R; Schellong, S M; Haas, S; Tebbe, U; Gerlach, H-E; Abletshauser, C; Sieder, C; Melzer, N; Bramlage, P; Riess, H

    2011-06-01

    Patients with severe renal insufficiency (sRI) have been suggested to be at an increased risk of bleeding with low-molecular-weight heparins (LMWH). We aimed at assessing the benefits and risks of certoparin in comparison to unfractionated heparin (UFH) in these patients. In this subgroup analysis of the CERTIFY trial, acutely ill, non-surgical patients ≥70 years received certoparin 3,000U aXa o.d. or UFH 5,000 IU t.i.d. One hundred eighty-nine patients had a glomerular filtration rate (GFR) ≤30 ml/min/1.73 m2, 3,050 patients served as controls. Patients with sRI had a mean age of 85.9 ± 6.6 years (controls 78.4 ± 6.0) and were treated for a mean of 9.3 ± 3.7 days (9.9 ± 4.3). Thromboembolic event rates were comparable (4.55 vs. 4.21%; OR1.08; 95%CI 0.5-2.37) but bleeding was increased in sRI (9.52 vs. 3.54%; OR2.87; 95%CI 1.70-4.83). The incidence of the combined end-point of proximal DVT, symptomatic non-fatal PE and VTE related death was 6.49% with certoparin and 2.60% with UFH (OR2.60; 95%CI 0.49-13.85). There was a decrease in total bleeding with certoparin (OR0.33; 95%CI 0.11-0.97), which was non-significant in patients with GFR >30 ml/min/1.73 m2. In two multivariable regression models certoparin and immobilisation 30 ml/min/1.73 m2). In conclusion, certoparin 3,000U anti Xa o.d. was as efficacious as 5,000 IU UFH t.i.d. in patients with sRI but had a reduced risk of bleeding.

  10. Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort.

    Science.gov (United States)

    Dubin, Ruth F; Deo, Rajat; Bansal, Nisha; Anderson, Amanda H; Yang, Peter; Go, Alan S; Keane, Martin; Townsend, Ray; Porter, Anna; Budoff, Matthew; Malik, Shaista; He, Jiang; Rahman, Mahboob; Wright, Jackson; Cappola, Thomas; Kallem, Radhakrishna; Roy, Jason; Sha, Daohang; Shlipak, Michael G

    2017-01-06

    Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD. We evaluated echocardiograms of 2567 participants without self-reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height(2.7), and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7-7.6) years. Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m(2). During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B-type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death. Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is

  11. Electrocardiogram Feature for Chronic Renal Insufficiency%慢性肾功能不全心电图分析

    Institute of Scientific and Technical Information of China (English)

    付新

    2015-01-01

    目的:探讨慢性肾功能不全患者心电图变化特点。方法回顾性总结186例慢性肾功能不全患者心电图(观察组),并选择同期100例肾功能正常患者(对照组)。结果观察组186例患者,其中144例(77.42%)心电图异常,主要表现为心律失常、ST-T变化及左心室肥大等;对照组仅36例(36.0%)心电图异常。结论慢性肾功能不全患者的异常心电图发生率较高,因此应提高对心电图的重视力度,积极进行防治措施,从而改善患者生存质量。%Objective To study the characteristic of electrocardiogram(ecg)changes in patients with chronic renal insufficiency. Methods We summaried the ecg data in 186 cases of chronic renal insufficiency patients(observation group)retrospectively,and selected the same period 100 patients with normal renal function(control group). Results 144 cases(77.42%)in the observation group was abnormal ecg,the main clinical was arrhythmia,ST-t change and left ventricular hypertrophy,etc,only 36 cases(36.0%)in the control group was abnormal ecg. Conclusion The incidence of abnormal ecg in patients with chronic renal insufficiency is higher,we should increase efforts to the attention of the ecg,positive for prevention and control measures,to improve the patients quality of life.

  12. Efficacious response with low-dose indapamide therapy in the treatment of type II diabetic patients with normal renal function or moderate renal insufficiency and moderate hypertension.

    Science.gov (United States)

    Madkour, Hosameldin; Ali, Kareim; Nosrati, Saeid; Massry, Shaul G

    2002-01-01

    We examined the efficacy of low daily dose (1.25 mg/day) of indapamide in the treatment of high blood pressure in patients with diabetes mellitus with normal renal function and those with moderate renal insufficiency (serum creatinine <1.5 mg/dl). The study was an open label one of four months duration. Twenty-eight patients were enrolled in the study and only 15 completed it. Within 2 weeks of therapy, systolic blood pressure fell from 173 +/- 4.5 to 144 +/- 2.0 mm Hg and diastolic blood pressure from 96 +/- 2.1 to 80 +/- 1.8 mm Hg (p < 0.01) and blood pressure remained at these levels throughout the study. The results show that low dose indapamide is effective in the treatment of moderate hypertension in patients with diabetes mellitus who have normal renal function or moderate renal insufficiency. Therefore, this dose of 1.25 mg/day is recommended for the treatment of such patients.

  13. [Peripheral nerve disease associated with acute renal failure due to bromate poisoning].

    Science.gov (United States)

    Deshimaru, M; Miyagawa, T; Sumiyoshi, S; Nomura, Y

    1976-08-01

    A case of 21 year old male with neuropathy caused by renal insufficiency was present. He had taken bromate (mixed powder of potassium bromate and sodium bromate) for the purpose of suicide and suffered from acute renal insufficiency and hard of hearing. Renal dysfunction improved gradually by peritoneal dialysis and hemodialysis. However, on the 32th day after the onset, burning pain appeared in the bilateral feets. Following this, he began to complain of the disturbances of superficial and deep sensory below the ankle jerks and the weakness of his toes. Considering the clinical features, we supposed that the disturbance of the peripheral nerve was caused by uremia due to taking bromate. N. suralis was biopsied on the 80th day after the onset and examined electron microscopically. Electroscopical findings was as follows. Degeneration of the Schwann cells and irregularity or destruction of the myelin sheaths were observed. The axoplasm of the myelinated nerve fiber were relatively preserved as compared with the changes of the myelin sheaths. In the unmyelinated nerve fibers, cavity formations were observed. The findings of regeneration were not observed. From the electron microscopical findings, we speculate that the changes of the Schwann cells and the myelin sheaths are primary resulting from the disturbance of the metabolism of the Schwann cells. We speculate that anemia and hypoproteinemia caused by bromate disturbed regeneration.

  14. Renal, gastric and thyroidal amyloidosis due to familial Mediterranean fever.

    Science.gov (United States)

    Kavukçu, S; Türkmen, M; Eroğlu, Y; Canda, T; Yörükoğlu, K; Iğci, E; Büyükgebiz, A

    1997-04-01

    Chronic renal failure developed in a 10-year-old girl due to renal amyloidosis secondary to familial Mediterranean fever (FMF). During management of the chronic renal failure by hemodialysis and of FMF with colchicine, goiter and hypothroidism were observed. Thyroid fine-needle aspiration and gastric endoscopical biopsies, performed when recurrent abdominal pain could not be controlled, revealed amyloid deposits in both thyroid and gastric tissues. After 6 months' therapy with colchicine and levothyroxine, there was no significant change in the thyroid volume. This is the first case in which gastric amyloidosis secondary to FMF in childhood has been demonstrated. Patients with amyloidosis secondary to FMF who have thyroid enlargement and unexplained gastrointestinal symptoms despite adequate therapy should be evaluated with imaging studies and biopsy examinations.

  15. Indapamide is superior to thiazide in the preservation of renal function in patients with renal insufficiency and systemic hypertension.

    Science.gov (United States)

    Madkour, H; Gadallah, M; Riveline, B; Plante, G E; Massry, S G

    1996-02-22

    The long-term effects of indapamide or hydrochlorothiazide on blood presssure and renal function were examined in patents with impaired renal function and moderate hypertension. Both drugs controlled hypertension and blood pressure remained normal during the 2 years of the study. Despite this comparable control of hypertension, indapamide therapy was associated with a 28.5 +/- 4.4% increase in creatinine clearance, whereas treatment with hydrochlorothiazide was associated with a 17.4 +/- 3.0% decrease in creatinine clearance. The results of the study indicate that indapamide is superior to hydrochlorothiazide in the treatment of patients with impaired renal function and moderate hypertension.

  16. Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure.

    Science.gov (United States)

    Reis, Francisco José Farias Borges dos; Fernandes, André Maurício Souza; Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Kuwano, André Yoichi; França, Victor Hugo Pinheiro; Macedo, Cristiano Ricardo Bastos de; Cruz, Cristiano Gonçalves da; Sahade, Viviane; Aras Júnior, Roque

    2009-09-01

    Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

  17. Lethal progressive thoracic insufficiency in a neonate due to jarcho levin syndrome.

    Science.gov (United States)

    Bhutia, Euden; Maria, Arti; Verma, Arushi; Sethi, Sidharth Kumar

    2014-01-01

    A rare case of Jarcho Levin syndrome (JLS) presenting as a lethal progressive respiratory insufficiency in early neonatal period is reported. The neonate had classical features of this syndrome including vertebral segmentation defects, typical costo-vertebral fusion defects and scoliosis resulting in small thoracic volume and limited chest expansion; all consistent with a clinical diagnosis of JLS with thoracic insufficiency. In addition, our case had a rare association of dextrocardia and acyanotic congenital heart disease.

  18. Evaluación nutricional de niños con insuficiencia renal aguda que reciben diálisis Nutritional assessment of children presenting with acute renal insufficiency and underwent to dialysis

    Directory of Open Access Journals (Sweden)

    Jorge Silva Ferrera

    2010-03-01

    admitted due to acute renal insufficiency in two children hospitals of Santiago de Cuba from December, 2006 to December, 2008. Authors analyzed the age, sex, etiology, renal replacement therapy, cause of parenteral feeding use, nutritional assessment according to Cuban percentile tables and anthropometry parameters (age, weight, height and parenteral nutrients support. RESULTS: Prerenal events were the cause of acute renal insufficiency in the 44,4% of cases and renal and postrenal ones in the 33,4% and 22,2%, respectively. As a renal depuration method we used the peritoneal dialysis in the 66,6% of cases and the hemodialysis in remainder. The main causes that justified the parenteral feeding were the surgical affections, hypercatabolic states, the digestive hemorrhage and the pancreatitis in a decreasing order. Four patients were assessed as of low weight. CONCLUSIONS: The average support of proteins and lipids was under the established nutritional supports and that of kilocalories was higher than recommended. It is essential to improve these parameters in the treatment of these patients.

  19. CLINICAL PROFILE OF NON-ALBUMINURIC RENAL INSUFFICIENCY IN TYPE 2 DIABETES MELLITUS IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    P. Sathya Murthy

    2016-07-01

    Full Text Available INTRODUCTION Diabetes mellitus is one of the most prevalent metabolic diseases which is characterised by elevated blood sugar levels. Type 2 diabetes mellitus constitutes about 90 percent of this group. Untreated DM leads to many complications which are traditionally classified as acute and chronic. The microvascular complications include retinopathy, nephropathy and peripheral neuropathy. Diabetic nephropathy is the most common cause for dialysis and end-stage renal failure across the world. Diabetic nephropathy usually starts with microalbuminuria (UAE 30-300 mg/dL followed by macroalbuminuria (UAE > 300 mg/dL and eventually there is progressive loss of renal function by tissue scarring leading on to end-stage renal disease. However, in type 2 DM, there can be a group of patients who can have impaired renal function without albuminuria (UAE<30 mg/ day. This is being called as “non-albuminuric renal failure”. Reduced GFR in long duration diabetic patients with normal urine albumin excretion have been reported in increasing frequency. There are very few Indian studies which have been done on this group of type 2 diabetic patients. Hence, this study is aimed to evaluate the clinical profile of non-albuminuric renal insufficiency in type 2 diabetes mellitus. AIM To study the clinical profile of non-albuminuric renal insufficiency in type 2 DM. MATERIALS AND METHODS The study population included 97 patients with non-albuminuric (urine microalbumin less than 30 mg/day, renal insufficiency (GFR less than 60 mL/min. as per Cockcroft–Gault formula and are diabetic (type 2 admitted in the Department of General Medicine and Nephrology. Patients with comorbidities other than diabetes which can cause renal insufficiency were excluded from the study. A detailed history was taken and clinical assessment was done for all patients. All patients underwent a panel of tests which included complete blood count, blood urea nitrogen, serum creatinine

  20. [The application of artificial protein premixes for nutritive support of patients with chronic renal insufficiency, being treated by perinateal dialysis].

    Science.gov (United States)

    Pichugina, I S; Vetchinnikova, O N; Vereshchagina, V M; Gapparov, M M; Vatazin, A V

    2008-01-01

    As a result of a survey of 56 patients with chronic renal insufficiency, who undergone hemodialysis, it was established, that clinical condition of patients, biochemical and hematological blood indices as well as results of anthropometric research improve upon application of artificial balanced high-protein premixes -"Nutrinil" and "Nutrien-Nefro". Irrespective of way of administration - introperitoneal ("Nutrinil" solution) or enteral ("Nutrien-Nefro" mixture) protein-energetic insufficiency diminishes or totally disappears, body weight, fat and muscle content of the body weight, as well as indices of whole protein, albumine, lymphocytes, haemoglobin, pH approache the norm. Intraperitoneal way of administration of artificial protein premixes increase patients adherence to this procedure, though enteral way of their administration is more preferable from economic point of view.

  1. Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Sun Young; Park, Seong Ho; Lee, Seung Soo; Lee, Ju Hee; Kim, Ah Young; Park, Su Ki; Han, Duck Jong; Ha, Hyun Kwon [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-06-15

    To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean {+-} SD in age, 51 {+-} 6.4 years) and CTC (n = 176; 50 {+-} 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of {>=} 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p 0.046). Electrolyte changes were similar in the two groups. In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

  2. Distribution of Arsenic, Manganese, and Selenium in the Human Brain in Chronic Renal Insufficiency, Parkinsons Disease and Amyotrophic Lateral Sclerosis

    DEFF Research Database (Denmark)

    Larsen, N. A.; Pakkenberg, H.; Damsgaard, Else;

    1981-01-01

    The concentrations of arsenic, manganese and selenium/g wet tissue weight were determined in samples from 24 areas of the human brain from 3 patients with chronic renal insufficiency, 2 with Parkinson's disease and 1 with amyotrophic lateral sclerosis. The concentrations of the 3 elements were...... determined for each sample by neutron activation analysis with radiochemical separation. Overall arsenic concentrations were about 2.5 times higher in patients with chronic renal failure than in controls, and lower than normal in the patients with Parkinson's disease and amyotrophic lateral sclerosis....... There were no obvious differences in the overall concentrations of manganese and selenium from one group to another. Even multivariate data analysis by the SIMCA method failed to reveal any significant difference in the distribution pattern of manganese and selenium in Parkinson's disease compared to normal...

  3. Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort Study.

    Science.gov (United States)

    Sandsmark, Danielle K; Messé, Steven R; Zhang, Xiaoming; Roy, Jason; Nessel, Lisa; Lee Hamm, Lotuce; He, Jiang; Horwitz, Edward J; Jaar, Bernard G; Kallem, Radhakrishna R; Kusek, John W; Mohler, Emile R; Porter, Anna; Seliger, Stephen L; Sozio, Stephen M; Townsend, Raymond R; Feldman, Harold I; Kasner, Scott E

    2015-08-01

    Chronic kidney disease is associated with an increased risk of cardiovascular events. However, the impact of chronic kidney disease on cerebrovascular disease is less well understood. We hypothesized that renal function severity would be predictive of stroke risk, independent of other vascular risk factors. The study population included 3939 subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a prospective observational cohort. Stroke events were reported by participants and adjudicated by 2 vascular neurologists. Cox proportional hazard models were used to compare measures of baseline renal function with stroke events. Multivariable analysis was performed to adjust for key covariates. In 3939 subjects, 143 new stroke events (0.62 events per 100 person-years) occurred over a mean follow-up of 6.4 years. Stroke risk was increased in subjects who had worse baseline measurements of renal function (estimated glomerular filtration rate and total proteinuria or albuminuria). When adjusted for variables known to influence stroke risk, total proteinuria or albuminuria, but not estimated glomerular filtration rate, were associated with an increased risk of stroke. Treatment with blockers of the renin-angiotensin system did not decrease stroke risk in individuals with albuminuria. Proteinuria and albuminuria are better predictors of stroke risk in patients with chronic kidney disease than estimated glomerular filtration rate. The impact of therapies targeting proteinuria/albuminuria in individuals with chronic kidney disease on stroke prevention warrants further investigation. © 2015 American Heart Association, Inc.

  4. Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease

    Science.gov (United States)

    ZENGIN, KURSAD; TANIK, SERHAT; SENER, NEVZAT CAN; ALBAYRAK, SEBAHATTIN; EKICI, MUSA; BOZKURT, IBRAHIM HALIL; BAKIRTAS, HASAN; GURDAL, MESUT; IMAMOGLU, MUHAMMED ABDURRAHIM

    2015-01-01

    The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population. PMID:26171211

  5. Direct magnification technique of radiographs of the hand in children with chronic renal insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Ponhold, W.; Balzar, E.

    1984-04-01

    The characteristic changes of renal osteopathy in the hand are shown by the X-rays of seven children with end stage renal disease using the direct magnification technique. All children had pathologic conditions in the hands. Most frequently tunnelation, spiculae in the phalanges and metaphyseal translucent bands in the forearm were seen. Less constantly acroosteolyses and generalized osteoporosis could be observed. The X-rays of the hands using the direct magnification technique with rare earth film-screen system and a microfocus X-ray tube are sufficient to determine renal osteopathy. If clinical symptoms are present, X-rays of other parts of the skeleton are necessary. By using the above mentioned radiologic technique the radiographic diagnostic effort could be minimized.

  6. Tophaceous Gout and Renal Insufficiency: A New Solution for an Old Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Anne-Kathrin Tausche

    2011-01-01

    Full Text Available The prevalence of gout is increasing with increased life expectancy. Approximately half of the patients with gout have some degree of renal impairment. If both conditions persistently coexist, and in severe tophaceous gout, in particular, treatment has been difficult. We here report on the case of an 87-year-old woman, who had been suffering from recurrent gouty arthritis over 4 years. Monthly polyarthritis attacks were accompanied by subcutaneous tophi. Serum uric acid levels were constantly above 600 μmol/L (10 mg/dL. Allopurinol was no option because of intolerance, while benzbromarone was ineffective because of renal impairment. Therefore, the novel xanthin oxidase inhibitor febuxostat was started, achieving rapid control of serum urate levels (<360 μmol/L. After initial worsening of inflammation in the first weeks, gouty attacks stopped and all tophi resolved within the following 10 months. Renal function remained stable.

  7. Branchio-oto-renal syndrome caused by partial EYA1 deletion due to LINE-1 insertion

    DEFF Research Database (Denmark)

    Morisada, Naoya; Rendtorff, Nanna Dahl; Nozu, Kandai

    2010-01-01

    A 7-year-old Japanese girl with conductive deafness and preauricular fistulae developed proteinuria. She had renal insufficiency, and ultrasound revealed bilateral small kidneys. These findings indicated that she had branchio-oto-renal (BOR) syndrome. In the present patient, we identified, by using...

  8. Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

    NARCIS (Netherlands)

    Damman, Kevin; Tang, W. H. Wilson; Felker, G. Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J. V.

    2014-01-01

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients

  9. Clorazepate dipotassium and diazepam in renal insufficiency: serum concentrations and protein binding of diazepam and desmethyldiazepam.

    Science.gov (United States)

    Ochs, H R; Rauh, H W; Greenblatt, D J; Kaschell, H J

    1984-01-01

    5 patients with chronic renal failure on maintenance hemodialysis and 5 healthy matched controls received single 20-mg intravenous doses of clorazepate dipotassium. Clearance of pharmacologically active unbound desmethyldiazepam was reduced in renal failure patients as opposed to controls, and free fraction in serum was greater. Since desmethyldiazepam distribution was reduced in renal patients, elimination half-life was actually shorter than in controls (36 vs. 57 h). In 10 dialysis patients receiving chronic diazepam treatment (5-15 mg/day), steady-state concentrations of diazepam (56 ng/ml) and desmethyldiazepam (77 ng/ml) were significantly lower than in age- and weight-matched controls receiving similar doses (189 and 216 ng/ml, respectively). However after correction for the higher free fractions of both compounds in renal patients as opposed to controls, steady-state concentrations of unbound drug were found to be similar between groups. Interpretation of kinetic variables and steady-state serum concentrations of extensively protein-bound drugs requires consideration of alterations in protein binding that may occur in disease states.

  10. Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

    Science.gov (United States)

    Guddati, Achuta K; Marak, Creticus P

    2012-05-01

    Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

  11. Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Achuta K. Guddati

    2012-05-01

    Full Text Available Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

  12. Cardiovascular disease and renal insufficiency:special considerations with cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Colin Lenihan; Donal Reddan

    2005-01-01

    Cardiovascular disease is an important cause of mortality in the chronic kidney disease (CKD) population. This review discusses cardiac surgery in the CKD population and considers ostoperative acute renal failure (ARF). CKD patients have worse outcomes following coronary artery bypass grafting (CABG) and cardiac valvular surgery than the general population. However,surgical revascularization is an effective treatment for coronary artery disease (CAD) in this population and may be associated with improved survival over percutaneous intervention (PCI) in advanced CKD. Cardiac surgery in the CKD population requires careful perioperative planning and management. Acute renal failure (ARF) is a serious complication following cardiac surgery, occurring in 1 to 8% of cases. Management of postoperative ARF is largely supportive and emphasis is placed on preoperative risk stratification and prevention.

  13. A Case of Chronic Pancreatic Insufficiency Due to Valproic Acid in a Child

    Directory of Open Access Journals (Sweden)

    Mary Anne Cooper

    2001-01-01

    Full Text Available A 14-year-old child treated with valproic acid over several years for a seizure disorder developed abdominal pain with radiological evidence of acute pancreatitis. The association with valproic acid was not recognized, and the child continued to take the drug. The patient eventually developed steatorrhea and weight loss that improved with pancreatic enzyme replacement. Radiological evaluation showed an atrophic pancreas. Without evidence of other etiological factors, valproic acid by itself appeared to be the cause of chronic pancreatitis with exocrine pancreatic insufficiency in this patient.

  14. Cetuximab insufficiently inhibits glioma cell growth due to persistent EGFR downstream signaling

    DEFF Research Database (Denmark)

    Hasselbalch, Benedikte; Lassen, Ulrik; Poulsen, Hans S;

    2010-01-01

    Overexpression and/or amplification of the epidermal growth factor receptor (EGFR) is present in 35-45% of primary glioblastoma multiforme tumors and has been correlated with a poor prognosis. In this study, we investigated the effect of cetuximab and intracellular signaling pathways downstream...... of EGFR, important for cell survival and proliferation. We show insufficient EGFR downregulation and competition with endogenous EGFR ligands upon cetuximab treatment. Dose-response experiments showed inhibition of EGFR phosphorylation without affecting two of the prominent downstream signaling pathways...

  15. Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.

    Science.gov (United States)

    Deo, Rajat; Yang, Wei; Khan, Abigail M; Bansal, Nisha; Zhang, Xiaoming; Leonard, Mary B; Keane, Martin G; Soliman, Elsayed Z; Steigerwalt, Susan; Townsend, Raymond R; Shlipak, Michael G; Feldman, Harold I

    2014-07-01

    Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease. Cox proportional hazards models were used to evaluate independent associations between elevated aldosterone concentrations and each outcome. Interactions were hypothesized and explored between aldosterone and sex, race, and the use of loop diuretics and renin-angiotensin-aldosterone system inhibitors. During a median follow-up period of 5.4 years, 587 participants died, 743 developed end-stage renal disease, 187 developed congestive heart failure, and 177 experienced an atherosclerotic event. Aldosterone concentrations (per SD of the log-transformed aldosterone) were not an independent risk factor for death (adjusted hazard ratio, 1.00; 95% confidence interval, 0.93-1.12), end-stage renal disease (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.17), or atherosclerotic events (adjusted hazard ratio, 1.04; 95% confidence interval, 0.85-1.18). Aldosterone was associated with congestive heart failure (adjusted hazard ratio, 1.21; 95% confidence interval, 1.02-1.35). Among participants with chronic kidney disease, higher aldosterone concentrations were independently associated with the development of congestive heart failure but not for death, end-stage renal disease, or atherosclerotic events. Further studies should evaluate whether mineralocorticoid receptor antagonists may reduce adverse events in individuals with

  16. Symptomatic Adrenal Insufficiency due to Bilateral Adrenal Non-Hodgkin’s Lymphoma

    Directory of Open Access Journals (Sweden)

    Şafak Akın

    2016-09-01

    Full Text Available Secondary involvement of the adrenal gland with non-Hodgkin’s lymphoma has been reported to occur in up to 25% of patients during the course of the disease. A 45-year-old man presented with a several month history of nausea, fatigue and weight loss. His medical history was unremarkable. Abdominal computed tomography (CT was performed and showed bilateral adrenal massive masses measuring 10x7.5 cm on the left and 4.8x4 cm on the right. He developed adrenal insufficiency in the follow-up period. The patient was started on replacement dose of prednisolone. A positron emission tomography-CT scan was acquired for further staging of the disease and showed intense fluorodeoxyglucose accumulation in both adrenal glands, additionally a slight fluorodeoxyglucose accumulation was observed in the ileocecal site. He did not accept adrenal biopsy or surgery. Histopathological examination of the ileocecal site revealed diffuse large B-cell lymphoma. He was administered rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Bilateral adrenal lymphoma is a rare entity when compared with the incidence of adenoma and adrenal metastases of other cancers. Adrenal insufficiency may be the primary symptom of presentation, especially with bilateral involvement as in bilateral adrenal lymphoma.

  17. [20 years' experience in the treatment of children with terminal renal insufficiency in Yugoslavia].

    Science.gov (United States)

    Peco-Antić, A; Popović-Rolović, M; Jovanović, O; Marsenić, O; Babić, D; Kostić, M; Kruscić, O; Culić, D; Trajković, D

    2000-01-01

    The first specialized haemodialysis (HD) paediatric centre in former Yugoslavia was established at the University Children's Hospital in Belgrade in January 1980. A total of 194 children (F: 98, M: 96), aged less than 19 years (10.12 +/- 4.23), were treated for renal replacement therapy (RRT) over 20 years. Average annual incidence rate was 1.59 per million of child population (pmcp) aged less than 19 years for the period 1980-1990 (former Yugoslavia) and 2.85 pmcp aged less than 19 years for the period 1990-2000 (present Yugoslavia). Reflux nephropathy was the most frequent underlying disease and accounted for 37.06% of total cases, while other primary renal diseases were: glomerulonephritis (GN) 17.26%, cystic/hereditary familial nephropathy 12.69%, congenital disease 11.68%, interstitial nephritis 5.58%, non-recovered tubular necrosis 3.55%, secondary GN 1.52% and 10.66% remained with doubtful diagnosis. HD was the first RRT in 84.02%, peritoneal dialysis (PD) in 14.43% and pre-emptive transplantation in 1.55% of all patients. A total of 53 patients (27.3% of total terminal renal failure (TRF) patients) received 56 kidney transplants (58.93% live related, 37.50% cadaveric, 3.57% live-non related). Actual survival in RRT was 64.53% 5 in years; 51.68% in 10 and 48.23% in 15 years. Patient survival in HD was significantly better over the last ten-year period than in the first ten-year period (35.88% vs. 75.75%; p Yugoslavia.

  18. [Aorto-caval fistula as a results of abdominal aortic aneurysm rupture imitating acute renal insufficiency].

    Science.gov (United States)

    Zaniewski, Maciej; Ludyga, Tomasz; Kazibudzki, Marek; Kowalewska-Twardela, Teresa

    2002-01-01

    Aorto-caval fistula (ACF) is a rare complication of abdominal aortic aneurysm. It occurs in 1-6% of cases. The classic diagnostic signs of an ACF (pulsatile abdominal mass with bruit and right ventricular failure) are present only in a half of the patients. The most common diagnostic imaging procedures like ultrasound and computed tomography often are not sufficient enough. This leads to the delay in diagnosis, which has a great impact on the results of operation. We report a case of a patient, who was treated before admission to the Clinic because of azotemia and oliguria suggesting renal failure.

  19. Prevalent Rate of Nonalbuminuric Renal Insufficiency and Its Association with Cardiovascular Disease Event in Korean Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Hye Won Lee

    2016-12-01

    Full Text Available BackgroundNonalbuminuric renal insufficiency is a unique category of diabetic kidney diseases. The objectives of the study were to evaluate prevalent rate of nonalbuminuric renal insufficiency and to investigate its relationship with previous cardiovascular disease (CVD event in Korean patients with type 2 diabetes mellitus (T2DM.MethodsLaboratory and clinical data of 1,067 subjects with T2DM were obtained and reviewed. Study subjects were allocated into four subgroups according to the CKD classification. Major CVD events were included with coronary, cerebrovascular, and peripheral vascular events.ResultsNonalbuminuric stage ≥3 CKD group, when compared with albuminuric stage ≥3 CKD group, had shorter diabetic duration, lower concentrations of glycated hemoglobin, high density lipoprotein cholesterol, and high-sensitivity C-reactive protein, lower prevalent rates of retinopathy and previous CVD, and higher rate of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Nonalbuminuric stage ≥3 CKD group showed a greater association with prior CVD events than no CKD group; however, albuminuric stage ≥3 CKD group made addition to increase prevalence of prior CVD events significantly when CKD categories were applied as covariates. Association of prior CVD events, when compared with normal estimated glomerular filtration rate (eGFR and nonalbuminuria categories, became significant for declined eGFR, which was higher for eGFR of <30 mL/min/1.73 m2, and albuminuria.ConclusionThe results show that subjects with nonalbuminuric stage ≥3 CKD is significantly interrelated with occurrence of prior CVD events than those with normal eGFR with or without albuminuria. Comparing with normal eGFR and nonalbuminuria categories, the combination of increased degree of albuminuria and declined eGFR is becoming significant for the association of prior CVD events.

  20. Characteristics and Outcomes Among Heart Failure Patients With Anemia and Renal Insufficiency With and Without Blood Transfusions (Public Discharge Data from California 2000–2006)

    Science.gov (United States)

    Kao, David P.; Kreso, Elma; Fonarow, Gregg C.; Krantz, Mori J.

    2013-01-01

    Renal insufficiency and anemia are increasingly recognized as predictors of adverse events in heart failure. The impact of blood transfusion on mortality in patients with heart failure has not been previously characterized. We examined temporal changes in admissions and in-hospital mortality using public discharge data from California (2000 to 2006) and then evaluated the impact of renal insufficiency, anemia, and transfusion on in-hospital mortality in univariate and multivariate analyses. In total 596,456 unique patient admissions for heart failure were recorded. Renal insufficiency and anemia were common co-morbidities (27.4% and 27.1%, respectively) and 6.2% of patients received a transfusion of red blood cells. Renal insufficiency and anemia were associated with increased mortality (unadjusted odds ratio [OR] 2.45, 95% confidence interval [CI] 2.39 to 2.52, and 1.27, 95% CI 1.24 to 1.30, respectively). After adjustment, renal insufficiency (OR 2.54, 95% CI 2.46 to 2.62) and anemia (OR 1.12 95% CI 1.07 to 1.17) remained significant; however, transfusion emerged as the strongest single predictor (OR 3.81, 95% CI 3.51 to 4.13) of mortality. In conclusion, these data suggest that anemia and renal insufficiency are independently associated with mortality in an unselected heart failure population. This is the first study to demonstrate that transfusion magnifies this effect and is associated with a particularly poor prognosis. PMID:21146689

  1. Usefulness of sup(99m)Tc-DTPA renogram in the functional and diagnostic evaluations of chronic renal insufficiency in children

    Energy Technology Data Exchange (ETDEWEB)

    Matsueda, Y.; Hiraiwa, M.; Meguro, H.; Fujii, R. (Teikyo Univ., Tokyo (Japan). Faculty of Medicine)

    1980-09-01

    As there are some difficulties in the performance of renal biopsy and intravenous pyelography is of little use in children with chronic renal insufficiency, we evaluated the usefulness of sup(99m)Tc-DTPA renogram in two children. The causes of the renal insufficiency presented were obstructive congenital anomalies and chronic pyelonephritis in one patient and polycystic kidneys in the other. As expected, intravenous pyelography poorly visualized in the upper urinary tracts of both the cases examined. Sup(99m)Tc-DTPA renogram gave us distinct image for the diagnosis of the kidneys and urinary tracts, and the individual renal functions were clarified as well. It was apparently superior to the combined use of sup(99m)Tc-DMSA renoscintigram and /sup 131/I-Hippuran renogram in both the imaging and functional evaluations. In such cases as are reported herein, sup(99m)Tc-DTPA renogram might be a useful alternative to several other diagnostic tests.

  2. Calcinosis Cutis, Renal Insufficiency and Low-Molecular-Weight Calcium Containing Heparins

    OpenAIRE

    2014-01-01

    Foi solicitada observação por Dermatologia de uma doente de 35 anos de idade, de raça negra, por 2 nódulos subcutâneos localizados na região paraumbilical direita e flanco direito com 2 semanas de evolução. Da história prévia, destaque para doença renal crónica em programa de hemodiálise e infeção pelo vírus da imunodeficiência humana (VIH-1). Ao exame objetivo observaram-se 2 nódulos bem delimitados, subcutâneos, sem alteração da coloração; à palpação, estes eram dolorosos, de consistê...

  3. Prevalence of nephrogenic systemic fibrosis in renal insufficiency patients: Results of the FINEST study

    Energy Technology Data Exchange (ETDEWEB)

    Janus, Nicolas [Department of Nephrology, Pitie-Salpetriere Hospital, 83 boulevard de l' Hopital, 75013 Paris (France)], E-mail: nicolas.janus@psl.aphp.fr; Launay-Vacher, Vincent; Karie, Svetlana [Department of Nephrology, Pitie-Salpetriere Hospital, 83 boulevard de l' Hopital, 75013 Paris (France); Clement, Olivier [Department of Radiology, Georges Pompidou European Hospital, Paris (France); Ledneva, Elena [Department of Nephrology, Pitie-Salpetriere Hospital, 83 boulevard de l' Hopital, 75013 Paris (France); Frances, Camille [Department of Dermatology, Tenon Hospital, Paris (France); Choukroun, Gabriel [Department of Nephrology, Amiens University Hospital, Amiens (France); Deray, Gilbert [Department of Nephrology, Pitie-Salpetriere Hospital, 83 boulevard de l' Hopital, 75013 Paris (France)

    2010-02-15

    Purpose: Nephrogenic systemic fibrosis (NSF) is characterized by widespread tissue fibrosis, mainly affecting the skin. Gadolinium chelates have been implicated in the onset of NSF in patients with renal impairment (RI). The FINEST study (FIbrose Nephrogenique SysTemique) was designed to determine the prevalence of NSF after magnetic resonance imaging (MRI) in French RI patients. Materials and methods: We studied all patients with RI who had at least one MRI examination during a one-year period, with or without gadolinium chelate administration. Data were collected retrospectively from 9 Nephrology Departments in France, and included sex, age, renal function, type of gadolinium administered, and subsequent cutaneous disorders. If a patient presented a cutaneous disorder, a skin biopsy was performed to confirm the diagnostic. Results: The 308 eligible patients had a mean age of 59.9 years, 59% were men, and 54% had stage 5 RI. 75% of those 308 patients received a Gadolinium chelate. Among those patients who received a gadolinium chelate, 76% received gadoterate, 20% gadopentetate, 3% gadodiamide and 1% gadobenate. No cutaneous disorders were recorded after MRI. Conclusion: These results confirm that NSF is a rare disease. Based on a reported frequency, {approx}3.5% in patients with glomerular filtration rate <30 ml/min/1.73 m{sup 2}), some cases should have been observed in our study which included 308 patients. Most patients received gadoterate, a macrocyclic gadolinium chelate for which no case of NSF has been observed worldwide. This suggests that more stable macrocyclic agents may be less likely to induce NSF.

  4. Sublethal exposure from microcystins to renal insufficiency patients in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Soares, Raquel M; Yuan, Moucun; Servaites, Jerome C; Delgado, Alvimar; Magalhães, Valéria F; Hilborn, Elizabeth D; Carmichael, Wayne W; Azevedo, Sandra M F O

    2006-04-01

    In November 2001, a cyanobacterial bloom dominated by Microcystis and Anabaena occurred in the Funil Reservoir and the Guandu River, both of which supply drinking water to Rio de Janeiro, Brazil. Using ELISA, microcystins were detected at a concentration of 0.4 microg/L in the drinking water, whereas a concentration of 0.32 microg/L was detected in activated carbon column-treated water for use at the renal dialysis center of Clementino Fraga Filho Hospital (HUCFF) at the Federal University of Rio de Janeiro. A total of 44 hemodialysis patients who received care at this center were believed to be exposed. Initial ELISA analyses confirmed the presence of serum microcystin concentrations > or = 0.16 ng/mL in 90% of serum samples collected from these patients. Twelve patients were selected for continued monitoring over the following 2-month period. Serum microcystin concentrations ranged from < 0.16 to 0.96 ng/mL during the 57 days after documented exposure. ELISA-positive samples were found throughout the monitoring period, with the highest values detected 1 month after initial exposure. ESI LC/MS analyses indicated microcystins in the serum; however, MS/MS fragmentation patterns typical of microcystins were not identified. LC/MS analyses of MMPB for control serum spiked with MCYST-LR. and patient sera revealed a peak at retention time of 8.4 min and a mass of 207 m/z. These peaks are equivalent to the peak observed in the MMPB standard analysis. Taken together ELISA, LC/MS, and MMPB results indicate that these renal dialysis patients were exposed to microcystins. This documents another incident of human microcystin exposure during hemodialysis treatment.

  5. Retinopathy and the risk of cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort study).

    Science.gov (United States)

    Grunwald, Juan E; Pistilli, Maxwell; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker-Ostroff, Candace; Mohler, Emile; Lo, Joan C; Townsend, Raymond R; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John W; Xie, Dawei

    2015-11-15

    Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2,605 participants of the CRIC study were invited to participate, and nonmydriatic fundus photographs were obtained in 1,936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant's information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and nontraditional risk factors, for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relation between increased venular diameter and risk of development of CVD; however, the relation was not statistically significant after adjustment for traditional risk factors. In conclusion, the presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings.

  6. The CECARI Study: Everolimus (Certican®) Initiation and Calcineurin Inhibitor Withdrawal in Maintenance Heart Transplant Recipients with Renal Insufficiency: A Multicenter, Randomized Trial

    Science.gov (United States)

    Derthoo, David; Van Caenegem, Olivier; De Pauw, Michel; Nellessen, Eric; Duerinckx, Nathalie; Droogne, Walter; Vörös, Gábor; Meyns, Bart; Belmans, Ann; Janssens, Stefan; Vanhaecke, Johan

    2017-01-01

    In this 3-year, open-label, multicenter study, 57 maintenance heart transplant recipients (>1 year after transplant) with renal insufficiency (eGFR 30–60 mL/min/1.73 m2) were randomized to start everolimus with CNI withdrawal (N = 29) or continue their current CNI-based immunosuppression (N = 28). The primary endpoint, change in measured glomerular filtration rate (mGFR) from baseline to year 3, did not differ significantly between both groups (+7.0 mL/min in the everolimus group versus +1.9 mL/min in the CNI group, p = 0.18). In the on-treatment analysis, the difference did reach statistical significance (+9.4 mL/min in the everolimus group versus +1.9 mL/min in the CNI group, p = 0.047). The composite safety endpoint of all-cause mortality, major adverse cardiovascular events, or treated acute rejection was not different between groups. Nonfatal adverse events occurred in 96.6% of patients in the everolimus group and 57.1% in the CNI group (p < 0.001). Ten patients (34.5%) in the everolimus group discontinued the study drug during follow-up due to adverse events. The poor adherence to the everolimus therapy might have masked a potential benefit of CNI withdrawal on renal function.

  7. Drug Dosing in Patients with Renal Insufficiency in a Hospital Setting using Electronic Prescribing and Automated Reporting of Estimated Glomerular Filtration Rate

    DEFF Research Database (Denmark)

    Nielsen, Anita L.; Henriksen, Daniel Pilsgaard; Marinakis, Christianna;

    2014-01-01

    . We conclude that despite implementation of electronic prescribing and automated reporting of eGFR, patients with renal insufficiency may still be exposed to inappropriate drug use, with potential increased risk of adverse effects. Initiatives to reduce medication errors such as the use of electronic......GFR in the range of 10-49 ml/min/1.73m(2) were included. We identified 436 episodes with administration of renal risk drugs (prescribed to 183 patients): 410 drugs required dose adjustment according to the eGFR and 26 should be avoided. In total, the use or dosing of 66 (15%) of the 436 renal risk drugs...

  8. [Oxidative stress and chronic renal insufficiency: what can be a prophylactic approach?].

    Science.gov (United States)

    Cristol, J P; Maggi, M F; Bosc, J Y; Badiou, S; Delage, M; Vernet, M H; Michel, F; Castel, J; Canaud, B; Descomps, B

    1997-01-01

    Cardiovascular diseases represent the first cause of mortality in chronic renal failure patients treated by hemodialysis. Alterations in lipid metabolism and oxidative stress are recognized as vascular risk factors. Their corrections could be of interest for atherosclerosis prevention. In order to evaluate interest of an therapeutic intervention, we have analyzed oxidative metabolism in hemodialysis patients by determining the production of oxygen reactive species (ROS), the level of defense mechanisms, and the balance between nitric oxide (NO) and ROS, responsible for anti- or proxidant effects of NO. During dialysis sessions performed with cellulosic membrane (Cuprophan) an increase in hydroperoxide production by platelets was noted (12 HETE) (5.62 +/- 0.94 pg); similarly, superoxide anion (O2(0)-) production by monocytes (fluorescence index: 115 +/- 24) and by polynuclear cells (fluorescence index: 115 +/- 24) was enhanced. On the other hand, anti-oxidant defenses were significantly reduced with a decrease in RBC SOC activity (0.92 +/- 0.06 U/mg Hg) and in RBC vitamin E (0.7 +/- 0.07 mg/l) concentration. We have demonstrated a profound alteration in the L-arginine/NO pathway consequently to an accumulation of NO synthases inhibitors or activators. The necessity to reduce the production of ROS during dialysis sessions justifies the use of more biocompatible membranes, such as modified cellulosic or synthetic membranes, decreasing leucocyte activation. In addition, NO synthetase inhibitors can be preferentially eliminated by convection. Finally, a supplementation with an exogenous anti-oxidant, such as oral vitamin E (500 mg/day for 6 months) normalizes RBC vitamin E levels and concomitantly allows a decrease in MDA concentrations In conclusion, oxidative metabolism alterations observed in hemodialysis are multifactorial: preventive measures include the use of a more biocompatible material, the reequilibrium of the NO/ROS balance, and supplementation with

  9. [Risk of acute hepatic insufficiency in children due to chronic accidental overdose of paracetamol (acetaminophen)

    NARCIS (Netherlands)

    Hameleers-Snijders, P.; Hogeveen, M.; Smeitink, J.A.M.; Kramers, C.; Draaisma, J.M.T.

    2007-01-01

    Two girls aged 4 and 3 years, respectively, experienced acute liver failure due to accidental ingestion of supratherapeutic doses of paracetamol (90 mg/kg/day or more). Recognition of chronic paracetamol intoxication as a cause of acute hepatic failure is often delayed. It is important to consider t

  10. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Rosaria M. Ruggeri

    2010-01-01

    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  11. Treatment-related changes in urinary excretion of high and low molecular weight proteins in patients with idiopathic membranous nephropathy and renal insufficiency.

    NARCIS (Netherlands)

    Buf-Vereijken, P.W.G. du; Wetzels, J.F.M.

    2006-01-01

    BACKGROUND: In patients with idiopathic membranous nephropathy, an increased urinary excretion of high (IgG) and low [beta(2)-microglobulin (beta(2)M), alpha(1)-microglobulin (alpha(1)M)] molecular weight proteins predicts prognosis and precedes renal insufficiency. We have studied the changes in th

  12. [Acute respiratory insufficiency due to COPD: invasive mechanical ventilation or not?].

    Science.gov (United States)

    Kant, K Merijn; Djamin, Remco S; Belderbos, Huub N A; van den Berg, Bart

    2014-01-01

    The decision to move to a form of mechanical ventilation in patients with acute respiratory failure due to an acute exacerbation of COPD is influenced by expectations about survival and quality of life after discharge from the ICU. Physicians tend to be too pessimistic about the survival outcome of an ICU stay with invasive mechanical ventilation. The forced expiratory volume in 1 second (FEV1) is not an adequate prognostic parameter. In order to prevent undertreatment of patients with respiratory failure due to an exacerbation of COPD, knowledge of prognostic parameters and quality of life in these patients is very important. End of life care should be integrated into the standard care of COPD patients.

  13. End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

    Directory of Open Access Journals (Sweden)

    Elizabeth De Francesco Daher

    Full Text Available Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC, and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0, leukocyturia (2+/4+ and mild proteinuria (1+/4+. She was also oliguric (urinary volume <400mL/day. Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

  14. [Acute respiratory insufficiency due to severe lung injury - ARDS and ALI].

    Science.gov (United States)

    Pfeifer, M

    2010-09-01

    As a consequence of the novel therapeutic option of mechanical ventilation in early intensive care medicine, the acute respiratory distress syndrome (ARDS) was defined as a disease entity of its own representing the most severe form of acute lung injury (ALI). Since its first description four decades ago, our knowledge about the aetiology, physiology, histology and epidemiology of this lethal pulmonary complication of severe acute diseases such as pneumonia or sepsis has been increasing steadily. The initial major therapeutic advances were due to improvements in intensive care medical procedures and monitoring. The large ARDS Network clinical trial on the magnitude of tidal volume impressively demonstrated the feasibility of targeted clinical trials in patients with ARDS that provide robust evidence in this field. This clinical trial, as well as following large-scale trials in ARDS patients, led to significant changes of ventilation therapy and therapeutic strategies that improve the outcome of this disease entity. Advances in the standardisation of care for ARDS patients involving innovative therapeutic procedures such as extracorporeal gas exchange systems will lead to a further improvement in ARDS management and outcome. Modern pulmonary medicine can play a pivotal role in this process and can contribute its rich experiences in all areas of the respiratory system.

  15. Pregnancy in patients with chronic renal insufficiency at Hospital de Clínicas of Porto Alegre, Brazil.

    Science.gov (United States)

    Trevisan, Glaucia; Ramos, José Geraldo Lopes; Martins-Costa, Sérgio; Barros, Elvino José Guardão

    2004-01-01

    Chronic renal insufficiency (CRI) decreases reproductive capability. The biggest challenge in monitoring pregnant women with renal disease is to keep the intrauterine environment favorable to the fetus. One of the common prognosis in this kind of pregnancy involves premature birth, restricted growth and mental retardation. Also, the risk of developing complications is higher for the mother. This study focuses on evaluating CRI patients' clinical conditions during pregnancy, checking fetal development and birth and verifying the prevalence of CRI in pregnant women attended at Hospital de Clínicas of Porto Alegre-Brazil (HCPA). This is a retrospective study with both a control and an case group of pregnant women with CRI who delivered their babies at HCPA from 1989 to 1999. The case group is composed of pregnant women with CRI, while the control group was paired according to maternal and gestational ages and to the time of the delivery, which should be the same both in the experimental and in the control group. Among the criteria usually used to identify CRI, we chose the creatinine level higher than 1.5 mg/dL. Significance was established in 0.05%. Our results demonstrate that the prevalence of CRI was 6/10,000 births. Average maternal age was 28. Sixty five per cent of the patients, in both the groups, underwent prenatal monitoring, 40% presented preeclampsia, 48% presented urinary infection. Among the CRI complications, 48% of the cases presented anemia and 56% presented systemic hypertension. Average hematocrit was 24% while hemoglobin was 6.7 g/dL, which leads us to the conclusion that patients presented anemia during pregnancy. Average creatinine was 4.61 mg/dL. It is relevant that 64% of the CRI cases migrated to a substitutive renal therapy method. As for the fetus evolution in the case group, we confirmed the findings of previous studies, such as larger number of premature births (newborns younger than 36 weeks in 60% of the cases), larger number of

  16. Sideroblastic anaemia and primary adrenal insufficiency due to a mitochondrial respiratory chain disorder in the absence of mtDNA deletion.

    Science.gov (United States)

    O'Grady, Michael J; Monavari, Ahmad A; Cotter, Melanie; Murphy, Nuala P

    2015-02-26

    A fatigued 8-year-old boy was found to have sideroblastic anaemia (haemoglobin 7.8 g/dL) which over time became transfusion dependent. Subtle neurological dysfunction, initially manifesting as mild spastic diplegia, was slowly progressive and ultimately led to wheelchair dependence. Elevated plasma lactate and urinary 3-methylglutaconate led to a muscle biopsy which confirmed partial complex IV deficiency. PCR in leucocytes and muscle was negative for mitochondrial DNA (mtDNA) deletions. Faltering growth prompted an insulin tolerance test which confirmed growth hormone sufficiency and adrenal insufficiency. Plasma renin was elevated and adrenal androgens were low, suggesting primary adrenal insufficiency. Glucocorticoid and mineralocorticoid replacement therapy was initiated. A renal tubular Fanconi syndrome and diabetes mellitus developed subsequently. Sideroblastic anaemia and primary adrenal insufficiency, both individually and collectively, are associated with mtDNA deletion; however, absence of the same does not exclude the possibility that sideroblastic anaemia and primary adrenal insufficiency are of mitochondrial origin.

  17. 50例儿童肾功能不全临床分析%Clinical Analysis for 50 Cases of Children with Renal Insufficiency

    Institute of Scientific and Technical Information of China (English)

    梁冰红

    2015-01-01

    Objective To explore the clinical and pathological features of renal insufficiency in children, and provide reference for clinical. Methods A retrospective analysis from January 2010 to December 2014 in our hospital 50 cases of chronic renal insuffi-ciency in children patients with the clinical data of 50 cases of children, etiology, clinical features, case analysis. Results In 50 patients with chronic renal insufficiency in children acquired glomerular disease in 33 cases, accounting for 66%. Congenital renal malformation in 12 cases, accounting for 24%. The children with chronic renal insufficiency the main clinical manifestations of re-nal anemia, hypertension, electrolyte disturbances, metabolic acidosis, growth retardation and infection. In 50 cases of chronic re-nal insufficiency patients had anemia, a negative relationship between hemoglobin and serum creatinine. Conclusion Children with renal insufficiency to obtain glomerulonephritis as the main cause of disease, renal dysfunction is more obvious, more severe ane-mia. Clinical on children with chronic kidney diseases such as alert the occurrence of renal insufficiency may be persistent anemi-a, with the degree of anemia to help assess the severity, renal insufficiency treatment as soon as possible, improve the quality of life.%目的:探究肾功能不全患儿的临床病理特点,为临床提供参考。方法回顾性分析2010年1月-2014年12期间在该院收治的50例儿童慢性肾功能不全患者的临床资料,对50例患儿的病因、临床特点,情况进行分析。结果①在50例儿童慢性肾功能不全的患者中,获得性肾小球疾病33例,占66%。先天性肾脏畸形12例,占24%。②儿童慢性肾功能不全主要临床表现为肾性贫血、高血压、电解质紊乱、代谢性酸中毒、生长发育迟缓和感染等。③50例慢性肾功能不全患儿均有贫血,血红蛋白与血肌酐呈负相关关系[结论过于笼统,没有针对结果。

  18. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency.

    Science.gov (United States)

    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

  19. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

  20. Effect of Shenxinning decoction on ventricular remodeling in AT1 receptor-knockout mice with chronic renal insufficiency

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    Xuejun Yang

    2014-01-01

    Full Text Available Objective: To observe the efficacy of Shenxinning Decoction (SXND in ventricular remodeling in AT1 receptor-knockout (AT1-KO mice with chronic renal insufficiency (CRI. Materials and Methods: AT1-KO mice modeled with subtotal (5/6 nephrectomy were intervened with SXND for 12 weeks. Subsequently, blood urea nitrogen (BUN, serum creatinine (SCr, brain natriuretic peptide (BNP, echocardiography (left ventricular end-diastolic diameter, LVDD; left ventricular end-systolic diameter, LVDS; fractional shortening, FS; and ejection fraction, EF, collagen types I and III in the heart and kidney, myocardial mitochondria, and cardiac transforming growth factor-β1 (TGF-β1 of the AT1-KO mice were compared with the same model with nephrectomy only and untreated with SXND. Results: AT1-KO mice did not affect the process of CRI but it could significantly affect cardiac remodeling process. SXND decreased to some extent the AT1-KO mice′s BUN, SCr, BNP, and cardiac LVDD, LVDS, and BNP, improved FS and EF, lowered the expression of collagen type I and III in heart and kidney, increased the quantity of mitochondria and ameliorated their structure, and down-regulated the expression of TGF-β1. Conclusion: SXND may antagonize the renin-angiotensin system (RAS and decrease uremia toxins, thereby ameliorating ventricular remodeling in CRI. Furthermore, SXND has a mechanism correlated with the improvement of myocardial energy metabolism and the down-regulation of TGF-β1.

  1. Adrenal insufficiency.

    Science.gov (United States)

    Li-Ng, Melissa; Kennedy, Laurence

    2012-10-01

    Adrenocortical insufficiency may arise through primary failure of the adrenal glands or due to lack of ACTH stimulation as a result of pituitary or hypothalamic dysfunction. Prolonged administration of exogenous steroids will suppress the hypothalamic-pituitary-adrenal axis, and hence cortisol secretion. We review briefly the causes, investigation, and treatment of adrenal insufficiency, and highlight aspects of particular relevance to patients with adrenal tumors.

  2. Renal amyloidosis due to familial Mediterranean fever misdiagnosed

    Directory of Open Access Journals (Sweden)

    Iman Hama

    2012-01-01

    Full Text Available Familial Mediterranean fever (FMF, MIM 249100 is an autosomal recessive disease affecting mainly patients of the Mediterranean basin. It is an autoinflammatory periodic disorder characterized by recurrent episodes of fever and abdominal pain, synovitis, and pleuritis. The major complication of FMF is the development of renal AA amyloidosis. Treatment with colchicine prevents the occurrence of recurrent seizures and renal amyloidosis. The disease is caused by mutations in the MEFV gene. We report here the cases of two unrelated patients, who have been late diagnosed with FMF complicated by renal amyloidosis. We focus on the importance of early diagnosis of FMF, both to start rapidly treatment with colchicine and avoid renal amyloidosis, and to provide genetic counseling to families.

  3. Gonadal vein tumor thrombosis due to renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Hamidreza Haghighatkhah

    2015-01-01

    Full Text Available Renal cell carcinoma (RCC had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC

  4. Gonadal vein tumor thrombosis due to renal cell carcinoma.

    Science.gov (United States)

    Haghighatkhah, Hamidreza; Karimi, Mohammad Ali; Taheri, Morteza Sanei

    2015-01-01

    Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC.

  5. Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Jian-ping LI; Mohetaboer MOMIN; Yong HUO; Chun-yan WANG; Yan ZHANG; Yan-jun GONG; Zhao-ping LIU; Xin-gang WANG; Bo ZHENG

    2012-01-01

    Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI),who were treated with emergency percutaneous coronary intervention (PCI).Methods:420 patients hospitalized in Peking University First Hospital,diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study.Estimated glomerular filtration rate (eGFR) was used as a measure of renal function.We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function.Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01).CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032,odds ratio (OR) 4.159,95% confidence interval (CI) 1.127-15.346).Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.

  6. Phosphate binding reduces aortic angiotensin-converting enzyme and enhances nitric oxide bioactivity in experimental renal insufficiency.

    Science.gov (United States)

    Eräranta, Arttu; Törmänen, Suvi; Kööbi, Peeter; Vehmas, Tuija I; Lakkisto, Päivi; Tikkanen, Ilkka; Moilanen, Eeva; Niemelä, Onni; Mustonen, Jukka; Pörsti, Ilkka

    2014-01-01

    Disturbed calcium-phosphorus metabolism is associated with increased kidney angiotensin-converting enzyme (ACE) in experimental chronic renal insufficiency (CRI). However, information about the effects of phosphate binding and loading on vascular ACE is lacking. Fifteen weeks after 5/6 nephrectomy (NX), rats were placed on a phosphate-binding (NX+Ca, 3.0% Ca), phosphate-loading (NX+Pi, 1.5% Pi), or control diet for 12 weeks (NX and sham). Aortic ACE, blood pressure, plasma phosphate, and parathyroid hormone were increased in the NX and NX+Pi groups, but were reduced with phosphate binding. Endothelium-mediated relaxations of isolated mesenteric conduit artery rings to acetylcholine were impaired in the NX and NX+Pi groups, but did not differ from sham in NX+Ca rats. Experiments with nitric oxide (NO) synthase inhibition in vitro suggested that the NO-mediated component of acetylcholine response was lower in the NX and NX+Pi groups, but did not differ from sham in NX+Ca rats. In all NX groups, aortic endothelial NO synthase (eNOS) was reduced, while plasma and urine concentrations of NO metabolites were increased. Aortic nitrated proteins and calcification were increased in the NX and NX+Pi groups when compared with the NX+Ca and sham groups. Hypertension in the NX model of CRI was associated with reduced vasorelaxation, decreased eNOS, and increased ACE and nitrated proteins in the aorta. Phosphate binding with calcium carbonate enhanced vasorelaxation via endogenous NO and suppressed elevation of ACE and nitrated proteins, suggesting reduced vascular oxidative stress. Our findings support the view that correction of the calcium-phosphorus balance prevents CRI-induced vascular pathophysiology.

  7. Acute Renal Failure due to Non-Traumatic Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Nagehan Aslan

    2016-04-01

    Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.

  8. Laparoscopic nephrectomy for complete renal infarction due to post traumatic renal artery thrombosis.

    Science.gov (United States)

    Gidaro, Stefano; Schips, Luigi; Cindolo, Luca; Ziguener, Richard

    2008-06-01

    We report a case of post traumatic thrombosis of the renal artery with renal infarction and associated liver injury. Conservative treatment was initially planned in consideration of the delayed diagnosis (> 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs. He underwent laparoscopy with nephrectomy and liver injury repair. Hypertension resolved after nephrectomy without further medical treatment. Laparoscopic nephrectomy is not a standard procedure for renal trauma but it could be an option in selected patients.

  9. Absence of exercise-induced leptin suppression associated with insufficient epinephrine reserve in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

    NARCIS (Netherlands)

    Riepe, F.G.; Krone, N.; Kruger, S.N.; Sweep, C.G.J.; Lenders, J.W.M.; Dotsch, J.; Monig, H.; Sippell, W.G.; Partsch, C.J.

    2006-01-01

    OBJECTIVE: Patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency suffer from glucocorticoid and mineralocorticoid deficiency. They have insufficient epinephrine reserves and increased basal leptin levels and are often insulin resistant. In healthy subjects, an inhibitor

  10. Study on the Relationship between Stroke and Chronic Renal Insufficiency%脑卒中与慢性肾功能不全的关系研究

    Institute of Scientific and Technical Information of China (English)

    地里木拉提·阿不都拉; 杨莉; 热娜古丽·努尔; 孙岩; 桑晓红

    2012-01-01

    Objective To understand the condition of patients with stroke combined with renal insufficiency and to explore the relationship between stroke and chronic renal insufficiency. Methods Clinical data of 486 stroke patients firstly admitted to our hospital were retrospectively analyzed. The sex, age, ethnicity, disease history and carotid artery condition of the patients were observed. Kidney Disease Diet Adjustment Method was used to calculate glomerular filtration rate and the criteria of judging chronic renal insufficiency was glomerular filtration rate < with 60 ml·min-1·(1. 73 m) according to the staging standard of K/DOQI. The neurological deficit was assessed by Stroke Scale of U. S. National Institutes of Health. Results 121 out of the 486 patients had renal insufficiency, accounting for 24. 9% . The sex composition, history of primary hypertension and incidences of dyslipidemia, hyperuricemia, intimal thickening of the carotid artery and carotid artery plaque showed statistically significant differences between the renal insufficiency group and non-renal insufficiency group (P < 0. 05). The incidences of brain hemorrhage and non-lacunar infarction between renal insufficiency group and non-renal insufficiency group showed statistically significant differences (P <0. 05). The level of neurological deficit between patients with stroke combined with renal insufficiency and patients without renal insufficiency showed statistically significant difference (u = 3. 609, P = 0. 000). Conclusion The incidence of stroke combined with renal insufficiency is high, indicating chronic renal insufficiency is of great importance in predicting the prognosis of new stroke patients.%目的 了解脑卒中患者合并肾功能不全的情况,并探讨脑卒中与慢性肾功能不全的关系.方法 回顾性分析我院收治的486例首次入院的脑卒中患者的临床资料,观察患者性别、年龄、民族、既往史及颈动脉情况;采用肾脏疾病饮食调整

  11. Utility of radioisotopic filtration markers in chronic renal insufficiency: Simultaneous comparison of sup 125 I-iothalamate, sup 169 Yb-DTPA, sup 99m Tc-DTPA, and inulin. The Modification of Diet in Renal Disease Study

    Energy Technology Data Exchange (ETDEWEB)

    Perrone, R.D.; Steinman, T.I.; Beck, G.J.; Skibinski, C.I.; Royal, H.D.; Lawlor, M.; Hunsicker, L.G. (National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, MD (USA))

    1990-09-01

    Assessment of glomerular filtration rate (GFR) with inulin is cumbersome and time-consuming. Radioisotopic filtration markers have been studied as filtration markers because they can be used without continuous intravenous (IV) infusion and because analysis is relatively simple. Although the clearances of 99mTc-DTPA, 169Yb-DTPA, and 125I-iothalamate have each been compared with inulin, rarely has the comparability of radioisotopic filtration markers been directly evaluated in the same subject. To this purpose, we determined the renal clearance of inulin administered by continuous infusion and the above radioisotopic filtration markers administered as bolus injections, simultaneously in four subjects with normal renal function and 16 subjects with renal insufficiency. Subjects were studied twice in order to assess within-study and between-study variability. Unlabeled iothalamate was infused during the second half of each study to assess its effect on clearances. We found that renal clearance of 125I-iothalamate and 169Yb-DTPA significantly exceeded clearance of inulin in patients with renal insufficiency, but only by several mL.min-1.1.73m-2. Overestimation of inulin clearance by radioisotopic filtration markers was found in all normal subjects. No differences between markers were found in the coefficient of variation of clearances either between periods on a given study day (within-day variability) or between the two study days (between-day variability). The true test variability between days did not correlate with within-test variability. We conclude that the renal clearance of 99mTc-DTPA, 169Yb-DTPA, or 125I-iothalamate administered as a single IV or subcutaneous injection can be used to accurately measure GFR in subjects with renal insufficiency; use of the single injection technique may overestimate GFR in normal subjects.

  12. Molecular Mechanisms of Renal Cellular Nephrotoxicity due to Radiocontrast Media

    Directory of Open Access Journals (Sweden)

    Ashour Michael

    2014-01-01

    Full Text Available Modern iodinated radiocontrast media are all based on the triiodinated benzene ring with various chemical modifications having been made over the last few decades in order to reduce their toxicity. However, CIN remains a problem especially in patients with pre-existing renal failure. In vitro studies have demonstrated that all RCM are cytotoxic. RCM administration in vivo may lead to a decrease in renal medullary oxygenation leading to the generation of reactive oxygen species that may cause harmful effects to renal tissue. In addition, endothelin and adenosine release and decreased nitric oxide levels may worsen the hypoxic milieu. In vitro cell culture studies together with sparse in vivo rat model data have shown that important cell signalling pathways are affected by RCM. In particular, the prosurvival and proproliferative kinases Akt and ERK1/2 have been shown to be dephosphorylated (deactivated, whilst proinflammatory/cell death molecules such as the p38 and JNK kinases and the transcription factor NF-κB may be activated by RCM, accompanied by activation of apoptotic mediators such as caspases. Increasing our knowledge of the mechanisms of RCM action may help to develop future therapies for CIN.

  13. Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Muntner, Paul; Anderson, Amanda; Charleston, Jeanne; Chen, Zhen; Ford, Virginia; Makos, Gail; O’Connor, Andrew; Perumal, Kalyani; Rahman, Mahboob; Steigerwalt, Susan; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wright, Jackson T

    2010-01-01

    Background A low rate of blood pressure control has been reported among patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness. Study Design Cross-sectional Setting & Participants Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612) were analyzed. Participants with an estimated glomerular filtration rate of 20 to 70 ml/min/1.73m2 were identified from physician offices and review of laboratory databases. Outcomes Prevalence and awareness of hypertension, treatment patterns, control rates and factors associated with hypertension control. Measurements Following a standardized protocol, blood pressure was measured three times by trained staff and hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported antihypertensive medication use. Patients’ awareness and treatment of hypertension were defined using self-report and two levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 mmHg and <130/80 mmHg. Results The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis, 98.3% were treated with medications while 67.1% and 46.1% had their hypertension controlled to <140/90 mmHg and <130/80 mmHg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26% and 32% were taking one, two, three and four or more antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, those with higher urinary albumin excretion were less likely while participants taking ACE-inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 mmHg and <130/80 mmHg. Limitations Data were derived from a single study visit. Conclusions Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of

  14. Cost-effectiveness analysis of HLA-B5801 genotyping in the treatment of gout patients with chronic renal insufficiency in Korea.

    Science.gov (United States)

    Park, Dong-Jin; Kang, Ji-Hyoun; Lee, Jeong-Won; Lee, Kyung-Eun; Wen, Lihui; Kim, Tae-Jong; Park, Yong-Wook; Park, Sung-Hwan; Lee, Shin-Seok

    2015-02-01

    Allopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare but cause high rates of morbidity and mortality. Studies have shown that the HLA-B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guidelines recommend that, prior to treatment with allopurinol, the HLA-B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown. This study evaluated the cost-effectiveness of HLA-B5801 genotyping for the treatment of gout in patients with chronic renal insufficiency in Korea. A decision analytical model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA-B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real patients with SCARs from 2 tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio. In the base model, the total expected cost and probability of continuation of gout treatment without SCARs for the conventional and HLA-B5801 screening strategies were $1,193 and 97.8% and $1,055 and 100%, respectively. The results were robust according to sensitivity analyses. Our model suggests that gout treatment informed by HLA-B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA-B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths. Copyright © 2015 by the American College of Rheumatology.

  15. Demyelinating Peripheral Neuropathy Due to Renal Cell Carcinoma

    Science.gov (United States)

    Nishioka, Kenya; Fujimaki, Motoki; Kanai, Kazuaki; Ishiguro, Yuta; Nakazato, Tomoko; Tanaka, Ryota; Yokoyama, Kazumasa; Hattori, Nobutaka

    2017-01-01

    Renal cell carcinoma (RCC) patients who develop a paraneoplastic syndrome may present with neuromuscular disorders. We herein report the case of a 50-year-old man who suffered from progressive gait disturbance and muscle weakness. The results of a nerve conduction study fulfilled the criteria of chronic inflammatory demyelinating polyneuropathy. An abdominal CT scan detected RCC, the pathological diagnosis of which was clear cell type. After tumor resection and a single course of intravenous immunoglobulin therapy, the patient's symptoms drastically improved over the course of one year. The patient's neurological symptoms preceded the detection of cancer. A proper diagnosis and the initiation of suitable therapies resulted in a favorable outcome. PMID:28049985

  16. Plant Protein Intake Is Associated with Fibroblast Growth Factor 23 and Serum Bicarbonate in Patients with CKD: The Chronic Renal Insufficiency Cohort Study

    Science.gov (United States)

    Scialla, Julia J.; Appel, Lawrence J; Wolf, Myles; Yang, Wei; Zhang, Xiaoming; Sozio, Stephen M.; Miller, Edgar R.; Bazzano, Lydia A.; Cuevas, Magdalena; Glenn, Melanie J.; Lustigova, Eva; Kallem, Radhakrishna R.; Porter, Anna C.; Townsend, Raymond R.; Weir, Matthew R.; Anderson, Cheryl A.M.

    2012-01-01

    Background Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD), due to lower bioavailability of phosphate and lower nonvolatile acid load. Study Design Observational cross-sectional study. Setting & Participants 2938 participants with chronic kidney disease and information on dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors Percentage of total protein from plant sources (% plant protein) was determined by scoring individual food items from the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH), and hemoglobin. Measurements We modeled the association between % plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes, body mass index, eGFR, income, smoking, total energy intake, total protein intake, 24 hour urinary sodium, use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers and use of diuretics. Results Higher % plant protein was associated with lower FGF23 (p=0.05) and higher HCO3 (p=0.01), but not with serum phosphate or PTH (p=0.9 and 0.5, respectively). Higher % plant protein was not associated with higher serum potassium (p=0.2), lower serum albumin (p=0.2) or lower hemoglobin (p=0.3). The associations of % plant protein with FGF23 and HCO3 did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5) or total protein intake (≤ 0.8 g/kg/d vs. >0.8 g/kg/d) (p-interaction > 0.10 for each). Limitations Cross-sectional study; Determination of % plant protein using the DHQ has not been validated. Conclusions Consumption of a higher percentage of protein from plant sources may lower FGF23 and raise HCO3 in patients with CKD. PMID:22480598

  17. Relationship of hyperglycemia with endothelial function, renal function, lipidemic profile, and morphological changes of blood cells in patients with insufficient compensation of type 2 diabetes mellitus with hypertension

    Directory of Open Access Journals (Sweden)

    N. O. Pertseva

    2014-12-01

    Full Text Available Many questions about the relationship between endothelial dysfunction and morphological substrate of hemostasis damage that occur during the progress of type 2 diabetes mellitus and arterial hypertension require clarification and further advance. In 87 patients with insufficient glycemic compensation using clinical, laboratory, morphological methods and correlational analysis were identified association between endothelial dysfunction, degree of renal function damage, lipidemic profile and morphological changes of vascular-platelet hemostasis. It has been established that in the insufficient glycemic control by a significant strengthening relationships between indicators of endothelial dysfunction and damaged platelet hemostasis (up to r=+0.95 formed significant correlations of ultrastructural characteristics of platelets with clinical and laboratory signs of nephropathic and dyslipidemic changes.

  18. Suboptimal medical care of patients with ST-Elevation Myocardial Infarction and Renal Insufficiency: results from the Korea acute Myocardial Infarction Registry

    Directory of Open Access Journals (Sweden)

    Choi Joon

    2012-09-01

    Full Text Available Abstract Background The clinical outcomes of ST-segment elevation myocardial infarction (STEMI are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR. Methods This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6% who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages. Results Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE inhibitor/angiotensin-receptor blocker (ARB, or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy. Conclusions Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.

  19. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study.

    Science.gov (United States)

    Dörks, Michael; Herget-Rosenthal, Stefan; Schmiemann, Guido; Hoffmann, Falk

    2016-01-01

    Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50% of all drugs were renally excreted, dose adjustments in patients with renal failure are required. To assess polypharmacy in German nursing homes, in particular in residents with renal failure. Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95% confidence intervals were used to study the association of renal failure and polypharmacy. Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6%) had a severe or moderate renal failure, defined as estimated creatinine clearance Polypharmacy (5-9 drugs) was found in 365 (53.3%) and excessive polypharmacy (≥10 drugs) in 112 (16.4%) residents. Diuretics and psycholeptics were the most commonly used drug classes. Severe renal failure (estimated creatinine clearance polypharmacy (OR: 2.8, 95% CI 1.4-5.7). Both, polypharmacy and renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.

  20. Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Sabroe, Jonas Emil; Thayssen, Per; Antonsen, Lisbeth

    2014-01-01

    -year all-cause mortality was 13.4% vs. 47.4% (log-rank p year mortality compared to patients with a preserved renal function (CrCl ≤30 60 mL/min: adjusted HR 2.71 [95% CI 2.09-3.51], p ... and more likely to have diabetes mellitus, hypertension and to present with a higher Killip class.Among patients with a preserved kidney function and patients with RI, 30-day all-cause mortality was 3.5% vs. 20.9% (log-rank p year all-cause mortality was 5.7% vs. 29.4% (log-rank p ...BACKGROUND: Chronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary...

  1. Therapeutic embolization of renal artery to control severe hypertension due to renal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cotroneo, A.R.; Patane, D.; De Cinque, M.; Falappa, P.; Doglietto, G.

    1987-05-01

    In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.

  2. Screening for renal insufficiency following ESUR (European Society of Urogenital Radiology) guidelines with on-site creatinine measurements in an outpatient setting

    Energy Technology Data Exchange (ETDEWEB)

    Ledermann, H.P.; Mengiardi, B.; Schmid, A. [IMAMED Radiologie Nordwest, Basel (Switzerland); Froehlich, J.M. [Guerbet AG, Medical Affairs, Zurich (Switzerland); University of Bern, Radiology Department, Bern (Switzerland)

    2010-08-15

    To report the results and implications for workflow following introduction of ESUR guidelines to screen for potential renal insufficiency (RI) in private practice with on-site creatinine measurements. A total of 1,766 consecutive outpatients scheduled for contrast-enhanced CT (CECT) completed the ESUR questionnaire enquiring about kidney disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout or use of nephrotoxic drugs. Patients with positive risk factors underwent on-site creatinine measurement and calculation of estimated glomerular filtration rate (eGFR). Attending radiologists adapted subsequent imaging depending on renal function and presence of risk factors. One or more ESUR risk factors were present in 796 (45.1%) patients, including hypertension (37.7%), nephrotoxic medication (21.3%), diabetes mellitus (8.0%), proteinuria (3.9%), renal disease (4.1%), gout (3.1%) and renal surgery (2.6%). Pre-procedural creatinine measurements revealed severe RI (eGFR < 30 ml min{sup -1} 1.73 m{sup -2}) in 10 (1.3%) and moderate RI (eGFR 30-59 ml min{sup -1} 1.73 m{sup -2}) in 106 (13.8%). Imaging work-up was adapted in 132 (16.6%) as follows: reduction of contrast material dose (n = 85), CT without contrast (n = 40), changeover to MRI (n = 3) or scintigraphy (n = 4). Screening for RI following ESUR guidelines requires creatinine measurements in nearly half of outpatients scheduled for CECT and reveals moderate to severe renal impairment in 6.6%. (orig.)

  3. Severe impaired deambulation in a patient with vitamin D and mineral deficiency due to exocrine pancreatic insufficiency

    DEFF Research Database (Denmark)

    Christensen, Anton Tedja; Østergård, Torben; Andersen, Vibeke

    2011-01-01

    Skeletal muscle weakness and impaired gait function are common risk factors for disease and even death. Therefore, identification of the modifiable causes of skeletal muscle weakness should have high priority. Knowledge regarding optimal vitamin D treatment in cases of pancreatic insufficiency...

  4. Granulomatous Interstitial Nephritis and Acute Renal Failure due to Renal-limited Sarcoidosis

    Directory of Open Access Journals (Sweden)

    El-Reshaid Kamel

    2000-01-01

    Full Text Available Renal failure secondary to granulomatous sarcoidosis without clinical features or radiological evidence of disease is rare. In this case report, we describe a 14-year old girl who developed progressive renal failure over a two-month period which was associated with weight loss and epigastric pain. Physical examination did not show any abnormality. Laboratory investigations were normal except for normocytic normochromic anemia, high serum urea, high serum creatinine (452 tmol/L and polyclonal gammopathy. Percutaneous kidney biopsy showed severe interstitial nephritis with non-caseating granulomata. She was treated with tapered prednisone after a starting dose of 1 mg/kg. The treatment with prednisolone resulted in a complete remission that lasted up to two years of follow up. This case highlights the variable expression of sarcoidosis, which should be considered in the management of such disease.

  5. Aortic insufficiency

    Science.gov (United States)

    ... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  6. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  7. [Data collection about the case management of end-stage renal insufficiency. Feasibility study. Nephrology Epidemiologic and information Network (REIN)].

    Science.gov (United States)

    Stengel, B; Landais, P

    1999-01-01

    End-stage renal failure (ESRD) is an important public health issue, because of both the increasing number of patients requiring renal replacement therapy and the cost of treatment. The need for a reliable data system, capable of describing the patient care network as a whole, including dialysis or transplantation, has often been reiterated. The Direction Générale de la Santé (the French Department of Health) commissioned INSERM (the National Institute of Health and Medical Research) to "study the feasibility of different scenarios of data collection about ESRD patient care in order to meet the priority needs of health care administration, physicians, and researchers". Analysis of these needs allowed the goals to be defined: to provide an accurate picture of ESRD patient care in order to guide and evaluate health care policy, to inform clinicians, and to provide a tool for more focused special studies in renal research issues. Three scenarios were studied: the first would use data systems of both the government and the National Health Insurance system for planning health care services, upon EfG (The French Transplant Agency) network to evaluate transplantation, and upon a few regional registries for epidemiology and research; the second is based on repeated cross-sectional surveys; the third would rely upon the organization of an information system, the Renal Epidemiology and Information Network (REIN). Regional centers and a national coordinating office would register and follow-up ESRD patients, principally to evaluate health care supply and quality. The REIN database would also be a resource for research. The advantage of the first scenario is its low cost; its principal drawback is that evaluations will not be possible in the regions without registries. The second suggestion is inadequate. The last project would fulfil the goals that were defined. The REIN data system would be a true public health project of interest to all the participants and institutions

  8. Renal insufficiency associated with adefovir dipivoxil overdose%阿德福韦酯过量相关肾功能不全

    Institute of Scientific and Technical Information of China (English)

    马小艳; 蔡晧东

    2015-01-01

    1例69岁男性乙型肝炎肝硬化患者加入抗病毒治疗临床试验,基线血清肌酐89μmol/L,肌酐清除率为56 ml/min。给予拉米夫定100 mg/d口服。治疗48周,血清肌酐91μmol/L,肌酐清除率为54 ml/min。加服阿德福韦酯10 mg/d。3年后,患者血清肌酐升至113μmol/L,肌酐清除率为39 ml/min。考虑为阿德福韦酯相关肾功能不全。阿德福韦酯减量为10 mg,隔日1次,拉米夫定原剂量应用。6个月后复查,患者血清肌酐88μmol/L,肌酐清除率50 ml/min。%A 69-year-old patient with hepatitis B cirrhosis to join clinical trials of antiviral therapy. His baseline serum creatinine level was 89 μmol/L and creatinine clearance was 56 ml/min. He was given oral lamivudine 100 mg daily. His serum creatinine level was 91 μmol/L and creatinine clearance was 54 ml/min 48 weeks later. Adefovir dipivoxil 10 mg daily was added to the regimen. Three years later,the patient′s serum creatinine level increased to 113 μmol/L and creatinine clearance was 39 ml/min. He was considered as renal insufficiency due to adefovir dipivoxil. The dosage of adefovir dipivoxil was reduced to 10 mg once every other day and lamivudine was continued according to the original dose. Six months later,the patient′s serum creatinine level was 88 μmol/L and the creatinine clearance was 50 ml/min.

  9. Renal failure due to renal vein thrombosis in a fetus with growth restriction and thrombophilia.

    Science.gov (United States)

    Has, Recep; Corbacioglu Esmer, Aytul; Kalelioglu, Ibrahim H; Yumru, Harika; Yüksel, Atil; Ziylan, Orhan

    2014-04-01

    We report a case of renal vein thrombosis diagnosed at 27 weeks of gestation in a dichorionic twin pregnancy. The left kidney of one fetus was hyperechoic and enlarged with echoic streaks following the direction of interlobular veins and the loss of corticomedullary differentiation. In the following weeks, left kidney became smaller and echoic, and Doppler examination showed no flow in both artery and vein. The right kidney had totally normal appearance in the beginning, but it became enlarged and hyperechoic, and progressed into a small echoic kidney with no flow in artery and vein. In the postnatal ultrasound examination, both kidneys appeared hyperechoic with no vascularization in the hilum region. There was thrombosis in arteries and veins of both kidneys, as well as in the inferior vena cava. The investigation for thrombophilia resulted with the combined presence of heterozygote mutation in factor V Leiden and prothrombin 20210 genes.

  10. Association analysis of ADPRT1, AKR1B1, RAGE, GFPT2 and PAI-1 gene polymorphisms with chronic renal insufficiency among Asian Indians with type-2 diabetes

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    Gupta Arvind

    2010-03-01

    Full Text Available Abstract Background To determine association of nine single nucleotide polymorphisms (SNPs in ADP ribosyltransferase-1 (ADPRT1, aldo-keto reductase family 1 member B1 (AKR1B1, receptor for advanced glycation end-products (RAGE, glutamine:fructose-6-phosphate amidotransferase-2 (GFPT2, and plasminogen activator inhibitor-1 (PAI-1 genes with chronic renal insufficiency (CRI among Asian Indians with type 2 diabetes; and to identify epistatic interactionss between genes from the present study and those from renin-angiotensin-aldosterone system (RAAS, and chemokine-cytokine, dopaminergic and oxidative stress pathways (previously investigated using the same sample set. Methods Type 2 diabetes subjects with CRI (serum creatinine ≥3.0 mg/dl constituted the cases (n = 196, and ethnicity and age matched individuals with diabetes for a duration of ≥ 10 years, normal renal functions and normoalbuminuria recruited as controls (n = 225. Allelic and genotypic constitution of 10 polymorphisms (SNPs from five genes namely- ADPRT1, AKR1B1, RAGE, GFPT2 and PAI-1 with diabetic CRI was investigated. The genetic associations were evaluated by computation of odds ratio and 95% confidence interval. Multiple logistic regression analysis was carried out to correlate various clinical parameters with genotypes, and to study epistatic interactions between SNPs in different genes. Results Single nucleotide polymorphisms -429 T>C in RAGE and rs7725 C>T SNP in 3' UTR in GFPT2 gene showed a trend towards association with diabetic CRI. Investigation using miRBase statistical tool revealed that rs7725 in GFPT2 was a perfect target for predicted miRNA (hsa miR-378 suggesting the presence of the variant 'T' allele may result in an upregulation of GFPT2 contributing to diabetic renal complication. Epistatic interaction between SNPs in transforming growth factor TGF-β1 (investigated using the same sample set and reported elsewhere and GFPT2 genotype was observed. Conclusions

  11. A mouse model of early-onset renal failure due to a xanthine dehydrogenase nonsense mutation.

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    Sian E Piret

    Full Text Available Chronic kidney disease (CKD is characterized by renal fibrosis that can lead to end-stage renal failure, and studies have supported a strong genetic influence on the risk of developing CKD. However, investigations of the underlying molecular mechanisms are hampered by the lack of suitable hereditary models in animals. We therefore sought to establish hereditary mouse models for CKD and renal fibrosis by investigating mice treated with the chemical mutagen N-ethyl-N-nitrosourea, and identified a mouse with autosomal recessive renal failure, designated RENF. Three-week old RENF mice were smaller than their littermates, whereas at birth they had been of similar size. RENF mice, at 4-weeks of age, had elevated concentrations of plasma urea and creatinine, indicating renal failure, which was associated with small and irregularly shaped kidneys. Genetic studies using DNA from 10 affected mice and 91 single nucleotide polymorphisms mapped the Renf locus to a 5.8 Mbp region on chromosome 17E1.3. DNA sequencing of the xanthine dehydrogenase (Xdh gene revealed a nonsense mutation at codon 26 that co-segregated with affected RENF mice. The Xdh mutation resulted in loss of hepatic XDH and renal Cyclooxygenase-2 (COX-2 expression. XDH mutations in man cause xanthinuria with undetectable plasma uric acid levels and three RENF mice had plasma uric acid levels below the limit of detection. Histological analysis of RENF kidney sections revealed abnormal arrangement of glomeruli, intratubular casts, cellular infiltration in the interstitial space, and interstitial fibrosis. TUNEL analysis of RENF kidney sections showed extensive apoptosis predominantly affecting the tubules. Thus, we have established a mouse model for autosomal recessive early-onset renal failure due to a nonsense mutation in Xdh that is a model for xanthinuria in man. This mouse model could help to increase our understanding of the molecular mechanisms associated with renal fibrosis and the

  12. Immunohistochemical study of pathological alterations of peritoneum in patients with terminal renal insufficiency and on peritoneal dialysis

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    Trbojević-Stanković Jasna

    2011-01-01

    Full Text Available Background/Aim. During peritoneal dialysis (PD an exchange of substances between blood and dialysate takes place through specific histological structures of peritoneum. Peritoneal double-layered serous membrane has, so far, mostly been studied with electron microscopy on experimental animals. The aim of this study was to assess integrity of peritoneal tissue in end-stage renal disease (ESRD and PD patients using standard light microscopy and immunohistochemical methods. Methods. Peritoneal tissue biopsies were performed on 25 persons: 8 healthy donors during nephrectomy, 9 ESRD patients upon insertion of PD catheter, and 8 PD patients upon removal of the catheter for medical indications. The samples were fixed and prepared routinely for immunocytochemical staining by standardized streptavidin biotin AEC method using a LSAB2® HRP kit (Dako®, Denmark for collagen IV and analyzed by light microscopy. Results. We observed mesothelial detachment from lamina propria, duplicated basement membrane and much thicker blood vessel walls in ESRD and PD patients, compared to healthy subjects. Differences in histological structure, emphasized with immunostaining, indicated pathological alterations of peritoneal tissue in the renal patients. Conclusions. Imunohistochemistry can be used in studying histological alterations of peritoneal tissue in ESRD and PD patients. This method may indicate possible problems in filtration and secretion processes in this tissue.

  13. Phytochemical screening, and assessment of ameliorating effect of aqueous and ethanolic extracts of Gmelina arborea on drug induced hepatic and renal insufficiency in rats.

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    Anthony, Ogbonnaya Enyinnaya; Mbuh, Awah Francis; Emmanuel, Mounmbegna Philippe

    2012-04-01

    Phytochemical screening of stem bark and leaves of Gmelina arborea; and effect of aqueous and ethanolic extracts of Gmelina arborea stembark on hepatic and renal insufficiency in rats was assessed in this study. Phytochemical screening was carried out on the air-dried leaf, oven-dried leaf, air-dried stembark and oven-dried stembark samples. Sixty five (65) wister albino rats, (50.7-117.5 g) were divided into thirteen groups of five animals each. Three groups serve as Controls and were administered Cisplatin (5mg/kg b.w; i.p), Paracetamol (200mg/kg b.w; i.p) and Normal saline (0.002 ml/kg b.w; oral). Other groups were administered, either, cisplatin and extracts (1g/kg b.w; oral); Paracetamol and extracts (1g/kg b.w; oral); extracts alone; or drugs and combination of extracts. Animals were starved, 24 hours prior to sacrifice and sacrificed on the 9th day after commencement of treatment. Phytochemical screening results show the presence of alkaloid, flavonoid, tannin, saponin, cyanogenic glycoside, phytate, and carbohydrate. Saponin and carbohydrate were shown to be much higher in concentration than other phytochemicals. The percentage composition of cyanogenic glycoside and phytate were highest in air-dried stembark and oven-dried leaf samples, respectively. All the Gmelina arborea extracts and extract mixture administered to both paracetamol and cisplatin treated animals, significantly, lowers both the activities of the SGOT and SGPT, and the levels of serum creatinine and urea. When administered alone, the aqueous and ethanolic extracts show little or no sign of toxicity. Thus Gmelina arborea extracts may have ameliorating effect on hepatic and renal insufficiency caused by paracetamol and cisplatin respectively, and any inherent toxicity may be reduced or eliminated through adequate heat treatment.

  14. Convergence Insufficiency

    Science.gov (United States)

    ... from convergence insufficiency? Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. Many patients ... another time or simply watched for symptoms of diplopia or headaches with near work. A patient who ...

  15. Absorption fever characteristics due to percutaneous renal biopsy-related hematoma.

    Science.gov (United States)

    Hu, Tingyang; Liu, Qingquan; Xu, Qin; Liu, Hui; Feng, Yan; Qiu, Wenhui; Huang, Fei; Lv, Yongman

    2016-09-01

    This study aims to describe the unique characteristics of absorption fever in patients with a hematoma after percutaneous renal biopsy (PRB) and distinguish it from secondary infection of hematoma.We retrospectively studied 2639 percutaneous renal biopsies of native kidneys. We compared the clinical characteristics between 2 groups: complication group (gross hematuria and/or perirenal hematoma) and no complication group. The axillary temperature of patients with a hematoma who presented with fever was measured at 06:00, 10:00, 14:00, and 18:00. The onset and duration of fever and the highest body temperature were recorded. Thereafter, we described the time distribution of absorption fever and obtained the curve of fever pattern.Of 2639 patients, PRB complications were observed in 154 (5.8%) patients. Perirenal hematoma was the most common complication, which occurred in 118 (4.5%) of biopsies, including 74 small hematoma cases (thickness ≤3 cm) and 44 large hematoma cases (thickness >3 cm). Major complications were observed in only 6 (0.2%) cases resulting from a large hematoma. Of 118 patients with a perirenal hematoma, absorption fever was observed in 48 cases. Furthermore, large hematomas had a 5.23-fold higher risk for absorption fever than the small ones.Blood pressure, renal insufficiency, and prothrombin time could be risk factors for complications. Fever is common in patients with hematoma because of renal biopsy and is usually noninfectious. Evaluation of patients with post-biopsy fever is necessary to identify any obvious infection sources. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Absorption fevers will resolve in time without specific therapeutic interventions.

  16. Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance

    Science.gov (United States)

    Peng, Yong; Xia, Tian-li; Huang, Fang-yang; Huang, Bao-tao; Liu, Wei; Chai, Hua; Zhao, Zhen-gang; Zhang, Chen; Liao, Yan-biao; Pu, Xiao-bo; Chen, Shi-jian; Li, Qiao; Xu, Yuan-ning; Luo, Yang; Chen, Mao; Huang, De-jia

    2016-01-01

    Abstract The purpose of this study was to discuss the present situation of discharge medications in coronary artery disease (CAD) patients with different levels of renal function and assess the potential impact of these medications on the prognosis of this patient population. A retrospective cohort study was conducted. From July 2008 to Jan 2012, consecutive patients with CAD confirmed by coronary angiography of West China Hospital were enrolled and were grouped into 3 estimated glomerular filtration rate (eGFR) categories: ≥60, 30 to 60, and ACEIs] or angiotensin-receptor blockers [ARBs]) was a factor in reducing the risk of all-cause death and cardiovascular death. However, EBMs prescribed at discharge revealed an obvious underuse in renal insufficiency (RI) patients. The results of Cox regression showed that irrespective of the eGFR level, greater use of EBMs resulted in a greater reduction in the risk of all-cause death and cardiovascular death. A higher percentage of patients with CAD and concomitant RI suffered from cardiovascular disease (CVD) risk factors, whereas a lower percentage of these patients used EBMs to prevent CVD events. Strict use of EBMs, including beta-blockers, statins, and ACEIs or ARBs, can lead to more clinical benefits, even for patients with CAD and concomitant RI. Thus, treatment of this patient population with EBMs should be stressed. PMID:26871817

  17. Impact of benazepril on contrast-induced acute kidney injury for patients with mild to moderate renal insufficiency undergoing percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    LI Xi-ming; CONG Hong-liang; LI Ting-ting; HE Li-jun; ZHOU Yu-jie

    2011-01-01

    Background The role of angiotensin-converting enzyme inhibitors (ACEI) in contrast-induced acute kidney injury (CI-AKI) is controversial. Some studies pointed out that it was effective in the prevention of CI-AKI, while some concluded that it was one risk for CI-AKI, especially for patients with pre-existing renal impairment. The purpose of this study was to assess the influence of benazepril administration on the development of CI-AKI in patients with mild to moderate renal insufficiency undergoing coronary intervention.Methods One hundred and fourteen patients with mild to moderate impairment of renal function were enrolled before coronary angioplasty, who were randomly assigned to benazepril group (n=52) and control group (n=62). In the benazepril group, the patients received benazepril tablets 10 mg per day at least for 3 days before procedure. CI-AKI was defined as an increase of≥25% in creatinine over the baseline value or increase of 0.5 mg/L within 72 hours of angioplasty.Results Patients were well matched with no significant differences at baseline in all measured parameters between two groups. The incidence of CI-AKI was lower by 64% in the benazepril group compared with control group but without statistical significance (3.45% vs. 9.68%, P=0.506). Compared with benazepril group, estimated glomerular filtration rate (eGFR) level significantly decreased from (70.64+16.38) ml·min-1·1.73 m-2 to (67.30+11.99) ml·min-1·1.73 m-2 in control group (P=0.038). There was no significant difference for the post-procedure decreased eGFR from baseline (△eGFR)between two groups (benazepril group (0.67+12.67) ml·min-1·1.73 m-2 vs. control group (-3.33±12.39) ml·min-1·1.73 m-2,P=0.092). In diabetic subgroup analysis, △eGFR in benazepril group was slightly lower than that in the control group, but the difference was not statistically significant.Conclusions Benazepril has a protective effect on mild to moderate impairment of renal function during

  18. 表现为肾功能不全甲状腺功能减退症2例%Renal Insufficiency Caused by Hypothyroidism

    Institute of Scientific and Technical Information of China (English)

    宋丽娟; 曹赟赟; 潘秀萍

    2012-01-01

    目的:探讨甲状腺功能减退症引起肾功能异常的发病特点,进一步认识甲减引起肾功能不全的病因病机,减少误诊漏诊.方法:运用回顾性分析病例,通过对临床表现、治疗和疗效综合分析,得出临床结论.结果:甲状腺功能减退症以肾功能异常为特点,容易误诊漏诊,治疗甲减引起肾功能不全重在病因治疗.结论:甲状腺功能减退症引起肾功能异常经积极治疗可以治愈,在临床中应重视甲状腺功能减退引起的肾功能异常.%Objective:To study the renal disease caused by hypothyroidism, further understand the etiology and pathogenesis, reducing misdiagnosis and missed diagrosis. Methods: Retrospective analysis using case, Through to the clinical manifestations, treatment and curative effect of comprehensive analysis, the conclusion that clinical. Results : Hypothyroidism with abnormal kidney function, it is easy to. Be misdiagnosed missed hypothyroidism treatment cause renal insufficiency between etiology treatment. Conclusion: Hypothyroidism cause kidney function abnormal via active treatment can be cured, in clinical should pay attention to in the hypothyroidism cause renal abnormality.

  19. Urine Neutrophil Gelatinase-Associated Lipocalin and Risk of Cardiovascular Disease and Death in CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Liu, Kathleen D.; Yang, Wei; Go, Alan S.; Anderson, Amanda H.; Feldman, Harold I.; Fischer, Michael J.; He, Jiang; Kallem, Radhakrishna R.; Kusek, John W.; Master, Stephen R.; Miller, Edgar R.; Rosas, Sylvia E.; Steigerwalt, Susan; Tao, Kaixiang; Weir, Matthew R.; Hsu, Chi-yuan

    2015-01-01

    Background Chronic kidney disease is common and associated with increased cardiovascular disease risk. Currently, markers of renal tubular injury are not used routinely to describe kidney health and little is known about risk of cardiovascular events and death associated with these biomarkers independent of glomerular filtration—based markers (such as serum creatinine or albuminuria). Study Design Cohort study, Chronic Renal Insufficiency Cohort (CRIC) Study. Setting & Participants 3386 participants with estimated glomerular filtration rate of 20-70 mL/min/1.73 m2 enrolled from June 2003 through August 2008. Predictor Urine neutrophil gelatinase-associated lipocalin (NGAL) concentration. Outcomes Adjudicated heart failure event, ischemic atherosclerotic event (myocardial infarction, ischemic stroke or peripheral artery disease) and death through March 2011. Measurements Urine NGAL concentration measured at baseline with a two-step assay using chemiluminescent microparticle immunoassay technology on an ARCHITECT i2000SR (Abbott Laboratories). Results There were 428 heart failure events (during 16383 person-years of follow-up), 361 ischemic atherosclerotic events (during 16584 person-years of follow-up) and 522 deaths (during 18214 person-years of follow-up). In Cox regression models adjusted for estimated glomerular filtration rate, albuminuria, demographics, traditional cardiovascular disease risk factors and cardiac medications, higher urine NGAL levels remained independently associated with ischemic atherosclerotic events (adjusted HR for the highest [>49.5 ng/ml] vs. lowest [≤6.9 ng/ml] quintile, 1.83 [95% CI, 1.20-2.81]; HR, per 0.1-unit increase in log urine NGAL, 1.012 [95% CI, 1.001-1.023]), but not heart failure events or deaths. Limitations Urine NGAL was measured only once. Conclusions Among patients with chronic kidney disease, urine levels of NGAL, a marker of renal tubular injury, were independently associated with future ischemic atherosclerotic

  20. Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study.

    Science.gov (United States)

    Thomas, George; Xie, Dawei; Chen, Hsiang-Yu; Anderson, Amanda H; Appel, Lawrence J; Bodana, Shirisha; Brecklin, Carolyn S; Drawz, Paul; Flack, John M; Miller, Edgar R; Steigerwalt, Susan P; Townsend, Raymond R; Weir, Matthew R; Wright, Jackson T; Rahman, Mahboob

    2016-02-01

    The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure ≥140/90 mm Hg on ≥3 antihypertensives, or use of ≥4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRH-composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22-1.56]); renal events (1.28 [1.11-1.46]); CHF (1.66 [1.38-2.00]); and all-cause mortality (1.24 [1.06-1.45]). The subset of participants with ATRH and blood pressure at goal on ≥4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12-1.51]) and CHF (1.59 [1.28-1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate ≥30 mL/min per 1.73 m(2). Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

  1. Preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty

    Institute of Scientific and Technical Information of China (English)

    GENG Wei; XUE Ling; FU Xiang-hua; GU Xin-shun; WANG Yan-bo; WANG Xue-chao; LI Wei; JIANG Yun-fa; HAO Guo-zhen; FAN Wei-ze

    2012-01-01

    Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation.We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy (CIN) in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty.Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of 60 ml-1 ·min-1.1.73 m-2 or less,who were undergoing coronary angiography or angioplasty,were randomly assigned to receive an infusion of either sodium chloride (control group,n=128) or anisodamine (treatment group,n=132).Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg-1.min-1 from 12 hours before to 12 hours after coronary angiography or angioplasty,while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group.All patients received intravenous sodium chloride hydration.CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of >0.5 mg/dl within three days after contrast exposure.The primary end point was the incidence of CIN.The secondary end point was a 25% or greater reduction in eGFR.Results There were no significant differences between the two groups with regard to age,gender,risk factors,laboratory results,medications and interventions.The incidence of CIN was 9.8% (13/132) in the treatment group and 20.3% (26/128) in the control group (P <0.05).The secondary end point was 6.0% (8/132) in the treatment group and 16.4% (21/128) in the control group (P<0.05).Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.

  2. Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Wen-Tsan Chang

    2004-03-01

    Full Text Available A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.

  3. Fever of unknown origin (FUO) in a renal transplant recipient due to drug fever from sirolimus.

    Science.gov (United States)

    Sharif, Sairah; Kong, May W; Drakakis, James; Cunha, Burke A

    2016-08-01

    A variety of medications may cause drug fever. Drug fevers may persist for days to weeks until diagnosis is considered. The diagnosis of drug fever is confirmed when there is resolution of fever within 3 days after the medication is discontinued. Only rarely do undiagnosed drug fevers persist for over 3 weeks to meet fever of unknown origin (FUO) criteria. FUOs due to drug fever are uncommon, and drug fevers due to immunosuppressive drugs are very rare. This is a case of a 58-year-old female renal transplant recipient who presented with FUO that remained undiagnosed for over 8 weeks. We believe this is the first reported case of an FUO due to drug fever from sirolimus in a renal transplant recipient.

  4. A case of primary renal allograft dysfunction due to myeloma cast nephropathy

    Directory of Open Access Journals (Sweden)

    Umesh Lingaraj

    2015-01-01

    Full Text Available We report a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no overt clinical features of multiple myeloma preceding his transplantation. A 45-year-old man on hemodialysis for six months for end-stage kidney disease due to presumed chronic glomerulonephritis developed immediate graft dysfunction post-transplantation. The graft biopsy was diagnostic of myeloma cast nephropathy. Other criteria for lambda light chain multiple myeloma were fulfilled with immunofixation electrophoresis and bone marrow biopsy. He was treated with plasmapheresis, bortezomib and high-dose dexamethasone. However, the patient succumbed to septicemia on the 37 th post-operative day. This is probably the first report of primary renal allograft dysfunction due to myeloma cast nephropathy diagnosed within the first week posttransplanation in a patient with unrecognized multiple myeloma.

  5. A case of primary renal allograft dysfunction due to myeloma cast nephropathy.

    Science.gov (United States)

    Lingaraj, Umesh; Vankalakunti, Mahesha; Radhakrishnan, Hemachandar; Sreedhara, C G; Rajanna, Sunil

    2015-09-01

    We report a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no overt clinical features of multiple myeloma preceding his transplantation. A 45-year-old man on hemodialysis for six months for end-stage kidney disease due to presumed chronic glomerulonephritis developed immediate graft dysfunction post-transplantation. The graft biopsy was diagnostic of myeloma cast nephropathy. Other criteria for lambda light chain multiple myeloma were fulfilled with immunofixation electrophoresis and bone marrow biopsy. He was treated with plasmapheresis, bortezomib and high-dose dexamethasone. However, the patient succumbed to septicemia on the 37 th post-operative day. This is probably the first report of primary renal allograft dysfunction due to myeloma cast nephropathy diagnosed within the first week post-transplanation in a patient with unrecognized multiple myeloma.

  6. Surgical management of vertebrobasilar insufficiency due to pathology of the second-third segments of the vertebral artery.

    Science.gov (United States)

    Turliuk, D V; Ianushko, V A; Kardash, O F

    2009-01-01

    To determine efficacy of surgical management for vertebrobasilar insufficiency (VBI) associated with pathological passage of the vertebral artery (VA) within the bone canal. Over the period from 2003 to 2008, a total of twenty-five patients with no effect of conservative therapy during 6 months were subjected to reconstruction of the VA in the 3rd segment. The access to the artery was obtained in a manner similar to that used in reconstruction of the carotid arteries, without intersecting the nodding muscle. All the patients were prior to surgery subjected to neuropsychological testing, extra-and intracranial ultrasonographic study with the positional tests, angiography (NMR or digital subtraction angiography). Doppler ultrasonography of the bypass graft, neuropsychological testing, and angiography by the indications were repeated on postoperative day 7 and 3 months after surgery. In the postoperative period according to the VBI scale and Tinneti scale, we revealed significant improvement of the indices on day 7. The improvement of the cognitive functions was not statistically significant (P >0.05). Transcranial Doppler ultrasonography with the De Kleijn test at baseline revealed that five (21%) patients had a complete arrest of blood circulation along one of the VAs, with a decrease in the blood flow along the basilar artery by more than 50%. In the remaining cases, the difference in the volumetric characteristics of the blood stream along the basilar artery averagely amounted to 42.0 +/- 5.4%. Ultrasonographic study performed both in the short- and long-term postoperative periods (on day 7, at 3 months) did not reveal any significant decrease in the bloodflow along the basilar artery during the positional test. The external-carotid--vertebral transposition improves the blood circulation in the posterior cranial fossa. An operative intervention performed on the 3rd segment of the vertebral artery removes symptomatology of VBI as early as in the immediate

  7. Acute renal failure and arterial hypertension due to sub capsular hematoma: is percutaneous drainage a feasible treatment?

    DEFF Research Database (Denmark)

    Kobel, Marie Cæcilie; Nielsen, Tommy Kjærgaard; Graumann, Ole

    Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected...... urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient...

  8. EVALUATION OF ODONTO-PERIODONTAL PARAMETERS IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY (IRC TREATED BY HEMODIALYSIS (HD

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    Cerasella Dorina Şincar

    2012-09-01

    Full Text Available The scope of the study was to evaluate the odontoperiodontal modifications observed in patients with renal pathology in terminal stage, installed as a result of several chronic systemic pathologies, subjected to either dialysis or transplants. Materials and method. The group of patients suffering from IRC included 42 persons (30 men and 12 women, with an average age of 42.6 ± 9.2 years, while the control group was formed of 88 patients (36 men and 52 women, with an average age of 41.3 ± 8.4 years. 28 patients with IRC were treated by HD – hemodialysis, 8 by DPAC – continuous ambulatory peritoneal dialysis, and 6 by CCPD – continuous assisted cycle of peritoneal dialysis. The investigation was developed in the Specialized Policlinics of the „Sf. Apostol Andrei” Urgency Hospital of Galaţi. Results and discussion. The distribution of dialysed patients affected with IRC according to the type of therapy applied is the following: the highest ratio – 59% – is recorded for the patients treated by hemodialysis, followed by those subjected to ambulatory continuous peritoneal dialysis (DPAC and by those with continuous cycle assisted by peritoneal dialysis (CCDP. A statistically significant association was observed between the number of teeth covered by dental plaque or scale and the number of elements with bleeding on probing (r = 0.543, P<0.001 and r = 0.568, P<0.001, respectively. Conclusions: The study shows that the dialysed patients suffering from IRC are more susceptible to periodontal diseases, comparatively with those without IRC, which shows that maintaining of an optimum oral hygiene is essential.

  9. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  10. Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus.

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    Andy W Yang

    Full Text Available Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8-10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED visits for renal colic due to ureteral calculus.We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA.90 cases (16.1% were diagnosed during full moon phase, 89 cases (15.9% were diagnosed during new moon phase, and 380 cases (68.0% were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events.In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center.

  11. [Necrotizing tonsillitis and renal vein thrombosis due to acute myeloid leukaemia].

    Science.gov (United States)

    Akram, Javed; Josefsson, Pernilla; Rømeling, Frans

    2012-09-03

    A 37-year-old woman was admitted to hospital with severe tonsillitis with unilateral necrotizing tonsillitis. She suddenly got fever, malaise, difficulties swallowing, pain in the throat and deterioration despite four days of penicillin treatment. During hospitalisation, she experienced abdominal pain, and blood tests showed pancytopenia. She was transferred to a haematological department, where a bone marrow biopsy showed acute myeloid leukaemia. Subsequently, an abdominal computed tomography with intravenous contrast revealed bilateral renal vein thrombosis, probably because of coagulopathy due to leukaemia.

  12. Time-updated systolic blood pressure and the progression of chronic kidney disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Anderson, Amanda H; Yang, Wei; Townsend, Raymond R; Pan, Qiang; Chertow, Glenn M; Kusek, John W; Charleston, Jeanne; He, Jiang; Kallem, RadhaKrishna; Lash, James P; Miller, Edgar R; Rahman, Mahboob; Steigerwalt, Susan; Weir, Matthew; Wright, Jackson T; Feldman, Harold I

    2015-01-01

    Background Blood pressure (BP) is often inadequately controlled in patients with chronic kidney disease (CKD). Previous reports of the longitudinal association between achieved level of BP and end-stage renal disease (ESRD) have not incorporated time-updated BP with appropriate adjustment for known confounders. Objective To assess the association between baseline and time-updated systolic BP (SBP) with the progression of CKD. Design Observational, prospective cohort study (ClinicalTrials.gov identifier: NCT00304148) Setting Seven US clinical centers Patients Participants of the Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,708) followed for a median (25th, 75th percentiles) of 5.7 (4.6, 6.7) years Measurements The mean of three seated SBP measurements were used as the visit-specific SBP. SBP was time-updated as the mean of that visit and all prior visits. Outcomes were ESRD and the composite renal endpoint of ESRD (dialysis or transplantation) or halving of the estimated glomerular filtration rate (eGFR). Analyses investigating baseline and time-updated SBP utilized traditional Cox proportional hazards models and marginal structural models, respectively. Results SBP was ≥130 mmHg at all study visits in 19.2% of participants, and ≥140 mmHg in 10.6%. The hazard ratio (95% confidence interval) for ESRD among participants with SBP 130–139 mmHg, compared to SBP <120 mmHg, was 1.46 (1.13–1.88) using only baseline data, and was 2.37 (1.48–3.80) using all available time-updated data. Among those with SBP ≥140 mmHg, corresponding hazard ratios were 1.46 (1.18–1.88) and 3.37 (2.26–5.03), respectively. Limitations SBP was measured once annually, and the CRIC Study cohort is not a random sample. Conclusions Among participants in the CRIC Study, time-updated SBP over 130 mmHg was more strongly associated with progression of CKD than analyses based on baseline SBP. Funding The CRIC Study is funded under cooperative agreements from the National Institute of

  13. Acute renal failure due to bilateral uric acid lithiasis in infants.

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    Kaya, Mete; Boleken, M Emin; Soran, Mustafa; Kanmaz, Turan; Yücesan, Selçuk

    2007-06-01

    Acute renal failure (ARF) is one of the complications of urolithiasis, but the role of medical treatment to relieve urinary obstruction in children with ARF is uncertain. We report on infants with acute obstructive uric acid lithiasis. We describe presentation features as well as diagnosis methods and medical treatment in five infants who were admitted to our institution with ARF due to uric acid lithiasis. The medical treatments for all patients were fluid liberalization, urine alkalinization, and oral allopurinol. Two children underwent urinary diversion. Within 8 h, urine output improved in all patients, and the stones passed spontaneously. All obstructed kidneys were relieved with medical treatment, and no renal sequel remained. So this series has showed a role of medical therapy in acute obstructive uric acid lithiasis.

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

    Science.gov (United States)

    Vega, Jorge; Díaz, Rienzi

    2014-11-01

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

  15. A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Chao Li; Dayi Hu; Xubo Shi; Li Li; Jingang Yang; Li Song; Changsheng Ma

    2015-01-01

    Background:Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods:This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction (eGFR ≥ 90 ml·min-1·1.73 m-2),mild RI (60 ml·min-1· 1.73 m-2 < eGFR < 90 ml·min-1· 1.73 m2) and moderate or severe RI (eGFR < 60 ml·min-1· 1.73 m2).The association between RI and inhospital and 6-year mortality of was evaluated.Results:Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years.Two hundred and eighty patients (39.0%) had RI,in which 61 patients (8.5%) reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality (1.4% vs.5.9% vs.22.9%,P < 0.001),6-year all-cause mortality (9.5% vs.19.8 vs.45.2%,P < 0.001) and 6-year cardiac mortality (2.9% vs.12.2% vs.23.8%,P < 0.001) were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an

  16. Partial Recovery of Delayed Graft Function due to Cholesterol Emboli after Renal Transplantation

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    Ackoundou-N'Guessan C

    2008-01-01

    Full Text Available A 65-year-old man who received a deceased renal allograft in September 2001. The donor of the allograft was a 54-year-old hypertensive man who expired from intracerebral hemorrhage. Atheroma with hard plaques was present in both renal arteries and aortic patches. After vascular anastomosis and clamp release, the allograft recolo-ration was inadequate, and the patient remained anuric. Computerized tomography scan demonstrated disseminated infarction areas, suggesting cholesterol emboli, which was confirmed later by a graft biopsy. As approximately 50% of the renal parenchyma was perfused, graft nephrectomy was not indicated and dialysis was restarted. Diuresis was over 3000 ml/day and serum creatinine decreased and stabilized at 360 µmol/L by the 32 nd postoperative day. The allograft supported the patient for only two years, and he eventually was successfully retransplanted in June 2003. We believe that delayed graft function due to cholesterol emboli disease may be reversible if areas of infarction are not too large.

  17. Relapsing Urinary Tract Infection Due to Rectourethral Fistula in a Renal Transplant Recipient

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    Ayşegül ORUÇ KOÇ

    2015-12-01

    Full Text Available Objectives: Urinary tract infection (UTI is the most common cause of bacterial infection in renal transplant recipients. It occurs frequently in the early period because of the high-dose immunosuppressive agents and urethral catheterizations. Relapsing UTI may lead to graft dysfunction and further evaluations have to be performed for predisposing factors. We report the case of a renal transplant recipient who presented with relapsing bacterial UTI due to a rectourethral fistula. Case: A 24-year-old male patient underwent a successful renal transplantation from a living donor on May 2008. He had a history of surgical intervention for anal atresia and rectourethral fistula. He was hospitalized five times because of relapsing bacterial UTI after transplantation. We investigated the presence of an anatomical abnormality and found a rectourethral fistula. After the surgical repair of the fistula the UTI did not relapse. Conclusion: Relapsing infections are not uncommon and anatomical abnormalities can lead to relapsing UTI in transplant recipients. Further investigations must be performed regarding the factors that might contribute to the development of UTIs in the presence of relapsing UTI.

  18. Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies.

    Science.gov (United States)

    Lash, James P; Ricardo, Ana C; Roy, Jason; Deo, Rajat; Fischer, Michael; Flack, John; He, Jiang; Keane, Martin; Lora, Claudia; Ojo, Akinlolu; Rahman, Mahboob; Steigerwalt, Susan; Tao, Kaixiang; Wolf, Myles; Wright, Jackson T; Go, Alan S

    2016-10-01

    Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited. Prospective cohort. 3,785 adults with entry estimated glomerular filtration rates of 20 to 70mL/min/1.73m(2) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study. Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death. Multivariable Cox proportional hazards. During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity. Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality. There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart

  19. Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT

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    Utsunomiya, Daisuke; Yanaga, Yumi; Oda, Seitaro; Namimoto, Tomohiro; Yamashita, Yasuyuki (Dept. of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan)), email: utsunomi@kumamoto-u.ac.jp; Awai, Kazuo (Dept. of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima Univ., Hiroshima (Japan)); Funama, Yoshinori (Dept. of Medical Physics, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan))

    2011-06-15

    Background Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. Purpose To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. Material and Methods A total of 6586 patients (3630 men and 2956 women; mean age 57.0 +- 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m2) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 < =eGFR < 90, 45 < =eGFR < 60, 30 < =eGFR < 45 and eGFR < 30, respectively. Results Of the 6586 patients, 1.6%, 3.7%, 13.7%, and 54.2% were judged to present with severe, moderate-b, moderate-a, and mild RI, respectively. While moderate-b-to-severe RI was recorded in 133 (3.2%) of 4161 patients aged 70 years or less, it was observed in 218 (9.0%) of the 2425 patients who were 71 years or older. Among the 829 CVD patients, 9.9% manifested moderate-b-to-severe- and 73.0% mild-to-moderate-a RI. The corresponding rates were 4.4% and 68.9% for oncologic disease, 16.9% and 61.2% for DM, and 4.8% and 71.5% for CLD patients. By univariate analysis, there was a significant association between moderate-b-to-severe RI and the advanced age, CVD, DM, and non-oncologic disease. Multivariate analysis showed that the advanced age, DM, and non-oncologic disease were statistically associated with moderate-b-to-severe RI. Conclusion The incidence of RI of eGFR < 45mL/min/1.73 m2 at baseline was high in patients with advanced age, CVD and DM and

  20. Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report

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    Sountoulides P

    2008-05-01

    Full Text Available Abstract Introduction Congenital renal arteriovenous malformations (AVMs are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma. Case presentation A 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC of the upper tract, in view of the patient's age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed. Conclusion This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

  1. 睡眠对脊柱后侧凸患者呼吸衰竭的影响%Impact of sleep in respiratory insufficiency due to kyphoscoliosis

    Institute of Scientific and Technical Information of China (English)

    王亮; 韩芳; 罗妮娅

    2014-01-01

    脊柱后侧凸患者发生呼吸衰竭时,夜间低氧血症和高碳酸血症都会加重,这与睡眠时通气量下降直接相关,本文主要总结睡眠影响脊柱畸形患者呼吸衰竭机制及治疗方法.%Patients who have respiratory insufficiency due to kyphoscoliosis may develop profound hypoxaemia and hypercapnia during sleep,that is associated with nocturnal hypoventilation.The purpose of this review is to outline the mechanisms by which sleep influences respiratory failure and to discuss management strategies.

  2. Progressive renal failure due to renal infiltration by BK polyomavirus and leukaemic cells: which is the culprit?

    Science.gov (United States)

    Sangala, Nicholas; Dewdney, Alex; Marley, Nicholas; Cranfield, Tanya; Venkat-Raman, Gopalakrishnan

    2011-02-01

    Renal infiltration with leukaemic cells is a common finding in patients suffering with chronic lymphocytic leukaemia (CLL) but rarely does it lead to significant renal dysfunction. Similarly, BK nephropathy is a recognized cause of graft failure in renal transplant recipients but rarely causes significant disease in native kidneys. In the few reports where leukaemic infiltration of the kidney has led to significant renal impairment, the pathological process causing renal dysfunction is not identified on biopsy. In these cases, it is unclear whether BK polyomavirus (BKV) nephropathy has been excluded. We describe a case of dual pathologies in a patient with Binet stage C CLL and deteriorating renal function where renal biopsy reveals leukaemic infiltration of the kidney occurring alongside BKV nephropathy. The relative importance of each pathology in relation to the rapid decline to end-stage renal failure remains unclear, but the presence of both pathologies appears to impart a poor prognosis. Additionally, we describe the novel histological finding of loss of tubular integrity resulting in tubular infiltration and occlusion by leukaemic cells. It is possible that the patient with advanced CLL is at particular risk of BK activation, and the presence of BK nephropathy may compromise tubular integrity allowing leukaemic cell infiltration and obstruction of tubules. This case bares remarkable resemblance to the first and only other report of its kind in the literature. It is not clear how available immunocytochemistry for polyoma infection is outside transplant centres, and it is possible that BK nephropathy is being under-diagnosed in patients with CLL in the context of declining renal function. At present, the combination of BKV nephropathy and leukaemic infiltration represents a management conundrum and the prognosis is poor. Further research is required in order to better understand the pathological process and therefore develop management strategies.

  3. [Urolithiasis due to renal tubular acidosis associated with Sjögren's syndrome].

    Science.gov (United States)

    Umekawa, T; Esa, A; Uemura, T; Kohri, K; Kurita, T; Ishikawa, Y; Iguchi, M; Kataoka, K

    1990-03-01

    We encountered 4 patients with urolithiasis due to renal tubular acidosis (RTA) associated with Sjögren's syndrome. Laboratory results about RTA in 4 patients with Sjögrenhs syndrome were not significantly different from those in patients who suffered from urolithiasis due to RTA without Sjögren's syndrome. The incidence of urolitiasis in these cases was suspected to be higher than that in RTA patients without Sjögren's syndrome, because all 4 patients in this study had urolithiasis. When we examine patients with bilateral and multiple urolithiasis, particularly in middle-aged women, we should bear in mind that RTA and Sjögren's syndrome may exist in the background.

  4. Renal failure due to granulomatous interstitial nephritis in native and allograft renal biopsies: experience from a tertiary care hospital.

    Science.gov (United States)

    Gupta, Pallav; Rana, D S; Bhalla, A K; Gupta, Ashwini; Malik, Manish; Gupta, Anurag; Bhargava, Vinant

    2014-10-01

    Granulomatous interstitial nephritis is a rare cause of renal failure in both native and allograft renal biopsies. Drugs and sarcoidosis are the commonest causes of granulomatous interstitial nephritis as reported in Western countries. Unlike the west, tuberculosis is the commonest cause of granulomatous interstitial nephritis in Indian subcontinent. The etiological factors, clinical course, glomerular and tubulointerstitial changes associated with granulomatous interstitial nephritis have been analyzed in the present study along with the outcome in patients with granulomatous interstitial nephritis.

  5. The characteristics of chronic renal insufficiency complicated with infection and the related factors%慢性肾功能不全并发感染的特征及相关因素

    Institute of Scientific and Technical Information of China (English)

    陈卫东; 张燕; 贾平

    2001-01-01

    目的探讨慢性肾功能不全患者并发感染的特征及相关因素。方法对我科1996年6月~2000年6月慢性肾功能不全并发感染的297例患者进行回顾性统计分析,并与同期因慢性肾功能不全住院未并发感染的211例患者比较。结果慢性肾功能不全易并发感染,感染率达58.46%,其发生与血白蛋白水平降低及外周血白细胞减少等因素相关,各组间比较差异有非常显著性(P<0.001),病原菌以革兰阴性杆菌为主,临床表现多不典型,好发部位主要是泌尿道和呼吸道。结论对慢性肾功能不全合并感染患者应提高患者抵抗力,改善营养状况,积极控制感染。%Objective To investigate the characteristics of chronic renal insufficiency complicated with infection and the related factors.Methods A retrospective statistic analysis of 297 cases of chronic renal insufficiency complicated with infection from June 1996 to June 2000 was made in comparison with 211 cases of chronic renal insufficiency without infection.Results Chronic renal insufficiency was easy to complicate with infection.The infection rate was up to 58.46%.The occurrence was related to the lowering of serum albumin level and peripheral white blood count.The difference between the two groups was significant (P<0.001).The pathogens were mainly Gram negative organisms.The clinical features were not typical in most cases.Common involved locations were obviously in urethral and respiratory tracts.Conclusion In the case of chronic renal insufficiency complicated with infection,It is important to give patients better nutrition,active control of infection and improve the of patients’ resistance.

  6. Renal tubule cell repair following acute renal injury.

    Science.gov (United States)

    Humes, H D; Lake, E W; Liu, S

    1995-01-01

    Experimental data suggests the recovery of renal function after ischemic or nephrotoxic acute renal failure is due to a replicative repair process dependent upon predominantly paracrine release of growth factors. These growth factors promote renal proximal tubule cell proliferation and a differentiation phase dependent on the interaction between tubule cells and basement membrane. These insights identify the molecular basis of renal repair and ischemic and nephrotoxic acute renal failure, and may lead to potential therapeutic modalities that accelerate renal repair and lessen the morbidity and mortality associated with these renal disease processes. In this regard, there is a prominent vasoconstrictor response of the renal vasculature during the postischemic period of developing acute renal failure. The intravenous administration of pharmacologic doses of atrial natriuretic factor (ANF) in the postischemic period have proven efficacious by altering renal vascular resistance, so that renal blood flow and glomerular filtration rate improve. ANF also appears to protect renal tubular epithelial integrity and holds significant promise as a therapeutic agent in acute renal failure. Of equal or greater promise are the therapeutic interventions targeting the proliferative reparative zone during the postischemic period. The exogenous administration of epidermal growth factor or insulin-like growth factor-1 in the postischemic period have effectively decreased the degree of renal insufficiency as measured by the peak serum creatinine and has hastened renal recovery as measured by the duration of time required to return the baseline serum creatinine values. A similarly efficacious role for hepatocyte growth factor has also been recently demonstrated.

  7. Association of N-Terminal Pro-B-Type Natriuretic Peptide with Left Ventricular Structure and Function in Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort [CRIC])

    Science.gov (United States)

    Mishra, Rakesh K.; Li, Yongmei; Ricardo, Ana C.; Yang, Wei; Keane, Martin; Cuevas, Magdalena; Christenson, Robert; DeFilippi, Christopher; Chen, Jing; He, Jiang; Kallem, Radhakrishna R.; Raj, Dominic S.; Schelling, Jeffrey R.; Wright, Jackson; Go, Alan S.; Shlipak, Michael G.

    2017-01-01

    We evaluated the cross-sectional associations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) with cardiac structural and functional abnormalities in a cohort of chronic kidney disease (CKD) patients without clinical heart failure (HF), the Chronic Renal Insufficiency Cohort (n=3,232). Associations of NT-proBNP with echocardiographically determined left ventricular (LV) mass and LV systolic and diastolic function were evaluated by multivariable logistic and linear regression models. Reclassification of participants’ predicted risk of LV hypertrophy (LVH), systolic and diastolic dysfunction was performed using a category-free net reclassification improvement (NRI) index that compared a clinical model with and without NT-proBNP. The median (interquartile range) NT-proBNP was 126.6 pg/ml (55.5–303.7). The highest quartile of NT-proBNP was associated with nearly three-fold odds of LVH (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.8–4.0) and LV systolic dysfunction (2.7, 1.7–4.5) and two-fold odds of diastolic dysfunction (2.0, 1.3–2.9) in the fully adjusted models. When evaluated alone as a screening test, NT-proBNP functioned modestly for the detection of LVH (area under the curve, AUC 0.66) and LV systolic dysfunction (AUC 0.62), and poorly for the detection of diastolic dysfunction (AUC 0.51). However, when added to the clinical model, NT-proBNP significantly reclassified participants’ likelihood of having LVH (NRI 0.14, 95% CI 0.13–0.15; p<0.001) and LV systolic dysfunction (0.28, 0.27–0.30; p<0.001), but not diastolic dysfunction (0.10, 0.10–0.11; p=0.07). In conclusion, in this large CKD cohort without HF, NT-proBNP had strong associations with prevalent LVH and LV systolic dysfunction. PMID:23178053

  8. Relating circulating thyroid hormone concentrations to serum interleukins-6 and -10 in association with non-thyroidal illnesses including chronic renal insufficiency

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    Sabry Alaa A

    2008-01-01

    Full Text Available Abstract Background Because of the possible role of cytokines including interleukins (IL in systemic non-thyroidal illnesses' (NTI pathogenesis and consequently the frequently associated alterations in thyroid hormone (TH concentrations constituting the euthyroid sick syndrome (ESS, we aimed in this research to elucidate the possible relation between IL-6 & IL-10 and any documented ESS in a cohort of patients with NTI. Methods Sixty patients and twenty healthy volunteers were recruited. The patients were subdivided into three subgroups depending on their underlying NTI and included 20 patients with chronic renal insufficiency (CRI, congestive heart failure (CHF, and ICU patients with myocardial infarction (MI. Determination of the circulating serum levels of IL-6 and IL-10, thyroid stimulating hormone (TSH, as well as total T4 and T3 was carried out. Results In the whole group of patients, we detected a significantly lower T3 and T4 levels compared to control subjects (0.938 ± 0.477 vs 1.345 ± 0.44 nmol/L, p = 0.001 and 47.9 ± 28.41 vs 108 ± 19.49 nmol/L, p 2 = 0.338, p = 0.001 and not IL-10 was a predictor of low T3 levels with only a borderline significance for T4 (R2 = 0.082, p = 0.071. By subgroup analysis, the proportion of patients with subnormal T3, T4, and TSH levels was highest in the MI patients (70%, 70%, and 72%, respectively who displayed the greatest IL-6 and IL-10 concentrations (192.5 ± 45.1 ng/L & 122.95 ± 46.1 ng/L, respectively compared with CHF (82.95 ± 28.9 ng/L & 69.05 ± 44.0 ng/L, respectively and CRI patients (40.05 ± 28.9 ng/L & 30.4 ± 10.6 ng/L, respectively. Surprisingly, CRI patients showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to CHF patients (40%, 45%, & 26% vs 35%, 25%, & 18%, respectively. Conclusion the high prevalence of ESS we detected in NTI including CRI may be linked to IL-6 and IL-10 alterations. Further

  9. Imaging of renal osteodystrophy

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    Jevtic, V. E-mail: vladimir.jevtic@mf.uni-lj.si

    2003-05-01

    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  10. Symptoms in patients with skin changes due to chronic venous insufficiency often lead to emergency care service: an Italian observational study.

    Science.gov (United States)

    Ruggiero, Michele; Grande, Raffaele; Naso, Agostino; Butrico, Lucia; Rubino, Paolo; Placida, Girolamo Domenico; Cannistrà, Marco; Serra, Raffaele

    2016-10-01

    Chronic venous insufficiency (CVI) is the most advanced form of chronic venous disease (CVD), and is often associated with skin changes such as hyperpigmentation, eczema, lipodermatosclerosis and venous skin ulceration that cause discomfort, pain, sleep disturbances, absenteeism in the workplace, disability and deteriorated quality of life (QoL). The purpose of this study is to evaluate the prevalence of CVI and skin changes in patients who turn to Continuous Assistance Services due to the presence of disturbing symptoms of their condition. Data were evaluated by consulting the medical records, during a 16-month period, available with three Continuous Assistance Services of the Italian territory. The overall population of the referring centres consisted of 1186 patients [739 females (62·31%) and 447 males (37·69%)]. Seventy-nine patients (6·66%) consulted the emergency unit for venous symptoms related to CVD. Patients with more severe disease (CVI, categories C4-C6) represented the majority accounting for 60·75%, while patients with moderate disease (C3) accounted for 35·44% and patients with mild disease (C1-C2 stages) accounted for 3·79%. The main finding of this study is that despite CVI not being a disease that commonly requires medical emergency/urgency intervention, patients with CVI, especially in advanced stage with skin changes, may turn to Continuous Assistance Service for treating bothersome symptoms related to their condition.

  11. Correlation analysis of homocystein and chronic heart failure combined with insufficient renal function%同型半胱氨酸与慢性心力衰竭合并肾功能不全的相关性分析

    Institute of Scientific and Technical Information of China (English)

    李剑平; 郭建浩

    2015-01-01

    Objective To explore the levels of homocystein (Hcy) in patients with chronic heart failure combined insuf-ficient renal function. Methods 58 patients with chronic heart failure in our hospital from June 2013 to June 2014 were selected as the research object.According to patient’s condition,all patients were divided into the chronic heart failure combined insufficient renal function group (n=28) and the chronic heart failure group (n=30).The left ventricular ejec-tion fraction (LVEF) was determined by cardiac ultrasound,the levels of plasma BNP were determined enzyme-linked immuno sorbent assay,the levels of plasma creatine were determined by enzymatic method. Results The proportion of patients of gradeⅢ and gradeⅣ in chronic heart failure and renal insufficiency group was higher than that in chronic heart failure group,the level of LVEF in chronic heart failure and renal insufficiency group was lower than that in chronic heart failure group,the levels of BNP and Hcy in peripheral blood of chronic heart failure and renal insufficien-cy group was higher than that in chronic heart failure group,with significant difference (P<0.05).The levels of plasma Hcy was positively correlated with the levels of plasma BNP and creatine,but negatively correlated with LVEF. Con-clusion Hcy is participated in the development of chronic heart failure concurrence insufficient renal function,which may be a potential target for patients with chronic heart failure combined renal dysfunction.%目的:探讨同型半胱氨酸(Hcy)在慢性心力衰竭并肾功能不全患者外周血中的表达。方法选取2013年6月~2014年6月本院心血管内科收治的58例慢性心力衰竭患者作为研究对象,根据患者病情分为慢性心力衰竭合并肾功能不全组(n=28)和慢性心力衰竭组(n=30)。分别予以心脏超声检测左室射血分数(LVEF),酶联免疫吸附法检测血浆脑钠肽(BNP)水平,酶法检测血浆肌酐水平。结果慢性心力衰竭并肾

  12. Renal sodium retention in cirrhotic rats depends on glucocorticoid-mediated activation of mineralocorticoid receptor due to decreased renal 11beta-HSD-2 activity

    DEFF Research Database (Denmark)

    Thiesson, Helle; Jensen, Boye L; Bistrup, Claus;

    2007-01-01

    rats with decompensated liver cirrhosis and ascites 7 wk after bile duct ligation (BDL). Renal 11beta-HSD-2 mRNA, protein, and activity were significantly decreased in decompensated rats. The urinary Na(+)/K(+) ratio was reduced by 40%. Renal epithelial sodium channel (ENaC) mRNA and immunostaining......, and reduced ascites formation to the same degree as direct inhibition of MR with K-canrenoate. Total potassium balance was negative in the BDL rats, whereas renal potassium excretion was unchanged. In the distal colon, expression of ENaC was increased in BDL rats. Fecal potassium excretion was increased...... by endogenous glucocorticoids. In addition, the overall potassium loss in the BDL model is due to increased fecal potassium excretion, which is associated with upregulation of ENaC in distal colon....

  13. Growth hormone and the kidney: the use of recombinant human growth hormone (rhGH) in growth-retarded children with chronic renal insufficiency.

    Science.gov (United States)

    Fine, R N

    1991-04-01

    Hypothalamic production of growth hormone releasing hormone stimulates the anterior pituitary gland to release growth hormone (GH). The clinical manifestations of GH on tissues are either direct or are mediated by insulin-like growth factors (IGF). Both the somatic effects of GH and the renal manifestations of an increase in glomerular filtration rate and renal plasma flow are mediated by IGF. The increase in glomerular filtration rate/renal plasma flow that occurs with either exogenous or endogenous GH is not apparent in patients with chronic renal failure (CRF); therefore, it is unlikely that recombinant human growth hormone (rhGH) treatment of patients with CRF will result in glomerular hyperfiltration. Longitudinal studies are required to determine if the glomerulosclerosis and renal functional impairment occurring in GH and growth hormone releasing hormone transgenic mice occurs after rhGH treatment of growth-retarded uremic rats with GH resulted in an improvement in growth velocity. This led to preliminary studies in growth-retarded children with CRF by using rhGH. The acceleration of growth velocity was dramatic despite the fact that GH levels are elevated in uremia. The elevated IGF carrier proteins in uremic children may contribute to the growth retardation. Treatment with rhGH may be efficacious by stimulating a net increase in the free (unbound) IGF levels. Hyposecretion of GH may contribute to the failure to achieve optimal growth after successful renal transplantation. Treatment with rhGH may be efficacious in improving the growth velocity of renal allograft recipients.

  14. [Fluoroquinolone induced acute renal failure. General review about a case report with crystalluria due to ciprofloxacin].

    Science.gov (United States)

    Montagnac, Richard; Briat, Claude; Schillinger, Francis; Sartelet, Hervé; Birembaut, Philippe; Daudon, Michel

    2005-03-01

    A 58 year-old woman developed an acute renal failure very quickly after ingestion of two 500 mg tablets of ciprofloxacin, without any other identifiable risk factor. Renal biopsy was performed. No sign of acute interstitial nephritis was observed but tubular lesions were found, accompanied by deposits of a brown-yellowish substance identified by infrared microscopy as a ciprofloxacin salt. The outcome was favourable. This observation gives the opportunity to remind the different forms of quinolone-induced renal injury and to discuss the possible ways for preventing renal side-effects related to the quinolone use.

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

    Directory of Open Access Journals (Sweden)

    Omkar U. Vaidya

    2012-01-01

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

  16. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

    Directory of Open Access Journals (Sweden)

    Ilić Radoje

    2005-01-01

    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  17. 轻度肾功能不全与急性冠状动脉综合征预后的相关性%The predictive value of mild renal insufficiency on the prognosis of patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    张建华; 徐岩; 陈旭华; 伍梦佐; 程自平; 陈斌

    2013-01-01

    目的 分析轻度肾功能不全对急性冠状动脉综合征患者(ACS)终点事件的预测价值.方法 按估算的肾小球滤过率(eGFR)水平不同,将552例ACS患者分为肾功能正常组(eGFR≥90ml·min-1·1.73 m-2)与轻度肾功能不全组(eGFR60~ <90 ml·min-1·1.73 m-2),前瞻性随访并分析轻度肾功能不全与ACS患者终点事件的相关性.结果 轻度肾功能不全组患者初级终点事件的发生率高于肾功能正常组[31例(12.6%)比15例(4.9%),P=0.001],次级终点事件的发生在两组间差异无统计学意义.初级终点事件中全因死亡[22例(8.9%)比7例(2.2%),P<0.001]及心源性死亡[16例(6.5%)比4例(1.3%),P=0.001]的发生率在轻度肾功能不全组较高,而非致死性卒中及心肌梗死的发生两组间差异无统计学意义.COX回归模型分析结果发现,轻度肾功能不全患者发生初级终点事件的相对危险度是肾功能正常患者的2.265倍(95% CI1.076 ~4.771,P=0.031),对各单独事件进一步分析表明轻度肾功能不全对全因死亡有预测价值(HR3.118,95% CI1.197~8.125,P=0.020).初级终点事件及全因死亡的Kaplan-Meier曲线显示,轻度肾功能不全组患者的初级终点事件(p=0.004)及全因死亡(P=0.001)的发生率高于肾功能正常组.结论 轻度肾功能不全对ACS患者的初级终点事件具有重要预测价值.%Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR <90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal

  18. Increased expression of HIF-1α, VEGF-A and its receptors, MMP-2, TIMP-1, and ADAMTS-1 at the venous stenosis of arteriovenous fistula in a mouse model with renal insufficiency

    Science.gov (United States)

    Misra, Sanjay; Shergill, Uday; Yang, Binxia; Janardhanan, Rajiv; Misra, Khamal D.

    2010-01-01

    Purpose A mouse model of renal insufficiency with arteriovenous fistula (AVF) and venous stenosis was created. We tested the hypothesis that there is increased gene expression of hypoxia inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor- A (VEGF-A) and its receptors (VEGFR-1, -2), matrix metalloproteinase-2 (MMP-2), -9 (MMP-9), tissue inhibitor of metalloproteinase-1, -2 (TIMP-1, -2), and a disintegrin and metalloproteinase thrombospondin-1 (ADAMTS-1) at the venous stenosis. Materials and methods Nineteen male C57BL/6 mice underwent a left nephrectomy and a surgical occlusion of the right upper pole to induce renal insufficiency and characterized in eight mice. Twenty eight days later, an AVF (n=11) was created from the right carotid artery to ipsilateral jugular vein and the mice were sacrificed at day 7 (n=4) and day 14 (n=4). The outflow and control veins were removed for gene expression. Three mice were sacrificed at day 28 for histologic analysis. Results The mean serum blood urea nitrogen remained significantly elevated for 8 weeks when compared to baseline (P<0.05). By day 7, there was a significant increase in the expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with HIF-1α and TIMP-1 being significantly elevated at day 14 (P<0.05). By day 28, the venous stenosis was characterized by a thickened vein wall and neointima. Conclusions A mouse model of renal insufficiency with AVF was developed which had increased expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with venous stenosis by day 28. PMID:20598569

  19. Effect of Shenqi Fuzheng Injection on Chronic Renal Insufficiency Anemia%参芪扶正注射液对慢性肾功能不全贫血的影响

    Institute of Scientific and Technical Information of China (English)

    韩鸿雁

    2016-01-01

    目的:探讨参芪扶正注射液对慢性肾功能不全贫血的影响。方法整群选取2013年11月-2015年1月医院收治的慢性肾功能不全贫血患者138例随机分成两组各69例,对照组给予蔗糖铁注射液,观察组给予参芪扶正注射液,比较两组的治疗效果,RBC、WBC及Hb和不良反应。结果观察组治疗有效率为85.5%,对照组治疗有效率为65.2%(P0.05﹚。结论参芪扶正注射液治疗慢性肾功能不全贫血疗效满意,不良反应少,值得应用。%Objective To discuss the effect of shenqi fuzheng injection on chronic renal insufficiency anemia. Methods 138 cases of patients with chronic renal insufficiency anemia treated in our hospital from November 2013 to January 2015 were randomly divided into two groups with 69 cases in each, the control group were treated with iron sucrose injection, the ob-servation group were treated with shenqi fuzheng injection, the treatment effect, RBC , WBC, Hb and adverse reaction of the two groups were compared. Results The treatment effective rate was 85.5% in the observation group and 65.2% in the control group (P0.05﹚. Conclusion Shenqi fuzheng injection in treatment of chronic renal insufficiency anemia has a satisfactory curative effect and few adverse reactions, which is worth application.

  20. 急性心肌梗死患者肾功能状态及对预后的影响%The Relationsc of renal insufficiency and in-hospital prognosis in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李超; 胡大一; 王建旗; 杨进刚; 孙艺红; 宋丽

    2012-01-01

    目的 探评价急性ST段抬高型心肌梗死(STEMI)患者入院即刻肾功能状态及对院内预后的影响.方法 多中心、前瞻性队列研究.入选自2005年12月至2007年1月,在发病后24小时内至北京市19家医院就诊的STEMI患者718例.入院即刻测定血清肌酐,根据改良的简化MDRD公式计算估计的肾小球滤过率(eGFR).分为肾功能正常组(eGFR≥90 ml/ (min·1.73m2)、轻度肾功能不全组(60ml/(min·1.73m2≤eGFR<90 ml/ (min·1.73m2)和中度肾功能不全组(eGFR<60 ml/ (min·1.73m2),比较三组的临床特点和院内死亡和心血管事件发生情况,采用多元Logistic回归分析影响STEMI患者院内死亡和主要心血管事件的危险因素.结果 718例患者中共有280例(39.0%)已经存在不同程度的肾功能不全(eGFR<90ml/min),其中61例(8.5%)为中度以上肾功能不全(eGFR<60ml/min).与肾功能正常组相比,轻度肾功能不全组和中度肾功能不全组患者年龄偏大(57±12)岁vs (66±13)岁vs (72±13)岁,P<0.01),女性比例多(16.9%vs 39.2% vs 48.3%,P<0.01),既往有高血压病(47.7% vs 59.8% vs 70.5%,P<0.01),心力衰竭(0% vs 2.7% vs 6.6%,P<0.01),脑卒中或一过性脑缺血(TIA)病史(8.9% vs 10.6% vs 19.3%,P<0.05),入院时心功能Killip≥Ⅱ级(34.7% vs 37.0% vs 65.5%,P<0.01)较多.院内病死率(1.4% vs 5.9% vs 22.9%,P<0.01)和心血管事件(18.0% vs 27.4% vs 63.9%,P<0.01)显著增高.多因素Logistic回归分析显示入院即刻肾功能不全是STEMI患者发生院内死亡和心血管事件的独立危险因素(OR值分别为3.870;95%CI:1.767-8.474,P<0.01和1.712;95%CI:1.217-2.408,P<0.01).结论 STEMI患者中肾功能不全发生率较高,院内死亡及心血管事件的发生率随肾功能恶化而增加,肾功能不全是院内死亡和心血管事件的独立危险因素.%Aim To investigate the association of renal insufficiency and in-hospital prognosis in

  1. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain.

    Science.gov (United States)

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-09-18

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  2. A Case of Progressive Tubulo-Interstitial Nephritis due to Culture-negative Renal Tuberculosis

    Directory of Open Access Journals (Sweden)

    El-Reshaid Kamel

    2001-01-01

    Full Text Available This report describes a woman with progressive renal failure without proteinuria, urinary obstruction or overt systemic disease. The progressive renal disease without pelvicalyceal deformities in the left kidney was not consistent with the vesicoureteric reflux nephropathy. A needle biopsy of the left kidney showed interstitial caseating granulomata. The patient did not have clinical, radiological or urine culture evidence of renal tuberculosis. She improved after treatment with antituberculous therapy. This case report demonstrates the value of kidney biopsy in establishing the diagnosis of such common and treatable disease even if clinically silent and urine culture negative.

  3. Lipid-storage myopathy and respiratory insufficiency due to ETFQO mutations in a patient with late-onset multiple acyl-CoA dehydrogenation deficiency

    DEFF Research Database (Denmark)

    Olsen, Rikke Katrine Jentoft; Pourfarzam, M; Morris, A A M;

    2004-01-01

    response to treatment, she developed respiratory insufficiency at age 14 years and has required long-term overnight ventilation. Thus, MADD is one of the few conditions that can cause a myopathy with weakness of the respiratory muscles out of proportion to the limb muscles. Udgivelsesdato: 2004-null...

  4. Management of a patient with unstable angina, left main coronary artery disease, and respiratory insufficiency due to eventration of the diaphragm.

    Science.gov (United States)

    Khanna, Surendra Nath; Paul, Mathews; Bal, Sabyasachi; Karlekar, Anil

    2013-09-01

    The incidence of eventration of diaphragm before cardiac surgery is rare. We describe the management of a patient with eventration of the diaphragm who underwent a coronary artery bypass grafting (CABG) for left main coronary artery disease followed by left diaphragm plication with video-assisted thoracic surgery (VATS) for the postoperative respiratory insufficiency.

  5. A rare case of renal vein thrombosis due to urinary obstruction.

    Science.gov (United States)

    Jana, Tanima; Orlander, Philip R; Molony, Donald A

    2015-08-01

    Renal vein thrombosis (RVT) is an uncommon condition in adults and may be caused by endothelial damage, stasis, or hypercoagulable states. RVT is commonly identified in patients with nephrotic syndrome or malignancy. We present the case of a 57-yearold man with no past medical history who presented with a 1-month history of abdominal pain, dysuria, and hematuria. Initial laboratory studies were consistent with acute kidney injury (AKI). Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. His renal failure and presenting symptoms resolved with placement of a Foley catheter and ureteral stent. The patient was discharged on anticoagulation. Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein.

  6. Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients

    OpenAIRE

    Vassallo, Matteo; Moranne, Olivier; Ambrosetti, Damien; Jeandel, Pierre-Yves; Pomares, Christelle; Cassuto, Elisabeth; Boscagli, Annick; Giraud, Guillaume; Montagne, Nathalie; Dentone, Chiara; Demacina, Ilaria; Villaggio, Barbara; Secondo, Giovanni; Ferrea, Giuseppe; Passeron, Corinne

    2014-01-01

    Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete reco...

  7. RENOVASCULAR HYPERTENSION DUE TO RENAL ARTERY STENOSIS IN KLIPPEL-FEIL SYNDROME

    OpenAIRE

    Foyaca-Sibat H. MD.; Ibañez-Valdés LdeF. MD,

    2003-01-01

    ABSTRACT We report one patient with Klippel-Feil (KFS) syndrome, other associated anomalies, uncontrolled arterial hypertension, and renal artery stenosis. Because this patient underwent for surgical revascularization with unsuccessful result, all proposed way of treatments are revised, and we have hypothesized that probably for patients with KFS and unilateral renal artery stenosis, medical treatment with ACE inhibitors can provide more benefits than surgical revascularization or percutan...

  8. Relative Incidence of ESRD Versus Cardiovascular Mortality in Proteinuric Type 2 Diabetes and Nephropathy : Results From the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) Database

    NARCIS (Netherlands)

    Packham, David K.; Alves, Tahira P.; Dwyer, Jamie P.; Atkins, Robert; de Zeeuw, Dick; Cooper, Mark; Shahinfar, Shahnaz; Lewis, Julia B.; Lambers Heerspink, Hiddo J.

    2012-01-01

    Background: Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome tha

  9. A new type of defecation disorder due to insufficient fixation of the rectum to the sacrum is improved by rectopexy: A report of three cases

    Directory of Open Access Journals (Sweden)

    Wataru Sumida

    2016-07-01

    Full Text Available Chronic constipation is the most common clinical disorder in children. However, some cases of constipation do not meet the criteria defined by Rome III. We encountered such defecation disorders in three patients who presented with constipation as a chief complaint along with excessive strain and bleeding hemorrhoids during defecation despite normal stools. Contrast enema revealed that the rectum was separated from the sacrum in each patient, which may have been caused by insufficient fixation of the rectum. Conservative treatment with laxatives and suppositories failed to achieve improvement. Therefore, all underwent a laparoscopic rectopexy. After surgery, each patient was able to evacuate without strain and the hemorrhoids disappeared. Insufficient fixation of the rectum should be considered as a potential cause of defecation disorders. Rectopexy is effective for this type of defecation disorder.

  10. Budesonide-related adrenal insufficiency.

    Science.gov (United States)

    Arntzenius, Alexander; van Galen, Louise

    2015-10-01

    Iatrogenic adrenal insufficiency is a potential harmful side effect of treatment with corticosteroids. It manifests itself when an insufficient cortisol response to biological stress leads to an Addisonian crisis: a life-threatening situation. We describe a case of a patient who developed an Addisonian crisis after inappropriate discontinuation of budesonide (a topical steroid used in Crohn's disease) treatment. Iatrogenic adrenal insufficiency due to budesonide use has been rarely reported. Prescribers should be aware of the resulting risk for an Addisonian crisis.

  11. Serum uric acid is a GFR-independent long-term predictor of acute and chronic renal insufficiency: the Jerusalem Lipid Research Clinic cohort study

    Science.gov (United States)

    Kark, Jeremy D.

    2011-01-01

    Background. Kidney disease is commonly accompanied by hyperuricemia. However, the contribution of serum uric acid (SUA) to kidney injury is debated. Our objective was to assess the long-term prediction of renal failure by SUA. Methods. Visit 2 participants in the Jerusalem Lipid Research Clinic cohort with normal baseline kidney function were followed for 24–28 years. SUA levels were assessed for associations with acute renal failure (ARF) and chronic renal failure (CRF) as defined by hospital discharge records, and mortality, ascertained through linkage with the national population registry. Results. Among 2449 eligible participants (1470 men, 979 women aged 35–78 years in 1976–79), SUA was positively linked with male sex, serum creatinine and components of the metabolic syndrome but was lower in smokers and in diabetic subjects. The 22- to 25-year incidence of hospital-diagnosed kidney failure (145 first events, 67% CRF) and the 24- to 28-year mortality (587 events) were higher in subject with hyperuricemia (>6.5 mg/dL in men and >5.3 mg/dL in women, reflecting the upper quintiles), independent of baseline kidney function and covariates. Hyperuricemia conferred adjusted hazard ratios of 1.36 (P = 0.003), 2.14 (P < 0.001) and 2.87 (P = 0.003) for mortality, CRF and ARF, respectively. Conclusions. SUA predicts renal failure incidence and all-cause mortality independently of demographic and clinical covariates. These results lend support to the undertaking of clinical trials to examine the effect of uric acid-lowering strategies on kidney outcomes. PMID:21220750

  12. [Acute renal failure due to obstructive ureteral stone associated with norovirus gastroenteritis in an infant with congenital solitary kidney].

    Science.gov (United States)

    Kato, Taiki; Hamano, Atsushi; Kawamura, Hideki

    2014-10-01

    We report a 35 month-old boy with acute renal failure caused by an obstructive ureteral stone associated with norovirus gastroenteritis. He visited his family physician because of fever, abdominal pain and vomiting. He was diagnosed as acute gastroenteritis. The symptoms relieved once, but abdominal pain and vomiting recurred two days after the visit and the volume of urine decreased. He was diagnosed as norovirus gastoenteritis and acute renal failure which was unresponsive to fluid replacement. Ultrasound study of the abdomen showed a solitary kidney with mild hydronephrosis. He was then admitted to our hospital. He was finally diagnosed as acute postrenal failure due to obstructive ureteral stone with left solitary kidney by abdominal computer tomography (CT). We performed transurethral catheterization immediately. The creatinine and blood urea nitrogen returned to normal level in 2 days. The CT performed on the 28th day post operation showed disappearance of the stone after uric alkalization. Recently, some cases of postrenal failure due to bilateral obstructive ureteral stones, mainly ammonium acid urate stones, associated with viral gastroenteritis were reported. As clinical features, they are common in boys three years or younger after an episode of rotavirus gastroenteritis with high uric acid concentration. By far, the most common cause of acute renal failure in patients with severe gastroenteritis is prerenal failure resulting from hypovolemia. But postrenal cause due to bilateral obstructive stones should be taken in a consideration.

  13. 急性ST段抬高心肌梗死患者肾功能不全的发生率和预后价值%Incidence and prognostic value of renal insufficiency in patients with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    曾汇庆; 郑海生

    2010-01-01

    目的 评估急性ST段抬高心肌梗死(STEMI)患者肾功能不全的发生率及其预后价值.方法 采用改良的简化肾脏病改良饮食(MDRD)方程估算.肾小球滤过率(GFR),以GFR133 μmol/L判断肾功能不全,则其漏诊率为42.6%(40/94).伴肾功能不全的STEMI患者年龄较大,陈旧性心肌梗死、血脂异常患病率高,Killip分级较高,入院时尿素氮(BUN)、Cr水平较高.用Logistic回归分析筛选出年龄、肾功能不全、未再灌注治疗是STEMI患者住院期间死亡的危险因素.伴肾功能不全的STEMI患者院内死亡的相对危险度为2.411(95%可信区间为1.249~4.656).结论 STEMI患者肾功能不全的发生率高,并且是STEMI患者住院期间死亡的危险因素.%Objective To evaluate the incidence and prognostic value of renal insufficiency in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The glomerular filtration rate(GFR)was estimated with the modified abbreviated modification of diet in renal disease (MDRD)study equation.Renal insufficiency was defined as GFR133 μmol/L,renal insufficiency was unrecognized in 40 cases(42.6%)of them.The renal insufficiency was associated with elder,old myocardial infarction,dyslipidemia,higher Killip-grade,and higher level of blood urea nitrogen(BUN)and Cr.By the Logistic regression analysis,renal insufficiency and no reperfusion was the risk factor of in-hospital mortality.The mortality relative risk between the STEMI patients with renal insufficiency and those without renal insufficiency was2.411(95% confidence interval:1.249-4.656).Conclusion The incidence of renal insufficiency is higher in the patients with STEMI,and it is an independent predictor for in-hospital mortality.

  14. RENOVASCULAR HYPERTENSION DUE TO RENAL ARTERY STENOSIS IN KLIPPEL-FEIL SYNDROME

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    Foyaca-Sibat H. MD.

    2003-01-01

    Full Text Available ABSTRACT We report one patient with Klippel-Feil (KFS syndrome, other associated anomalies, uncontrolled arterial hypertension, and renal artery stenosis. Because this patient underwent for surgical revascularization with unsuccessful result, all proposed way of treatments are revised, and we have hypothesized that probably for patients with KFS and unilateral renal artery stenosis, medical treatment with ACE inhibitors can provide more benefits than surgical revascularization or percutaneous transluminal angioplasty. We considered that those patients should be manage by a team of medical doctors being aware of their common associated anomalies, identifying all of them when it is possible then, making an integral evaluation of the each individual situation for establishing their medical priorities in order, and then address its treatments accordingly. If at this stage any surgical treatment is required, is important to bring those problems to the anesthesiologist’s attention for a very careful manipulation of the neck and head during induction of anesthesia. The final results will be strongly related with the capacity of management of the underlying cardio-respiratory, renal, skeletal, urogenital, and nervous system problems. . We also propose the term of Klippel-Feil syndrome "Plus" for those patients with cervical vertebral fusion and many other associated deformities rather than to add new eponyms to the long list that already exist. _____________ RESUMEN: HIPERTENSION RENOVASCULAR DEBIDO A ESTENOSIS DE LA ARTERIA RENAL EN EL SÍNDROME DE KLIPPEL-FEIL Reportamos un paciente afectado por un syndrome de Klippel-Feil, otras anormalias congenitas, hipertension arterial incontrolada y una estenosis unilateral de la arteria renal. Este paciente fue sometido a un tratamiento quirÚrgico de la estenosis de la arteria renal, cuyos resultados fueron no satisfactorios por lo que revisamos todas las alternativas de tratamiento para la estenosis

  15. Carnitine Profile and Effect of Suppletion in Children with Renal Fanconi Syndrome due to Cystinosis

    OpenAIRE

    Besouw, M.; Cornelissen, E.; Cassiman, D.; Kluijtmans, L.; L. van den Heuvel; Levtchenko, E

    2014-01-01

    Background: Cystinosis is an autosomal recessive disorder marked by intralysosomal cystine accumulation. Patients present with generalized proximal tubular dysfunction called renal Fanconi syndrome. Urinary carnitine loss results in plasma and muscle carnitine deficiency, but no clinical signs of carnitine deficiency have been described. Also, the optimal dose of carnitine supplementation is undefined. This study aimed to determine whether currently recommended carnitine doses result in adequ...

  16. Severe de novo Hepatitis B Recovered from Late-Onset Liver Insufficiency with Prolonged Ascites and Hypoalbuminemia due to Hepatitis B Virus Genotype Bj with Precore Mutation

    Directory of Open Access Journals (Sweden)

    Akira Sato

    2016-10-01

    Full Text Available De novo hepatitis B is associated with a high risk of hepatic failure often resulting in fatal fulminant hepatitis even when nucleotide analogues are administered. A 77-year-old female developed de novo hepatitis B after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone treatment for diffuse large B-cell lymphoma. Hepatitis B virus (HBV isolated from the patient was of genotype Bj, with a precore mutation (G1896A exhibiting an extremely high viral load at the onset of hepatitis. She showed markedly high levels of transaminase with mild jaundice on admission and rapid decrease of prothrombin activity after admission. Although acute liver failure was averted by the administration of entecavir and corticosteroid pulse therapy, liver volume decreased to 860 ml, and marked hypoalbuminemia accompanying massive ascites occurred 2 months after the onset of hepatitis and persisted for 3 months with high levels of HBV DNA and mild abnormal alanine aminotransferase levels. Frequent infusions of albumin solution, nutrition support, and alleviation therapy showed limited effect. However, overall improvement along with HBV DNA reduction was observed after increasing the dose of entecavir and completion of prednisolone that was administered with a minimum dose for adrenal insufficiency. An immediate and sufficient suppression of virus replication with potent antiviral therapy is critical, particularly in patients infected with HBV precore mutation (G1896A and/or Bj genotype, which may have a high viral replication and direct hepatocellular damage.

  17. Prospective Study to Assess Progression of Renal Markers after Interruption of Tenofovir due to Nephrotoxicity

    Directory of Open Access Journals (Sweden)

    Anna Bonjoch

    2016-01-01

    Full Text Available Background. Prospective studies about the reversibility of tenofovir disoproxil fumarate- (TDF- related renal impairment remain scarce. Methods. This is an observational prospective study including all patients that presented at our HIV Unit who interrupted TDF owing to nephrotoxicity. We assessed the evolution of renal parameters after discontinuation of this drug. Results. We included 59 patients, who were followed up for 72 weeks. Most were male (41, 69.5%, median (IQR age was 53 (44; 58 years, and median time receiving TDF-containing regimens was 55.4 (28; 87.7 months. Most patients were receiving PI-based treatments (67%. At the final visit, most of the subjects showed complete recovery (35, 59.3% or improvement (13 subjects, 22%. Significant improvements were observed in creatinine levels (from 84.9 [73.8; 97.5] to 78 [69.6; 91] μmol/L, p=0.013, estimated glomerular filtration rate (eGFR, CKD EPI equation, from 87.7 [67; 99] to 89.9 [73.6; 99.3] mL/min/1.73 m2, p=0.017, and number of patients with eGFR <60 mL/min/1.73 m2 (from 9 [15.3%] to 1 [1.7%], p=0.031. A trend toward significance was observed in abnormal urine proteinuria/creatinine ratio (from 22 [37%] to 8 [13.6%], p=0.057. Conclusions. Our results corroborate the high frequency of complete or partial renal recovery in patients receiving TDF-containing regimens who discontinued therapy owing to nephrotoxicity.

  18. Acute Hemolysis with Renal Failure due to Clostridium Bacteremia in a Patient with AML

    Science.gov (United States)

    Medrano-Juarez, R. M.; Sotello, D.; D'Cuhna, L.; Payne, J. D.

    2016-01-01

    We present a case of acute hemolytic anemia, renal failure, and Clostridium perfringens bacteremia in a patient with acute myelogenous leukemia. The high fatality of C. perfringens bacteremia requires that clinicians recognize and rapidly treat patients at risk for this infection. Although other hemolytic processes are in the differential diagnosis of these events, the presence of high fever, chills, and rapidly positive blood cultures may help narrow the diagnosis. Most cases of C. perfringens bacteremia have a concomitant coinfection, which makes broad spectrum empiric therapy essential. There is a high mortality rate of C. perfringens infections associated with leukemia.

  19. Renal transplant failure due to urologic complications: Comparison of static fluid with contrast-enhanced magnetic resonance urography

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D. [University Hospital Duesseldorf, Institute of Diagnostic Radiology, Moorenstr. 5, D-40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Koester, A.; Andersen, K.; Kurz, K.D.; Moedder, U.; Cohnen, M. [University Hospital Duesseldorf, Institute of Diagnostic Radiology, Moorenstr. 5, D-40225 Duesseldorf (Germany)

    2009-02-15

    Purpose: Postrenal reasons of renal transplant failure can be assessed by magnetic resonance urography. This study was designed to retrospectively compare the diagnostic accuracy of static fluid (T2-)MRU compared to contrast enhanced (CE-)MRU in patients with renal transplant failure. Material and methods: Thirty-five consecutive patients (14 female, 21 men; mean age 48.6 years) with renal transplant failure and sonographically detected hydronephrosis were examined both with T2-MRU as well as CE-MRU resulting in 39 MRU examinations. MRU was performed both using T2-weighted HASTE-sequence (T2-MRU) as well as Gadolinium-enhanced 3D-FLASH-sequence (CE-MRU) on a 1.5-T clinical MRI scanner (Magnetom Vision, Siemens Medical Solutions). Subjective image quality of resulting maximum intensity projection was assessed in consensus by two readers blinded to the final diagnosis, using a five point scale. MRU findings were correlated to sonography, operative results or clinical follow up. Results: CE-MRU yielded a sensitivity of 85.7% (T2-MRU 76.2%), and a specificity of 83.3% (T2-MRU: 73.7%), however statistical significance was not reached. The subjective image quality was significantly better in CE-MRU. Conclusions: Only concerning subjective image quality CE-MRU proved superior to T2-MRU. Yet, there was no significant difference in diagnostic accuracy between T2- and CE-MRU. Thinking of incipient nephrogenic systemic fibrosis, T2-MRU can be used as reliable alternative in patients with decreased renal transplant function due to urological complications.

  20. Renal transplant failure due to urologic complications: Comparison of static fluid with contrast-enhanced magnetic resonance urography.

    Science.gov (United States)

    Blondin, D; Koester, A; Andersen, K; Kurz, K D; Moedder, U; Cohnen, M

    2009-02-01

    Postrenal reasons of renal transplant failure can be assessed by magnetic resonance urography. This study was designed to retrospectively compare the diagnostic accuracy of static fluid (T2-)MRU compared to contrast enhanced (CE-)MRU in patients with renal transplant failure. Thirty-five consecutive patients (14 female, 21 men; mean age 48.6 years) with renal transplant failure and sonographically detected hydronephrosis were examined both with T2-MRU as well as CE-MRU resulting in 39 MRU examinations. MRU was performed both using T2-weighted HASTE-sequence (T2-MRU) as well as Gadolinium-enhanced 3D-FLASH-sequence (CE-MRU) on a 1.5-T clinical MRI scanner (Magnetom Vision, Siemens Medical Solutions). Subjective image quality of resulting maximum intensity projection was assessed in consensus by two readers blinded to the final diagnosis, using a five point scale. MRU findings were correlated to sonography, operative results or clinical follow up. CE-MRU yielded a sensitivity of 85.7% (T2-MRU 76.2%), and a specificity of 83.3% (T2-MRU: 73.7%), however statistical significance was not reached. The subjective image quality was significantly better in CE-MRU. Only concerning subjective image quality CE-MRU proved superior to T2-MRU. Yet, there was no significant difference in diagnostic accuracy between T2- and CE-MRU. Thinking of incipient nephrogenic systemic fibrosis, T2-MRU can be used as reliable alternative in patients with decreased renal transplant function due to urological complications.

  1. Analysis of antibiotic treatment on elderly patients with chronic renal insufficiency and bacterial infection%老年慢性肾功能不全合并细菌感染的抗生素治疗分析

    Institute of Scientific and Technical Information of China (English)

    陈振汉; 滕玲

    2013-01-01

    目的 探索应用抗生素治疗慢性肾功能不全失代偿期合并下呼吸道感染的老年患者的临床效果和对其肾功能的影响.方法 选取某院自2008年5月~2011年10月治疗的60例肾功能不全合并肺部感染的老年患者纳入观察组,同期选取60肾功能正常的老年下呼吸道感染的患者纳入对照组.两组患者应用头孢哌酮进行治疗,观察两组患者的总体治疗效果差异以及观察组患者治疗前后的肾功能血肌酐、尿素氮、尿酸、肌酐清除率水平差异.结果 观察组和对照组患者平均治疗时间分别为(10.15±3.23)d和(7.32±2.18)d,差异有统计学意义(P<0.05);两组患者的总体治疗效果差异无统计学意义(P>0.05),但痊愈率差异有统计学意义(P<0.05);观察组治疗前后患者的血肌酐、尿素氮、内生肌酐清除率水平与治疗前比较差异有统计学意义(P<0.05).结论 肾功能不全的老年患者一旦发生下呼吸道感染,应用抗生素治疗的难度增大,治疗过程中应密切留意患者的肾功能情况,并合理控制药物用量,一旦出现肾功能衰竭应立即停药,必要时进行血液透析.%OBJECTIVE To explore the clinical effect of antibiotic treatment on elderly patients with chronic renal insufficiency and bacterial infection,and its influence on the renal function.METHODS 60 elderly patients with chronic renal failure (the experimental group) and 60 elderly patients with normal renal function (the control group) were chosen,and all patients suffered from lower respiratory tract infection and were treated by Cefiazidime in our hospital from May 2008 to October 2011.The difference of clinical effect and renal function change before and after treatment were observed.RESULTS The average treatment time of experimental group and control group were (10.15 ± 3.23) d and (7.32 ± 2.18) d with a stastical difference (P < 0.05) ; There was no statistical difference in overall treatment

  2. Serotonin syndrome due to fluoxetine and tramadol in renal impaired patient

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    Rajnish Raj

    2014-02-01

    Full Text Available Serotonin syndrome causes confusion or altered mental status; other symptoms include myoclonus, shivering, tremors, diaphoresis, hyperreflexia, incoordination, fever and diarrhoea. Tramadol possesses dual pharmacological effects i.e., a weak opiate agonist at mu, kappa and delta opiate receptors along with reuptake inhibition of norepinephrine and serotonin. Risk associated with tramadol increases when co-administered with serotonergic antidepressants or MAOIs (monoamine oxidase inhibitors and in renal impaired. The incidence of this syndrome is less than 1% as most of the cases remain unreported. The case highlights the fact that interaction between serotonergic agents like fluoxetine and tramadol especially in the presence of co-morbid medical illness can lead to serotonin syndrome. [Int J Basic Clin Pharmacol 2014; 3(1.000: 227-229

  3. Hypokalemic periodic paralysis due to proximal renal tubular acidosis in a case with membranoproliferative glomerulonephritis.

    Science.gov (United States)

    Santra, Gouranga; De, Dibyendu; Sinha, Pradip Kumar

    2011-11-01

    Proximal renal tubular acidosis (pRTA) is a rare disorder. Hypokalemia may be associated with it; occasionally leading to features like hypokalemic periodic paralysis. Though pRTA is a tubulointerstitial kidney disease, glomerulonephritis may occasionally lead to pRTA by tubular damage through leaking proteins, cytokines or by inflammatory infiltrates. In our reported case a 27 year old male had recurrent episodes of hypokalemic quadriparesis. Investigations revealed features of pRTA including hypokalemia and non-anion-gap hyperchloremic metabolic acidosis. His urine pH dropped to 5 with NH4Cl loading test. Kidney biopsy showed membranoproliferative glomerulonephritis with tubulointerstitial damage. Hypokalemic periodic paralysis and pRTA are uncommon associations of membranoproliferative glomerulonephritis.

  4. Lipid-storage myopathy and respiratory insufficiency due to ETFQO mutations in a patient with late-onset multiple acyl-CoA dehydrogenation deficiency

    DEFF Research Database (Denmark)

    Olsen, R K J; Pourfarzam, M; Morris, A A M

    2004-01-01

    We report a patient with lipid-storage myopathy due to multiple acyl-CoA dehydrogenation deficiency (MADD). Molecular genetic analysis showed that she was compound heterozygous for mutations in the gene for electron transfer flavoprotein:ubiquinone oxidoreductase (ETFQO). Despite a good initial r...

  5. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

    Directory of Open Access Journals (Sweden)

    Cleva Roberto de

    2001-01-01

    Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

  6. Seizure occurrence in patients with chronic renal insufficiency in regular hemodialysis program Ocorrência de crises epilépticas em pacientes com insuficiência renal crônica em programa dialítico regular

    Directory of Open Access Journals (Sweden)

    Fulvio Alexandre Scorza

    2005-09-01

    Full Text Available Hemodialysis-associated seizure is a complication of hemodialysis. This report describes the occurrence of seizures in patients with end stage renal disease on dialysis therapy at the Nephrology Institute of Mogi das Cruzes, São Paulo State, Brazil. A retrospective medical history of 189 patients was reviewed to investigate the occurrence of convulsive seizures during dialytic program. Seven patients with history of seizures were selected but five of them were included in our study. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Three patients presented seizure just during the dialysis (unique seizure and one of them presented convulsive status epilepticus. The two other patients had already presented seizures prior the beginning of dialysis. We conclude that seizures in renal failure could be considered as occasional events that do not usually become chronic.Convulsões durante o tratamento dialítico podem constituir uma complicação da hemodiálise. Esse artigo descreve a ocorrência de crises em pacientes em estágio final de insuficiência renal crônica sob tratamento dialítico no Instituto de Nefrologia de Mogi das Cruzes, São Paulo, Brasil. Foram revistos os prontuários de 189 pacientes, com o objetivo de investigar a ocorrência de crises convulsivas durante o tratamento dialítico. Dos sete pacientes selecionados com história de crises, cinco concordaram em participar de nosso estudo. Três pacientes apresentaram crises generalizadas tônico-clônicas, um apresentou crise parcial com generalização subseqüente e um apresentou crise inclassificada. Três pacientes apresentaram crises apenas durante o processo dialítico (crise única sendo que um deles apresentou status epilepticus convulsivo. Os outros dois pacientes já haviam apresentado crises antes do início do tratamento dialítico. Nós concluímos que as crises

  7. 冠状动脉硬化性心脏病并发肾功能不全患者的药学监护%Pharmaceutical Care on Patients with Coronary Heart Disease and Renal Insufficiency

    Institute of Scientific and Technical Information of China (English)

    葛鹏程; 党大胜; 任天舒; 史国兵

    2014-01-01

    Objective To explore the pharmaceutical care plan of clinical pharmacist for elderly patients with coronary heart disease and renal insufficiency. Methods To develop the therapeutic schedule in cooperation with clinicians through clinical rounds, in order to offer specific pharmaceutical care and further develop individualized care plan during patient ' s hospitalization. Results Clinical pharmacists paid close attention to the indicators and adjusted administration time when the adverse reactions such as lower blood pressure, leukopenia, and deterioration of renal function occurred, and finally avoided further potential adverse reactions. Conclusion The incidence of adverse drug reactions were reduced, the safety and efficacy of drugs used were guaranteed, which can promote rational and effective use of drugs in clinic. The overall quality of healthcare was improved with pharmacist involvement.%临床药师通过临床查房,与临床医师共同对老年冠心病并发肾功能不全患者制定治疗方案,对患者用药进行具体化药学服务和制定个体化监护计划。当患者出现血压偏低、白细胞减少、肾功能恶化等不良反应时,临床药师密切监测相关指标,及时调整药物,避免了临床治疗中潜在的不良反应。临床药师积极参与临床的治疗过程,可减少药品不良反应的发生,确保在院期间用药的安全性及有效性,提高了整体治疗水平。

  8. 1例晚期小细胞肺癌合并肾功能不全患者的药学监护%Pharmaceutical care for advanced small cell lung cancer patient associated with renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    李萌; 雷嘉川; 戎佩佩; 杨健; 宋金春

    2016-01-01

    Objective To monitor the medication process of advanced lung cancer patients with renal insufficiency .Meth‐ods Pharmaceutical care ,pharmaceutical intervention and medication were offered according to the individual condition of pa‐tient with renal function based on pharmaceutical experience and related literature .Results The patient finished chemotherapy successfully without adverse reaction .Conclusion Clinical pharmacists should keep improving their knowledge and participat‐ing in first‐line clinical treatment activities;the patient‐centered hospital pharmacy service will be founded and the level of ra‐tional medication will be improved when doctors ,pharmacists and nurses could cooperate sincerely .%目的:监护肾功能不全晚期肺癌患者的用药过程。方法利用药学经验和查阅文献,针对患者肾功能个体化情况,为其提供药学监护、干预和用药教育。结果患者未出现不良反应,顺利完成本次化疗。结论临床药师需要完善知识储备,积极参与临床一线治疗;医、药、护精诚合作才能促进以患者为中心的医院药学服务模式的建立,提高临床合理用药水平。

  9. Comparison of clinical therapeutic effects between high-flux hemodialysis and conventional hemodialysis on renal insufficiency%高通量血液透析与常规血液透析的临床透析效果比较

    Institute of Scientific and Technical Information of China (English)

    杜娟; 谭峰

    2016-01-01

    Objective To compare the clinical therapeutic effects between high-flux hemodialysis and conventional hemodialysis on renal insufficiency,and to explore optimized dialysis method to treat renal insufficiency.Methods Sixty-four patients with renal insufficiency who were treated in our hospital from April 2013 to October 2014 were divided into observation group and control group according to different dialysis methods, with 32 patients in each group.The patients in observation group were treated by high -flux hemodialysis, however, the patients in control group were treated by conventional hemodialysis for three months.Before and after hemodialysis,the levels of blood urea nitrogen (BUN), blood creatinine (SCR), albumin ( ALb), and serum β2-M microspheres protein (β2-M), parathyroid hormone ( PTH) and serum electrolytes ( Na, K, CA, CL, P ) were detected, moreover, the adverse reactions after hemodialysis were observed and compared between two groups.Results After hemodialysis, the levels of Ur, Scr in both groups were significantly decreased, as compared with those before dialysis ( P 0.05).After dialysis the serum levels of Alp in control group were obviously decreased,as compared with those before dialysis,but there were no significant differences in observation group before and after dialysis ( P >0.05) .Before dialysis, there were no significant differences in the levels of β2-M and PTH between two groups ( P >0.05),however,after dialysis there were significant differences between two groups ( P 0.05) ,the levels of Ca were increased,as compared with those before dialysis,but there were no significant differences between two groups ( P >0.05).The infection rate after dialysis in observation group was 18.75%,which in control group was 46.87%,there was a significant difference between two groups ( P <0.05) .Conclusion The high-flux hemodialysis has not only filtration effects,but also can decrease obviously the levels ofβ2-M and PTH, meanwhile, the infection

  10. Renal dysfunction due to hydronephrosis by SAPHO syndrome: a case report

    OpenAIRE

    Kakoki, Katsura; Miyata, Yasuyoshi; Enokizono, Mikako; Uetani, Masataka; Sakai , Hideki

    2015-01-01

    Key Clinical Message Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) syndrome shows varied pathological symptoms. This is the first report of hydronephrosis due to the mechanical compression of bilateral ureters as a result of SAPHO syndrome. From our experience, MRI is the most useful imaging examination to check the upper urinary tract in SAPHO syndrome.

  11. Renal dysfunction due to hydronephrosis by SAPHO syndrome: a case report.

    Science.gov (United States)

    Kakoki, Katsura; Miyata, Yasuyoshi; Enokizono, Mikako; Uetani, Masataka; Sakai, Hideki

    2015-08-01

    Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) syndrome shows varied pathological symptoms. This is the first report of hydronephrosis due to the mechanical compression of bilateral ureters as a result of SAPHO syndrome. From our experience, MRI is the most useful imaging examination to check the upper urinary tract in SAPHO syndrome.

  12. Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida.

    Science.gov (United States)

    Wang, Hsin-Hsiao S; Lloyd, Jessica C; Wiener, John S; Routh, Jonathan C

    2016-04-01

    Bladder dysfunction in patients with spina bifida can lead to significant morbidity due to renal insufficiency. Indications for surgery vary among institutions and the impact is unclear. We examined trends and variations in urological interventions and chronic renal insufficiency in patients with spina bifida. We reviewed NIS (Nationwide Inpatient Sample) for all patients with spina bifida treated from 1998 to 2011. We used ICD-9-CM codes to identify urological surgery and chronic renal insufficiency. We calculated the Spearman correlation coefficients between rates of spina bifida related bladder surgeries and rates of chronic renal insufficiency outcomes by state. Linear regression models were fitted to investigate the associations between rates of spina bifida related surgery and chronic renal insufficiency across treatment years. We identified 427,616 spina bifida hospital admissions. Mean patient age was 26 years and 56% of patients were female. Of the admissions 35,249 (8%) were for chronic renal insufficiency and 11,078 (3%) were for surgery. During the study period chronic renal insufficiency rates doubled from 6% to 12% and surgery rates decreased from 2.0% to 1.8%. There was a moderately weak inverse association between surgery and chronic renal insufficiency rates with time (r = -0.3, p = 0.06) and by state (r = -0.3, p = 0.04). On multivariate analysis higher rates of surgery were associated with the state in which the patient was treated (p spina bifida related surgery (p = 0.67). We observed a temporal and geographic trend toward decreasing urological surgery and increasing chronic renal insufficiency rates in spina bifida and a wide variation in urological surgical rates among states. Further study is needed to determine the factors behind these trends and variations in spina bifida management. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Etiological analysis of nosocomial infections in elderly patients with chronic renal insufficiency and treatment measures%老年慢性肾功能不全患者医院感染的病原学分析与治疗

    Institute of Scientific and Technical Information of China (English)

    朱瑶; 刘维波; 费景萍; 严旺

    2015-01-01

    OBJECTIVE To explore the etiological diagnosis of the elderly chronic renal insufficiency patients com‐plicated with nosocomial infections and put forward the treatment measures so as to provide guidance for the clini‐cal diagnosis and treatment .METHODS A total of 3 793 elderly patients with chronic renal insufficiency who were treated in the hospital from Apr 2006 to Mar 2014 were enrolled in the study ,then the body fluid specimens that were collected from the patients with nosocomial infections were cultured ,the drug susceptibility testing was per‐formed for the isolated pathogens ,and the prevalence of the nosocomial infections and the infection sites were sta‐tistically analyzed according to the clinical manifestations and laboratory examinations .RESULTS Of 3 793 pa‐tients ,201 had the nosocomial infections with the infection rate of 5 .30% ,of whom 57 .21% had urinary system infections and 20 .40% had the respiratory system infections .A total of 195 strains of pathogens have been isola‐ted ,including 125 (64 .10% ) strains of gram‐positive bacteria ,68 (34 .87% ) strains of gram‐negative bacteria , and 2 (1 .03% ) strains of fungi .The drug susceptibility rates of the Staphylococcus aureus ,Streptococcus pneu‐moniae ,and Staphylococcus epidermidis to vancomycin were 100 .00% ,the drug susceptibility rates to teicopla‐nin were more than 97 .00% ,and the drug susceptibility rates to penicillin and sulfamethoxazole‐trimethoprim were less than 18 .00% .The drug susceptibility rates of the Pseudomonas aeruginosa ,K lebsiella pneumoniae ,and Escherichia coli to imipenem and cefoperazone‐sulbactam were more than 90 .00% ,while the drug susceptibility rates to ampicillin were less than 4 .00% .CONCLUSION The gram‐positive bacteria are dominant among the pathogens causing the nosocomial infections in the elderly patients with chronic renal insufficiency .It is an effective way to formulate individualized treatment program based on the

  14. Acute Interstitial Nephritis due to Leptospira grippotyphosa in the Absence of Weil’s Disease

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    Tanja Schmidhauser

    2013-01-01

    Full Text Available Anicteric leptospirosis is a self-limited flu-like disease, whereas the icteric form is a severe illness characterized by multiple organ involvement or even failure. A case involving a patient with rapidly progressing renal insufficiency requiring intermittent renal replacement therapy due to Leptospira grippotyphosa in the absence of a Weil’s disease is reported.

  15. Cotidiano e trabalho: concepções de indivíduos portadores de insuficiência renal crônica e seus familiares Cotidiano y trabajo: concepciones de individuos portadores de insuficiencia renal crónica y sus familiares Daily life and work: conceptions of chronic renal insufficiency patients and their relatives

    Directory of Open Access Journals (Sweden)

    Ligia Carreira

    2003-12-01

    importantes. Consideramos que los profesionales de la salud se deben unir para buscar apoyo en familiares y en la sociedad en general para que estos individuos puedan ser inseridos en el mercado de trabajo cuando lo deseen y tengan condiciones para ello.This descriptive and exploratory research aimed to know the conceptions, attitudes and behaviors about work as reported by 16 chronic renal insufficiency patients and their relatives. Data were collected from April to August 2000 through semi-structured interviews. The results revealed that work is valued by all families as a source of health and financial resources, besides being important for individuals' character formation; that most CRI patients do not carry out any remunerated activities and, when they do, they count on the help and understanding of the boss and relatives. We conclude that CRI and its treatment do not directly or absolutely impede the realization of this kind of activity, but entail important limitations. We consider it is necessary for health professionals to join in the search for support by relatives and society, so that these people can be inserted in the labor market when they want to and are in the right conditions.

  16. Cuidado em situação de Doença Renal Crônica: representações sociais elaboradas por adolescentes Atención en situación de Enfermedad Renal Crónica: representaciones sociales de adolescentes Care in situation of Severe Renal Insufficiency: social representations elaborated by adolescent

    Directory of Open Access Journals (Sweden)

    Islane Costa Ramos

    2008-04-01

    Full Text Available O objetivo do estudo foi apreender as representações sociais dos adolescentes em relação ao cuidado em situação de Insuficiência Renal Crônica. Aplicou-se o teste de associação livre de palavras a 70 adolescentes e a entrevista semi-estruturada a oito adolescentes. Foram evocadas 1630 palavras a partir dos estímulos doença, saúde, diálise, cuidado de si, cuidado profissional e cuidado familiar. Das entrevistas foram construídos dois núcleos temáticos que trazem significações sobre o cuidado familiar e o cuidado profissional que influenciam nas formas de perceber e agir em relação ao cuidado à saúde. Conclui-se que a representação social do adolescente focaliza as significações do adoecimento e do cuidado, marcada pela indissociabilidade entre as práticas de cuidado e as relações psico-afetivas e sociais imbrincadas na sua vivência.El estudio tuvo como objetivo aprehender las representaciones sociales de los adolescentes en relación a la atención en situación de Insuficiencia Renal Crónica. Se utilizó la prueba de asociación libre de palabras y la entrevista estructura en parte. Fueron 1.630 palabras a partir de los estímulos enfermedad, salud, dialisis, atención de si, atención profesional y atención familiar. De las entrevistas fueron construídos dos grupos de temas que tuvieron significaciones sobre la atención familiar y la atención profesional com influjos en las maneras de percibir y además agir en relación a la atención a la salud. La representación social del adolescente observa las significaciones del adoecimiento y de la atención, señalada, todavía, por la indisociabilidad entre las prácticas de atención y las relaciones psicoafectivas y sociales que hay en su vivencia.The objective of the study was to apprehend the social representations of teenagers in relation to care in situation of Severe Renal Insufficiency. It was applied the test of free association of words to 70 teenagers

  17. 尼麦角林治疗椎基底动脉供血不足性眩晕的临床观察%Clinical efficacy of nicergoline in treatment of vertigo due to vertebrobasilar insufficiency

    Institute of Scientific and Technical Information of China (English)

    张福添

    2014-01-01

    目的:观察尼麦角林治疗椎基底动脉供血不足性眩晕的临床疗效。方法选择我院2012年1月至2014年1月收治的60例椎基底动脉供血不足性眩晕患者为研究对象,抽签将其分为两组,各30例,对照组患者给予培他司汀治疗,观察组患者采取尼麦角林治疗,比较两组疗效及不良反应情况。结果观察组治愈16例(53.33%),好转13例(43.33%),治疗总有效率96.67%;对照组治愈15例(50%),好转13例(43.33%),治疗总有效率93.33%,两组治疗总有效率比较差异无统计学意义,P>0.05。结论尼麦角林治疗椎基底动脉供血不足性眩晕疗效明确,不良反应少,值得临床利用。%Objective To explore the clinical efficacy of nicergoline in treating vertigo due to vertebrobasilar insufficiency. Methods Sixty patients with vertigo due to vertebrobasilar insufficiency who were admitted to our hospital from January 2012 to January 2014 were equally and randomly divided into control group and observation group. The control group was given betahistine, while the observation group was given nicergoline. The clinical outcomes and adverse reactions were compared between the two groups. Results In the observation group, 16 (53.33%) patients were cured, and 13 (43.33%) patients were improved, so the overall response rate was 96.67%. In the control group, 15 (50%) patients were cured, and 13 (43.33%) patients were improved, so the overall response rate was 93.33%. There was no significant difference in the overall response rate between the two groups (P>0.05). Conclusion Nicergoline has significant clinical efficacy and fewer adverse effects in treating vertigo due to vertebrobasilar insufficiency, so it is worthy of wider clinical application.

  18. [Sodium transport in chronic renal insufficiency].

    Science.gov (United States)

    Noé, D

    1985-03-24

    From an analysis of the literature covering the problem of sodium contribution in uraemic patients subjected to both conservative treatment and maintenance dialysis, it has been shown that excessive reduction in dietary sodium intake can be harmful unless it is justified by severe hypertension or oedema since it aggravates the state of uraemia. In these cases, the addition of a minimum controlled amount of hyposodic salt to an otherwise salt free diet is undoubtedly useful. The hyposodic salt, "Misura" manufactured by the company "Plasmon" was used in the dietary treatment of a series of patients subjected to mild restriction in dietary salt intake. Misura was well tolerated and well accepted thanks to its pleasing taste.

  19. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  20. A single center kidney transplant experience among ten Caucasian females with end-stage renal disease due to scleroderma
.

    Science.gov (United States)

    Saxena, Nishkarsh; Djamali, Arjang; Astor, Brad C; Mohamed, Maha; Mandelbrot, Didier; Parajuli, Sandesh

    2017-07-01

    There is limited information on kidney transplant recipients with end-stage renal disease (ESRD) due to scleroderma. We conducted an observational study on kidney transplant recipients with ESRD due to scleroderma who received kidney transplant at our center between 01/1994 and 06/2013. During the study period, there were 10 kidney transplant recipients, all of whom were Caucasian females. Seven of them were living-donor kidney transplant recipients, and the mean age at time of transplant was 56.6 ± 11.99 years. The mean post-transplant follow-up was 76.75 ± 56.18 months; the mean dialysis vintage was 46.4 ± 80.35 months, ranging from 8 to 272 months; and the mean serum creatinine (Cr) levels at 3, 6, and 12 months were 1.31 ± 0.47 mg/dL, 1.35 ± 0.51 mg/dL, and 1.34 ± 0.49 mg/dL, respectively. There were 5 graft failures with median graft survival of 101 months. None had recurrence of scleroderma renal crisis. In those without graft failure, the mean serum Cr at last follow-up was 0.96 ± 0.39 mg/dL. Six patients were on angiotensin converting enzyme inhibitors (ACE-I) after transplant. In univariate analysis, none of the factors including, age at time of transplant, dialysis vintage, use of ACE-I, living-donor transplant, cytomegalovirus infection, and serum Cr at 1 year were predictive of graft failure. In our study, we hoped to find outcomes and various factors associated with graft failure in these patients. We found a wide variation in outcomes after kidney transplantation. More studies are needed to assess the factors that may influence the graft survival in this rare disease.
.

  1. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki

    2013-01-01

    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  2. Neonatal Sepsis and Neutrophil Insufficiencies

    Science.gov (United States)

    Melvan, John Nicholas; Bagby, Gregory J.; Welsh, David A.; Nelson, Steve; Zhang, Ping

    2011-01-01

    Sepsis has continuously been a leading cause of neonatal morbidity and mortality despite current advances in chemotherapy and patient intensive care facilities. Neonates are at high risk for developing bacterial infections due to quantitative and qualitative insufficiencies of innate immunity, particularly granulocyte lineage development and response to infection. Although antibiotics remain the mainstay of treatment, adjuvant therapies enhancing immune function have shown promise in treating sepsis in neonates. This chapter reviews current strategies for the clinical management of neonatal sepsis and analyzes mechanisms underlying insufficiencies of neutrophil defense in neonates with emphasis on new directions for adjuvant therapy development. PMID:20521927

  3. 慢性心力衰竭急性加重伴2型糖尿病肾功能不全患者应用糖皮质激素的临床分析%THE CLINICAL ANALYSIS OF GLUCOCORTICOID ON PATIENTS WITH ACUTE EXACERBATION OF CONGESTIVE HEART FAILURE,TYPE 2 DIABETES AND RENAL INSUFFICIENCY

    Institute of Scientific and Technical Information of China (English)

    甄宇治; 高延秋; 刘超; 刘刚; 籍振国; 刘坤申

    2011-01-01

    Objective To determine the clinical efficacy of glucocorticoid on patients with acute exacerbation of congestive heart failure, type 2 diabetes and renal insufficiency. Methods Prednisone was used in addition to traditional treatment in 13 patients with acute exacerbation of congestive heart failure,type 2 diabetes and renal insufficiency. Results Prednisone dramatically improved patients ' symptoms, clinical status, heart function and renal function ( i. e. the glomerular filtration rate ).Conclusion In patients with acute exacerbation of congestive heart failure, type 2 diabetes and renal insufficiency , glucocorticoid treatment could remarkably improve the renal function.%目的 探讨糖皮质激素对于慢性充血性心力衰竭急性加重伴2型糖尿病肾功能不全患者的治疗效果.方法 慢性心力衰竭急性加重伴2型糖尿病肾功能不全患者13例在常规治疗基础上加用糖皮质激素治疗.结果 加用糖皮质激素治疗后,13例患者临床症状均好转,心功能改善,肾功能改善,血肌酐下降,肾小球滤过率升高.结论 慢性心力衰竭急性加重伴2型糖尿病肾功能不全患者在常规治疗基础上加用糖皮质激素治疗,肾功能可得到明显改善.

  4. Clinical application of continuous renal replacement therapy for postoperative renal insufficiency in patient with severe heart valve disease%连续性肾脏替代治疗在重症心脏瓣膜病术后急性肾功能衰竭的临床应用

    Institute of Scientific and Technical Information of China (English)

    王松; 谢凯; 李红; 王琴; 谭君

    2013-01-01

    Objectives To evaluate clinical application the of continuous renal replacement therapy (CRRT) for postoperative renal insufficiency in patient with severe heart valve disease. Methods We retrospectively analyzed the clinical data of 27 patients (live group 15 cases, death group 12 cases) with severe heart valves diseases who got postoperative renal insufficiency and performed CRRT. Results Gender, age, the classification of preoperative heart function classification and extracorporeal circulation time has no significant difference (P<0. 05) between live group and death group. But the duration of AKI before CRRT(P<0. 05)and the time of urine volume<0. 5ml·kg-1·h-1 before CRRT (P<0. 05) in death group were significantly longer than that in live group. The serum creatinine of death group before CRRT is also significantly higher than live group (P<0. 05). The serum creatinine, blood urea nitrogen, mean arterial pressure, central venous blood pressure, K+ and blood HCO3- of all 27 patients after CRRT are statistically significant difference (P<0. 05) with those before CRRT. Conclusion CRRT is an important treatment to these patients with severe heart valve disease who got postoperative renal insufficiency. But the most important problem in this process is the recognition of AKI and early beginning of the therapy. It is suggested that early CRRT therapy is beneficial for reducing mortality rate of these patients.%目的 探讨连续性肾脏替代治疗(CRRT)在心脏瓣膜病术后出现急性肾功能衰竭的临床应用价值.方法 回顾性分析心脏瓣膜病术后合并急性肾功能衰竭行CRRT治疗的27例患者(存活组15例,死亡组12例)的临床资料,并进行统计分析.结果 死亡组CRRT距AKI时间和距尿量<0.5ml/Kg·h时间明显长于存活组(P<0.05),且死亡组CRRT开始前的血肌酐显著高于存活组(P<0.05).27例患者CRRT治疗前后血肌酐、尿素氮、平均动脉压、中心静脉压、血K+、血HCO3

  5. High Fat High Cholesterol Diet (Western Diet Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide.

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    Siddhartha S Ghosh

    Full Text Available A high fat meal, frequently known as western diet (WD, exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx or WD (Nx+WD. The controls were sham operated animals on normal diet (control and WD (WD. To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM, a known LPS antagonist, and curcumin (CU, a compound known to ameliorate chronic kidney disease (CKD, was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively. Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency.

  6. High Fat High Cholesterol Diet (Western Diet) Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide.

    Science.gov (United States)

    Ghosh, Siddhartha S; Righi, Samuel; Krieg, Richard; Kang, Le; Carl, Daniel; Wang, Jing; Massey, H Davis; Sica, Domenic A; Gehr, Todd W B; Ghosh, Shobha

    2015-01-01

    A high fat meal, frequently known as western diet (WD), exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS) leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx) or WD (Nx+WD). The controls were sham operated animals on normal diet (control) and WD (WD). To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM), a known LPS antagonist, and curcumin (CU), a compound known to ameliorate chronic kidney disease (CKD), was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively). Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency.

  7. Adhesions due to peritoneal carcinomatosis caused by a renal carcinoma leading to mechanical gastric outlet obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Gruttadauria Salvatore

    2011-07-01

    Full Text Available Abstract Introduction Gastric outlet obstruction is a clinical syndrome caused by a variety of mechanical obstructions. Peptic ulcer disease used to be responsible for most gastric outlet obstruction, but in the last 40 years the prevalence of malignant tumors has risen significantly. Adhesive disease is an infrequent and insidious cause of mechanical gastric outlet obstruction. Case presentation We report the case of a 78-year-old Caucasian man who had a clinical history of a right nephrectomy for malignancy three years earlier and who was admitted for a severe gastric outlet obstruction (score of 1 confirmed both by an upper endoscopy and by a fluoroscopic view after contrast injection. A computed tomography scan and a laparotomy, with omental biopsies, showed a peritoneal carcinomatosis with the development of abdominal adhesions that prompted an abnormal gastric rotation around the perpendicular axis of his antrum with a dislocation in the empty space of his right kidney. Symptoms disappeared after surgical bypass through a gastrojejunostomy. Conclusions Our patient experienced a very rare complication characterized by the development of adhesions due to peritoneal carcinomatosis caused by a renal carcinoma treated with nephrectomy. These adhesions prompted an abnormal dislocation of his antrum, as an internal hernia, in the empty space of his right kidney.

  8. Vesicourethral reflux-induced renal failure in a patient with ICF syndrome due to a novel DNMT3B mutation.

    Science.gov (United States)

    Kutluğ, Seyhan; Ogur, Gönül; Yilmaz, Aysegül; Thijssen, Peter E; Abur, Ummet; Yildiran, Alisan

    2016-12-01

    ICF syndrome is a primary immunodeficiency disease characterized by hypo- or agammaglobulinemia, centromeric instability mainly on chromosomes 1, 9, and 16 and facial anomalies. ICF syndrome presents with frequent respiratory tract infections in infancy. A 20-month-old female patient was referred to our clinic due to frequent lower respiratory tract infections. ICF syndrome was considered because of comorbidity of hypogammaglobulinemia, facial anomalies, and neuromotor growth retardation. Metaphase chromosome analysis revealed centromeric instability on chromosomes 1, 9, and 16 and through Sanger a previously unreported homozygous missense mutation (c.1805T>C; [p.V602A]) was identified in the DNMT3B, confirming ICF1. The patient was found to have a breakdown in renal function 1 year later; the urinary system was examined and bilateral vesicoureteral reflux was found, warranting the need for dialysis in time. This report expands the mutation spectrum of ICF1 and is the first to describe bilateral vesicoureteral reflux accompanying ICF syndrome. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. Hidrocolpo por ectopia ureteral em hemivagina associado a displasia renal: relato de caso e revisão da literatura Congenital hydrocolpos due to ectopic ureter in hemivagina associated with renal dysplasia: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mario Flores Barba

    2004-04-01

    Full Text Available Os autores apresentam um caso de displasia renal associada a ectopia ureteral vaginal homolateral, com uretero-hidronefrose contralateral devida a compressão por hidrocolpo causado pela ectopia e por um septo vaginal oblíquo. Os exames de imagem utilizados foram urografia excretora, cistografia, ultra-sonografia, tomografia computadorizada e cintilografia renal com Tc-99m-DMSA. Foi realizada revisão da literatura sobre casos de hidrocolpo associado a malformações urinárias.The authors report a case of congenital hydrocolpos due to vaginal malformation (vaginal septae associated with ectopic ureter and renal displasia. Several imaging diagnostic procedures (ultrasonography, nuclear medicine, intravenous urography and computed tomography were performed. A review of the literature on hydrocolpos and its association with urinary malformations is also presented.

  10. Papilledema due to a permanent catheter for renal dialysis and an arteriovenous fistula: a "two hit" hypothesis.

    Science.gov (United States)

    Simon, Melissa A; Duffis, Ennis J; Curi, Michael A; Turbin, Roger E; Prestigiacomo, Charles J; Frohman, Larry P

    2014-03-01

    Elevated intracranial pressure in patients with chronic renal failure has several potential causes. Its rare occurrence secondary to the hemodynamic effects of hemodialysis is described and the findings support a multifactorial etiology ("two hits").

  11. Prevalence of Renal Tuberculosis in Patients With Chronic Renal Failure Prior toDialysis, Associated with Constitutional Symptoms

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    Mona Hosny

    2001-09-01

    Full Text Available ot yet on dialysis, were included in the renal failure: -: D.M. is a predispasing fact!"# # + $ %-­ proliferative glomerulonephritis as it is the most common cause in Egypt for renal failure. Their "# $ +%ars. Constitutional and urogenital symptoms were a guide to choose patients included in the study. For all patients the following was done: Complete urine analysis, Acid-Fast Bacilli (AFB in urine; Tuberculin test, chest X-Ray, Plain urinary tract, CT of (Kidneys ­ ureter ­ bladder and PCR of Mycobacterium Tuberculosis in urine using Gen-Probe Amplification test. &" '%(" %" '%(" %*+tests mentioned above. " %''" %with a total #'this study. We conclude that Diabetes Mellitus is a risk factor for renal Tuberculosis, but also chronic renal insufficiency in itself is another risk factor but to a lesser extent than DM. There was no significant statistical difference between chronic renal insufficiency due to diabetic nephropathy and chronic renal insufficiency due to membrano proliferative glomerulonephritis as regards renal Tuberculosis which was detected essentially by PCR of TB in urine. Compared to normal group, there were significant statistical differences in all parameters that were measured, between normal group and the other two groups together and separately.

  12. Electrocardiographic Analysis of Hyperkalemia in Renal Insufficiency Patients on Pre-and Post-Hemodialysis%肾功能不全高钾患者透析前、后心电图分析

    Institute of Scientific and Technical Information of China (English)

    陈娟; 刘仁光

    2014-01-01

    目的:观测肾功能不全高钾患者血液透析前、后随血清钾离子浓度变化对应的心电图变化特点,为临床高钾血症诊断提供线索。方法选择我院50例诊断为肾功能不全并高钾血症进行血液透析的患者,观测:(1)血液透析前、后血清钾离子浓度;(2)心电图:血液透析前后心率、 P波时限、 PR间期、 QRS时限、 T波振幅、 T波时限、 QT间期。结果(1)透析前T波时限较透析后缩短(145.20±23.49) ms vs (180.00±22.86) ms,振幅较透析后增大(0.76±0.54) mV vs (0.43±0.36) mV,均P<0.05,且随着血钾增高T波高尖程度增加;(2)透析前P波时限、 PR间期和QRS时限均较透析后延长(112.50±15.33) ms vs (98.80±14.88) ms、(175.98±35.40) ms vs (157.34±22.73) ms和(104.00±20.85) ms vs (88.76±10.39) ms,均P<0.05,这些改变主要出现在中、重度高钾病例并随着血钾浓度增加而加重。结论进一步证实T波增高是高钾最先出现、常见的心电图表现;房内阻滞( P波增宽至消失)、室内阻滞( QRS增宽)和房室阻滞是中、重度高钾的心电图表现。%Objective To observe the corresponding different electrocardiogram (ECG) manifestations with changes of serum po-tassium levels in patients with renal insufficiency and hyperkalemia on pre-and post-hemodialysis ( HD) , providing diagnostic clues of hyperkalemia for the clinicians .Method A total of 50 cases of patients with renal insufficiency and hyperkalemia receiving hemodi-alysis in our hospital were selected.This study was preformed to evaluate the parameters such as serum potassium concentration and electrocardiographic findings including such factors as heart rate, P duration, PR interval, QRS duration, T amplitude and duration and QT intervals on pre-and post-hemodialysis respectively.Results (1) T wave duration on pre-HD was shorter than the post-HD (145.20±23.49 ) ms

  13. Primary Ovarian Insufficiency (POI)

    Science.gov (United States)

    ... insufficiency in the adolescent : Committee opinion no. 502. Obstetrics and Gynecology, 118 , 741–745. ... Search of Answers for Those Struggling With Infertility Study finds genetic clue to menopause-like condition ...

  14. 异常凝血酶原和唾液酸在慢性肾功能不全患者血清中的表达及临床意义%Serum expression of PIVKA-Ⅱand SA in patients with chronic renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    公帅; 孙桂荣; 刘明军; 席强; 彭冲; 孙晓岚

    2016-01-01

    目的:观察慢性肾功能不全对血清异常凝血酶原(PIVKA‐Ⅱ)和唾液酸(SA)水平的影响。方法用化学发光法和酶法分别检测127例慢性肾功能不全、32例肾功能正常肾脏疾病患者、57例体检健康者和120例肝细胞癌(HCC )患者血清PIV‐KA‐Ⅱ和SA水平。分别测定上述受试者血清尿素(Urea)和肌酐(Cr)水平,并估算肾小球滤过率值(eGFR)。结果健康对照组、肾功能正常疾病组和肾功能不全疾病组三组间血清PIVKA‐Ⅱ水平没有统计学差异(H=2.902,P>0.05),且明显低于 HCC组(U值分别为319.50、203.00、665.50,P均<0.001)。肾功能不全疾病组中各期之间血清 PIVKA -Ⅱ水平也没有统计学差异( H=3.991,P>0.05)。血清S A水平在健康对照组、肾功能正常疾病组和肾功能不全疾病组之间( H=63.685,P<0.001),以及在肾功能不全疾病组各期之间(H=64.689,P<0.001)均有统计学差异。血清SA水平与eGFR呈负相关(r=-0.705,P<0.001),与Urea、Cr水平呈正相关(r=0.599、0.704,P<0.001)。 HCC组血清SA水平较CKD1~4期均明显升高(U值分别为126.00、163.50、247.00、715.00,P均<0.001),较CKD5期无明显变化(U=419.00,P>0.05)。结论肾功能不全对血清 PIVKA‐Ⅱ表达无明显影响,但可明显提高血清SA的表达水平,并与肾功能损害程度密切相关。可见血清SA水平升高不仅对HCC及其他多种恶性肿瘤有辅助诊断价值,还可较好地反映慢性肾功能不全患者的肾功能状态。%Objective To investigate the impact of chronic renal insufficiency on serum levels of protein induced by vitamin K absence or antagonist‐Ⅱ(PIVKA‐Ⅱ) and sialic acid (SA) .MethodsThe levels of serum PIVKA‐Ⅱ ,SA ,urea and creatinine(Cr) were detected in 127 cases of chronic renal insufficiency ,32

  15. O Transplante renal sob a ótica de crianças portadoras de insuficiência renal crônica em tratamento dialítico: estudo de caso El transplante renal bajo la óptica de los niños que llevan la insuficiencia renal crónica en el tratamiento dialítico: estudio del caso The renal transplant under the optics of children with chronic renal insufficiency in dialysis treatment: study of case

    Directory of Open Access Journals (Sweden)

    Vanessa Grespan Setz

    2005-09-01

    Full Text Available INTRODUÇÃO: Para compreender quais são as implicações da doença crônica para a criança e seus familiares é necessário partir-se da premissa de que a doença crônica não pode ser curada e que a cura almejada pode se transformar em mito perigoso, que compromete todo o processo de desenvolvimento da criança. OBJETIVOS: Compreender o significado do transplante renal para crianças em tratamento dialítico e conhecer suas expectativas em relação a este tratamento. MÉTODO: Estudo qualitativo, utilizando o Estudo de Caso como método de investigação e os pressupostos de Mayeroff como referencial teórico-filosófico. Para coleta de dados foram utilizadas as técnicas de entrevista semi-estruturada e o Desenho-Estória com tema. Foram entrevistadas 15 crianças em tratamento dialítico e hemodialítico, com idades entre 6 e 16 anos que consentiram em participar do estudo RESULTADO: Da análise de conteúdo emergiram quatro categorias: Construindo o conhecimento sobre o transplante; Buscando entender a espera pelo transplante; Criando expectativas de mudanças; Em contato com a frustração. E do desenho-estória com tema a categoria: Desvelando os sentimentos através do desenho. Neste artigo apresentaremos os resultados referentes às questões semi-estruturadas que emergiram das falas dos sujeitos. CONCLUSÃO: O estudo possibilitou compreender que as crianças percebem a realização do transplante renal como a única possibilidade de voltarem a vivenciar uma vida normal.RESUMEN INTRODUCCIÓN: Para comprender cuales son las implicaciones de la enfermedad crónica para el niño y sus familiares és necessário partir del presupuesto de que la enfermedad crónica no puede ser curada y que la cura deseada puede se transformarse en un mito peligroso, que puede comprometer todo el proceso de desarrolo del niño. OBJETIVOS: Compreender el significado del transplante renal para los niños en tratamiento dialítico y conocer sus expectativas

  16. 小剂量多巴胺联合前列地尔治疗慢性肾功能不全的临床疗效分析%Analysis clinical effect of the low-dose dopamine combined with alprostadil for treatment of chronic renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    孙丽萍

    2013-01-01

      目的分析小剂量多巴胺联合前列地尔治疗慢性肾功能不全的疗效。方法将我院2010年3月-2012年12月90例慢性肾功能不全患者随机分为两组各45例,对照组患者给予常规治疗,观察组患者在此基础上加用小剂量多巴胺和前列地尔治疗。结果观察组24h尿蛋白量、内生肌酐清除率、血肌酐、尿素氮及疗效均优于对照组(P<0.05)。结论小剂量多巴胺联合前列地尔治疗慢性肾功能不全的疗效确切,能延缓疾病进展,值得临床推广。%Objective To analyze the effect of low-dose dopamine combined with alprostadil for treatment of chronic renal insufficiency. Methods 90 patients with chronic renal insufficiency in our hospital from March 2010 to December 2012 were randomly divided into observation group and control group. Observation group was given low-dose dopamine combined with alprostadil on the basis of general treatment therapy and control group was given general treatment therapy. Results The 24h urine protein quantity, endogenous creatinine clearancerate, serum creatinine, blood urea nitrogen, and the clinical effect in the observation group were significant better than those in the control group(P<0.05). Conclusions The low-dose dopamine combined with alprostadil for treatment of chronic renal insufficiency is efficacy, decrease in development. It is worthy to be popularized.

  17. Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados Prevalencia de anemia e insuficiencia renal en portadores de insuficiencia cardiaca no hospitalizados Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure

    OpenAIRE

    Francisco José Farias Borges dos Reis; André Maurício Souza Fernandes; Almir Galvão Vieira Bitencourt; Flávia Branco Cerqueira Serra Neves; André Yoichi Kuwano; Victor Hugo Pinheiro França; Cristiano Ricardo Bastos de Macedo; Cristiano Gonçalves da Cruz; Viviane Sahade; Roque Aras Júnior

    2009-01-01

    FUNDAMENTOS: Insuficiência cardíaca (IC) é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR) são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de ...

  18. Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados Prevalencia de anemia e insuficiencia renal en portadores de insuficiencia cardiaca no hospitalizados Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure

    OpenAIRE

    Francisco José Farias Borges dos Reis; André Maurício Souza Fernandes; Almir Galvão Vieira Bitencourt; Flávia Branco Cerqueira Serra Neves; André Yoichi Kuwano; Victor Hugo Pinheiro França; Cristiano Ricardo Bastos de Macedo; Cristiano Gonçalves da Cruz; Viviane Sahade; Roque Aras Júnior

    2009-01-01

    FUNDAMENTOS: Insuficiência cardíaca (IC) é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR) são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de ...

  19. Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados Prevalencia de anemia e insuficiencia renal en portadores de insuficiencia cardiaca no hospitalizados Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure

    Directory of Open Access Journals (Sweden)

    Francisco José Farias Borges dos Reis

    2009-09-01

    Full Text Available FUNDAMENTOS: Insuficiência cardíaca (IC é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de julho de 2003 a novembro de 2006. Anemia foi definida como níveis de hemoglobina abaixo de 13 mg/dl para homens e de 12 mg/dl para mulheres. A função renal foi avaliada por meio da taxa de filtração glomerular (TFG, calculada pela fórmula simplificada do estudo MDRD (Modification of Diet in Renal Disease. RESULTADOS: Dos trezentos e quarenta e cinco pacientes incluídos neste estudo, 26,4% (n = 91 tinham anemia e 29,6% tinham insuficiência renal moderada a grave (TFG FUNDAMENTO: La insuficiencia cardiaca (IC es una enfermedad común con alta tasa de mortalidad. La anemia y la insuficiencia renal (IR, encontradas frecuentemente en portadores de IC, son asociadas a mayor severidad de la enfermedad cardiaca y peor pronóstico. OBJETIVO: Evaluar la prevalencia de anemia e insuficiencia renal, así como la asociación entre esos dos cuadros, en portadores de IC no hospitalizados. MÉTODOS: Se observaron a pacientes seguidos en la clínica de IC de un hospital universitario de julio de 2003 a noviembre de 2006. Se definió la anemia como niveles de hemoglobina abajo de 13 mg/dl para varones y de 12 mg/dl para mujeres. La función renal se evaluó por medio de la tasa de filtración glomerular (TFG, calculada por la fórmula simplificada del estudio MDRD (Modification of Diet in Renal Disease. RESULTADOS: Teniendo en cuenta los trescientos y cuarenta y cinco pacientes incluidos en este estudio, el 26,4% (n = 91 tenía anemia y el 29

  20. Secondary oxalosis due to excess vitamin C intake: A cause of graft loss in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    S Yaich

    2014-01-01

    Full Text Available Renal oxalate deposition can be seen with primary hyperoxaluria, malabsorptive states, ethylene glycol toxicity and, rarely, with excessive vitamin C ingestion. We report a case of secondary hyperoxaluria in which the diagnosis was not considered initially because there was no past history of urinary calculi and no evidence of nephrocalcinosis on plain X-ray of the abdomen and ultrasonography. The disease was detected and diagnosed only after kidney transplantation. Secondary oxalosis can cause graft loss or delayed graft function. Biopsy of the allograft should be carefully examined for oxalate deposits even in the absence of a family history. When oxalosis is diagnosed, intensifying hemodialysis (HD to eliminate calcium oxalate can help in the recovery of renal function in some cases. Systematic vitamin C supplementation in HD patients should be avoided as it can be a cause of secondary oxalosis.

  1. Efeitos do exercício físico durante a hemodiálise em indivíduos com insuficiência renal crônica: uma revisão Effects of physical exercise during hemodialysis in patients with chronic renal insufficiency: a literature review

    Directory of Open Access Journals (Sweden)

    Regina Márcia Faria de Moura

    2008-01-01

    Full Text Available As principais alterações observadas em indivíduos com insuficiência renal crônica são anemia, hipertensão arterial sistêmica e atrofia muscular, que levam à baixa capacidade aeróbica e perda de força muscular. Assim, parte do tratamento desses indivíduos consiste em programas de exercício físico. O objetivo desta revisão da literatura foi documentar os efeitos agudos e as adaptações crônicas, cardiovasculares e musculares em indivíduos no estágio final da doença renal, submetidos a programas de exercício físico durante a hemodiálise. Foram selecionados artigos científicos nas bases eletrônicas Medline, Lilacs e PEDro, assim como no acervo de periódicos da biblioteca da Faculdade de Medicina da UFMG. Foram analisados 13 artigos envolvendo exercício físico aeróbico associado ou não a fortalecimento muscular durante a hemodiálise, variando quanto à intensidade, freqüência e duração da intervenção. A maioria demonstrou que exercícios físicos realizados durante a hemodiálise promovem efeitos benéficos na melhora da capacidade aeróbica, força muscular e no controle dos fatores de risco cardiovasculares, auxiliando a remoção dos solutos durante a hemodiálise. Embora o tema seja ainda pouco explorado, a literatura disponível evidencia benefícios do exercício durante a hemodiálise sobre a capacidade aeróbica e força muscular dos pacientes.Main alterations seen in patients with chronic renal insufficiency are anemia, systemic arterial hypertension, and muscular atrophy, which lead to low aerobic capacity and loss of muscle strength. Hence part of these patients treatment consists in programs of physical exercise. The purpose of this literature review was to assess muscle and cardiovascular acute effects and chronic adaptations in end-stage renal disease patients submitted to physical exercise during hemodialysis. After browsing through Medline, Lilacs and PEDro databases, as well as searching for

  2. Clinical study on treatment of IgA nephropathy with renal insufficiency by corticosteroid, corticosteroid combined with cyclophosphamide and corticosteroid combined with mycophenolate mofetil%单纯激素、激素联合环磷酰胺和激素联合麦考酚酯治疗肾功能不全IgA肾病的临床研究

    Institute of Scientific and Technical Information of China (English)

    王伟铭; 贾晓媛; 潘晓霞; 沈平雁; 刘剑; 徐丽梨; 李娅; 王朝晖; 李晓

    2013-01-01

    Objective To investigate the clinical efficacy and safety of corticosteroid, corticosteroid combined with cyclophosphamide ( CTX) and corticosteroid combined with mycophenolate mofetil ( MMF) in IgA nephropathy (IgAN) with renal insufficiency. Methods Patients confirmed as primary IgAN by renal biopsy were selected, with chronic renal disease (CKD) of 3-4 stage and moderate renal lesions. Sixty patients were enrolled, and randomly received corticosteroid therapy (corticosteroid group, re =20), corticosteroid combined with CTX therapy (corticosteroid + CTX group, n=20) and corticosteroid combined with MMF therapy ( corticosteroid + MMF group, n = 20) . The 24 h urine protein, renal function parameters and adverse effect were observed during treatment. Results With the time of treatment, 24 h urine protein was gradually reduced in each group, and 24 h urine protein in corticosteroid group and corticosteroid + CTX group 3, 6 and 12 months after treatment and in corticosteroid + MMF group 12 months after treatment was significantly lower than the baseline (P 0. 05). Eight patients (8/20) in corticosteroid + MMF group suffered from serious pulmonary infection during treatment for 3 to 4 months, the baseline eGFR of whom was significantly lower than that of patients without serious pulmonary infection in corticosteroid + MMF group (P <0. 05). Conclusion Twenty-four hour urine protein can be significantly decreased with corticostsroid therapy, corticosteroid combined with CTX therapy and corticosteroid combined with MMF therapy in patients with IgAN and impaired renal function, and stable renal function can be maintained during treatment. Intensive follow-up should be carried out in the treatment with MMF due to the possibility of occurrence of serious pulmonary infection.%目的 观察单纯激素、激素联合环磷酰胺(CTX)、激素联合霉酚酸酯(MMF)治疗伴慢性肾功能不全原发性IgA肾病(IgAN)患者的临床效果和安全性.方法 选取经肾穿

  3. [Amyotrophic lateral sclerosis and respiratory insufficiency].

    Science.gov (United States)

    Siirala, Waltteri; Korpela, Jaana; Vuori, Arno; Saaresranta, Tarja; Olkkola, Klaus T; Aantaa, Riku

    2015-01-01

    Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. Recognizing the respiratory insufficiency can be challenging for a clinician. It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.

  4. Acidosis láctica por metformina desencadenada por una insuficiencia renal aguda Metformin-induced lactic acidosis due to acute renal failure

    Directory of Open Access Journals (Sweden)

    M.D. Macías-Robles

    2011-04-01

    Full Text Available La acidosis láctica es una complicación grave pero infrecuente asociada al empleo de metformina. Se discuten los mecanismos fisiopatológicos implicados en la acidosis láctica, con especial atención al papel potencial del fármaco. Presentamos un caso severo de este efecto secundario de la metformina en una paciente con diabetes tipo 2 que ingresó en el Servicio de Urgencias Hospitalario por un cuadro de insuficiencia renal aguda. El diagnóstico quedó apoyado por unos niveles séricos elevados de la biguanida, procedimiento escasamente utilizado en la práctica clínica. El tratamiento consiste en suspender la administración del fármaco e iniciar de forma inmediata la hemodiálisis con bicarbonato, lo cual proporciona un tratamiento sintomático y etiológico al eliminar del suero tanto el lactato como el antidiabético oral. Los síntomas de la acidosis láctica por metformina son inespecíficos y el comienzo es sutil, lo que hace necesario un alto nivel de sospecha para establecer un diagnostico precoz.Lactic acidosis is a serious but uncommon side effect of metformin use. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. We report on a severe case of this kind of drug toxicity in a patient with type 2 diabetes mellitus, admitted to the emergency department with acute renal failure symptoms. The diagnosis was supported by elevated serum levels of the biguanide, a procedure scarcely used in clinical practice. The management of this complication consists in drug discontinuation and hemodialysis with bicarbonate that provides symptomatic and ethiological treatment by removing both the lactate and the hypoglycemic agent from the serum. Since the symptoms of metformin-associated lactic acidosis are unspecific and its onset is subtle, a high level of suspicion is needed to establish an early diagnosis.

  5. Is there something special about cardiovascular abnormalities and sudden unexpected death in epilepsy among patients with chronic renal insufficiency in regular hemodialysis program? Existe algo de especial a respeito das anormalidades cardíacas e morte súbita e inesperada na epilepsia nos pacientes com insuficiência renal crônica no programa regular de hemodiálise?

    Directory of Open Access Journals (Sweden)

    Rui A. Gomes

    2009-06-01

    Full Text Available Of the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP, higher frequency of seizures is a very consistent issue. Following this reasoning, it has been established that hemodialysis-associated seizure is a complication of dialysis procedure. Based on these facts, this study investigated a possible association between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program. For that, a retrospective medical history of 209 patients was reviewed to investigate the occurrence of convulsive seizures and EKG abnormalities during dialytic program. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Any EKG abnormalities and SUDEP event were found in all patients evaluated. In conclusion, the present findings demonstrated uncommon the occurrence of seizures and also SUDEP. Probably, the main justification to not allow us to demonstrated a direct relation between SUDEP and cardiovascular diseases in hemodialysis are the reduced number of cases examined.Um dos principais fatores de risco para a morte súbita e inesperada na epilepsia (SUDEP é a alta freqüência de crises epilépticas. Seguindo este raciocínio, tem sido estabelecido que as crises epilépticas associadas à hemodiálise seja uma complicação do procedimento dialítico. Baseado neste fato, este estudo investigou uma possível associação entre anormalidades cardiovasculares e SUDEP nos pacientes com insuficiência renal crônica em um programa regular de hemodiálise. Para isto, um histórico médico retrospectivo de 209 pacientes foi revisado para avaliar a ocorrência de crises epilépticas e possíveis anormalidades no ECG durante o programa de diálise. Três pacientes apresentaram crises tônico-clonica generalizadas, um apresentou crise parcial com generalização secundária e um apresentou

  6. Modeling and Simulation for Estimating the Influence of Renal Dysfunction on the Hypouricemic Effect of Febuxostat in Hyperuricemic Patients Due to Overproduction or Underexcretion of Uric Acid.

    Science.gov (United States)

    Hirai, Toshinori; Kimura, Toshimi; Echizen, Hirotoshi

    2016-01-01

    Whether renal dysfunction influences the hypouricemic effect of febuxostat, a xanthine oxidase (XO) inhibitor, in patients with hyperuricemia due to overproduction or underexcretion of uric acid (UA) remains unclear. We aimed to address this question with a modeling and simulation approach. The pharmacokinetics (PK) of febuxostat were analyzed using data from the literature. A kinetic model of UA was retrieved from a previous human study. Renal UA clearance was estimated as a function of creatinine clearance (CLcr) but non-renal UA clearance was assumed constant. A reversible inhibition model for bovine XO was adopted. Integrating these kinetic formulas, we developed a PK-pharmacodynamic (PK-PD) model for estimating the time course of the hypouricemic effect of febuxostat as a function of baseline UA level, febuxostat dose, treatment duration, body weight, and CLcr. Using the Monte Carlo simulation method, we examined the performance of the model by comparing predicted UA levels with those reported in the literature. We also modified the models for application to hyperuricemia due to UA overproduction or underexcretion. Thirty-nine data sets comprising 735 volunteers or patients were retrieved from the literature. A good correlation was observed between the hypouricemic effects of febuxostat estimated by our PK-PD model and those reported in the articles (observed) (r=0.89, p<0.001). The hypouricemic effect was estimated to be augmented in patients with renal dysfunction irrespective of the etiology of hyperuricemia. While validation in clinical studies is needed, the modeling and simulation approach may be useful for individualizing febuxostat doses in patients with various clinical characteristics.

  7. Neurosarcoidosis-associated central diabetes insipidus masked by adrenal insufficiency.

    Science.gov (United States)

    Non, Lemuel; Brito, Daniel; Anastasopoulou, Catherine

    2015-01-22

    Central diabetes insipidus (CDI) is an infrequent complication of neurosarcoidosis (NS). Its presentation may be masked by adrenal insufficiency (AI) and uncovered by subsequent steroid replacement. A 45-year-old woman with a history of NS presented 2 weeks after abrupt cessation of prednisone with nausea, vomiting, decreased oral intake and confusion. She was diagnosed with secondary AI and intravenous hydrocortisone was promptly begun. Over the next few days, however, the patient developed severe thirst and polyuria exceeding 6 L of urine per day, accompanied by hypernatraemia and hypo-osmolar urine. She was presumed to have CDI due to NS, and intranasal desmopressin was administered. This eventually normalised her urine output and serum sodium. The patient was discharged improved on intranasal desmopressin and oral prednisone. AI may mask the manifestation of CDI because low serum cortisol impairs renal-free water clearance. Steroid replacement reverses this process and unmasks an underlying CDI.

  8. Adrenal Insufficiency and Addison's Disease

    Science.gov (United States)

    ... People Who Were Treated with hGH Adrenal Insufficiency & Addison's Disease What is adrenal insufficiency? Adrenal insufficiency is an ... under “ How is adrenal insufficiency treated? ” What causes Addison’s disease? Autoimmune disorders cause most cases of Addison’s disease. ...

  9. Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales

    Directory of Open Access Journals (Sweden)

    S Galipothu

    2015-01-01

    Full Text Available Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales

  10. Efficacy Analysis of 60 Cases of Senile Chronic Renal Insufficiency Combined with Infection Treated with Antibiotics%抗生素治疗老年慢性肾功能不全合并感染60例临床分析

    Institute of Scientific and Technical Information of China (English)

    滕玲; 覃建阳

    2012-01-01

    目的 探索抗生素治疗慢性肾功能不全失代偿期合并下呼吸道感染的老年患者的临床效果及其对肾功能影响.方法 选取2008年5月~2011年10月我院治疗的60例肾功能不全合并肺部感染老年患者,同期选取60例肾功能正常的老年下呼吸道感染患者作对照.应用头孢哌酮治疗后观察两组患者的总体疗效差异及治疗组患者治疗前后的肾功能情况差异.结果 治疗组和对照组患者的总体治疗效果比较,差异无统计学意义(P>0.05),但治愈率差异有统计学意义(P<0.05);治疗组治疗前后患者的血肌酐、尿素氮、内生肌酐清除率水平与治疗前比较,差异有统计学意义(P<0.05).结论 肾功能不全合并下呼吸道感染老年患者,治疗中应密切留意患者的肾功能,一旦出现肾功能衰竭应积极处理.%Objective To explore the clinical efficacy of antibiotics on chronic renal insufficiency at the compensatory stage combined with lower respiratory infection for the aged patients and the impacts on renal function. Methods From May 2008 to October 2011,60 aged patients with renal insufficiency combined with pulmonary infection were selected. In the same term, 60 aged patients with lower respiratory infection and normal renal function were selected as the control. After treated with cefoperazone, the difference in the total efficacy between two groups and the difference in renal function before and after treatment in the treatment group were observed. Results In comparison of the total efficacy for the patients between the treatment group and the control group, there was no statistical significant difference( P > 0.05 ), but the difference in the curative rate was significant statistically( P < 0. 05 ). In the treatment groups, the levels of creatinine( Cr ), urea nitrogen( BUN )and the endogenous creatinine clearance rate( CCr )were different significantly as compared with those before treatment P <0. 05

  11. 应用抗生素治疗老年慢性肾功能不全并细菌感染60例疗效分析%Clinical Effect of Antibiotics to Treat 60 Elderly Patients with Chronic Renal Insufficiency and Bacterial Infection

    Institute of Scientific and Technical Information of China (English)

    滕玲; 覃建阳

    2012-01-01

    目的 探索应用抗生素治疗慢性肾功能不全失代偿期合并下呼吸道感染的老年患者的临床效果和对其肾功能的影响.方法 选取我院自2008年5月~2011年10月我院治疗的60例肾功能不全合并肺部感染的老年患者纳入观察组,同期选取60肾功能正常的老年下呼吸道感染的患者纳入对照组.两组患者应用头孢哌酮进行治疗,观察两组患者的总体治疗效果差异以及观察组患者治疗前后的肾功能血肌酐、尿素氮、尿酸、肌酐清除率水平差异.结果 观察组和对照组患者平均治疗时间分别为(10.15±3.23)天和(7.32±2.18)天,差异有统计学意义(P<0.05);两组患者的总体治疗效果差异不明显(P>0.05),但痊愈率差异有统计学意义(P<0.05);观察组治疗前后患者的血肌酐、尿素氮、内生肌酐清除率水平与治疗前比较差异有统计学意义(P<0.05).结论 肾功能不全的老年患者一旦发生下呼吸道感染,应用抗生素治疗的难度增大,治疗过程中应密切留意患者的肾功能情况,并合理控制药物用量,一旦出现肾功能衰竭应立即停药,必要时进行血液透析.%Objective Explore the clinical effect of antibiotics to treat 60 elderly patients with chronic renal insufficiency and bacterial infection, and influence to the renal function. Methods Choosing 60 elderly patients with chronic renal failure and 60 elderly patients with normal renal function, all patients were suffered from lower respiratory tract infection, who were treated by Ceftazidime in our hospital from May 2008 to October 2011. Observe the difference of clinical effect and renal function change before and after treatment. Results The average treatment time of observation group and control group were(10.15±3.23) d and (7.32±2.18) d (P<0.05); There were no statistical means of overall treatment effect(P>0.05), but difference of cure rate between two groups was significant(P<0

  12. 慢性心力衰竭患者肝、肾功能不全发生率及其与心衰严重程度的关系%The incidence rate of liver and renal insufficiency in the patients with chronic cardiac failure and its relationship with heart failure severity

    Institute of Scientific and Technical Information of China (English)

    戴希友

    2014-01-01

    Objective:To explore the incidence rate of liver and renal insufficiency in the patients with chronic cardiac failure(CHF) and its relationship with heart failure severity.Methods:96 cases with CHF were selected.According to the NYHA heart function classification,they were randomly divided into cardiac function Ⅰ,Ⅱ,Ⅲ,Ⅳ group.The incidence rates of liver and renal insufficiency of each groups were respectively calculated.The changs of alanine aminotransferase(ALT)、 glomerular filtration rate(eGFR) level and the relationship with heart failure severity.Results:The incidence rates of liver and renal insufficiency in the patients with chronic cardiac failure were respectively 42.0% and 38.5% .With the rise of heart function classification,the incidence rate of liver and renal insufficiency was rised.With the continuous deterioration of heart function, serum ALT and eGFR concentration were gradually increased,and there was significant difference in 4 groups(P<0.05). Conclusion:The phenomenon of liver and renal insufficiency in the patients with chronic cardiac failure is quite common.The cardiac functional grading of patients is more higher.The liver and kidney function damage will be more serious.%目的:探讨慢性心力衰竭(CHF)患者肝、肾功能不全发生率及其与心衰严重程度的关系。方法:收治CHF患者96例,按照NYHA心功能分级随机分为心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组,分别计算各组肝、肾功能不全发生率,探讨丙氨酸氨基转移酶(ALT)、肾小球滤过率(eGFR)水平的变化与心衰严重程度的关系。结果:慢性心衰患者肝、肾功能不全的发生率分别为42.0%、38.5%,并且随心功能分级的升高,肝、肾功能不全发生率也在升高;随着心功能的不断恶化,血清ALT、eGFR浓度也逐渐升高,且4组组间差异有统计学意义(P<0.05)。结论:慢性心衰患者中肝、肾功能不全的现象相当普遍,且患者心功能分级越

  13. [Two elderly case reports of renal excretion type drug poisoning caused by dehydration that was due to poor eating in home care].

    Science.gov (United States)

    Ibata, Takeshi; Hinokiyama, Hiromi; Nakashita, Chisako; Mito, Saori; Doi, Seiko; Shiki, Satomi; Hata, Akiko; Sato, Miyuki; Komuro, Ryutaro; Iijima, Hohei

    2010-12-01

    The elderly patients are susceptible to acute renal failure due to dehydration or infection. Therefore, the drug should be administered with caution. We report two cases of acute renal failure from dehydration that led to a subsequent drug poisoning. Case 1: An 85-year-old woman with a history of colorectal cancer surgery was admitted to our emergency department for appetite loss and weakness. Because she was given a normal amount of drugs under the condition of poor oral intake, she was hospitalized by digitalism. Case 2: A 72-year-old woman was admitted to our emergency department for disturbance of consciousness and appetite loss. The medication given by a staff in geriatric health services facility appeared to have caused a pilsicainide poisoning. As the elderly patients were given a normal amount of drugs under the poor oral intake condition, blood levels of renal excretion type drug had increased in both cases. Medication management for the elderly should be comprehensively considered the background of the individual.

  14. Interstitial renal fibrosis due to multiple cisplatin treatments is ameliorated by semicarbazide-sensitive amine oxidase inhibition.

    Science.gov (United States)

    Katagiri, Daisuke; Hamasaki, Yoshifumi; Doi, Kent; Negishi, Kousuke; Sugaya, Takeshi; Nangaku, Masaomi; Noiri, Eisei

    2016-02-01

    Elucidation of acute kidney diseases and disorders (AKD), including acute kidney injury (AKI), is important to prevent their progression to chronic kidney disease. Current animal AKI models are often too severe for use in evaluating human AKI. Therefore, new animal models of mild kidney injury are needed. Here a new clinically relevant animal model using multiple low doses of cisplatin (CP) was used to evaluate AKD. When 10 mg/kg CP was administered intraperitoneally once weekly for three times to L-type fatty acid-binding protein (L-FABP) transgenic mice, moderate renal interstitial fibrosis and tubule dilatation occurred, accompanied by brush-border loss. Urinary L-FABP, a promising biomarker of AKI, changed more drastically than blood urea nitrogen or creatinine. Preventing fibrosis in organs was also studied. Oral administration of a recently reported selective semicarbazide-sensitive amine oxidase inhibitor, PXS-4728A, for 1 week attenuated kidney injury and interstitial fibrosis compared with vehicle. Inhibition of renal lipid accumulation in semicarbazide-sensitive amine oxidase inhibitor-treated mice, together with reduced oxidative stress and L-FABP suppression in proximal tubules, suggested an antifibrotic effect of semicarbazide-sensitive amine oxidase inhibition in this CP-AKD model, a representative onco-nephrology. Thus, semicarbazide-sensitive amine oxidase inhibitors may be promising candidates for the prevention of chronic kidney disease in patients using CP to treat malignancy.

  15. Current Concepts in the Diagnosis and Classification of Renal Dysfunction in Cirrhosis

    Science.gov (United States)

    Mindikoglu, Ayse L.; Weir, Matthew R.

    2013-01-01

    Background Renal dysfunction is one of the most common complications of cirrhosis with high morbidity and mortality. Summary In subjects with cirrhosis, renal dysfunction can present either as a direct consequence of cirrhosis (e.g. hepatorenal syndrome Type I and Type II) or secondary to etiologies other than cirrhosis (chronic kidney disease due to diabetic nephropathy, prerenal azotemia). Or, patients with cirrhosis may have renal dysfunction resulting directly from cirrhosis; and an underlying chronic kidney disease. Key Messages Given the challenges in the differential diagnosis of renal dysfunction and insufficient accuracy of serum creatinine and creatinine-based glomerular filtration rate estimating equations in cirrhosis, there is an urgent need for more accurate biomarkers of renal dysfunction in this population. This review will discuss novel concepts for the diagnosis and classification of renal dysfunction in cirrhosis to overcome at least some of the diagnostic and therapeutic challenges. Additionally, a new classification will be proposed for renal dysfunction in cirrhosis. PMID:24107793

  16. Effect observation of enteral nutrition“integration of medical care” for renal insufficiency patients in ICU%ICU肾功不全患者实施肠内营养“医护一体化”的效果观察

    Institute of Scientific and Technical Information of China (English)

    冯碧翠; 胡超娅; 夏蕊

    2014-01-01

    目的:探讨“医护一体化”在ICU对肾功能不全危重患者肠内营养支持的应用效果。方法58例诊断含“肾功能不全”的危重患者,随机分为研究组28例和对照组30例,其中对照组患者每日常规采用肠内营养乳剂(internal nutrition emulsion)持续胃管泵注补充能量;研究组采用“医护一体化”为患者制定个性化肠内营养支持方案。2周后对两组患者的肾功指标与肠内营养并发症发生率进行分析对比。结果两组患者经过治疗后,肾功指标均下降,研究组下降趋势较对照组明显,两组差异具有统计学意义(P<0.05);肠内营养并发症研究组发生率低于对照组,差异有统计学意义(P<0.05)。结论“医护一体化”在肾功能不全患者肠内营养支持中的实施具有促进患者疾病恢复和降低肠内营养并发症的作用,在临床有一定优势。%Objective To explore “integration of medical care” effects on enteral nutrition support for severe renal insufficiency patients in ICU.Methods A total of 58 ICU patients on diagnosis of renal insufficiency were randomly divided into the study group (n=28) and the control group (n=30). The control group was treated by internal nutrition emulsion from tube, while the study group received a personalized internal nutrition of “integration of medical care”. The two groups’ renal parameters and complication rate were compared after 2 weeks. Results Two groups’ renal functions both decreased, and the decline of the study group was more obvious than that of the control group. The difference was statistically significant (P<0.05). The incidence of enteral nutrition complications of the study group was lower than that of the control group, and the difference had statistical significance (P<0.05).Conclusion Integration of medical care for renal insufficiency patients can promote renal insufficiency patients’ recovery and reduces the complications, and

  17. Renal mass biopsy--a renaissance?

    Science.gov (United States)

    Lane, Brian R; Samplaski, Mary K; Herts, Brian R; Zhou, Ming; Novick, Andrew C; Campbell, Steven C

    2008-01-01

    Advances in our understanding of the natural history and limited aggressive potential of many small renal masses, expanding treatment options and the integration of molecular factors into prognostic and therapeutic algorithms have stimulated renewed interest in percutaneous renal mass biopsy. A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the indications, techniques, complications and efficacy of renal mass biopsy. Reported techniques of renal mass biopsy vary widely with different modes of radiographic guidance, needle size, number of cores and pathological analyses. Percutaneous renal mass biopsy with 2 or 3 cores using 18 gauge needles may improve diagnostic accuracy without increasing morbidity. Serious complications of percutaneous biopsy are rare and the minor complication rate in recent series has been less than 5%. The reported rate of technical failure of renal mass biopsy due to insufficient material was about 9% before 2001 and 5% in more recent studies. The likelihood of indeterminate or inaccurate pathological findings has decreased from 10% to 4% when comparing clinical studies before and since 2001. Currently a total success rate of greater than 90% is attainable using renal mass biopsy with standard histopathological analysis. Recent studies demonstrated that combining immunohistochemical and molecular analyses may further improve renal mass biopsy accuracy. Research on expanded analysis of percutaneous renal mass biopsy specimens should remain a top priority. Enhanced renal mass biopsy should not change treatment in most patients with small renal masses, who should be treated with surgical excision. However, future clinical algorithms will likely incorporate enhanced biopsy in situations in which decision making is more challenging.

  18. Therapeutic effect and safety of half dose tirofiban combined PCI in patients with acute myocardial infarction complicated early renal insufficiency%半剂量替罗非班联合PCI对早期肾功能不全急性心肌梗死患者的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    沈冲; 方雪花; 赵炳朕; 余清; 马飞; 张伟; 高德全; 赵雪东

    2012-01-01

    目的:观察半剂量替罗非班联合经皮冠脉介入治疗(PCI)对合并早期肾功能不全急性心肌梗死(AMI)患者的疗效及安全性.方法:选择合并早期肾功能不全的AMI患者55例作为肾功能不全组,56例肾功能正常的AMI患者作为AMI对照组,两组均应用常规抗凝、抗血小板治疗,肾功能不全组于穿刺成功后开始应用半剂量替罗非班,AMI对照组全量应用替罗非班.比较两组间住院期主要不良心血管事件(MACE),出血、血小板减少发生率及对比剂肾病发生率的差异.结果:与AMI对照组比较,肾功能不全组3支病变比例(21.1%比43.6%)、术后肌酸激酶峰值浓度[(1863.1±86.7)IU/L比(2371.5±126.3)IU/L]明显升高(P均<0.05);两组术后TIMI 3级血流率、校正的TIMI计帧数和Blush 3级率未见显著性差异(P>0.05),术后2h心电图相关导联ST段下降幅度及住院期间的MACE发生率亦无显著性差异(P>0.05),出血事件发生率和血小板减少发生率亦无显著差异(P>0.05).对比剂肾病:AMI对照组无发生,肾功能不全组有3例发生(0%比5.45%,P<0.05).结论:合并早期肾功能不全的急性心肌梗死患者三支病变比例高,半剂量替罗非班联合PCI能有效再灌注心肌,降低住院心血管事件发生,未见明显出血及血小板减少发生率增加,但需警惕对比剂肾病的发生,术后应加强监测与干预.%To investigate therapeutic effect and safety of half dose tirofiban combined percutaneous coronary intervention (PCI) on patients with acute myocardial infarction (AMI) complicated early renal insufficiency. Methods: A total of 55 AMI patients with early renal insufficiency were enrolled as renal insufficiency group and 56 AMI patients with normal renal function were regard as AMI control group. Both groups received routine anticoagulant and antiplatelet therapy, renal insufficiency group received half dose tirofiban after successful puncture while AMI control group

  19. [Chronic respiratory insufficiency in France].

    Science.gov (United States)

    Chailleux, E; Boffa, C

    2001-05-31

    The data concerning the prevalence of chronic respiratory insufficiency (CRI) in France are scarce: in 1994 official numbers were 14,000 deaths due to chronic bronchitis, 2,000 due to asthma for a total number of 40,000 deaths with respiratory cause; the same year 27,000 new patients were compensated for chronic respiratory insufficiency by social security services. On January 1st 2000 the non-profit organizations was in charge of 21,500 patients with long term oxygen therapy and 10,500 with home ventilation, and the commercial companies respectively 30,000 and 6,000. Accordingly the total of patients treated at home for CRI is about 68,000. The repartition by cause of CRI, the characteristics of patients and the prognosis can be evaluated thanks to the ANTADIR observatory which collects medical data since 1981. Chronic obstructive pulmonary diseases (chronic bronchitis, emphysema, asthma, bronchiectasis) count for more than half of the total of cases. Other causes comprise pleuro-parietal diseases (tuberculosis sequelae, kyphoscoliosis), neuro-muscular diseases and interstitial lung diseases. CRI is a severe disease with a survival median of three years for chronic obstructive pulmonary diseases, and a prognosis slightly better for kyphoscoliosis and neuro-muscular diseases, and worse for pulmonary fibrosis.

  20. Alterations of renal phenotype and gene expression profiles due to protein overload in NOD-related mouse strains

    Directory of Open Access Journals (Sweden)

    Agarwal Anupam

    2005-12-01

    Full Text Available Abstract Background Despite multiple causes, Chronic Kidney Disease is commonly associated with proteinuria. A previous study on Non Obese Diabetic mice (NOD, which spontaneously develop type 1 diabetes, described histological and gene expression changes incurred by diabetes in the kidney. Because proteinuria is coincident to diabetes, the effects of proteinuria are difficult to distinguish from those of other factors such as hyperglycemia. Proteinuria can nevertheless be induced in mice by peritoneal injection of Bovine Serum Albumin (BSA. To gain more information on the specific effects of proteinuria, this study addresses renal changes in diabetes resistant NOD-related mouse strains (NON and NOD.B10 that were made to develop proteinuria by BSA overload. Methods Proteinuria was induced by protein overload on NON and NOD.B10 mouse strains and histology and microarray technology were used to follow the kidney response. The effects of proteinuria were assessed and subsequently compared to changes that were observed in a prior study on NOD diabetic nephropathy. Results Overload treatment significantly modified the renal phenotype and out of 5760 clones screened, 21 and 7 kidney transcripts were respectively altered in the NON and NOD.B10. Upregulated transcripts encoded signal transduction genes, as well as markers for inflammation (Calmodulin kinase beta. Down-regulated transcripts included FKBP52 which was also down-regulated in diabetic NOD kidney. Comparison of transcripts altered by proteinuria to those altered by diabetes identified mannosidase 2 alpha 1 as being more specifically induced by proteinuria. Conclusion By simulating a component of diabetes, and looking at the global response on mice resistant to the disease, by virtue of a small genetic difference, we were able to identify key factors in disease progression. This suggests the power of this approach in unraveling multifactorial disease processes.

  1. Betahistine in vertebrobasilar insufficiency.

    Science.gov (United States)

    Kaźmierczak, Henryk; Pawlak-Osińska, Katarzyna; Kaźmierczak, Wojciech

    2004-01-01

    The aim of this study was to observe the usefulness of betahistine dihydrochloride--Betaserc--in therapy for vestibular disorders in patients with vertebrobasilar insufficiency. Two groups of patients, in each of which were 150 patients (mean age, 52.2 years), were tested on the basis of videonystagmography and stabilometry. Betaserc was administrated in two separate doses: 8 mg three times daily and 16 mg three times daily for 120-180 days (mean, 132 days). In every case before and after therapy, visuo-oculomotor and vestibulo-oculomotor reflexes were tested, and amplitude and velocity of the sway were measured during dynamic posturographic testing. After Betaserc treatment, pathological visuo-oculomotor reactions and pathological cervical test results disappeared in most cases: Smooth pursuit improved in 59.9% of cases and saccadic movements in 55.9% of patients, and cervical nystagmus disappeared in 62.2% of tested people. During stabilometry, mean and maximal platform amplitude and mean head velocity decreased as compared with results from tests performed before treatment. These observations were significant after the greater dose of Betaserc; nonetheless, improvement was noted after both doses. The usefulness of Betaserc in vertebrobasilar insufficiency was proved, 4-6 months' therapy was sufficient, and the effect on central compensation seemed to be most probable.

  2. Effect of synchronous health education of family member on the quality of life in patients with chronic renal insufficiency%家属同步健康教育对慢性肾功能不全患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    汪春燕

    2014-01-01

    目的:探讨对家属实施同步教育在慢性肾功能不全患者治疗中的应用效果。方法:选取60例慢性肾功能不全患者,随机分为对照组和观察组,2组患者均接受常规教育,观察组家属实施同步教育。采用生活质量表( SF-36)进行问卷调查,比较2组患者生活质量。结果:2组患者健康教育后生活质量提高(P<0.01),而观察组生活质量各项评分均较对照组提高更明显(P<0.01)。结论:实施家属同步健康教育可明显改善慢性肾功能不全患者生存状态,增强自我护理知识和能力,促进患者更好地配合治疗和护理,提高生活质量。%Objective:To explore the effects of synchronous health education of family member on the quality of life in patients with chronic renal insufficiency. Methods:Sixty patients with chronic renal insufficiency were randomly divided into control group and observation group. All patients were educated with routine instruction,the observation group were additionally educated with synchronous health education of family member. The quality of life of two groups were analyzed by SF-36 scale. Results:After health education,the quality of life in all patients were significantly improved(P<0. 01),the improvement of the quality of life in observation group was significantly better than that in control group(P <0. 01). Conclusions:The synchronous health education of family member can significantly improve the living condition,strengthen the knowledge and self-care ability,promote better treatment and care and improve the quality of life of patients with chronic renal insufficiency.

  3. Peritoneal Dialysis in the Treatment of young Clinical Therapeutic Effect on Acute renal Insufficiency in Children after Cardiac Surgery%腹膜透析治疗低龄患儿心脏术后急性肾功能不全的临床疗效

    Institute of Scientific and Technical Information of China (English)

    陈磊; 赵永成; 万志坤; 查光彦

    2015-01-01

    Objective To investigate the peritoneal dialysis(PD)clinical curative effect in the treatment of acute renal insufficiency in children after cardiac surgery.Methods From 2009 March to 2013 May in our hospital treatment of children after cardiac surgery in children with acute renal insufficiency in 35 cases as the research object,and al patients were treated by surgical operation,the placement of peritoneal dialysis catheter. After 4~8 h in the beginning PD treatment,at the same time,with the strong heart diuresis,respiratory support and other comprehensive treatment. Results After the treatment of 0~6 h,7~12 h and the observation of the index before treatment,the difference was statisticaly significant(P<0.05).In 35 cases,32 cases were cured,the cure rate was 91.4%,3 cases of death. Conclusion Children after cardiac surgery complicated by acute renal insufficiency in application of peritoneal dialysis way to treatment,not only can timely stability in children with the disease,also can reduce the pain of patients.%目的:探讨腹膜透析(PD)治疗低龄小儿心脏术后急性肾功能不全的临床疗效。方法选取2009年3月至2013年5月在我院治疗的低龄小儿心脏术后急性肾功能不全患儿35例为研究对象,患儿均采用外科手术,放置腹膜透析管。在术后4~8 h内开始PD治疗,同时采用强心利尿、呼吸支持等综合治疗。结果治疗后0~6 h、7~12 h与治疗前各观察指标比较,差异均有统计学意义(均P<0.05)。35例患儿中,治愈32例,治愈率为91.4%,病死3例。结论低龄小儿心脏术后并发急性肾功能不全患儿应用腹膜透析的方式予以治疗,不仅可及时稳定患儿病情,还能减轻患儿痛苦。

  4. Subcutaneous phaeohyphomycosis due to Alternaria infectoria in a renal transplant patient: surgical treatment with no long-term relapse.

    Science.gov (United States)

    Salido-Vallejo, Rafael; Linares-Sicilia, María José; Garnacho-Saucedo, Gloria; Sánchez-Frías, Marina; Solís-Cuesta, Francisco; Gené, Josepa; Moreno-Giménez, José Carlos

    2014-01-01

    Phaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression. We present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size. A skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed. Histopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up. There are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  5. Adrenal insufficiency: diagnosis and management.

    Science.gov (United States)

    Munver, Ravi; Volfson, Ilya A

    2006-01-01

    Adrenal insufficiency is a disorder characterized by hypoactive adrenal glands resulting in insufficient production of the hormones cortisol and aldosterone by the adrenal cortex. This disorder may develop as a primary failure of the adrenal cortex or be secondary to an abnormality of the hypothalamic-pituitary axis. Patients with adrenal insufficiency often are asymptomatic or they may present with fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin. The presentation of adrenal insufficiency varies dramatically and poses a major diagnostic dilemma. This review focuses on the diagnosis and treatment of primary and secondary adrenal insufficiency.

  6. Luteal insufficiency in first trimester

    Directory of Open Access Journals (Sweden)

    Duru Shah

    2013-01-01

    Full Text Available Luteal phase insufficiency is one of the reasons for implantation failure and has been responsible for miscarriages and unsuccessful assisted reproduction. Luteal phase defect is seen in women with polycystic ovaries, thyroid and prolactin disorder. Low progesterone environment is created iatrogenically due to interventions in assisted reproduction. Use of gonadotrophin-releasing hormone analogs to prevent the LH surge and aspiration of granulosa cells during the oocyte retrieval may impair the ability of corpus luteum to produce progesterone. Treatment of the underlying disorder and use of progestational agents like progesterone/human chorionic gonadotrophin have been found to be effective in women with a history of recurrent miscarriage. There has been no proved beneficial effect of using additional agents like ascorbic acid, estrogen, prednisolone along with progesterone. Despite their widespread use, further studies are required to establish the optimal treatment. Literature review and analysis of published studies on luteal phase support.

  7. Delayed diagnosis of adrenal insufficiency in a patient with severe penoscrotal hypospadias due to two novel P450 side-change cleavage enzyme (CYP11A1) mutations (p.R360W; p.R405X).

    Science.gov (United States)

    Parajes, Silvia; Chan, Angel O K; But, W M; Rose, Ian T; Taylor, Angela E; Dhir, Vivek; Arlt, Wiebke; Krone, Nils

    2012-12-01

    Cytochrome P450 side-chain cleavage enzyme (CYP11A1) catalyses the first and rate-limiting step of steroidogenesis, the conversion of cholesterol to pregnenolone. CYP11A1 deficiency is commonly associated with adrenal insufficiency, and in 46,XY individuals, with variable degrees of disorder of sex development (DSD). The patient was born with hyperpigmentation, micropenis, penoscrotal hypospadias, and mild cryptorchidism. Biochemical and hormonal findings were normal except for low testosterone and low-borderline cortisol. However, no short synacthen test was undertaken. Development was unremarkable apart from an episode labeled as sepsis with documented hyperkalemia and elevated C-reactive protein at age 15 days. Diagnosis of 46,XY DSD was made at age 2.5 months. Progression of hyperpigmentation prompted further investigations and the diagnosis of adrenal insufficiency was established at 2 years with raised ACTH, normal renin activity, and failure of cortisol to respond to short synacthen test. Genetic analyses were performed. The novel CYP11A1 mutations were characterized in vitro and in silico. The patient was compound heterozygous for two novel CYP11A1 mutations, p.R360W and p.R405X. p.R360W retained 30-40% of wild-type activity. In silico analyses confirmed these findings and indicated that p.R405X is severe. This study demonstrates the pathogenicity of two novel CYP11A1 mutations found in a patient with delayed diagnosis of CYP11A1 deficiency. Patients with partial deficiencies of steroidogenic enzymes are at risk to be misdiagnosed if adrenal function is not assessed. The adrenocortical function should be routinely assessed in all patients with DSD including severe hypospadias of unknown origin to prevent life-threatening adrenal crises.

  8. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kyriakos Neofytou

    2014-01-01

    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  9. Fluoride-induced chronic renal failure.

    Science.gov (United States)

    Lantz, O; Jouvin, M H; De Vernejoul, M C; Druet, P

    1987-08-01

    Renal fluoride toxicity in human beings is difficult to assess in the literature. Although experimental studies and research on methoxyflurane toxicity have shown frank renal damage, observations of renal insufficiency related to chronic fluoride exposure are scarce. We report a case of fluoride intoxication related to potomania of Vichy water, a highly mineralized water containing 8.5 mg/L of fluoride. Features of fluoride osteosclerosis were prominent and end-stage renal failure was present. The young age of the patient, the long duration of high fluoride intake, and the absence of other cause of renal insufficiency suggest a causal relationship between fluoride intoxication and renal failure.

  10. Cortical Blindness due to Bilateral Occipital Infarcts in a Renal Failure Patient with Prostate Cancer: A Rare Complication of Hemodialysis

    Directory of Open Access Journals (Sweden)

    O. G. Doluoglu

    2013-01-01

    Full Text Available Loss of vision is a rare complication seen in hemodialysis patients. It is thought to develop because of the hypotension that can be observed during dialysis. This paper involves a patient with acute loss of vision during hemodialysis due to bilateral occipital infarcts.

  11. Renal hypomagnesemia, hypercalciuria and nephrocalcinosis in a middle-aged man.

    Science.gov (United States)

    Enríquez, R; Sirvent, A E; Amorós, F; Martínez, M; Cabezuelo, J B; Reyes, A

    2003-01-01

    We report a 41-year-old man with hypomagnesemia, hypercalciuria, nephrocalcinosis, myopia and horizontal nystagmus. The hypomagnesemia was due to primary renal magnesium loss. He was diagnosed as having the syndrome of renal hypomagnesemia, hypercalciuria and nephrocalcinosis. This is a rare condition generally diagnosed by the first to third decades of life. Renal failure is common and end-stage renal disease can occur in children or young adults. The patient was treated with oral magnesium, chlorthalidone, potassium citrate and allopurinol and was followed up for 3 years. Treatment resulted in an improvement in hypercalciuria but serum magnesium level could not be normalized. The patient's renal function remains stable, with a mild degree of renal insufficiency.

  12. Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study

    Directory of Open Access Journals (Sweden)

    Ávila-Albuerne Yisel

    2005-05-01

    Full Text Available Abstract Background Recombinant human erythropoietin (EPO is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. Methods A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A, a newly developed product and Eprex (CILAG AG, Switzerland, formulation B, as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. Results Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively. The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their

  13. Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study

    Science.gov (United States)

    Pérez-Oliva, Jorge F; Casanova-González, Martha; García-García, Idrian; Porrero-Martín, Pedro J; Valenzuela-Silva, Carmen M; Hernández-Montero, Tairí; Lagarde-Ampudia, Marcia; Casanova-Kutsareva, Yuri; Ávila-Albuerne, Yisel; Vargas-Batista, Alicia; Bobillo-López, Hailen; Herrera-Valdés, Raúl; López-Saura, Pedro A

    2005-01-01

    Background Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. Methods A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. Results Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more

  14. Bone mineral density in renal osteodystrophy: Comparison of dual energy X-ray absorptiometry and quantitative computed tomography. Vergleichende Untersuchungen mit der quantitativen Computertomographie und der Dual-Energy-X-Ray-Absorptiometrie zur Knochendichte bei renaler Osteopathie

    Energy Technology Data Exchange (ETDEWEB)

    Funke, M.; Maeurer, J.; Grabbe, E. (Abt. Roentgendiagnostik, Klinikum, Goettingen Univ. (Germany)); Scheler, F. (Abt. Nephrologie und Rheumatologie, Klinikum, Goettingen Univ. (Germany))

    1992-08-01

    Measurements of bone density were carried out in 25 patients on dialysis for terminal renal insufficiency, using quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA). Unlike in subjects with normal kidneys, there was no significant correlation between these methods in this series. Ten patients showed an increase in bone density of the vertebral spongiosa on QCT measurements, which was interpreted as due to osteosclerotic bone changes in renal osteopathy. QCT showed advantages over DXA in demonstrating these changes. (orig.).

  15. Diagnosis and management of adrenal insufficiency.

    Science.gov (United States)

    Bancos, Irina; Hahner, Stefanie; Tomlinson, Jeremy; Arlt, Wiebke

    2015-03-01

    Adrenal insufficiency continues to be a challenge for patients, their physicians, and researchers. During the past decade, long-term studies have shown increased mortality and morbidity and impaired quality of life in patients with adrenal insufficiency. These findings might, at least partially, be due to the failure of glucocorticoid replacement therapy to closely resemble physiological diurnal secretion of cortisol. The potential effect of newly developed glucocorticoid drugs is a focus of research, as are the mechanisms potentially underlying increased morbidity and mortality. Adrenal crisis remains a threat to lives, and awareness and preventative measures now receive increasing attention. Awareness should be raised in medical teams and patients about adrenal insufficiency and management of adrenal crisis to improve clinical outcome.

  16. The progression of nutritional therapy and nutritional evaluation of child chronic renal insufficiency%儿童慢性肾功能不全的营养评估和营养治疗进展

    Institute of Scientific and Technical Information of China (English)

    姜明霞; 夏正坤

    2012-01-01

    营养治疗是慢性肾功能不全综合治疗的一个组成部分,患病儿童营养状况的好差不仅能影响治疗效果,而且还影响其生长发育.适量的蛋白质,充足的热量以及维生素和矿物质的供给,能延缓疾病的发展和减少并发症的发生.定期做营养评估,可为患病儿童营养治疗方案的调整提供依据.%Nutritional therapy is one part of combined therapy of chronic renal disease. The nutritional status is very important to growth and development of the children patients. The supplementation of appropriate amount of protein, abundant energy, vitamin and minerals can remission the development of disease and decrease the incidence of the complication. The regular nutritional evaluation can offer the basis of the adjustment of nutritional therapeutic schedule.

  17. T-Cell Cytokine Gene Polymorphisms and Vitamin D Pathway Gene Polymorphisms in End-Stage Renal Disease due to Type 2 Diabetes Mellitus Nephropathy: Comparisons with Health Status and Other Main Causes of End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Alicja E. Grzegorzewska

    2014-01-01

    Full Text Available Background. T-cell cytokine gene polymorphisms and vitamin D pathway gene polymorphisms were evaluated as possibly associated with end-stage renal disease (ESRD resulting from type 2 diabetes mellitus (DM nephropathy. Methods. Studies were conducted among hemodialysis (HD patients with ESRD due to type 2 DM nephropathy, chronic glomerulonephritis, chronic infective tubulointerstitial nephritis, and hypertensive nephropathy as well as in healthy subjects. A frequency distribution of T-cell-related interleukin (IL genes (IL18 rs360719, IL12A rs568408, IL12B rs3212227, IL4R rs1805015, IL13 rs20541, IL28B rs8099917, IL28B, and rs12979860 and vitamin D pathway genes (GC genes: rs2298849, rs7041, and rs1155563; VDR genes: rs2228570, rs1544410; and RXRA genes: rs10776909, rs10881578, and rs749759 was compared between groups. Results. No significant differences in a frequency distribution of tested polymorphisms were shown between type 2 DM nephropathy patients and controls. A difference was found in IL18 rs360719 polymorphic distribution between the former group and chronic infective tubulointerstitial nephritic patients (Ptrend=0.033, which also differed in this polymorphism from controls (Ptrend=0.005. Conclusion. T-cell cytokine and vitamin D pathway gene polymorphisms are not associated with ESRD due to type 2 DM nephropathy in Polish HD patients. IL18 rs360719 is probably associated with the pathogenesis of chronic infective tubulointerstitial nephritis.

  18. 急性脑梗死伴非瓣膜性心房颤动患者肾功能不全的影响因素分析%Analysis of influencing factors of renal insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    董恺; 张倩; 俞志鹏; 丁建平; 宋海庆; 黄小钦

    2016-01-01

    retrospectively. Renal function was assessed by the estimated glomerular filtration rate (eGFR),eGFR 0. 05). (2)Multiple Logistic regression analysis showed that the age (≥65 years)was an independent risk factor for the occurrence of renal insufficiency in acute cerebral infarction patients with atrial fibrillation (OR,1. 147,95% CI 1. 087 -1. 209;P < 0. 01),and the histories of hypertension (OR,0. 870,95% CI 0. 362-2. 089;P = 0. 755),diabetes mellitus (OR,1. 078,95% CI 0. 403 -2. 883;P = 0. 882 ), and hyperlipidemia (OR,1. 666,95% CI 0. 645 - 4. 302;P = 0. 292 )were not associated with renal insufficiency in cerebral infarction patients with atrial fibrillation. Conclusions The incidence of renal insufficiency in cerebral infarction patients with atrial fibrillation is higher. Age (≥65 years)is an independent risk factor for renal insufficiency in this type of patients.

  19. [Treatment of erectile insufficiency].

    Science.gov (United States)

    Bondil, P

    1995-10-28

    Impotency, or impaired erectile function, affects approximately 10% of the adult males in France. The psychological consequences can have a major impact not only on the subject's sexual life but also his familial and professional relationships. The task facing the urologists is to carefully evaluate the patient's request for care and adapt treatment not only to the physiological situation but also the patient's psychological and social context. Several approaches have been developed. Search for an aetiology, excepting exceptional cases with a recognized organic origin, is often unsatisfactory due to the multifactor processes involved and the self-sustaining inter-relationship between the psychological impact and the physiological disorder. Sex therapy is aimed at reducing anxiety and helping the couple better understand their sexual relationship. Such behavioural counselling is particularly indicated in absence of organic disorders or as complementary therapy combined with medical or surgical treatment. The pharmacological approach relies on alphablockers or certain psychotropic drugs which have a moderate but real effect when taken orally. Local non-invasive applications of protaglandin E1 can also improve erectile function. The mechanism of intrapenial injections is to release the erectile smooth muscles. The most widely used drugs in France are papaverine, phentolamine and moxisylite as well as prostaglandin E1. Self-injections may be required in certain cases but are abandoned by about half of the patients after one or two months. Vacuum with a mechanical pump can produce a non-physiological erection but is rarely used in France. Surgical repair of arterial or venous disorders can also provide excellent, particularly long-term, results in carefully selected patients. Despite undeniable progress, the treatment of impotency remains a difficult therapeutic challenge, basically due to the large number of casual factors and their complex interactions.

  20. Principais causas de insuficiência renal aguda em unidades de terapia intensiva: intervenção de enfermagem

    National Research Council Canada - National Science Library

    Eliandro deSouza Santos; Carina Martins daSilva Marinho

    2013-01-01

    ...: To identify the main causes of Acute Renal Insufficiency in patients admitted to an intensive care unit and to describe the nursing interventions to address the causes of Acute Renal Insufficiency in...

  1. Chronic renal disease in pregnancy.

    Science.gov (United States)

    Ramin, Susan M; Vidaeff, Alex C; Yeomans, Edward R; Gilstrap, Larry C

    2006-12-01

    The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).

  2. Repercussões da insuficiência renal crônica na capacidade de exercício, estado nutricional, função pulmonar e musculatura respiratória de crianças e adolescentes Consequences of chronic renal insufficiency on the exercise capacity, nutritional status, pulmonary function and respiratory musculature of children and adolescents

    OpenAIRE

    2008-01-01

    OBJETIVO: Avaliar a capacidade funcional, função pulmonar, musculatura respiratória e estado nutricional de crianças e adolescentes portadores de insuficiência renal crônica (IRC) em tratamento conservador. MÉTODOS: Este estudo foi realizado com 30 voluntários, divididos em dois grupos: Portadores de IRC em tratamento conservador (Grupo IRC) e grupo sem comprometimento da função renal (Grupo Controle). Os voluntários foram submetidos à avaliação fisioterapêutica, espirometria, avaliação de fo...

  3. Insufficiency fracture after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Dong Ryul; Huh, Seung Jae [Dept.of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

  4. Renal involvement in antiphospholipid syndrome.

    Science.gov (United States)

    Pons-Estel, Guillermo J; Cervera, Ricard

    2014-02-01

    Renal involvement can be a serious problem for patients with antiphospholipid syndrome (APS). However, this complication has been poorly recognized and studied. It can be present in patients who have either primary or systemic lupus erythematosus-associated APS. Clinical and laboratory features of renal involvement in APS include hypertension, hematuria, acute renal failure, and progressive chronic renal insufficiency with mild levels of proteinuria that can progress to nephrotic-range proteinuria. The main lesions are renal artery stenosis, venous renal thrombosis, and glomerular lesions (APS nephropathy) that may be acute (thrombotic microangiopathy) and/or chronic (arteriosclerosis, arterial fibrous intimal hyperplasia, tubular thyroidization, arteriolar occlusions, and focal cortical atrophy). APS can also cause end-stage renal disease and allograft vascular thrombosis. This article reviews the range of renal abnormalities associated with APS, and their diagnosis and treatment options.

  5. Clinicopathological conference (CPC: renal transplant recipient with pulmonary nodules = Conferencia clínico-patológica (CPC: trasplantado renal con nódulos pulmonares

    Directory of Open Access Journals (Sweden)

    Alonso Encarnación, Alexánder

    2012-10-01

    Full Text Available We present the case of a 41 year-old man, who had a renal transplantation in 2005. He was admitted to the hospital because of 10 days of fever, diarrhea and respiratory symptoms. During his stay, a nodular lesion in the skin, several pulmonary nodules and colon ulcers were documented; due to his past medical history he was highly suspicious of having a fungal infection; antifungal therapy was started, but he died due to respiratory insufficiency.

  6. Neonatal multiorgan failure due to ACAD9 mutation and complex I deficiency with mitochondrial hyperplasia in liver, cardiac myocytes, skeletal muscle, and renal tubules.

    Science.gov (United States)

    Leslie, Nancy; Wang, Xinjian; Peng, Yanyan; Valencia, C Alexander; Khuchua, Zaza; Hata, Jessica; Witte, David; Huang, Taosheng; Bove, Kevin E

    2016-03-01

    Complex I deficiency causes Leigh syndrome, fatal infant lactic acidosis, and neonatal cardiomyopathy. Mutations in more than 100 nuclear DNA and mitochondrial DNA genes miscode for complex I subunits or assembly factors. ACAD9 is an acyl-CoA dehydrogenase with a novel function in assembly of complex I; biallelic mutations cause progressive encephalomyopathy, recurrent Reye syndrome, and fatal cardiomyopathy. We describe the first autopsy in fatal neonatal lethal lactic acidosis due to mutations in ACAD9 that reduced complex I activity. We identified mitochondrial hyperplasia in cardiac myocytes, diaphragm muscle, and liver and renal tubules in formalin-fixed, paraffin-embedded tissue using immunohistochemistry for mitochondrial antigens. Whole-exome sequencing revealed compound heterozygous variants in the ACAD9 gene: c.187G>T (p.E63*) and c.941T>C (p.L314P). The nonsense mutation causes late infantile lethality; the missense variant is novel. Autopsy-derived fibroblasts had reduced complex I activity (53% of control) with normal activity in complexes II to IV, similar to reported cases of ACAD9 deficiency.

  7. Chronic Heroin Dependence Leading to Adrenal Insufficiency

    Directory of Open Access Journals (Sweden)

    Gautam Das

    2014-01-01

    Full Text Available Opioids have been the mainstay for pain relief and palliation over a long period of time. They are commonly abused by drug addicts and such dependence usually imparts severe physiologic effects on multiple organ systems. The negative impact of opioids on the endocrine system is poorly understood and often underestimated. We describe a patient who developed severe suppression of the hypothalamic-pituitary adrenal (HPA axis leading to secondary adrenal insufficiency due to long standing abuse of opioids.

  8. Renal artery stenosis presenting as crescendo angina pectoris.

    Science.gov (United States)

    Tami, L F; McElderry, M W; al-Adli, N M; Rubin, M; Condos, W R

    1995-07-01

    The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hypertension and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with crescendo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterization. Renal artery stenting resulted in stabilization of the coronary syndrome and obviated the need for further coronary intervention. To our knowledge, this is the first case of renovascular hypertension precipitating an unstable coronary syndrome in a patient with documented stable coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for renovascular disease, particularly in the presence of other predictive factors such as documented coronary artery disease, older age, female gender, congestive heart failure, peripheral vascular disease, renal insufficiency, and smoking. Firm recommendations for routine screening renal angiography in patients undergoing peripheral or coronary angiography will need further studies.

  9. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases

    OpenAIRE

    Bush, Lisabeth A.; Chew, Felix S.

    2015-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was foc...

  10. Pharmacokinetics of sugammadex in subjects with moderate and severe renal impairment
.

    Science.gov (United States)

    Min, K Chris; Lasseter, Kenneth C; Marbury, Thomas C; Wrishko, Rebecca E; Hanley, William D; Wolford, Dennis G; Udo de Haes, Joanna; Reitmann, Christina; Gutstein, David E

    2017-09-01

    Sugammadex rapidly reverses moderate and deep rocuronium- or vecuronium-induced neuromuscular blockade at doses of 4 mg/kg and 2 mg/kg, respectively. Sugammadex is renally eliminated. This study evaluated the pharmacokinetics of sugammadex in subjects with renal impairment versus those with normal renal function. This open-label, two-part, phase 1 study included adults with moderate (creatinine clearance (CLcr) 30 - cr cr ≥ 80 mL/min). A single intravenous (IV) bolus injection of sugammadex 4 mg/kg was administered into a peripheral vein over 10 seconds directly by straight needle in part 1 (n = 24; 8/group), and via an IV catheter followed by a saline flush in part 2 (n = 18; 6/group). Plasma concentrations of sugammadex were collected after drug administration. Due to dosing issues in part 1, pharmacokinetic parameters were determined for part 2 only. Safety was assessed throughout the study. Pharmacokinetic data were obtained from 18 subjects. Mean sugammadex exposure (AUC0-∞) in subjects with moderate and severe renal impairment was 2.42- and 5.42-times, respectively, that of healthy controls. Clearance decreased and apparent terminal half-life was prolonged with increasing renal dysfunction. Similar Cmax values were observed in subjects with renal impairment and healthy controls. There were no serious adverse events. Sugammadex exposure is increased in subjects with moderate and severe renal insufficiency due to progressively decreased clearance as a function of worsening renal function. Sugammadex 4 mg/kg was well tolerated in subjects with renal impairment, with a safety profile similar to that of healthy subjects. These results indicate that dose adjustment of sugammadex is not required in patients with moderate renal impairment; however, current safety experience is insufficient to support the use of sugammadex in patients with CLcr < 30 mL/min.
.

  11. 肾功能不全对急性 ST 段抬高型心肌梗死患者住院期间预后的影响%Impact of Renal Insufficiency of Patients with Acute ST segment Elevation Myocardial Infarction on Prognosis in Duration of Hospital Stay

    Institute of Scientific and Technical Information of China (English)

    夏雪; 郑再星; 朱千里; 黄伟剑

    2015-01-01

    目的:探讨急性 ST 段抬高型心肌梗死(ST segment elevation myocardial infarction ,STEMI)合并肾功能不全(re-nal insufficiency ,RI)患者的临床特征,并分析肾功能不全对 STEMI 患者住院期间预后的影响。方法对温州医科大学附属第一医院2007年3月至2012年3月收治的950例急性 STEMI 患者资料进行回顾性分析,根据简化 MDRD(modifi-cation of diet in renal disease)方程计算患者的肾小球滤过率(estimated glomerular filtration rate ,eGFR),将患者分为肾功能正常组(eGFR ≥90ml・min -1・1.73m -2)、轻度 RI 组(60ml・min -1・1.73m -2≤ eGFR <90ml・min -1・1.73m -2)及中重度 RI 组(eGFR <60ml・min -1・1.73m -2)。分析 STEMI 合并 RI 患者的临床特征及对住院期间预后的影响。结果950例急性STEMI 患者中肾功能正常患者共444例(46.74%),轻度 RI 组351例(36.95%),中重度 RI 组155例(16.32%)。 RI 患者年龄更大,女性比例更高,吸烟、饮酒者更少,既往存在高血压病、糖尿病、高脂血症、陈旧性脑梗死患者比例更高,病程中出现心房颤动、Ⅱ/Ⅲ度房室传导阻滞更多(P<0.05)。同时 RI 患者更易合并冠状动脉三支病变及左主干、右冠状动脉、回旋支严重病变,但接受急诊冠状动脉血运重建比例更低(P<0.05)。多因素 Logistic 回归分析显示相对于肾功能正常组,中重度 RI 是 STEMI 患者住院期间出现心力衰竭(OR =2.25,95% CI :1.36~3.71)、心源性休克(OR =4.13,95% CI :1.52~11.22)的独立危险因素,而轻度 RI(OR =2.20,95% CI :1.27~6.70)及中重度 RI(OR =14.54,95% CI :6.12~34.53)均为住院期间出现全因死亡的的独立危险因素。结论肾功能不全是 STEMI 患者住院期间出现全因死亡、心源性休克和心力衰

  12. [Adrenal mass and adrenal insufficiency].

    Science.gov (United States)

    Martínez Albaladejo, M; García López, B; Serrano Corredor, S; Alguacil García, G

    1996-12-01

    Primary adrenal insufficiency is a non frequent disease, that is declared in young adults and in the most of the cases is produced from an autoimmune mechanism or a tuberculous disease. The incidence of these forms in the different geographic areas is dependent of degree of irradication of the tuberculosis. We report the case of a patient with latent chronic adrenal insufficiency of tuberculous origin who was affected for an addisonian crisis during an intercurrent infectious disease, which permitted the diagnosis of the addisonian crisis, and Mal of Pott was moreover detected. Evolution with corticosteroid and specific treatment was very favorable.

  13. Prognostic value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Starklint, Henrik; Petersen, J;

    1999-01-01

    To evaluate factors with possible influence on the renal outcome in patients with lupus nephritis but without chronic renal insufficiency (CRI).......To evaluate factors with possible influence on the renal outcome in patients with lupus nephritis but without chronic renal insufficiency (CRI)....

  14. Reversible Fetal Renal Impairment following Angiotensin Receptor Blocking Treatment during Third Trimester of Pregnancy: Case Report and Review of the Literature

    Science.gov (United States)

    Saar, Tal; Levitt, Lorinne

    2016-01-01

    Background. Late pregnancy usage of angiotensin converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) may cause severe oligohydramnios due to fetal renal impairment. Affected neonates will often suffer from fatal, renal, and respiratory failure. Case. A 39-year-old multigravida admitted due to anhydramnios secondary to valsartan (ARB) exposure at 30 weeks' gestation. Following secession of treatment amniotic fluid volume returned to normal. Delivery was induced at 34 weeks' gestation following premature rupture of membranes and maternal fever. During the two-year follow-up, no signs of renal insufficiency were noted. Conclusions. This description of reversible fetal renal damage due to ARB intake during pregnancy is the first to show no adverse renal function in a two-year follow-up period. This case may help clinicians counsel patients with pregnancies complicated by exposure to these drugs. PMID:27672462

  15. Reversible Fetal Renal Impairment following Angiotensin Receptor Blocking Treatment during Third Trimester of Pregnancy: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Tal Saar

    2016-01-01

    Full Text Available Background. Late pregnancy usage of angiotensin converting enzyme inhibitors (ACE-I and angiotensin II receptor blockers (ARB may cause severe oligohydramnios due to fetal renal impairment. Affected neonates will often suffer from fatal, renal, and respiratory failure. Case. A 39-year-old multigravida admitted due to anhydramnios secondary to valsartan (ARB exposure at 30 weeks’ gestation. Following secession of treatment amniotic fluid volume returned to normal. Delivery was induced at 34 weeks’ gestation following premature rupture of membranes and maternal fever. During the two-year follow-up, no signs of renal insufficiency were noted. Conclusions. This description of reversible fetal renal damage due to ARB intake during pregnancy is the first to show no adverse renal function in a two-year follow-up period. This case may help clinicians counsel patients with pregnancies complicated by exposure to these drugs.

  16. Bilateral renal masses in a 10-year-old girl with renal failure and urinary tract infection: the importance of functional imaging

    Energy Technology Data Exchange (ETDEWEB)

    Urbania, Thomas H. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Ave., Box 0628, San Francisco, CA (United States); Kammen, Bamidele F.; Nancarrow, Paul A. [Children' s Hospital and Research Center Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Morrell, Rose Ellen [Children' s Hospital and Research Center Oakland, Department of Nephrology, Oakland, CA (United States)

    2009-02-15

    Renal sonography is a routine step in the evaluation of new onset renal failure. When renal masses are discovered in this setting, functional imaging may be critical. We report a case of bilateral renal masses in a girl with urinary tract infection and renal insufficiency found to have vesicoureteral reflux. Renal scintigraphy revealed these masses to be the only remaining functional renal tissue, preventing potentially harmful resection. (orig.)

  17. Renal replacement therapy in ICU

    Directory of Open Access Journals (Sweden)

    C Deepa

    2012-01-01

    Full Text Available Diagnosing and managing critically ill patients with renal dysfunction is a part of the daily routine of an intensivist. Acute kidney insufficiency substantially contributes to the morbidity and mortality of critically ill patients. Renal replacement therapy (RRT not only does play a significant role in the treatment of patients with renal failure, acute as well as chronic, but also has spread its domains to the treatment of many other disease conditions such as myaesthenia gravis, septic shock and acute on chronic liver failure. This article briefly outlines the role of renal replacement therapy in ICU.

  18. Clinical aspects of cervical insufficiency

    NARCIS (Netherlands)

    Lotgering, F.K.

    2007-01-01

    Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the

  19. A diagnostic conundrum: acute interstitial nephritis due to armodafinil versus acute cellular rejection in a renal transplant recipient--a case report.

    Science.gov (United States)

    Baradhi, K M; Gohh, R

    2013-03-01

    Acute interstitial nephritis is a well-recognized cause of acute kidney injury in native kidneys. While the most common etiology being drug-induced, other causes are infectious, autoimmune, and idiopathic forms of disease. Drug-induced acute interstitial nephritis is not only uncommon in renal transplant recipients but is difficult to diagnose as it mimics acute cellular rejection histologically. We have described herein a renal transplant recipient with acute kidney injury to highlight the difficulties to distinguish acute interstitial nephritis from acute cellular rejection.

  20. Conduct protocol in emergency: Acute adrenal insufficiency

    Directory of Open Access Journals (Sweden)

    Adil Bachir Fares

    Full Text Available Summary Introduction: Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. Objective: To alert all health professionals about the diagnosis and correct treatment of this complication. Method: We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic. Results: Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests. Conclusion: Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.

  1. Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Nazma Akter

    2015-03-01

    Full Text Available Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 μg ACTH (adrenocorticotropic hormone stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist.

  2. Sociodemographic and Geographic Predictors of Quality of Care in United States Patients With End-Stage Renal Disease Due to Lupus Nephritis

    Science.gov (United States)

    Plantinga, Laura C.; Drenkard, Cristina; Patzer, Rachel E.; Klein, Mitchel; Kramer, Michael R.; Pastan, Stephen; Lim, S. Sam; McClellan, William M.

    2017-01-01

    Objective To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region. Methods National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region. Results Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63–0.85] and OR 0.73 [95% CI 0.60–0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68–0.91] and HR 0.82 [95% CI 0.68–0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44–0.58]) or no insurance (HR 0.36 [95% CI 0.29–0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49–0.79]). ESRD quality-of-care measures varied 2–3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care. Conclusion LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD. PMID:25692867

  3. Rapidly progressive renal disease as part of Wolfram syndrome in a large inbred Turkish family due to a novel WFS1 mutation (p.Leu511Pro)

    DEFF Research Database (Denmark)

    Yuca, Sevil Ari; Rendtorff, Nanna Dahl; Boulahbel, Houda

    2012-01-01

    Wolfram syndrome, also named "DIDMOAD" (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), is an inherited association of juvenile-onset diabetes mellitus and optic atrophy as key diagnostic criteria. Renal tract abnormalities and neurodegenerative disorder may occur in the thir...

  4. Low Birth Weight due to Intrauterine Growth Restriction and/or Preterm Birth: Effects on Nephron Number and Long-Term Renal Health

    Directory of Open Access Journals (Sweden)

    Vladislava Zohdi

    2012-01-01

    Full Text Available Epidemiological studies have clearly demonstrated a strong association between low birth weight and long-term renal disease. A potential mediator of this long-term risk is a reduction in nephron endowment in the low birth weight infant at the beginning of life. Importantly, nephrons are only formed early in life; during normal gestation, nephrogenesis is complete by about 32–36 weeks, with no new nephrons formed after this time during the lifetime of the individual. Hence, given that a loss of a critical number of nephrons is the hallmark of renal disease, an increased severity and acceleration of renal disease is likely when the number of nephrons is already reduced prior to disease onset. Low birth weight can result from intrauterine growth restriction (IUGR or preterm birth; a high proportion of babies born prematurely also exhibit IUGR. In this paper, we describe how IUGR and preterm birth adversely impact on nephrogenesis and how a subsequent reduced nephron endowment at the beginning of life may lead to long-term risk of renal disease, but not necessarily hypertension.

  5. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge

    Directory of Open Access Journals (Sweden)

    Mohsin Ijaz

    2015-01-01

    Full Text Available Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function. In patients with advanced renal disease this can be a fatal event. We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis. High citrate load in plasma exchange fluid is the underlying etiology. Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues. Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure. Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO and anti-glomerular basement membrane antibodies (anti-GBM. Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining. Patient did not respond to intravenous steroids. Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis. This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis. ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months. Patient still required maintenance hemodialysis.

  6. Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment : improving drug safety in primary healthcare by low eGFR alerts

    NARCIS (Netherlands)

    Joosten, Hanneke; Drion, Iefke; Boogerd, Kees J.; van der Pijl, Emiel V.; Slingerland, Robbert J.; Slaets, Joris P. J.; Jansen, Tiele J.; Schwantje, Olof; Gans, Reinold O. B.; Bilo, Henk J. G.

    2013-01-01

    Objectives: To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) Design: Clinical survey. Setting: The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practiti

  7. Upregulation of the transcription factor TFEB in t(6;11)(p21;q13)-positive renal cell carcinomas due to promoter substitution

    NARCIS (Netherlands)

    Kuiper, RP; Schepens, M; Thijssen, J; van Asseldonk, M; van den Berg, E; Bridge, J; Schuuring, E; Schoenmakers, EFPM; van Kessel, AG

    2003-01-01

    The MITF/TFE subfamily of basic helix-loop-helix leucine-zipper (bHLH-LZ) transcription factors consists of four closely related members, TFE3, TFEB, TFEC and MITF, which can form both homo- and heterodimers. Previously, we demonstrated that in t(X;1)(p11;q21)-positive renal cell carcinomas (RCCs),

  8. Upregulation of the transcription factor TFEB in t(6;11)(p21;q13)-positive renal cell carcinomas due to promoter substitution

    NARCIS (Netherlands)

    Kuiper, RP; Schepens, M; Thijssen, J; van Asseldonk, M; van den Berg, E; Bridge, J; Schuuring, E; Schoenmakers, EFPM; van Kessel, AG

    2003-01-01

    The MITF/TFE subfamily of basic helix-loop-helix leucine-zipper (bHLH-LZ) transcription factors consists of four closely related members, TFE3, TFEB, TFEC and MITF, which can form both homo- and heterodimers. Previously, we demonstrated that in t(X;1)(p11;q21)-positive renal cell carcinomas (RCCs),

  9. 血浆置换联合日间连续性血液滤过治疗肝衰竭并肾功能不全的护理%Nursing care of plasma exchange combined with daytime continuous ve-nous-venous hemofiltration in the treatment of liver failure accompanied with renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    李颖; 周莉; 陈占军; 郑素军; 段钟平

    2015-01-01

    Objective To summarize the nursing care of plasma exchange combined with daytime continuous venous-venous hemofiltration in liver failure patients accompanied with renal insufficiency. Methods 187 liver failure patients accompanied with renal insufficiency received plasma exchange combined with daytime continuous venous-venous hemofiltration in Artificial Liver Center, Beijing You'an Hospital Affiliated to Capital Medical University from January 2013 to May 2014 were selected as research objects. Liver and kidney function and blood coagulation indexes before and after treatment were compared. The nursing measures included the pretreatment conversation with patient, close observation, correct handling to adverse reactions with effective nursing intervention during treatment, health education and follow up after treatment. Results Alanine transaminase [(220.2±109.9) v s (366.4±153.3) U/L], aspartate transami-nase [(148.2±71.7) vs (219.8±90.0) U/L], total bilirubin [(283.0±78.2) vs (420.0±106.3)μmol/L], direct bilirubin [(141.5±38.1) vs (206.7±52.4)μmol/L], serum urea [(25.0±5.8) vs (28.8±5.6) mmol/L], creatinine [(176.6±38.6) vs (290.7±63.3)μmol/L] of patient after treatment was significantly lower than that before treatment respectively, albumin [(28.1±3.0) v s (26.6±3.1) g/L], prothrombin activity [(32.3±7.1)%v s (27.7±7.0)%] of patient after treatment was significantly higher than that before treatment respectively, with significantly statistical difference (P﹤ 0.01). Conclusion The combination of plas-ma exchange and daytime continuous venous-venous hemofiltration provides a good option for treatment of liver failure patients accompanied with renal insufficiency. Nurs-ing care support during the whole treatment proce-dures is the key of success.%目的:总结肝衰竭合并肾功能不全患者行血浆置换联合日间连续性血液滤过治疗的护理。方法选取首都医科大学附属北京佑安医院人工肝中心2013年1

  10. 不同肾造瘘管及固定方式对肾结石合并肾功能不全患者术后并发症的影Ⅱ向%Impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy

    Institute of Scientific and Technical Information of China (English)

    陈亮; 李建兴; 杨波; 胡卫国; 黄晓波; 王晓峰

    2011-01-01

    Objective: To investigate impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy. Methods: A total of 72 renal insufficiency patients were enrolled in this study, who were randomized into three groups with 24 patients in each group according to nephrostomy tube diameter and its fixation way: Group Ⅰ , I. E. Stretch group with 14 Fr silicon tube( Urevision) with balloon; Group Ⅱ , I. E. Not strech group with 14 Fr silicon tube( Urovision) with balloon; Group Ⅲ , I. E. Not strech group with 20Fr latex tube without balloon. The data collected included preoperative serum cretinine, hemoglobin value, midstream urine culture, stone volume, and operative time, and number of operative tract. It was also recorded that the change of hemoglobin between preoperation and 24 h or 72 h postoperation, presence of postoperative extravasation, systemic inflammatory respose syndrome, narcotic usage and blood transfusion. Results: There were no statistically significant differences among the three groups in terms of the incidence of postooperative extravasation(P = 0. 301), S1RS( P = 0. 099) and narcotic usage (P = 0. 898). In the aspects of the change of hemoglobin between preoperation and 24 h or 72 h postoperation, there were significant differences between group Ⅰ and group Ⅱ (P = 0. 001, P = 0. 009) or group Ⅲ ( P = 0.021, P= 0.003). No difference was found between groups Ⅱ and Ⅲ(P =0.989, P= 0.962). In the aspect of blood transfusion cases, group Ⅰ(1 case) <group Ⅲ (6 cases) < group Ⅱ (10 cases). The number of patients needing blood transfusion in group Ⅰ was significantly lower than that in group Ⅱ (P=0.002), but the differences between group Ⅲ and group Ⅰ (P=0.102) or group Ⅱ (P=0.221) were not statistically significant. Conclusion: It is worth recommending indwelling 14 Fr silicon nephrostomy tube with balloon oppressing the

  11. Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis.

    Science.gov (United States)

    Ramadoss, Suresh; Jones, Robert G; Foggensteiner, Lukas; Willis, Andrew P; Duddy, Martin J

    2012-10-01

    A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.

  12. Pancreatic exocrine insufficiency in critically ill adult patients.

    Science.gov (United States)

    Ma, Lijie; Liu, Yuhao; Lu, Zhifeng; Zhao, Li; Wang, Sheng

    2016-03-01

    Pancreatic exocrine insufficiency is usually present in patients with pancreatic diseases. Surprisingly, recent studies indicated that patients with critical illness often suffer from pancreatic injury due to non-specific reasons other than pancreatic diseases, and pancreatic exocrine insufficiency is also commonly observed in critically ill adult patients without preexisting pancreatic diseases. It is well known that malnutrition is the main clinical consequence of pancreatic exocrine insufficiency, thus, the high incidence of pancreatic exocrine insufficiency is most likely to be an important contributor of malnutrition which is a frequent problem associated with detrimental clinical outcomes in critically ill patients admitted into intensive care unit. In order to prevent pancreatic exocrine insufficiency due to primary pancreatic diseases, pancreatic enzyme replacement therapy is indispensable to treat indigestion, malabsorption and nutritional deficiency. Similarly, pancreatic enzyme supplementation has the potential to be an adjuvant therapy in critically ill patients with enteral nutrition therapy, which may be helpful to improve the nutritional status and the prognosis of critically ill patients by reducing the occurrence of malnutrition. Here, we reviewed the diagnostic methods of pancreatic exocrine function, the epidemiology and risk factors of pancreatic exocrine insufficiency, and potential treatment strategies for pancreatic exocrine insufficiency in critically ill adult patients.

  13. Ping-pong champion with adrenal insufficiency

    OpenAIRE

    2009-01-01

    A 62-year-old Japanese man, a bronze medal winner in the World Championship of table tennis when in his 20s, was diagnosed with secondary adrenocortical insufficiency due to isolated adrenocorticotropic hormone (ACTH) deficiency, and steroid administration was started. About 1 year after the diagnosis, he took part in a table tennis championship which was open to those 40 years or older. He took 10 mg hydrocortisone after breakfast as usual, played 10 matches, each of which took 20–30 min, an...

  14. Growth failure in children with renal disease : incidence, pathophysiology, new perspectives with growth hormone therapy

    NARCIS (Netherlands)

    A.C.S. Hokken-Koelega (Anita)

    1994-01-01

    textabstractStunted growth is a serious problem for children with chronic renal insufficiency (CRI). Advances in the treatment of renal insufficiency, including dialysis and renal transplantation, have greatly improved the survival rate for these patients. Consequently the failure to grow has become

  15. Growth failure in children with renal disease : incidence, pathophysiology, new perspectives with growth hormone therapy

    NARCIS (Netherlands)

    A.C.S. Hokken-Koelega (Anita)

    1994-01-01

    textabstractStunted growth is a serious problem for children with chronic renal insufficiency (CRI). Advances in the treatment of renal insufficiency, including dialysis and renal transplantation, have greatly improved the survival rate for these patients. Consequently the failure to grow has become

  16. Influence of renal function on the pharmacokinetics of lomefloxacin compared with other fluoroquinolones.

    Science.gov (United States)

    Blum, R A

    1992-04-06

    Fluoroquinolones have similar chemical structures but wide differences in their pharmacokinetic profiles. Disparity in fluoroquinolone elimination is most evident in patients with various degrees of renal insufficiency. Ofloxacin is almost exclusively eliminated by the kidney, whereas pefloxacin is predominantly cleared by the liver. The fluoroquinolones eliminated by both renal and nonrenal routes (hepatic and transintestinal) include norfloxacin, ciprofloxacin, enoxacin, fleroxacin, temafloxacin, and lomefloxacin. The primary renal mechanism of elimination for norfloxacin, ciprofloxacin, enoxacin, fleroxacin, temafloxacin, and lomefloxacin is glomerular filtration and tubular secretion. Both total clearance and renal clearance significantly correlate with creatinine clearance for these fluoroquinolones, and creatinine clearance is a useful clinical marker on which to base dosage adjustments. For some fluoroquinolones, dosage adjustments are recommended when creatinine clearances fall below 30-40 mL/min. This is especially evident for lomefloxacin, temafloxacin, norfloxacin, ciprofloxacin, enoxacin, and fleroxacin. There is very little removal of fluoroquinolones from the plasma during hemodialysis due to their extensive tissue distribution.

  17. Vitamin E mitigates cisplatin-induced nephrotoxicity due to reversal of oxidative/nitrosative stress, suppression of inflammation and reduction of total renal platinum accumulation.

    Science.gov (United States)

    Darwish, Mostafa A; Abo-Youssef, Amira M; Khalaf, Marwa M; Abo-Saif, Ali A; Saleh, Ibrahim G; Abdelghany, Tamer M

    2017-01-01

    Cisplatin (CP) is one of the most effective chemotherapeutic agents. Unfortunately, CP-induced nephrotoxicity hampered its use. This study aims to investigate the effect of vitamin E (Vit E) on CP-induced nephrotoxicity. Male white albino rats were divided to four group's six rats each and received either, 1% tween 80 in normal saline or Vit E (75 mg/kg) per day for 14 consecutive days or a single injection of CP (6 mg/kg) alone or CP (6 mg/kg) together with Vit E (75 mg/kg per day for 14 consecutive days). Five days after the CP injection, rats were euthanized; blood samples were collected; kidneys were dissected; and biochemical, immunohistochemical, and histological examinations were performed. Our results revealed that CP treatment significantly increased serum levels of creatinine and urea. Moreover, reduced glutathione (GSH) content as well as superoxide dismutase (SOD) and catalase (CAT) activities were significantly reduced with concurrent increase in kidney malondialdehyde (MDA) content following CP treatment. Vit E successfully lowered serum levels of urea and creatinine, enhanced creatinine clearance and diuresis, and normalized relative kidney/body weight. Furthermore, Vit E successfully normalized renal MDA and nitrite concentrations, elevated GSH level, and restored CAT and SOD activities in renal tissues. Histopathological examination of rat kidney revealed that Vit E significantly mitigated CP-induced renal damage. Importantly, administration of Vit E reduced kidney total platinum concentration indicating a role of platinum renal accumulation on the ability of Vit E to protect against CP nephrotoxicity.

  18. Diphenylamine-induced renal lesions in the chicken.

    Science.gov (United States)

    Sorrentino, F; Fella, A; Pota, A

    1978-01-01

    Chronic intoxication with diphenylamine (DPA), which causes a cystic kidney disease in the rat and the guinea-pig, caused degeneration of the renal tubular epithelium in the chicken. This was similar to but much more serious than that preceding the formation of cysts in the rodents, but did not actually result in cyst formation, probably because of the high mortality rate observed in the birds even at this early stage. In the chicken until now it had been possible to obtain a pattern of renal cysts only with polychlorinated biphenyls (PCB) which also induce the "chick oedema" syndrome. The renal lesions due to DPA in the chicken were similar to those produced by PCB, but were not accompanied by oedema, which suggests that "chick oedema" caused by PCB is not due to renal insufficiency. The differences in the renal lesions noted in the various animal species give credit to the hypothesis that DPA may have two effects on the tubular epitelium, one stimulating cell proliferation and one leading to degeneration. Cysts may be formed only in those species in which there is cell proliferation.

  19. 腔内修复治疗合并慢性肾功能不全的急性B型主动脉夹层%Short-term results of endovascular aortic repair for patients with acute type B aortic dissection and chronic renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    潘旭东; 黄连军; 郑军; 刘永民; 马维国; 刘宁宁; 李建荣; 孙立忠

    2012-01-01

    Objective To analyze the short-term results of endovascular aortic repair (EVAR)for patients with acute type B aortic dissection and chronic renal insufficiency (CRI ).Methods Between February 2009 and December 2012,EVAR was performed in 30 patients with acute type B aortic dissection and CRI (CRI group).Consecutive 30 patients with acute type B aortic dissection whose renal function was normal during the same period was chosen as the control group (non-CRI group).All patients were within 14 days after onset,in which Marfan syndrome was excluded and diagnosis made by computed tomographic angiography (CTA) before the procedure.In 57 patients,EVAR was performed under looal anesthesia and associated procedures included insertion of a chimney stent in the left subclavian artery in 2 case and a bare metal stent in the renl artery in 2,In 3 patients,EVAR was done following right axillary artery-to-left axillary and left subclavian artery bypass with a Y-shaped graft under general anesthesia.Follow-up regimen included renal function and CTA at I month and 1 year postoperatively.Results Compared to the non-CRI group,patients in the CRI grup was significantly younger [ (44.7±13.2) years versus (53.7±16.2)years,P <0.05)and had a higher rate of perioperative complications (cerebrospinal ischemia,deterioration of renal dysfunction,and gastroenteral dysfunction) (16.7% versus 3.3%,P <0.05 ),all of which resolved after surgical or medical treatment.One patient in CRI group was readmitted at 6 months for a redo EVAR to treat a new tear distal to the stent.At 1 month and I year postoperatively,no patients suffered from deterioration ofthe renal function,and their CTAs detected no apparent device deformation,alteration and endoleak,with remsrkable improvement in the blood supply of the aortic trie lumen and branches.Conchusion Satisfactory short-term results can be achieved with EVAR for patients with acute type B aortic dissection and CRI.At I month and 1 year

  20. X-ray signals in renal osteopathy

    Energy Technology Data Exchange (ETDEWEB)

    Rieden, K.

    1984-10-01

    Chronic renal insufficiency is associated with metabolic disturbances which ultimately lead to typical, partly extremely painful changes in the skeletal system the longer the disease persists. Regular X-ray control of certain skeletal segments allows early detection of renal oesteopathy if the radiological findings described in this article are carefully scrutinised and interpreted.

  1. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  2. 临床药师参与癌痛伴肾功能不全患者止痛方案的实践与经验%Practice and experience in the participant of the clinical pharmacist in the treatment of cancer pain with renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    伊佳; 侯幸赟; 黄立峰; 陈万生

    2016-01-01

    Objective To investigate the effect of clinical pharmacists in the analgesic therapysoas to improve the rational use of analgesic drugs .Methods Clinical pharmacists participated in the formulation of drug therapy plan for the patient of cancer pain with renal insufficiency in respects of drug selection ,dosage and adverse reaction monitoring .Results Physicians accepted suggestions from clinical pharmacists .The first day ,the morphine hydrochloride tablets were used for rapid titration . The next day doxycodone were used ,adding the morphine hydrochloride tablets when required .After the pain was controlled stability ,the transdermal fentanyl was used to alleviate the damage of kidney .Conclusion The clinical pharmacist could assist clinicians to adjust the therapeutic regimen of the cancer patients with severe pain and improve the level of clinical drug treat-ment .%目的:探讨临床药师在止痛治疗中的作用,促进镇痛药更加规范的使用。方法临床药师通过参与癌痛伴肾功能不全患者止痛方案的制定,从药物的选择、给药剂量以及不良反应预计等方面,提出药学观点。结果医师采用了临床药师的建议,首日使用盐酸吗啡片进行快速滴定,次日起使用羟考酮缓释片控制背景疼痛,小剂量盐酸吗啡片控制爆发痛,在疼痛控制稳定后,改用芬太尼贴剂以减轻肾功能损害。结论临床药师参与到重度癌痛患者的治疗方案制定中,能提高患者用药安全性、合理性,提高临床治疗效果。

  3. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

    Directory of Open Access Journals (Sweden)

    Achilles Ploumidis

    2013-01-01

    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  4. Renal arteriography

    Science.gov (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  5. Insufficient Sleep Is a Public Health Epidemic

    Science.gov (United States)

    ... this? Submit Button Past Emails CDC Features Insufficient Sleep Is a Public Health Problem Language: English Español ( ... insufficient sleep is an important public health concern. Sleep-Related Unhealthy Behaviors The Behavioral Risk Factor Surveillance ...

  6. Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature.

    Science.gov (United States)

    Ambrosio, Maria Raffaella; Rocca, Bruno Jim; Ginori, Alessandro; Onorati, Monica; Fabbri, Alberto; Carmellini, Mario; Lazzi, Stefano; Tripodi, Sergio

    2012-05-08

    Angioimmunoblastic T-cell lymphoma is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases), accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes. Polyarteritis nodosa is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a 40-year-old man who underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, the diagnosis of angioimmunoblastic T-cell lymphoma was performed. The patient was successfully treated with cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of angioimmunoblastic T-cell lymphoma, a whole body computed tomography showed a lesion in the lower pole of the left kidney. Renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between polyarteritis nodosa and angioimmunoblastic T-cell lymphoma has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessels walls injury. A careful evaluation is needed in the management of angioimmunoblastic T-cell lymphoma patients with signs of renal failure in order to avoid delay of treatment and organ damage.

  7. Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature

    Directory of Open Access Journals (Sweden)

    Ambrosio Maria

    2012-05-01

    Full Text Available Abstract Angioimmunoblastic T-cell lymphoma is one of the most common subtypes of peripheral T-cell lymphoma (15-20% of all cases, accounting for approximately 1-2% of all non-Hodgkin lymphomas. It often presents autoimmune phenomena including hemolytic anemia, thrombocytopenia, glomerulonephrities and circulating immune complexes. Polyarteritis nodosa is an autoimmune disease characterized by necrotizing vasculitis of medium vessels, which rarely develops in association with hematological malignant disorders. Herein we report the case of a 40-year-old man who underwent lymph node biopsy in the suspicious of sarcoidosis. On the basis of histological and immunohistochemical findings, the diagnosis of angioimmunoblastic T-cell lymphoma was performed. The patient was successfully treated with cytarabine-based regimen for 6 cycles. Three months after the initial diagnosis of angioimmunoblastic T-cell lymphoma, a whole body computed tomography showed a lesion in the lower pole of the left kidney. Renal cell carcinoma was suspected, thus a nephrectomy was carried out. The histological findings were compatible with polyarteritis nodosa. To the best of our knowledge, the association between polyarteritis nodosa and angioimmunoblastic T-cell lymphoma has been described only once. This relation may be secondary to the induction of an autoimmune phenomenon by the lymphoma with the formation of circulating immune complexes, leading to vessels walls injury. A careful evaluation is needed in the management of angioimmunoblastic T-cell lymphoma patients with signs of renal failure in order to avoid delay of treatment and organ damage.

  8. Can renal infarction occur after renal cyst aspiration? Case report.

    Science.gov (United States)

    Emre, Habib; Soyoral, Yasemin Usul; Tanik, Serhat; Gecit, Ilhan; Begenik, Huseyin; Pirincci, Necip; Erkoc, Reha

    2011-01-01

    Renal infarction (RI) is a rarely seen disorder, and the diagnosis is often missed. The two major causes of RI are thromboemboli originhating from a thrombus in the heart or aorta, and in-situ thrombosis of a renal artery. We report a case of RI that developed due to renal artery and vein thrombosis, as confirmed by pathological evaluation of the nephrectomy material, three weeks after renal cyst aspiration.

  9. Renal parenchymal histopathology predicts life-threatening chronic kidney disease as a result of radical nephrectomy.

    Science.gov (United States)

    Sejima, Takehiro; Honda, Masashi; Takenaka, Atsushi

    2015-01-01

    The preoperative prediction of post-radical nephrectomy renal insufficiency plays an important role in the decision-making process regarding renal surgery options. Furthermore, the prediction of both postoperative renal insufficiency and postoperative cardiovascular disease occurrence, which is suggested to be an adverse consequence caused by renal insufficiency, contributes to the preoperative policy decision as well as the precise informed consent for a renal cell carcinoma patient. Preoperative nomograms for the prediction of post-radical nephrectomy renal insufficiency, calculated using patient backgrounds, are advocated. The use of these nomograms together with other types of nomograms predicting oncological outcome is beneficial. Post-radical nephrectomy attending physicians can predict renal insufficiency based on the normal renal parenchymal pathology in addition to preoperative patient characteristics. It is suggested that a high level of global glomerulosclerosis in nephrectomized normal renal parenchyma is closely associated with severe renal insufficiency. Some studies showed that post-radical nephrectomy severe renal insufficiency might have an association with increased mortality as a result of cardiovascular disease. Therefore, such pathophysiology should be recognized as life-threatening, surgically-related chronic kidney disease. On the contrary, the investigation of the prediction of mild post-radical nephrectomy renal insufficiency, which is not related to adverse consequences in the postoperative long-term period, is also promising because the prediction of mild renal insufficiency might be the basis for the substitution of radical nephrectomy for nephron-sparing surgery in technically difficult or compromised cases. The deterioration of quality of life caused by post-radical nephrectomy renal insufficiency should be investigated in conjunction with life-threatening matters.

  10. INTERMEDIATE SYNDROME: A TYPICAL PATTERN OF PRE-RENAL ACUTE RENAL FAILURE IN THE ELDERLY

    Directory of Open Access Journals (Sweden)

    Greloni G

    2004-01-01

    Full Text Available Acute renal failure is a frequent entity in the elderly. This is due on one hand to the structural and physiological changes of the aged kidney, and on the other hand to the exposure of this population to polypharmacy and their reduced capability to metabolize drugs. In the present report we present a case of a seventy year-old woman who developed acute renal failure secondary to severe dehydration with a clinical and laboratory pattern of intermediate syndrome: laboratory results compatible with parenchymal renal insufficiency (elevated urinary sodium, plasma urea and creatinine, but with a positive response to hydration. The main characteristics of the aged kidney that predispose to the development of an intermediate syndrome are: the vascular dysautonomy and reduced capability of sodium and water reabsorption. The intermediate syndrome is a typical pattern of pre-renal insufficiency in the elderly. RESUMEN: La insuficiencia renal aguda es frecuente en el anciano. Esto se debe por un lado a los cambios estructurales y funcionales propios del riñón senil, y por otro a la gran exposición que esta población tiene a la polifarmacia, y su reducida capacidad para metabolizar los medicamentos. En este reporte presentamos el caso de una mujer de 70 años que desarrolló una insuficiencia renal aguda secundaria a severa deshidratación, mostrando un patrón clínico y de laboratorio propio de un sindrome intermedio: laboratorios compatibles con una insuficiencia renal parenquimatosa (sodio urinario, uremia y creatininemia elevadas, pero con una respuesta favorable a la hidratación. Las principales características del riñón senil que predisponen al desarrollo del sindrome intermedio: son la disautonomía vascular y la reducida capacidad en la recuperación de sodio y agua El sindrome intermedio es un patrón típico de insuficiencia prerrenal en el anciano.

  11. Evaluation of absorbed dose in studies of renal function due to {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido al {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA)

    Energy Technology Data Exchange (ETDEWEB)

    Vasquez, M.V.; Castillo, C.E.; Rojas, R.; Cabrera, C.; Abanto, D.; Morgan, A. [Universidad Nacional de Trujillo (UNT), Area de Fisica Medica, Trujillo (Peru); Diaz, E.E., E-mail: marvva@hotmail.com [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (Brazil)

    2015-07-01

    The absorbed dose of the kidneys during renal function studies of adult patients is estimated through biokinetics of radiopharmaceuticals containing the {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA). Using the methodology MIRD and representation Cristy-Eckerman for adult kidneys, it is shown that dosimetric contributions of organs of biokinetics {sup 123}I/{sup 131}I (hippuran) e {sup 111}In (DPTA) are significant, in estimative of dose for renal function studies. Dosimetric contributions (body and whole bladder, kidneys excluding) are given by 11.90% (for {sup 123}I), 4.97% (for {sup 131}I) and 28.32% (for {sup 111}In). In all cases, the dosimetric contributions are mainly due to photons issued by the whole body.

  12. Cadmium and cisplatin damage erythropoietin-producing proximal renal tubular cells

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Hyogo; Oguma, Etsuko; Kayama, Fujio [Jichi Medical School, Division of Environmental Medicine, Center for Community Medicine, Tochigi (Japan); Core Research for Evolutional Science and Technology, Japan Science Technology Corporation (CREST-JST), Saitama (Japan)

    2006-10-15

    The concomitant manifestations of proximal renal tubular dysfunction and anemia with erythropoietin (Epo) deficiency observed in chronic cadmium (Cd) intoxication, such as Itai-itai disease, suggest a close local correlation between the Cd-targeted tubular cells and Epo-producing cells in the kidney. Therefore, we investigated the local relationship between hypoxia-induced Epo production and renal tubular injury in rats injected with Cd at 2 mg/kg twice a week for 8 months. Anemia due to insufficient production of Epo was observed in Cd-intoxicated rats. In situ hybridization detected Epo mRNA expression in the proximal renal tubular cells of hypoxic rats without Cd intoxication, and the Cd-intoxicated rats showed atrophy of Epo-expressing renal tubules and replacement of them with fibrotic tissue. A single dose of cisplatin at 8 mg/kg, which can induce clinical manifestations similar to those of Cd including renal tubular damage along with Epo-deficient anemia, resulted in Epo-expressing renal tubule destruction on day 4. These data indicate that Cd and cisplatin would induce anemia through the direct injury of the proximal renal tubular cells that are responsible for Epo production. (orig.)

  13. Future of the Renal Biopsy: Time to Change the Conventional Modality Using Nanotechnology

    Science.gov (United States)

    Khosroshahi, Hamid Tayebi; Sarbaz, Yashar; Shakeri Bavil, Abolhassan

    2017-01-01

    At the present time, imaging guided renal biopsy is used to provide diagnoses in most types of primary and secondary renal diseases. It has been claimed that renal biopsy can provide a link between diagnosis of renal disease and its pathological conditions. However, sometimes there is a considerable mismatch between patient renal outcome and pathological findings in renal biopsy. This is the time to address some new diagnostic methods to resolve the insufficiency of conventional percutaneous guided renal biopsy. Nanotechnology is still in its infancy in renal imaging; however, it seems that it is the next step in renal biopsy, providing solutions to the limitations of conventional modalities.

  14. Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

    DEFF Research Database (Denmark)

    Tsakiris, D.J.; Stel, V.S.; Finne, P.;

    2010-01-01

    of death and survival rates of RRT for ESRD due to MM or LCDD in the ERA-EDTA Registry. Methods. Thirteen national registries providing data on patients who started RRT from 1986-2005 to the ERA-EDTA Registry participated. Incidence per million population (pmp) of RRT for ESRD due to MM or LCDD and other...

  15. Genetics of primary ovarian insufficiency.

    Science.gov (United States)

    Rossetti, R; Ferrari, I; Bonomi, M; Persani, L

    2017-02-01

    Primary ovarian insufficiency (POI) is characterized by a loss of ovarian function before the age of 40 and account for one major cause of female infertility. POI relevance is continuously growing because of the increasing number of women desiring conception beyond 30 years of age, when POI prevalence is >1%. POI is highly heterogeneous and can present with ovarian dysgenesis and primary amenorrhea, or with secondary amenorrhea, and it can be associated with other congenital or acquired abnormalities. In most cases POI remains classified as idiopathic. However, the age of menopause is an inheritable trait and POI has a strong genetic component. This is confirmed by the existence of several candidate genes, experimental and natural models. The variable expressivity of POI defect may indicate that, this disease may frequently be considered as a multifactorial or oligogenic defect. The most common genetic contributors to POI are the X chromosome-linked defects. Here, we review the principal X-linked and autosomal genes involved in syndromic and non-syndromic forms of POI with the expectation that this list will soon be upgraded, thus allowing the possibility to predict the risk of an early age at menopause in families with POI.

  16. Renal scar formation after urinary tract infection in children

    OpenAIRE

    2012-01-01

    Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephrop...

  17. [Case report of live threatening complications due to self insertion of foreign body into the vagina for masturbation purpose].

    Science.gov (United States)

    Kuzaka, Bolesław; Kobryń, Andrzej; Niemierko, Maciej; Czaplicki, Maciej

    2009-01-01

    Authors have reported a case report of life threatening complications due to insertion of foreign bodies into the vagina, because of masturbation purpose. In this case subsequently came to perforation of the urinary bladder by the huge calculus that developed over the foreign body, and next to the peritoneum with development peritonitis and acute renal insufficiency with the need of dialysotherapy. After a number of surgical operations, the patient with a definitive percutaneous nephrostomy was discharged.

  18. 临床药师参与1例慢性肾功能不全伴尿路感染的治疗实践%A treatment practice of a clinical pharmacist participating in 1 case of chronic renal insufficiency with urinary tract infection

    Institute of Scientific and Technical Information of China (English)

    刘俊; 安益国; 杨冬梅; 周光树; 张圣雨

    2013-01-01

    目的 通过临床药师参与1例慢性肾功能不全伴尿路感染的治疗实践,探讨药师在合理用药中发挥的作用.方法 临床药师积极参与了该患者的抗感染,控制高血压,纠正贫血,抗凝的治疗实践,针对患者的治疗方案,药品的选择、剂量、相互作用、不良反应、注意事项等提出了一些合理化的建议,同时对患者实施了药学监护,健康教育和用药教育.结果 临床药师参与治疗实践,提高了临床治疗效果.患者住院用药期间无相关不良反应发生,出院时尿路感染已经控制,血压平稳,无电解质紊乱,病情控制尚可.结论 临床药师参与临床药物治疗,为病人提供个体化药学服务,可使用药更合理、有效和经济;临床药师只有参与临床实践与临床医师密切配合,才能有助于更好地开展临床药学服务工作,更好地为病人服务.%Objective To investigate the role of a pharmacist in rational drug use by participating in 1 case of chronic renal insufficiency with urinary tract infection treatment practice. Methods The clinical pharmacist actively participated in the patient' s treatment practice of anti-infection,high blood pressure controlling,anemia correction,and anticoagulation,and also proposed reasonable suggestions according to the patient s treatment practice on drug selection, dosage, interactions, adverse reactions and points for attention, meanwhile implement pharmaceutical care, health education and drug education for the patient at the same time. Results The clinical pharmacist s participating in the treatment practice helped improve the clinical treatment effect. There was no relevant adverse reaction during the patient s hospitalization. And his urinary tract infection had been controlled, with smooth blood pressure, and normal electrolyte after his hospital discharge. Conclusion The clinical pharmacist s participation in clinical drug therapy for patients provides individualized service

  19. Postoperative repeated respiratory insufficiency and thyrotoxicosis in molar pregnancy.

    Science.gov (United States)

    Cekic, B; Geze, S; Ulusoy, H; Coskun, I; Erturk, E

    2012-06-01

    Following the removal of a hydatiform mole in a 34-year-old, 14-week pregnant patient, thyrotoxicosis and respiratory insufficiency attacks were twice unexpectedly repeated. The symptoms were resolved with the administration of plasmapheresis, antithyroid and β-blocker drugs and non-invasive mechanical ventilation; however, she was again operated due to prolonged elevated β-hCG.

  20. Failure of posaconazole therapy in a renal transplant patient with invasive aspergillosis due to Aspergillus fumigatus with attenuated susceptibility to posaconazole

    NARCIS (Netherlands)

    Kuipers, S.; Bruggemann, R.J.M.; Sevaux, R.G. de; Heesakkers, J.P.F.A.; Melchers, W.J.G.; Mouton, J.W.; Verweij, P.E.

    2011-01-01

    We report the case of a kidney transplant recipient with invasive aspergillosis due to Aspergillus fumigatus resistant to voriconazole and intermediately susceptible to posaconazole who failed posaconazole therapy. Plasma posaconazole concentrations indicated an unfavorable ratio of the area under t

  1. TrueFISP MR imaging to determine the influence of hemodialysis on the myocardial functional parameters in patients with terminal renal insufficiency; TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Haemodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, U.; Fenchel, M.; Kraft, A.; Tomaschko, K.; Stauder, N.; Claussen, C.D.; Miller, S. [Tuebingen Univ. (Germany). Radiologische Klinik; Wolf, S.; Risler, T. [Tuebingen Univ. (Germany). Medizinische Klinik

    2004-03-01

    Purpose: To assess the characteristic signs of uremic cardiomyopathy in patients with chronic renal failure (CRF) in comparison with healthy volunteers and to determine changes of left ventricular (LV) functional parameters in patients undergoing hemodialysis (HD). Methods and Materials: Using a 1.5 T Magnetron Sonata system (Siemens, Erlangen), cardiac MR imaging was performed on 26 patients (20 men, 6 women, mean age 54.7 years) and 14 volunteers (8 men, 6 women, mean age 27.7 years). Single-slice true FISP sequences (TR 3.2 ms, TE 1.6 ms, flip angel 58 , matrix 256 x 208, slice thickness 5 mm) were used to obtain contiguous short axis slices covering the whole left ventricle. Patients were examined before and immediately afte HD. Cardiodynamic parameters end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), myocardial mass (MM), cardiac output (CO) were calculated using the modified Simpson's rule (Argus Software, Siemens). Patient data were compared to reference values taken from healthy volunteers. Results: As a consequence of HD, significant differences (p<0.01) were observed for EDV (150+47 ml/114+49 ml), ESV (71+46 ml/60+56 ml), SV (79+25 ml/57+27 ml) and CO (3.6+1.0 l/min x m{sup 2}/2.6+1.1 l/min x m{sup 2}). Although EF (56+15%/53+18%) was decreased after HD, values did not differ significantly (p>0.05). MM (148+47 g/148+52 g) and myocardial mass index (80.7{+-}27.4 g/m{sup 2}/80.1{+-}9.1 g/m{sup 2}) did not change before and after HD. In all patients, signs of LV-hypertrophy (LVH) and increased CO were diagnosed compared to reference values. In 8 of 26 patients, additional pathology, such as valvular dysfunction or global cardiac insufficiency, was detected. Conclusion: Cardiac MRI is an accurate tool to identify uremic cardiomyopathy in patients with chronic renal failure undergoing HD. LV functional parameters could be monitored reliably. [German] Zielsetzung: Die vorliegende Studie an Patienten mit

  2. Cerebrovascular Reactivity in Complex Diagnostics of Vertebrobasilar Insufficiency

    Directory of Open Access Journals (Sweden)

    Goydenko V. S.

    2016-12-01

    Full Text Available The article presents the results of the assessment of cerebrovascular reactivity parameters due to transcranial Doppler sonography in 104 patients (62 women and 42 men with spondilogenic vertebrobasilar insufficiency. Mean age of patients was 42.9±12.2 years. It was found that the assessment of cerebrovascular reactivity and type of response to functional loading tests allows to confirm vertebrobasilar stage insufficiency, to determine the activity of various regulatory mechanisms of compensation of cerebral circulation and adaptation reserve of the cerebral vascular system.

  3. Changes of the cerebral metabolite patterns in patients undergoing hemodialysis due to chronic renal failure: evaluation with proton magnetic resonance spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Hye Won; Yu, Hyeon; Yu, Soo Jeong; Kim, Gi Hyeon [Chung-Ang University Medical Center, College of Medicine, Seoul (Korea, Republic of)

    2007-08-15

    We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and were wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter ({rho} < 0.001) and the Myo/Cr ratio in both the gray and white matter ({rho} < 0.01) were significantly elevated compared with those in the control subjects. For the patients with CRF after hemodialysis, their Cho/Cr ratios were significantly reduced in both the gray and white matter compared with that before hemodialysis ({rho} < 0.05). There was a significant positive correlation between the Cho/Cr ratio and serum Cr in the gray matter of CRF patients after hemodialysis (r = 0.54, {rho} < 0.05). The cerebral metabolite ratios were not significantly correlated with the duration after starting the initial hemodialysis. The cerebral metabolite patterns are significantly different between the patients with CRF and who are undergoing hemodialysis and the normal controls. The cerebral metabolite ratios are not significantly correlated with the duration after starting the initial hemodialysis.

  4. Exocrine pancreatic insufficiency following esophagectomy.

    Science.gov (United States)

    Huddy, J R; Macharg, F M S; Lawn, A M; Preston, S R

    2013-08-01

    Weight loss following esophagectomy is a management challenge for all patients. It is multifactorial with contributing factors including loss of gastric reservoir, rapid small bowel transit, malabsorption, and adjuvant chemotherapy. The development of a postoperative malabsorption syndrome, as a result of exocrine pancreatic insufficiency (EPI), is recognized in a subgroup of patients following gastrectomy. This has not previously been documented following esophageal resection. EPI can result in symptoms of flatulence, diarrhea, steatorrhea, vitamin deficiencies, and weight loss. It therefore has the potential to pose a significant level of morbidity in postoperative patients. There is some evidence that patients with proven EPI (fecal elastase-1 PERT). We observed symptoms compatible with EPI in a subgroup of patients following esophagectomy. We hypothesized that this was contributing to malabsorption and malnutrition in these patients. To investigate this, fecal elastase-1 was measured in postoperative patients, and in those with proven EPI, a trial of PERT was commenced in combination with specialist dietary education. At routine postoperative follow-up, which included assessment by a specialist dietitian, those patients with symptoms suggestive of malabsorption were given the opportunity to have their fecal elastase-1 measured. PERT was then offered to patients with fecal elastase-1 less than 200 μg/g (EPI) as well as those in the 200-500 μg/g range (mild EPI) with more severe symptoms. Fecal elastase-1 was measured in 63 patients between June 2009 and January 2011 at a median of 4 months (range 1-42) following surgery. Ten patients had fecal elastase-1 less than 200 μg/g, and all had failed to maintain preoperative weight. All accepted a trial of PERT. Nine (90%) had symptomatic improvement, and seven (70%) increased their weight. Thirty-nine patients had a fecal elastase-1 in the 200-500 μg/g range. Twelve were given a trial of PERT based on level of

  5. Evaluation of absorbed dosis during studies of renal function due AI {sup 123}I / {sup 131}I (Hippuran) and {sup 111} In (DPTA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido AI I{sup 123} / I{sup 131} (Hippuran) E In{sup 111} (DPTA)

    Energy Technology Data Exchange (ETDEWEB)

    Arteaga, Marcial V.V.; Diestra, Carlos E.C.; Villanueva, Raul A.S.; Alegria, Roberto R.; Salvatierra, Carlos C.; Rosales, Jorge M.; Gonzalez, Denis A.; Cruz, Carlos A.M., E-mail: marvva@hotmail.com [Universidad Nacional de Trujillo (UNT), Trujillo (Peru). Fisica Medica; Rios, Edulfo E.D., E-mail: ediaz@ufrgs.br [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil)

    2014-07-01

    Using the MIRD methodology and Cristy-Eckerman representation for for adult kidneys, it proves that the dosimetric contributions of bodies of the biokinetics of {sup 123} I / {sup 131}I (Hippuran) and {sup 111}In (DTPA) are significant, in the estimated of dose, during studies of renal function. Dosimetric contributions (whole body and urinary bladder, kidney excluding) are given by 11.90% (for {sup 123}I), 4.97% (for {sup 131}I) and 28.32% (for {sup 111} In). In all cases, the dosimetric contributions are mainly due to photons emitted by the entire body.

  6. Pregnancy in women with renal disease. Yes or no?

    Science.gov (United States)

    Edipidis, K

    2011-01-01

    Women with renal disease who conceive and continue pregnancy, are at significant risk for adverse maternal and fetal outcomes. Although advances in antenatal and neonatal care continue to improve these outcomes, the risks remain proportionate to the degree of underlying renal dysfunction.The aim of this article, is to examine the impact of varying degrees of renal insufficiency on pregnancy outcome, in women with chronic renal disease and to provide if possible, useful conclusions whether and when, a woman with Chronic Kidney Disease (CKD), should decide to get pregnant.This article, reviews briefly the normal physiological changes of renal function during pregnancy, and make an attempt to clarify the nature and severity of the risks, in the settings of chronic renal insufficiency and end stage renal disease, including dialysis patients and transplant recipients.

  7. Hypothalamic functions in patients with pituitary insufficiency

    NARCIS (Netherlands)

    Borgers, A.J.F.

    2013-01-01

    The main objective of this thesis is to increase our understanding of hypothalamic (dys)function in patients with pituitary insufficiency. This goal is driven by the clinical experience of persisting symptoms in patients adequately treated for pituitary insufficiency. We focus primarily on patients

  8. Calciphylaxis following acute renal injury: a case and literature review

    OpenAIRE

    Oda, Tomoko; Sawada, Yu; YAMAGUCHI, TAKASHI; Ohmori, Shun; Omoto, Daisuke; Haruyama, Sanehito; Yoshioka, Manabu; Okada, Etsuko; Nakamura, Motonobu

    2016-01-01

    Background Calciphylaxis following acute renal failure is rare. Findings We report A 57-year-old male with an acute renal failure associated with necrotizing fasciitis. We also review the cases of calciphylaxis due to acute renal disorder further. Conclusions It should be kept in mind that calciphylaxis is observed in patient with not only chronic renal disease but also acute renal failure.

  9. Failure of Posaconazole Therapy in a Renal Transplant Patient with Invasive Aspergillosis Due to Aspergillus fumigatus with Attenuated Susceptibility to Posaconazole ▿

    OpenAIRE

    Kuipers, Saskia; Brüggemann, Roger J. M.; Ruud G.L. de Sévaux; Heesakkers, John P. F. A.; Melchers, Willem J. G.; Mouton, Johan W.; Verweij, Paul E.

    2011-01-01

    We report the case of a kidney transplant recipient with invasive aspergillosis due to Aspergillus fumigatus resistant to voriconazole and intermediately susceptible to posaconazole who failed posaconazole therapy. Plasma posaconazole concentrations indicated an unfavorable ratio of the area under the concentration-time curve over the MIC. Posaconazole should be used with caution for invasive aspergillosis caused by strains with attenuated posaconazole susceptibility, as drug exposure may be ...

  10. [Irreversible coma following hypoglycemia in Sheehan syndrome with adrenocortical insufficiency].

    Science.gov (United States)

    Sas, A M; Meynaar, I A; Laven, J S; Bakker, S L; Feelders, R A

    2003-08-23

    A 24-year-old woman of Somali origin delivered at term after an uncomplicated pregnancy. Post-partum haemorrhage resulted in hypovolaemic shock which was treated by hysterectomy. Five days later she became comatose due to unrecognised hypoglycaemia which caused severe irreversible brain damage and status epilepticus. Treatment in the intensive care unit with artificial respiration, prednisolone, desmopressin, inotropic support, barbiturates and an anaesthetic under EEG guidance was unsuccessful. The patient died 28 days post-partum. The hypoglycaemia was due to a combination of (a) inadequate glucose intake and (b) lack of counter-regulatory mechanisms due to a deficiency of steroids and growth hormone as a result of loss of pituitary function (Sheehan syndrome) together with adrenocortical insufficiency. The combination of Sheehan syndrome and primary adrenocortical insufficiency has not been described previously in the literature.

  11. Traumatic Tricuspid Insufficiency Requiring Valve Repair in an Acute Setting.

    Science.gov (United States)

    Enomoto, Yoshinori; Sudo, Yoshio; Sueta, Tomonori

    2015-01-01

    Tricuspid insufficiency due to penetrating cardiac trauma is rare. Patients with tricuspid insufficiency due to trauma can tolerate this abnormality for months or even years. We report a case of a 66-year-old female with penetrating cardiac trauma on the right side of her heart that required tricuspid valve repair in an acute setting. She sustained cut and stab wounds on her bilateral forearms and in the neck and epigastric region. She had cardiac tamponade and developed pulseless electrical activity, which required emergency surgery. The right ventricle and superior vena cava were dissected approximately 5 cm and 2 cm, respectively. After these wounds had been repaired, the patient's inability to wean from cardiopulmonary bypass suggested rightsided heart failure; transesophageal echocardiography revealed tricuspid insufficiency. Right atriotomy was performed, and a detailed examination revealed that the tricuspid valve septal leaflet was split in two. There was also an atrial septal injury that created a connection with the left atrium; these injuries were not detected from the right ventricular wound. After repair, weaning from cardiopulmonary bypass with mild tricuspid insufficiency was achieved, and she recovered uneventfully. This case emphasized the importance of thoroughly investigating intracardiac injury and transesophageal echocardiography.

  12. Renal perfusion scintiscan

    Science.gov (United States)

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  13. Effects of initiating chronic renal replacement therapy in children, now and later in life: Data from the LERIC cohort and ERA-EDTA Registry

    NARCIS (Netherlands)

    J.L. Vogelzang

    2015-01-01

    This thesis describes the most important results of LERIC (Late Effects of Renal Insufficiency in Children), a very a long-term follow-up study to the late somatic and psychosocial consequences of renal insufficiency in children. LERIC is a comprehensive study to evaluate the late effects of renal i

  14. Cervical insufficiency and cervical cerclage.

    Science.gov (United States)

    Brown, Richard; Gagnon, Robert; Delisle, Marie-France; Gagnon, Robert; Bujold, Emmanuel; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Crane, Joan; Davies, Gregory; Gouin, Katy; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank; Senikas, Vyta

    2013-12-01

    Objectif : La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une insuffisance cervicale, ainsi que pour déterminer les circonstances en présence desquelles la mise en place d’un cerclage pourrait s’avérer souhaitable. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2012 au moyen d’un vocabulaire contrôlé (p. ex. « uterine cervical incompetence ») et de mots clés appropriés (p. ex. « cervical insufficiency », « cerclage », « Shirodkar », « cerclage », « MacDonald », « cerclage », « abdominal », « cervical length », « mid-trimester pregnancy loss »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n’a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en janvier 2011. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Recommandations 1. Les femmes qui sont enceintes ou qui planifient connaître une grossesse devraient faire l’objet d’une évaluation visant les facteurs de

  15. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing

    Science.gov (United States)

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D’Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M.; Mascellino, Maria T.; Vullo, Vincenzo

    2016-01-01

    Abstract Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary. A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock. The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients. PMID:26886594

  16. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing: A Case Report.

    Science.gov (United States)

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D'Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M; Mascellino, Maria T; Vullo, Vincenzo

    2016-02-01

    Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary.A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock.The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients.

  17. Estimation of glomerular filtration rate with different background region of interest for renography in severe renal insufficiency patients%肾动态显像中不同本底的选取在重度肾功能不全患者肾小球滤过率的评估

    Institute of Scientific and Technical Information of China (English)

    杜晓英; 朱阳军; 李林法; 何强; 陈江华

    2008-01-01

    Objective To evaluate the improvement of diagnostic accuracy with background region of interest(ROI)rectification for 99mTc-DTPA renography in patients with GFR≤plasma sampling method). Methods Thirty-three patients(age>20 years,male/female=13/20)dose of 111 MBq/0.5 ml of 99mTc-DTPA was injected into an antecubital vein.The background ROI was selected below the kidney(Gates method,method a)or around the kidney(method b),then these two different GFR(GFRa,GFRb)were automatically estimated by computer.Meanwhile,3 ml blood samples were collected 2 h and 4 h after injection respectively,and radioactivity of 1 ml plasma was measured.GFR was calculated by dual plasma sampling method(GFRp)and the results were all standardized with the body surface area.The accuracies and correlations of GFRa and GFRb were compared to GFRp respectively. Results The correlation coefficients were ra=0.602 and rb=0.834.The median of difference of GFRa and GFRb was 8.33,-4.41.The median of absolute difference of GFRa and GFRb was 8.33,4.49.The accuracies within±15%,±30%and±50%of GFRa were 24.2%,30.3%and 48.5%,and those of GFRb were 33.3%,51.5%and 81.8%.Conclusion The background ROI around kidney can obviously improve the diagnostic accuracy of 99mTc-DTPA renography in patients with severe renal insufficiency.%目的 以99mTc-DTPA血浆清除率为标准,评价在重度肾功能不全[GFR≤30 ml·min-1·(1.73 m2)-1]患者GFR的评估中,本底矫正在提高99mTc-DTPA肾动态显像检查准确性中的价值.方法 选择重度慢性肾脏病患者33例,年龄均>20岁,男性/女性=13/20,平均Scr334 μmol/L,诊断均符合美国NKF-K/DOQI关于慢性肾脏病定义.排除肾功能急性恶化因素、水肿、肢体缺如及心功能不全.分别检测患者身高、体质量.常规99mTc-DTPA肾动态功能显像,采用双肾下极(传统Gates法,a法)及肾周环形勾画法(b法)获取图像本底,并分别由计算机自动计算GFR值(GFRa和GFRb).于注射后2 h、4 h各抽血4

  18. Renal complications in multiple myeloma and related disorders: Survivorship care plan of the IMF Nurse Leadership Board

    Science.gov (United States)

    Faiman, Beth; Tariman, Joseph D.; Mangan, Patricia A.; Spong, Jacy

    2012-01-01

    Kidney dysfunction is a common clinical feature of symptomatic multiple myeloma. Some degree of renal insufficiency or renal failure is present at diagnosis or will occur during the course of the disease, and which, if not reversed, will adversely effect overall survival and quality of life. Chronic insults to the kidneys from other illnesses, treatment, or multiple myeloma itself can further damage renal function and increase the risk for additional complications, such as anemia. Patients with multiple myeloma who have light chain (Bence Jones protein) proteinuria may experience renal failure or progress to end-stage renal disease (ESRD) and require dialysis due to light chain cast nephropathy. Kidney failure in patients with presumed multiple myeloma may also result from amyloidosis, light chain deposition disease, or acute tubular necrosis caused by nephrotoxic agents; therefore identification of patients at risk for kidney damage is essential. The International Myeloma Foundation’s Nurse Leadership Board have developed these practice recommendations for screening for renal function, identifying positive and negative contributing risk and environmental factors, selecting appropriate therapies and supportive care measures to decrease progression to ESRD and dialysis, and reducing and managing renal complications in patients with multiple myeloma. PMID:21816711

  19. Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? Deve-se evitar a flebo-extração completa até o tornozelo no tratamento das varizes primárias por insuficiência da veia safena magna?

    Directory of Open Access Journals (Sweden)

    Hakan Uncu

    2009-10-01

    Full Text Available PURPOSE: The most preferred method for the treatment of primary varicose veins due to greater saphenous vein (GSV insufficiency is saphenofemoral high ligation and thigh stripping of the GSV, and ambulatory phlebectomy. Stripping is usually ended at the knee level to prevent nerve injury in the calf. However, different surgical modalities may be used depending on the surgeon's choice and experience. METHODS: We present the results of complete stripping of the GSV to the ankle and ambulatory phlebectomies performed by a single surgeon. Ninety-six patients (102 limbs who underwent standardized surgical procedure were participated in this study. Median follow-up time was 3.4 years. RESULTS: All complaints due to varicose veins were resolved in all extremities. Some temporary complications observed were resolved fully during follow-up. Permanent paresthesia which was the most important complication was found only in two patients (2%. No recurrence was observed. CONCLUSION: The risk of saphenous nerve injury in the calf should not to be considered a reason to avoid complete stripping of the GSV to the ankle. If it is applied carefully and with appropriate technique, complete stripping still seems to be a good treatment option.OBJETIVO: O método de escolha para o tratamento das varizes primárias devido a insuficiência da veia safena magna (VSM é a ligagura safenofemoral e a fleboextração em coxa e a flebectomia ambulatorial. A fleboextração é geralmente feita ao nível do joelho para prevenir a lesão neurológica no tornozelo. Diferentes modalidades operatórias, no entanto, podem ser utilizadas dependendo da escolha e da experiência do cirurgião. MÉTODOS: Apresentamos os resultados da fleboextração completa da VSM até o tornozelo e flebectomias ambulatoriais realizadas por um único cirurgião. Noventa e seis pacientes (102 membros que foram submetidos a procedimento cirúrgico padrão participaram deste estudo. A mediana do tempo de

  20. Pancreatic insufficiency secondary to abdominal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H. (Leicester Royal Infirmary (United Kingdom). Dept. of Surgery)

    1993-02-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author).

  1. Enhanced propagation of adult human renal epithelial progenitor cells to improve cell sourcing for tissue-engineered therapeutic devices for renal diseases.

    Science.gov (United States)

    Westover, Angela J; Buffington, Deborah A; Humes, H D

    2012-08-01

    Renal cell therapy employing cells derived from adult renal epithelial cell (REC) progenitors promises to reduce the morbidity of patients with renal insufficiency due to acute renal failure and end stage renal disease. To this end, tissue engineered devices addressing the neglected biologic component of renal replacement therapy are being developed. Because human donor tissue is limited, novel enhanced progenitor cell propagation (EP) techniques have been developed and applied to adult human kidney transplant discards from six donors. Changes include more efficient digestion and the amplification of progenitors prior to terminal epithelial differentiation promoted by contact inhibition and the addition of retinoic acid. Differentiated morphology in EP populations was demonstrated by the ability to form polarized epithelium with tight junctions, apical central cilia and expression of brush border membrane enzymes. Evaluation of lipopolysaccharide stimulated interleukin-8 secretion and γ-glutamyl transpeptisade activity in EP derived cells was used to confirm therapeutic equivalence to REC obtained using published techniques, which have previously shown efficacy in large animal models and clinical trials. Yield exceeded 10(16) cells/gram cortex from the only kidney obtained due to an anatomical defect, while the average yield from diseased kidneys ranged from 1.1 × 10(9) to 8.8 × 10(11) cells/gram cortex, representing an increase of more than 10 doublings over standard methods. Application of the EP protocol to REC expansion has solved the problem of cell sourcing as the limiting factor to the manufacture of cell based therapies targeting renal diseases and may provide a method for autologous device fabrication from core kidney biopsies. Copyright © 2012 John Wiley & Sons, Ltd.

  2. Bilateral undisplaced insufficiency neck of femur fractures associated with short-term steroid use: a case report

    Directory of Open Access Journals (Sweden)

    Gurdezi Sabahat

    2008-03-01

    Full Text Available Abstract Introduction We present an interesting and unusual case of a 61-year-old woman with bilateral, undisplaced, stress neck of femur fractures associated with short-term steroid use. Insufficiency fractures of the neck of femur without preceding trauma have been described in the literature, although bilateral involvement is infrequent. These fractures have been associated with strenuous exercise, seizures, renal osteodystrophy, fluoride treatment, long-term corticosteroid use, amenorrhoea, abnormal anatomy and osteomalacia due to nutritional and/or hormonal factors. Case Presentation The case we present differs from other published reports, in that the patient's symptoms developed acutely after only a short course of steroids and with no associated trauma or strenuous exercise. It is also the only case described where no operative intervention was required. Conclusion Our case reiterates the importance of considering insufficiency or stress fractures in high-risk patients who present with musculoskeletal pain. Institution of bone protection should also be considered in these patients. Morbidity related to delayed treatment has been well documented, so a high level of clinical suspicion is imperative.

  3. Iatrogenic velopharyngeal insufficiency caused by neonatal nasogastric feeding tube.

    Science.gov (United States)

    Pollack, Aron Z; Ward, Robert F; DeRowe, Ari; April, Max M

    2014-08-01

    Complications from a prolonged nasogastric tube intubation, though seldom reported, are well described. Herein we describe the first two reported cases of velopharyngeal insufficiency secondary to velopharyngeal scarring and immobility from repetitive nasogastric tube insertions and prolonged use. Differing only in location, the proposed pathophysiologic mechanism of injury is identical to that of the nasogastric tube syndrome, a rare and serious, well described entity consisting of bilateral vocal fold paralysis due to pressure-induced ulceration of the posterior cricoarytenoid musculature.

  4. Acute renal infarction secondary to atrial fibrillation - mimicking renal stone picture.

    Science.gov (United States)

    Salih, Salih Bin; Al Durihim, Huda; Al Jizeeri, Ahmed; Al Maziad, Ghassan

    2006-06-01

    Acute renal infarction presents in a similar clinical picture to that of a renal stone. We report a 55-year-old Saudi female, known to have atrial fibrillation secondary to mitral stenosis due to rheumatic heart disease. She presented with a two day history of right flank pain that was treated initially as a renal stone. Further investigations confirmed her as a case of renal infarction. Renal infarction is under-diagnosed because the similarity of its presentation to renal stone. Renal infarction should be considered in the differential diagnosis of loin pain, particularly in a patient with atrial fibrillation.

  5. CUTANEOUS MANIFESTATIONS OF CHRONIC RENAL FAILURE AND RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    R. Suganya Gnanadeepam

    2017-07-01

    Full Text Available BACKGROUND The kidney and the skin are the two large networks of the body with abundant blood supply associated with various cutaneous manifestations. This study aims to detect the various cutaneous manifestations and its incidence in patients with chronic renal failure and renal transplantation. MATERIALS AND METHODS This study was done for a period of 1 year from January 2016 to December 2016 at Nephrology OPD ward and Medicine wards, Government KAPV Medical College Hospital, Trichy. During this period, 100 patients who had the presence of skin manifestations were selected and studied (80 renal failure patients and 20 renal transplantation patients. RESULTS Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus and xerosis were the most common manifestations noted in chronic renal failure while infections was commonly noted in renal transplantation patients. CONCLUSION Pruritus and xerosis were the most common among the specific cutaneous manifestations in chronic renal failure followed by nail abnormalities and pigmentary changes. Cutaneous manifestations of renal transplantation were mostly due to infections of which fungal infection is the most common followed by viral infection.

  6. RENAL CRYOABLATION

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2012-01-01

    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  7. Renal angiomyolipoma

    DEFF Research Database (Denmark)

    Holm-Nielsen, P; Sørensen, Flemming Brandt

    1988-01-01

    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  8. OBSTETRIC RENAL FAILURE

    Directory of Open Access Journals (Sweden)

    Rajeshwari

    2015-11-01

    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  9. The controversy on chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Paolo Zamboni

    2013-08-01

    Full Text Available The objective of this review is to analyze the actual scientific controversy on chronic cerebrospinal venous insufficiency (CCSVI and its association with both neurodegenerative disorders and multiple sclerosis (MS. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as ecent data characterizing the pathology of the venous wall in course of CCSVI. Finally, safety and pilot data on effectiveness of endovascular CCSVI treatment were further updated. Studies of prevalence show a big variability in prevalence of CCSVI in MS patients assessed by established ultrasonographic criteria. This could be related to high operator dependency of ultrasound. However, 12 studies, by the means of more objective catheter venography, show a prevalence >90% of CCSVI in MS. Global hypo-hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies and histology corroborate the 2009 International Union of Phlebology (UIP Consensus decision to insert CCSVI among venous malformations. Finally, safety of balloon angioplasty of the extracranial veins was certainly demonstrated, while prospective data on the potential effectiveness of endovascular treatment of CCSVI support to increase the level of evidence by proceeding with a randomized control trial (RCT. Taking into account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion and cerebro-spinal fluid flow, we conclude that CCSVI can be definitively inserted among the medical entities. Research is still inconclusive in elucidating the CCSVI role in the pathogenesis of neurological disorders. The controversy between the vascular and the

  10. Urinary potassium excretion, renal ammoniagenesis, and risk of graft failure and mortality in renal transplant recipients1-3

    NARCIS (Netherlands)

    Eisenga, Michele F.; Kieneker, Lyanne M.; Soedamah-Muthu, Sabita S.; Berg, Van Den Else; Deetman, Petronella E.; Navis, Gerjan J.; Gans, Reinold O.B.; Gaillard, Carlo A.J.M.; Bakker, Stephan J.L.; Joosten, Michel M.

    2016-01-01

    Background: Renal transplant recipients (RTRs) have commonly been urged to limit their potassium intake during renal insufficiency and may adhere to this principle after transplantation. Importantly, in experimental animal models, low dietary potassium intake induces kidney injury through stimula

  11. Insufficient insulin administration to diabetic rats increases substrate utilization and maintains lactate production in the kidney

    OpenAIRE

    Laustsen, Christoffer; Lipsø, Hans Kasper Wigh; Østergaard, Jakob Appel; Nørregaard, Rikke; Flyvbjerg, Allan; Pedersen, Michael; Palm, Fredrik; Ardenkjær-Larsen, Jan Henrik

    2014-01-01

    Abstract Good glycemic control is crucial to prevent the onset and progression of late diabetic complications, but insulin treatment often fails to achieve normalization of glycemic control to the level seen in healthy controls. In fact, recent experimental studies indicate that insufficient treatment with insulin, resulting in poor glycemic control, has an additional effect on progression of late diabetic complications, than poor glycemic control on its own. We therefore compared renal metab...

  12. Acute renal dysfunction in liver diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (MRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.

  13. Renal function and risk of myocardial infarction in an elderly population: The Rotterdam study

    NARCIS (Netherlands)

    J.J. Brugts (Jasper); A.M. Knetsch (Anneke); F.U.S. Mattace Raso (Francesco); A. Hofman (Albert); J.C.M. Witteman (Jacqueline)

    2005-01-01

    textabstractBackground: Renal insufficiency is a risk factor for cardiovascular disease in patients with renal disease or coronary heart disease; however, it is unknown whether renal function is an independent predictor of cardiovascular disease in the general population. Methods: We investigated wh

  14. Renal infarction secondary to ketamine abuse.

    Science.gov (United States)

    Chen, Chin-Li; Chen, Jin-Li; Cha, Tai-Lung; Wu, Sheng-Tang; Tang, Shou-Hung; Tsao, Chih-Wei; Meng, En

    2013-07-01

    Renal infarction is an uncommon condition that resulted from inadequate perfusion of the kidney and is easily missed diagnosed due to its nonspecific clinical presentations. Major risk factors for renal infarction are atrial fibrillation, previous embolism, and ischemic and valvular heart disease. Progressive decrease in renal function or even death can occur if renal infarction is not diagnosed accurately and promptly. Ketamine abuse may cause variable urinary tract injury. However, renal infarction caused by ketamine abuse has never been reported. To our knowledge, this is the first documented case of renal infarction following nasal insufflation of ketamine.

  15. Neonatal renal vein thrombosis.

    Science.gov (United States)

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K

    2011-12-01

    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  16. Diarrhea-An uncommon presentation of tertiary adrenal insufficiency following heart transplantation.

    Science.gov (United States)

    Sikanderkhel, Saad; Choudhry, M Waqas; Valentine, Vincent; Al-Dossari, Ghannam; Khalife, Wissam I

    2017-08-01

    Diarrhea following organ transplantation is usually associated with infection and immunosuppression therapy. We describe two patients with diarrhea following orthotopic heart transplantation due to tertiary adrenal insufficiency. © 2017 Wiley Periodicals, Inc.

  17. [Membranous nephropathy associated to autoimmune thyroiditis, chronic pancreatitis and suprarrenal insufficiency].

    Science.gov (United States)

    Merino, J L; Fernández Lucas, M; Teruel, J L; Valer, P; Moreira, V; Arambarri, M; Ortuño, J

    2004-01-01

    A 33 year old female was admitted to the hospital to study aedema and bocio, A nephrotic syndrome was diagnosed and the renal biopsy demonstrated membranous glomerulonephritis, stage II. She was also diagnosed of Hashimoto's autoinmmune thyroiditis: TSH (41.5 uUl/ml), T4 (0.07 ng/dl), antithyroglobuline (1/2560) and antimicrosome (1/6400). Four year latter she was diagnosed of autoinmmune pancreatitis, without evidence of diabetes mellitus or exocrine pancreatic insufficiency. Eight years latter she was diagnosed of primary autoimmune suprarrenal insufficiency: basal cortisol: 2.7 mcg/dl, post ACTH estimulated cortisol: 5.6 mcg/dl, antinuclear antibody (1/160) and antiparietal (1/320). We present a pluriglandular autoimmune syndrome with membranous glomerulonephritis, thyroiditis, pancreatitis and suprarrenal insufficiency. To the best of our knowledge this complex syndrome has not been previously described.

  18. Nutrition and renal disease.

    Directory of Open Access Journals (Sweden)

    Iris de Castaño

    2009-11-01

    Full Text Available Kidney plays an important roll in body homeostasis through excretory, metabolic and endocrine functions. Kidneys filter fluids and solutes and reabsorbed water , electrolytes an minerals. Urine volume and solute excretion are adjusted to keep composition of the extracellular space, serum osmolarity and intravascular volume in constant balance. Kidneys also regulate acid base equilibrium, hormone metabolism and excretion and amino acid concentration. Vitamin D hydroxylation takes place in the kidney, this is the active form of this vitamin, which inhibits PTH. In addition they produce erythropoietin which control hemoglobin concentration in erythrocytes. When renal insufficiency develops, and glormerular filtration rate is between 50 to 75% of normal, this functions are decreased .When renal function is less than 10%, this functions ceased. In children small changes in water, solute, acid base, calcium and phosphorus can alter normal growth and development. If kidneys can not maintain internal equilibrium, specific nutrients should be used. Compensation should be done according to age, type or renal disease and level of glomerular filtration rate.

  19. A case of human intramuscular adrenal gland transplantation as a cure for chronic adrenal insufficiency.

    Science.gov (United States)

    Grodstein, E; Hardy, M A; Goldstein, M J

    2010-02-01

    Intramuscular endocrine gland transplantation has been well described as it pertains to parathyroid autotransplantation; however, transplantation of the adrenal gland is less well characterized. While adrenal autotransplantation in the setting of Cushing's disease has been described, intramuscular adrenal allotransplantation as a cure for adrenal insufficiency to our knowledge has not been previously carried out. Current treatment for adrenal insufficiency leaves patients without diurnal variation in cortisol release and susceptible to the detrimental effects of chronic hypercortisolism. We describe here the case of a 5-year-old girl with renal failure who had adrenal insufficiency following fulminant meningococcemia that led to requirements for both stress-dose steroid and mineralocorticoid replacement. Ten months after the onset of her disease, she received a simultaneous renal and adrenal gland transplant from her mother. The adrenal gland allograft was morselized into 1 mm(3) segments and implanted into three 2 cm pockets created in her rectus abdominis muscle. Three years after surgery, her allograft remains fully functional, responding well to adrenocorticotropin hormone stimulation and the patient does not require any steroid or mineral-corticoid supplementation. We believe this case represents the first description of successful functional intramuscular adrenal allograft transplantation with long-term follow up as a cure for adrenal insufficiency.

  20. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  1. Renal fallure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  2. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  3. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  4. Birt-Hogg-Dubé syndrome: novel FLCN frameshift deletion in daughter and father with renal cell carcinomas.

    Science.gov (United States)

    Näf, Ernst; Laubscher, Dominik; Hopfer, Helmut; Streit, Markus; Matyas, Gabor

    2016-01-01

    Germline mutation of the FLCN gene causes Birt-Hogg-Dubé syndrome (BHD), a rare autosomal dominant condition characterized by skin fibrofolliculomas, lung cysts, spontaneous pneumothorax and renal tumours. We identified a hitherto unreported pathogenic FLCN frameshift deletion c.563delT (p.Phe188Serfs*35) in a family of a 46-year-old woman presented with macrohematuria due to bilateral chromophobe renal carcinomas. A heritable renal cancer was suspected due to the bilaterality of the tumour and as the father of this woman had suffered from renal cancer. Initially, however, BHD was overlooked by the medical team despite the highly suggestive clinical presentation. We assume that BHD is underdiagnosed, at least partially, due to low awareness of this variable condition and to insufficient use of appropriate genetic testing. Our study indicates that BHD and FLCN testing should be routinely considered in patients with positive family or personal history of renal tumours. In addition, we demonstrate how patients and their families can play a driving role in initiating genetic diagnosis, presymptomatic testing of at-risk relatives, targeted disease management, and genetic counselling of rare diseases such as BHD.

  5. Adrenal insufficiency in a child with MELAS syndrome.

    Science.gov (United States)

    Afroze, Bushra; Amjad, Nida; Ibrahim, Shahnaz H; Humayun, Khadija Nuzhat; Yakob, Yusnita

    2014-11-01

    Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) are established subgroups of mitochondrial encephalomyopathy. m.3243A>G a common point mutation is detected in tRNA in majority of patients with MELAS phenotype whereas m.8344A>G point mutation in tRNA is observed, in MERRF phenotype. Adrenal insufficiency has not been reported in mitochondrial disease, except in Kearns-Sayre Syndrome (KSS), which is a mitochondrial deletion syndrome. We report an unusual presentation in a five year old boy who presented with clinical phenotype of MELAS and was found to have m.8344A>G mutation in tRNA. Addison disease was identified due to hyperpigmentation of lips and gums present from early childhood. This is the first report describing adrenal insufficiency in a child with MELAS phenotype.

  6. [Oral cavity pathology by renal failure].

    Science.gov (United States)

    Maĭborodin, I V; Minikeev, I M; Kim, S A; Ragimova, T M

    2014-01-01

    The analysis of the scientific literature devoted to organ and tissue changes of oral cavity at the chronic renal insufficiency (CRI)is made. The number of patients in an end-stage of CRI constantly increases and patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or renal transplantation will comprise an enlarging segment of the dental patient population. Owing to CRI and its treatment there is a set of changes of teeth and oral cavity fabrics which remain even in a end-stage. Renal replacement therapy can affect periodontal tissues including gingival hyperplasia in immune suppressed renal transplantation patients and increased levels of bacterial contamination, gingival inflammation, formation of calculus, and possible increased prevalence and severity of destructive periodontal diseases. Besides, the presence of undiagnosed periodontitis may have significant effects on the medical management of the patients in end-stage of CRI.

  7. [Pregnancy in patients with underlying renal disease].

    Science.gov (United States)

    Golshayan, D; Mathieu, C; Burnier, M

    2007-03-07

    Pregnancy has generally been regarded as very high risk in women with chronic renal insufficiency. In this review, we describe the physiologic changes in systemic and renal haemodynamics during pregnancy, as well as the nature and severity of possible maternal and foetal complications in the setting of underlying renal disease. The risks are proportional to the degree of functional renal impairment, the presence or not of proteinuria and/or arterial hypertension at the time of conception, and are related to the type of underlying nephropathy or systemic disease in the mother. Furthermore, if the renal disease has been diagnosed before pregnancy, a better planning of the moment of conception, as well as a tight follow-up, allow for a better maternal and obstetrical outcome.

  8. Minimally invasive treatments for perforator vein insufficiency.

    Science.gov (United States)

    Kuyumcu, Gokhan; Salazar, Gloria Maria; Prabhakar, Anand M; Ganguli, Suvranu

    2016-12-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

  9. [Pediatric emergency: adrenal insufficiency and adrenal crisis].

    Science.gov (United States)

    Martínez, Alicia; Pasqualini, Titania; Stivel, Mirta; Heinrich, Juan Jorge

    2010-04-01

    Adrenal insufficiency is defined by impaired secretion of adrenocortical hormones. It is classified upon the etiology in primary and secondary. Rapid recognition and therapy of adrenocortical crisis are critical to survival. Patients often have nonspecific symptoms: anorexia, vomiting, weakness, fatigue and lethargy. They are followed by hypotension, shock, hypoglicemia, hyponatremia and hyperkalemia. All patients with adrenal insufficiency require urgent fluid reposition, correction of hypoglycemia and glucocorticoid replacement, in order to avoid serious consequences of adrenal crisis. After initial crisis treatment, maintenance dose of corticoids should be indicated. Mineralocorticoids replacement, if necessary, should also be initiated.

  10. AMH as Predictor of Premature Ovarian Insufficiency

    DEFF Research Database (Denmark)

    Lunding, Stine Aa; Aksglæde, Lise; Anderson, Richard A

    2015-01-01

    CONTEXT: The majority of Turner syndrome (TS) patients suffer from accelerated loss of primordial follicles. Low circulating levels of anti-Müllerian hormone (AMH) may predict the lack of spontaneous puberty in prepubertal girls and imminent premature ovarian insufficiency (POI) in TS women...

  11. Surgical strategy for mild ischemic mitral insufficiency

    Institute of Scientific and Technical Information of China (English)

    GU Cheng-xiong; WEI Hua; YU Yang

    2010-01-01

    @@ To the Editor: We read with the interest the article by FAN Hong-guang and colleagues~1 having obtained outstanding early and long-term clinical outcomes of left ventricular restoration for the patients with postinfarction ventricular aneurysm and low left ventricular ejection fraction (LVEF) of mean 37.7%. We would like to comment on surgical strategy for mild ischemic mitral insufficiency.

  12. Tarlov Cyst Causing Sacral Insufficiency Fracture.

    Science.gov (United States)

    Puffer, Ross C; Gates, Marcus J; Copeland, William; Krauss, William E; Fogelson, Jeremy

    2017-06-01

    Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

  13. [Chronic respiratory insufficiency and the elderly patient].

    Science.gov (United States)

    Cobarzan, Daniel

    2012-01-01

    Chronic respiratory failure is a complex entity of varied etiology and physio-pathological mechanisms. It is mainly characterised by the respiratory system's difficulty in ensuring correct aeration at rest, resulting initially in insufficient oxygenation of arterial blood. Treatment is adapted to each etiology and aims to compensate for respiratory failure and to ensure the oxygenation of the organism.

  14. Primary Ovarian Insufficiency: Genes, hormones, and beyond

    NARCIS (Netherlands)

    Janse, F.

    2012-01-01

    Primary ovarian insufficiency (POI) is characterized by amenorrhea in association with postmenopausal follicle-stimulating hormone (FSH) levels in women younger than 40 years. POI affects 1% of women and greatly influences a woman’s fertility potential and her overall health. The exact cause of POI

  15. Renal teratogens.

    Science.gov (United States)

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O

    2014-09-01

    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  16. Evaluation of the absorbed dose during studies of the renal function due to I{sup 123} / I{sup 131} (hippuran) and In{sup 111} (DTPA); Evaluacion de la dosis absorbida durante estudios de la funcion renal debido a I{sup 123} / I{sup 131} (hippuran) e In{sup 111} (DPTA)

    Energy Technology Data Exchange (ETDEWEB)

    Vasquez, M.; Castillo, C.; Sarachaga, R.; Rojas, R.; Zelada, L.; Melendez, J.; Gomez, M. [Universidad Nacional de Trujillo, Av. Juan Pablo II s/n, Ciudad Universitaria, Trujillo (Peru); Diaz, E., E-mail: marvva@hotmail.com [Universidade Federal do Rio Grande do Sul, Av. Paulo Gamma 110, Bairro Farropilhas, Porto Alegre, RS 90040-060 (Brazil)

    2014-08-15

    Using the methodology MIRD and representation Cristy-Eckerman for kidneys, bladder, and whole body as organs of the bio-kinetics of I{sup 123} / I{sup 131} (hippuran) and the In{sup 111} (D PTA), the absorbed dose for studies of the renal function of adults due to the I{sup 123} is 0,0071 mGy/MBq where 88.16% corresponds to its auto-dose and 11,96% to the organs of their bio-kinetics; while for the I{sup 131} their dose is 0,032 mGy/MBq where 95,03% corresponds to its auto-dose and 4,97% to the organs of their bio-kinetics. For the In{sup 111} their dose is 0,0168 mGy/MBq where 71,68% corresponds to their auto-dose and 28,32% to the organs of their bio-kinetics. In all the cases the dosimetric contributions of the organs of the bio-kinetics (whole body and urinary bladder) are very significant, and this fundamentally is due to the photons of the whole body. (Author)

  17. CT features of renal infarction

    Energy Technology Data Exchange (ETDEWEB)

    Suzer, Okan; Shirkhoda, Ali; Jafri, S. Zafar; Madrazo, Beatrice L.; Bis, Kostaki G.; Mastromatteo, James F

    2002-10-01

    Purpose: To demonstrate the different patterns of renal infarction to avoid pitfalls. To present 'flip-flop enhancement' pattern in renal infarction. Materials and methods: Retrospective review of a total of 41 renal infarction in 37 patients were done. These patients underwent initial CT and the diagnosis of renal infarction was confirmed with either follow up CT or at surgery. Results: Twenty-three patients had wedge-shaped focal infarcts, nine patients had global and five patients had multifocal infarcts of the kidneys. Cortical rim sign was seen predominantly with global infarcts. In five patients, a 'flip-flop enhancement' pattern was observed. In two patients, planned renal biopsies due to tumefactive renal lesions were cancelled because of 'flip-flop enhancement' pattern on follow up CTs. Conclusion: Although most of our cases were straightforward for the diagnosis of renal infarction, cases with tumefactive lesions and global infarctions without the well-known cortical rim sign were particularly challenging. We describe a new sign, flip-flop enhancement pattern, which we believe solidified the diagnosis of renal infarction in five of our cases. The authors recommend further investigations for association of flip-flop enhancement and renal infarction.

  18. Renal rickets-practical approach

    Directory of Open Access Journals (Sweden)

    Manisha Sahay

    2013-01-01

    Full Text Available Rickets/osteomalacia is an important problem in a tropical country. Many cases are due to poor vitamin D intake or calcium deficient diets and can be corrected by administration of calcium and vitamin D. However, some cases are refractory to vitamin D therapy and are related to renal defects. These include rickets of renal tubular acidosis (RTA, hypophosphatemic rickets, and vitamin D dependent rickets (VDDR. The latter is due to impaired action of 1α-hydroxylase in renal tubule. These varieties need proper diagnosis and specific treatment.

  19. Color Doppler in the Assessment of Uteroplacental Circulation Insufficiency

    Directory of Open Access Journals (Sweden)

    Ahmad Soltani Shirazi

    2010-05-01

    Full Text Available Usage of color Doppler ultrasound in the diagnosis of uteroplacental or fetal-placental vascular insufficiency is based on the theory that many of these insufficiencies are due to small vessel disease in the uteroplacental or fetal-placental vasculature which ultimately results in fetal intrauterine growth retardation, increase in prenatal mortality and morbidity and fetal neurological development. "nIn a prospective study on patients who were sus-pected for developing uteroplacental insufficiency, color Doppler ultrasound was done and the results were compared with neonatal weight (one of the most important criteria for IUGR determination which was measured just after delivery."nDirect significant relation was showed to be present between prepartum vascular changes detected in Doppler ultrasound and prognosis of IUGR. "nThree vessel types were assessed in this study:"n1. Umbilical-middle cerebral arteries"n2. Uterine arteries"n3.Venous system (umbilical, ductus venosus, IVC, which is used to assess the compensation process in fetal circulation."nThree Doppler indices of vascular resistance were studied and their abnormalities according to the age of pregnancy were assessed.

  20. Sarcoidose renal

    Directory of Open Access Journals (Sweden)

    AQUINO MARIA ENEDINA CLAUDINO DE

    2001-01-01

    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  1. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  2. Practical uses of a quantitative renal scintillation camera study. [/sup 131/I tracer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Bueschen, A.J.; Lloyd, L.K.

    1976-10-01

    A quantitative renal scintillation camera study has been described for the evaluation of total renal function and the split function of the two kidneys by a noninvasive technic. It requires no patient preparation, is not affected by bowel gas, and no allergic reactions have been reported. Six cases are reported to illustrate its usefulness with renal tumors, neurogenic bladders, pyelonephritis, nephrolithiasis, congenital anomalies, and renal insufficiency.

  3. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  4. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  5. Renal Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    İbrahim Halil Bozkurt

    2015-03-01

    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  6. Acute pancreatitis, acute hepatitis and acute renal failure favourably resolved in two renal transplant recipients.

    Science.gov (United States)

    Voiculescu, Mihai; Ionescu, Camelia; Ismail, Gener; Mandache, Eugen; Hortopan, Monica; Constantinescu, Ileana; Iliescu, Olguta

    2003-03-01

    Renal transplantation is often associated with severe complications. Except for acute rejection, infections and toxicity of immunosuppressive treatment are the most frequent problems observed after transplantation. Infections with hepatic viruses (HBV, HDV, HCV, HGV) and cytomegalic virus (CMV) are the main infectious complications after renal transplantation. Cyclosporine toxicity is not unusual for a patient with renal transplantation and is even more frequent for patients with hepatic impairment due to viral infections. The subjects of this report are two renal transplant recipients with acute pancreatitis, severe hepatitis and acute renal failure on graft, receiving immunosuppressive therapy for maintaining renal graft function

  7. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  8. [Postoperative respiratory insufficiency and its treatment].

    Science.gov (United States)

    Kösek, V; Wiebe, K

    2015-05-01

    The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.

  9. Novel insights into adrenal insufficiency in childhood.

    Science.gov (United States)

    Levy-Shraga, Y; Pinhas-Hamiel, O

    2014-12-01

    Adrenal insufficiency (AI) is a rare disease in childhood and adolescence that results from disruption in the hypothalamic-pituitary-adrenal axis. Pediatricians should be familiar with this entity since acute adrenal crisis is a life-threatening condition that requires immediate treatment. In the early stages of AI, the clinical manifestations may be subtle and non-specific; thus, they are frequently unrecognized. The main therapeutic approach in all forms of adrenal insufficiency is glucocorticoid replacement; the dose should be titrated appropriately to avoid under or overtreatment. Patient and family education is particularly important, to enable adjustment of dosage replacement therapy during stress and to prevent crisis. This article summarizes the current knowledge of AI and provides new insights on its management in children.

  10. The rise, fall, and possible resurrection of renal denervation.

    Science.gov (United States)

    Gulati, Rajiv; Raphael, Claire E; Negoita, Manuela; Pocock, Stuart J; Gersh, Bernard J

    2016-04-01

    Renal denervation has a chequered history. Dramatic reductions in blood pressure after denervation of the renal arteries were observed in early trials, but later trials in which denervation was tested against a sham procedure produced neutral results. Although a sound pathophysiological basis exists for interruption of the renal sympathetic nervous system as a treatment for hypertension, trial data to date are insufficient to support renal denervation as an established clinical therapy. In this Perspectives article, we summarize the currently available trial data, device development, and trials in progress, and provide recommendations for future trial design.

  11. Convergence Insufficiency/Divergence Insufficiency Convergence Excess/Divergence Excess: Some Facts and Fictions

    OpenAIRE

    Edward Khawam; Bachir Abiad; Alaa Boughannam; Joanna Saade; Ramzi Alameddine

    2015-01-01

    Great discrepancies are often encountered between the distance fixation and the near-fixation esodeviations and exodeviations. They are all attributed to either anomalies of the AC/A ratio or anomalies of the fusional convergence or divergence amplitudes. We report a case with pseudoconvergence insufficiency and another one with pseudoaccommodative convergence excess. In both cases, conv./div. excess and insufficiency were erroneously attributed to anomalies of the AC/A ratio or to anomalies ...

  12. LMWH in cancer patients with renal impairment - better than warfarin?

    Science.gov (United States)

    Bauersachs, Rupert M

    2016-04-01

    Venous thromboembolism (VTE) is one of the leading causes of death in cancer patients, which are known to have a 5- to 7-fold increased risk for VTE. The anticoagulant treatment of VTE in cancer patients is less effective with a three-fold increased risk of VTE recurrence compared to non-cancer patients, and it is less safe with more than double rates of major bleeding. Compared to vitamin-K antagonists (VKA), long-term secondary prevention with low molecular weight heparin (LMWH) has been shown to reduce the risk of recurrent VTE in cancer-associated thrombosis (CAT), and therefore, current international guidelines recommend the use of LMWH over VKA. With increasing age, cancer prevalence and VTE incidence increase while renal function decreases. Anti-cancer treatment may impair renal function additionally. Therefore, renal insufficiency is a frequent challenge in CAT patients, which is associated with a higher risk of both bleeding and recurrent VTE. Both VKA and LMWH may be associated with less efficacy and higher bleeding risk in renal insufficiency. Unfortunately, there is a lack of prospective data on renal insufficiency and CAT. A recent sub-analysis from a large randomized controlled trial shows that the bleeding risk in patients with severe renal insufficiency in CAT is not elevated with the use of LMWH compared to VKA while efficacy is maintained. In addition, LMWH treatment has several practical advantages over VKA, particularly in patients with CAT while they are receiving anti-cancer treatment.

  13. Effect of renal revascularization on the development of renal dysfunction in atherosclerotic ischemic nephropathy

    OpenAIRE

    Rodrigo Hagemann; Vanessa dos Santos Silva; Roberto Jorge da Silva Franco; Pasqual Barretti; Luis Cuadrado Martin

    2014-01-01

    Chronic kidney disease (CKD) is characterized by a progressive loss of renal function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension is atherosclerotic renal disease (ARD). The development of CKD in patients with ARD appears to be due not only to the involvement of the main renal arteries, but also of the renal microcirculation, which may explain the fact that the success of the procedure does not guarantee an improvement in the progression of CKD...

  14. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases.

    Science.gov (United States)

    Bush, Lisabeth A; Chew, Felix S

    2008-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was focally increased T2 signal on MRI and a small, triangular ridge or cortical beak on radiographs. The lesion was initially thought to represent a metastasis, but after the patient returned with a transverse femoral shaft fracture through the ridge following minimal trauma, MRI and biopsy of the lesion failed to show any evidence of tumor. We suggest that this fracture is similar to the low-energy proximal femoral shaft fractures recently reported in postmenopausal women who have received oral bisphosphonates for osteoporosis. Suppression of bone turnover may play a role in the development of these fractures.

  15. Determination and its significance of the ratio of urine microalbumin to urine cretinine in patients with nephrolithiasis complicated with renal insufficiency%肾结石合并肾功能不全患者围手术期尿微量白蛋白与尿肌酐比值检测及意义

    Institute of Scientific and Technical Information of China (English)

    陈亮; 李建兴; 黄晓波; 杨波; 王佳; 王晓峰

    2011-01-01

    Objective: To investigate the significance of change of urine microalbumin/urine cretinine (mALB/Ucr) in nephrolithiasis patients with renal dysfunction (experimental group) before and after percutaneous nephrolithotomy (PCNL). Methods: mALB/Ucr value and serum cretinine (Scr) value were analyzed in 21 nephrolithiasis patients with renal dysfunction before PCNL, and 1, 7, 30 and 90 days after PCNL. Operative time and the number of tract were recorded and analyzed in the experimental group. The same work was done in 27 nephrolithiasis patients with normal renal function (control group) before surgery. Results: The levels of mALB/ Ucr in experimental group patients before PCNL were significantly higher than those in control group (P <0. 001) . The levels of mALB /Ucr between 7 days after operation and 30 days (P=0.054) or 90 days (P=0.062) after operation were not statistically significant. The levels of Scr of 30 days after operation in experimental group were lower than those of 7 days after surgery (P<0.001 ) ; But they were not statistically significant compared with those of 90 days after surgery (P =0. 106). The mALB/Ucr difference between before PCNL and 7 days after PCNL (ΔmALB/Ucr) was positively correlated to the number of operation tract ( r =0.486 ,P =0. 030) , but it was not correlated to operation time ( r = 0. 323 , P = 0. 129 ). The ΔmALB/Ucr was not correlated to Scr difference between before PCNL and 7 days after PCNL ( r =0. 323 , P =0. 153 ). Actually the ΔmALB/ Ucr was correlated to Scr difference between before PCNL and 30 days (r =0. 632, P =0.002) , or 90 days ( r =0. 476 , P =0. 003 ) after PCNL. Conclusion: The damage to kidney filtration of experimental group was more severe than that of control group. The mALB/Ucr or Scr level of experimental group trends to be stable in 7 or 30 days after operation. Increasing operation tracts ( less than 3 tracts) can help to restore kidney filtration function. A reliable assessment, of a long

  16. N-acetil-β-D-glicosaminidase como biomarcador precoce de disfunção renal para a exposição ocupacional ao chumbo inorgânico N-acetyl-β-D-glucosaminidase as an early biomarker of renal dysfunction due to occupational exposure to inorganic lead

    Directory of Open Access Journals (Sweden)

    Leandro Nishikawa Gonçales

    2008-08-01

    Full Text Available OBJETIVO: Este estudo teve como objetivo averiguar a atividade enzimática da N-acetil-β-D-glicosaminidase (NAG como possível biomarcador precoce de disfunção renal para a exposição ocupacional ao chumbo inorgânico. MATERIAIS E MÉTODOS: Foi selecionado um grupo de 30 pessoas do sexo masculino expostas ao chumbo inorgânico em uma fábrica de baterias localizada no estado do Paraná. Fizeram parte do grupo os funcionários que mostraram valores de chumbo sanguíneo inferiores a 40 mg/dl. O grupo controle foi representado por 15 adultos saudáveis com similaridade em relação à idade e ao gênero do grupo exposto. Foram determinados os níveis de plumbemia, do ácido d-aminolevulínico urinário e a atividade da NAG urinária. RESULTADOS E DISCUSSÃO: Foi evidenciado que a atividade urinária da NAG foi significativamente maior (p OBJECTIVE: This study aimed to verify the enzymatic activity of N-acetyl-β-D-glucosaminidase (NAG as a possible early biomarker of renal dysfunction due to occupational exposure to inorganic lead. MATERIALS AND METHODS: We selected a group of 30 males that had been exposed to inorganic lead in a battery factory in the state of Paraná. This group comprised those employees whose blood lead levels were below 40 mg/dl. The control group consisted of 15 healthy adults of similar age and gender compared with the exposed group. Blood lead concentrations, d-aminolevulinic acid levels and urinary NAG activity were measured. RESULTS AND DISCUSSION: It was shown that urinary NAG activity was significantly higher (p < 0.05, U test of Mann-Whitney in the exposed group in comparison to the control group, and there was a significant negative correlation (p < 0.05, Spearman Rank Order correlation between the biological indicator of lead exposure and urinary NAG activity. CONCLUSION: The results showed that the increase of urinary NAG activity may be used as an early biomarker of the exposure to inorganic lead.

  17. Trasplante renal Kidney transplant

    Directory of Open Access Journals (Sweden)

    P. Martín

    2006-08-01

    Full Text Available El trasplante renal es la terapia de elección para la mayoría de las causas de insuficiencia renal crónica terminal porque mejora la calidad de vida y la supervivencia frente a la diálisis. El trasplante renal de donante vivo es una excelente alternativa para el paciente joven en situación de prediálisis porque ofrece mejores resultados. El tratamiento inmunosupresor debe ser individualizado buscando la sinergia inmunosupresora y el mejor perfil de seguridad, y debe adaptarse a las diferentes etapas del trasplante renal. En el seguimiento del trasplante renal hay que tener muy en cuenta los factores de riesgo cardiovascular y los tumores puesto que la muerte del paciente con injerto funcionante es la segunda causa de pérdida del injerto tras el primer año del trasplante. La función alterada del injerto es un factor de mortalidad cardiovascular independiente que requerirá seguimiento y control de todas sus complicaciones para retrasar la entrada en diálisis.The kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. A kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. Immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. In the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. The altered function of the graft is a factor of independent cardiovascular mortality that will require follow-up and the control of all its complications to postpone the entrance in dialysis.

  18. [Treatment of renal anemia with erythropoietin].

    Science.gov (United States)

    Spustova, V; Kovac, A

    1999-08-01

    During the last decade, a considerable amount of new information has accumulated regarding therapy optimalization of renal anaemia with recombinant human erythropoietin (EPO). Key question involved is EPO hyporesponsiveness caused by absolute or functional iron deficiency. Most controversial issue in the treatment of renal anaemia in patients with chronic renal insufficiency is the definition of optimal target haemoglobin. Many questions about optimizing EPO therapy were considered at the 2nd European Epoetin Symposium which was held in April 1998 on Crete. Discussion was devoted also to revision of a draft version of the European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. The presented review is on summary of new insights presented at the symposium. (Ref. 85.)

  19. Efficacy of recombinant human brain natriuretic peptide on acute heart failure with renal function insufficiency%重组人脑钠肽治疗急性心力衰竭合并肾功能不全的近期疗效观察

    Institute of Scientific and Technical Information of China (English)

    卢鑫; 胡桃红; 谢晓春; 刘胜林; 李慧君; 张玮; 王晶

    2014-01-01

    Objective To analyze the efficacy of recombinant human brain natriuretic peptide (rhBNP) treating congestive heart failure complicated with renal failure.Methods A retrospective analysis of 105 cases of heart failure and renal failure patients were randomly divided into two groups:group rhBNP (55 cases,on the basis of conventional therapy plus rhBNP) and routine treatment group (50 cases,treated with routine therapy).The effect of recombinant human brain natriuretic peptide [0.007 5 μg/(kg · min) micro pump intravenous infusion,once a day,each lasting approximately 10 hours,7 days for a course of treatment] was recorded before treatment,7 days and 3 months after treatment,including left ventricular ejection fraction,left ventricular end diastolic volume,left ventricular systolic end diastolic volume,24 hour urine volume,blood urea nitrogen,serum creatinine,serum cystatin C,NT-proBNP and creatinine clearance rate.Results Compared with routine therapy group after 7 days,NT-proBNP[(1 516 ±432)ng/L vs (4 951 ± 1 314)ng/L],the left ventricular ejection fraction[(46.9 ±6.8)% vs (30.6 ± 2.5) %],left ventricular end diastolic diameter [(50 ± 3) mm vs (57 ± 5) mm],left ventricular end systolic diameter [(35 ±6)mm vs (43 ±3)mm],24 hours urine volume [(975 ± 172) ml vs (786 ± 143)ml],urea nitrogen [(7.3 ± 2.3)mmol/L vs (12.9 ± 3.2)mmol/L],serum creatinine [(93 ± 8)μmol/L vs (234 ± 69) μmol/L],glomerular filtration rate [(46 ±6)ml/min vs (34 ±3)ml/min],serum cystatin C[(1.4 ± 0.1)mg/L vs (3.2 ± 1.9)mg/L] had significant differences between the two groups (P < 0.05).Conclusion The recombinant human brain natriuretic peptide is safe and can improve the renal function in chronic heart failure.%目的 观察重组人脑钠肽(rhBNP)治疗心力衰竭合并肾功能不全的近期疗效.方法 回顾性分析心力衰竭合并肾功能不全的患者105例,根据不同治疗分为2组,常规治疗组50例,给予常规治疗;rhBNP组55例,常规治疗

  20. Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract.

    LENUS (Irish Health Repository)

    Snow, Aisling

    2011-02-09

    BACKGROUND: Alternative medical therapies are increasingly being prescribed due to their good safety profile and perceived limited side effects. They are often unregulated and prescribed over the counter. One such medication is horse chestnut seed extract (HCSE), which is used for the treatment of chronic venous insufficiency and is known to affect blood coagulation. Angiomyolipoma (AML) is a benign fat-containing mesenchymal tumor of the kidney. It is often found incidentally and in most cases can be managed conservatively. Rupture of the kidney with hemorrhage is a well-known complication that may be serious and life-threatening. Known risk factors for hemorrhage include anticoagulation as well as pregnancy, increased size of the lesion, high lesion vascularity, and aneurysm formation within the tumor. OBJECTIVES: The aim is to raise awareness of potential HCSE-induced anticoagulation, including, as in the case presented, acute renal AML hemorrhage. CASE REPORT: The case of a patient taking HCSE for venous insufficiency is presented. The patient suffered a life-threatening rupture of the kidney in the presence of known renal AML. She underwent emergency embolization with a successful outcome. Because HCSE-containing products are thought to be generally safe in the treatment of chronic venous insufficiency, it is important to be mindful of their potential anticoagulant properties and, therefore, their relative contraindication both in patients taking other anticoagulants and those with known renal AML. CONCLUSION: We demonstrate a potentially life-threatening association between HSCE-containing products and renal AML, highlighting the risk associated with HSCE-induced anticoagulation.

  1. News in Pathogenesis of Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Mazuchova J

    2016-08-01

    Full Text Available This review article is concentrating on the news in the pathophysiology of chronic venous insufficiency (CVD. Despite ongoing progress in understanding the molecular aspects of CVD the exact mechanism of its development remains unclear. Many different factors may play role in the pathogenesis of CVD, including changes in hydrostatic pressure, valvular incompetence, increased capillary permeability, endothelial dysfunction, activation of leukocytes, deep venous obstruction, capillary microthrombosis, ineffective function of calf muscle pump, biochemical and structural changes in the vessel wall, extracellular matrix alteration, and several other mechanisms. A better understanding of the pathophysiology is an important step in the finding of new potential treatment.

  2. Radiocontrast-induced renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Misson, R.T.; Cutler, R.E.

    1985-05-01

    Review of the literature concerning contrast-induced renal dysfunction shows that the currently used agents are remarkably safe with careful patient selection. Clinically apparent kidney failure after their use is essentially nonexistent in those without preexistent renal insufficiency. The incidence rises rapidly in those with azotemia from any cause, however, and diabetic persons with nephropathy are perhaps at special risk. Vigorous volume expansion is possibly effective as a preventive measure and may attenuate adverse effects in those in whom postcontrast dysfunction occurs. New agents are becoming available. It is not yet known if these will prove safer or cost-effective. They have some experimentally demonstrated and theoretical advantages over the presently used agents. 58 references, 1 figure, 2 tables.

  3. ``Aggressive`` renal angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Cittadini, G. Jr. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, F. [Univ. of Trieste (Italy). Dept. of Radiology; Danza, F.M. [Catholic Sacro Cuore Univ., Rome (Italy). Dept. of Radiology; Derchi, L.E. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, R.S. [Univ. of Trieste (Italy). Dept. of Radiology

    1996-11-01

    We describe the US and CT examinations of 4 patients with renal angiomyolipoma with an `aggressive` appearance, and review the literature. The imaging findings in 4 patients with benign renal angiomyolipomas associated with thrombosis of the renal vein and/or inferior vena cava are presented. CT demonstrated fat densities within both tumor and thrombus. In one patient, small lymph nodes with low density internal areas were detected in the para-aortic region. When considering our patients together with those reported in the literature, we found that most angiomyolipomas with venous invasion were large and centrally located within the kidney. Venous thrombosis was observed in 9 lesions of the right kidney, and in only 4 of the left one. One patient only had symptoms due to the thrombus; 10 had problems due to the tumor; and 3 were asymptomatic. Only 4 patients with pararenal enlarged lymph nodes have been reported on in the imaging literature. Fat-containing nodes were detected by CT in one case only; the others had enlarged nodes of soft-tissue density. In one patient the diagnosis of hamartomatous lymph node invasion was established by angiography. In patients with renal angiomyolipoma, demonstration of both fatty thrombus and the fatty infiltration of lymph nodes of the renal hilum cannot be regarded as an indication of malignancy, but only of local aggessive behavior. Conservative treatment seems possible. Detection of enlarged lymph nodes of soft tissue density may cause difficult diagnostic problems, with the diagnosis addressed only by the presence of associated lesions. (orig./MG).

  4. Hypertension, Chronic Kidney Disease, and Renal Pathology in a Child with Hermansky-Pudlak Syndrome

    Directory of Open Access Journals (Sweden)

    Roberto Gordillo

    2011-01-01

    Full Text Available We report a child with Hermansky-Pudlak Syndrome (HPS and chronic kidney disease (stage II with histological diagnosis of focal segmental glomerulosclerosis (FSGS. A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN, asthma, obesity, and chronic kidney disease (CKD stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9–1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified with chronic diffuse tubulopathy (tubular cytoplasmic droplets and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.

  5. Hypertension, chronic kidney disease, and renal pathology in a child with hermansky-pudlak syndrome.

    Science.gov (United States)

    Gordillo, Roberto; Del Rio, Marcela; Thomas, David B; Flynn, Joseph T; Woroniecki, Robert P

    2011-01-01

    We report a child with Hermansky-Pudlak Syndrome (HPS) and chronic kidney disease (stage II) with histological diagnosis of focal segmental glomerulosclerosis (FSGS). A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN), asthma, obesity, and chronic kidney disease (CKD) stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9-1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC) ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified) with chronic diffuse tubulopathy (tubular cytoplasmic droplets) and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney) in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.

  6. Renal Cysts

    Science.gov (United States)

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  7. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  8. Drug-induced renal injury

    African Journals Online (AJOL)

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  9. Inflammatory manifestations of experimental lymphatic insufficiency.

    Directory of Open Access Journals (Sweden)

    Raymond Tabibiazar

    2006-07-01

    Full Text Available BACKGROUND: Sustained lymph stagnation engenders a pathological response that is complex and not well characterized. Tissue inflammation in lymphedema may reflect either an active or passive consequence of impaired immune traffic. METHODS AND FINDINGS: We studied an experimental model of acute post-surgical lymphedema in the tails of female hairless, immunocompetent SKH-1 mice. We performed in vivo imaging of impaired immune traffic in experimental, murine acquired lymphatic insufficiency. We demonstrated impaired mobilization of immunocompetent cells from the lymphedematous region. These findings correlated with histopathological alterations and large-scale transcriptional profiling results. We found intense inflammatory changes in the dermis and the subdermis. The molecular pattern in the RNA extracted from the whole tissue was dominated by the upregulation of genes related to acute inflammation, immune response, complement activation, wound healing, fibrosis, and oxidative stress response. CONCLUSIONS: We have characterized a mouse model of acute, acquired lymphedema using in vivo functional imaging and histopathological correlation. The model closely simulates the volume response, histopathology, and lymphoscintigraphic characteristics of human acquired lymphedema, and the response is accompanied by an increase in the number and size of microlymphatic structures in the lymphedematous cutaneous tissues. Molecular characterization through clustering of genes with known functions provides insights into processes and signaling pathways that compose the acute tissue response to lymph stagnation. Further study of genes identified through this effort will continue to elucidate the molecular mechanisms and lead to potential therapeutic strategies for lymphatic vascular insufficiency.

  10. The chronic cerebrospinal venous insufficiency syndrome.

    Science.gov (United States)

    Zamboni, P; Galeotti, R

    2010-12-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

  11. Current status of renal biopsy for small renal masses.

    Science.gov (United States)

    Ha, Seung Beom; Kwak, Cheol

    2014-09-01

    Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered.

  12. Current Status of Renal Biopsy for Small Renal Masses

    Science.gov (United States)

    Ha, Seung Beom

    2014-01-01

    Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered. PMID:25237457

  13. DNA-guided hepatitis B treatment: Viral load is insufficient with few exceptions

    Institute of Scientific and Technical Information of China (English)

    Pankaj Jain

    2009-01-01

    In DNA-guided hepatitis B treatment, viral load is insufficient, and requires other viral markers for treatment of hepatitis B patients as in patients with acute exacerbation of chronic hepatitis B, end-stage renal disease on dialysis, human immunodeficiency virus co-infected patients. There are exceptions to this rule:a residual level hepatitis B virus (HBV) DNA at 24 wk predicts beneficial outcome and reduced resistance at 1 year. The genotypic viral resistance to antiviral agents and occult HBV infection can be determined by HBV-DNA levels.

  14. High serum enalaprilat in chronic renal failure

    DEFF Research Database (Denmark)

    Elung-Jensen, T; Heisterberg, J; Kamper, A L

    2001-01-01

    in patients with GFR ACE activity below the reference range. The ACE genotype did not influence the results. Additional pharmacokinetic studies were done in nine patients in whom GFR was 23 (10-42)ml/minute/1.73 m2. The median clearance of enalaprilat was 28 (16......BACKGROUND: Most angiotensin-converting enzyme (ACE) inhibitors and their metabolites are excreted renally and doses should hence be reduced in renal insufficiency. We studied whether the dosage of enalapril in daily clinical practice is associated with drug accumulation of enalaprilat in chronic...

  15. Open heart surgery in dialysis-dependent patients with end stage renal failure

    Directory of Open Access Journals (Sweden)

    Orkut Güçlü

    2013-09-01

    Full Text Available Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75% and nine women(25% totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76 years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3: 335-338Key words: Cardiac surgery, chronic renal failure, mortality

  16. Renal endogenous stem cells: a new source for regenerative medicine in preterms?

    Directory of Open Access Journals (Sweden)

    Gavino Faa

    2015-10-01

    Full Text Available The creation of new medical approaches based on stem cells to treat chronic kidney disease (CKD and in particular end stage renal disease (ESRD has become imperative in recent years, due to the significant burdens of patients affected by renal failure and to the limitations of dialysis and kidney transplantation to solve the problem. The initial prospective of utilizing stem cells for regenerating the affected kidney has been at the basis of excitement and hope for all patients affected by ESRD. Unfortunately, too many challenges have halted the possibility to make such regenerative approach a reality, and the vast majority of patients with CKD and renal insufficiency experience a reduced quality of life associated with high mortality. The problem appears particularly severe when ESDR develops in childhood. Children submitted to kidney transplantation have a 95% of survival rate at 5 years, but only 66% of them survive at 20 years after renal transplant. As a result, patients transplanted in childhood will need repeated renal transplants during their life.Renal regenerative medicine might experience a major renaissance in the next years, developing new methodologies stemmed from the previous attempts. Here, we present some major points to be addressed, in order to open a debate on the potential offered by the different regenerative methodologies:the “exogenous” approach; the “endogenous” approach; the “therapeutic” approach; the “prevention” approach. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  17. [Bilateral renal infarction after discontinuation of anticoagulant therapy].

    Science.gov (United States)

    Lavoignet, Charles-Éric; Le Borgne, Pierrick; Ugé, Sarah; Veneziano, Rinaldo; Brunhuber, Claudia; Kam, Claire; Bilbault, Pascal

    2016-07-01

    Acute renal infarction is an uncommon and often under diagnosed condition mostly because of misleading symptoms. Accurate data regarding clinical presentation, laboratory tests, diagnostic and treatment are lacking. Detection is often delayed or missed because of non-specific clinical presentation. The mechanisms of acute renal infarction are various, mainly embolic or thrombotic. Abdominal CT scan remains the most valuable exam to confirm the diagnosis. Therapeutic guidelines for the treatment of renal embolism have not been well established. The standard treatment strategy includes anticoagulation with or without thrombolysis. Despite the uncertainty regarding management, the renal outcome remains favorable. Some patients do develop some degree of renal insufficiency during the acute episode. We report here the case of a 73-year-old woman with bilateral acute renal infarction after discontinuation of anticoagulant therapy.

  18. SINDROME INTERMEDIO: UN PATRÓN TÍPICO DE INSUFICIENCIA RENAL AGUDA EN EL ANCIANO

    Directory of Open Access Journals (Sweden)

    Algranati L

    2004-01-01

    Full Text Available Acute renal failure is a frequent entity in the elderly. This is due on one hand to the structural and physiological changes of the aged kidney, and on the other hand to the exposure of this population to polypharmacy and their reduced capability to metabolize drugs. In the present report we present a case of a seventy year-old woman who developed acute renal failure secondary to severe dehydration with a clinical and laboratory pattern of intermediate syndrome: laboratory results compatible with parenchymal renal insufficiency (elevated urinary sodium, plasma urea and creatinine, but with a positive response to hydration. The main characteristics of the aged kidney that predispose to the development of an intermediate syndrome are: the vascular dysautonomy and reduced capability of sodium and water reabsorption. The intermediate syndrome is a typical pattern of pre-renal insufficiency in the elderly. RESUMEN: La insuficiencia renal aguda es frecuente en el anciano. Esto se debe por un lado a los cambios estructurales y funcionales propios del riñón senil, y por otro a la gran exposición que esta población tiene a la polifarmacia, y su reducida capacidad para metabolizar los medicamentos. En este reporte presentamos el caso de una mujer de 70 años que desarrolló una insuficiencia renal aguda secundaria a severa deshidratación, mostrando un patrón clínico y de laboratorio propio de un sindrome intermedio: laboratorios compatibles con una insuficiencia renal parenquimatosa (sodio urinario, uremia y creatininemia elevadas, pero con una respuesta favorable a la hidratación. Las principales características del riñón senil que predisponen al desarrollo del sindrome intermedio: son la disautonomía vascular y la reducida capacidad en la recuperación de sodio y agua El sindrome intermedio es un patrón típico de insuficiencia prerrenal en el anciano.

  19. An unusual cause of acute renal failure: renal lymphoma.

    Science.gov (United States)

    Ozaltin, Fatih; Yalçin, Bilgehan; Orhan, Diclehan; Sari, Neriman; Caglar, Melda; Besbas, Nesrin; Bakkaloglu, Aysin

    2004-08-01

    Renal involvement is a common finding in non-Hodgkin's lymphoma (NHL). Acute renal failure at initial presentation due to lymphomatous infiltration of the kidneys has been described infrequently. We report a 17-year-old male who presented with acute renal failure due to massive lymphomatous infiltration of the kidneys, which necessitated hemodialysis. The diagnosis of B-cell NHL was established by tru-cut biopsy of the kidneys and the patient had an excellent response to high-dose chemotherapy with no major complication. The presence of extrarenal involvement in the testes and the retroperitoneal lymph nodes made the diagnosis of primary renal lymphoma debatable. However, considering the delay in diagnosis and the high proliferative rate of B-cell NHL, we might postulate that the disease had originated primarily in the kidneys. We recommend that in NHL cases with severe renal involvement, full-dose chemotherapy should be instituted with meticulous clinical and laboratory follow-up in order to improve clinical and renal failure status rapidly and to avoid further dissemination of NHL.

  20. Renal Toxicities of Targeted Therapies.

    Science.gov (United States)

    Abbas, Anum; Mirza, Mohsin M; Ganti, Apar Kishor; Tendulkar, Ketki

    2015-12-01

    With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. This review will focus on these renal toxicities from commonly used targeted agents. This review discusses the mechanisms of these side effects and management strategies. Anti-vascular endothelial growth factor (VEGF) agents including the monoclonal antibody bevacizumab, aflibercept (VEGF trap), and anti-VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs) all cause hypertension, whereas some of them result in proteinuria. Monoclonal antibodies against the human epidermal growth factor receptor (HER) family of receptors, such as cetuximab and panitumumab, cause electrolyte imbalances including hypomagnesemia and hypokalemia due to the direct nephrotoxic effect of the drug on renal tubules. Cetuximab may also result in renal tubular acidosis. The TKIs, imatinib and dasatinib, can result in acute or chronic renal failure. Rituximab, an anti-CD20 monoclonal antibody, can cause acute renal failure following initiation of therapy because of the onset of acute tumor lysis syndrome. Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, can result in proteinuria. Discerning the renal adverse effects resulting from these agents is essential for safe treatment strategies, particularly in those with pre-existing renal disease.

  1. Wegener's granulomatosis with renal involvement: patient survival and correlations between initial renal function, renal histology, therapy and renal outcome.

    Science.gov (United States)

    Andrassy, K; Erb, A; Koderisch, J; Waldherr, R; Ritz, E

    1991-04-01

    Patient survival and renal outcome were followed in 25 patients with biopsy confirmed Wegener's granulomatosis and renal involvement. Fourteen out of 25 patients required dialysis on admission, 11/25 patients did not. All patients were treated with a novel protocol comprising methylprednisolone and cyclophosphamide. The median follow-up observation was 36 months (12-113 months). With the exception of 1 patient (who died from causes not related to Wegener's granulomatosis) all patients are alive. Among the patients initially requiring dialysis (n = 14) 4 are in terminal renal failure after 0, 7, 21 and 38 months respectively. In the nondialysis group (n = 11) only 1 patient subsequently required chronic dialysis 30 months after clinical admission. Renal failure was due to non-compliance with immunosuppressive therapy in at least 2 patients. Percentage of obsolescent glomeruli and the degree of tubulointerstitial lesions, but not active glomerular lesions (crescents, necroses) predicted renal outcome. The major cause of renal functional impairment was relapse of Wegener's granulomatosis usually within 2 years after clinical remission. Therefore prolonged treatment with cyclophosphamide for at least 2 years after clinical remission is recommended. Two patients with initially negative immunohistology had a second renal biopsy which revealed de novo appearance of mesangial IgA deposits.

  2. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  3. Blunt Renal Trauma in a Pre-Existing Renal Lesion

    Directory of Open Access Journals (Sweden)

    G.V. Soundra Pandyan

    2006-01-01

    Full Text Available A 70-year-old male presented with direct trauma to his loin with gross hematuria, as an isolated case of blunt renal trauma (BRT due to a traffic accident. A pre-existing renal lesion (PERL was strongly suspected by his past history of gross macroscopic hematuria and monotrauma to the kidney without other associated injuries. Spiral CT scan with contrast and a retrograde pyelogram (RGP confirmed an occult complex renal cyst. The gold standard of CT diagnosis in this situation is stressed. Computed tomography is particularly useful in evaluating traumatic injuries to kidneys with pre-existing abnormalities. The decision on the initial course of conservative management, ureteral retrograde stenting to drain extravasation, and its final outcome are discussed. Radical nephroureterectomy was carried out by a transperitoneal approach with an early vascular control of the renal pedicle. A brief review of recent literature has been undertaken.

  4. RENAL FUNCTION DERANGEMENT IN HELLP SYNDROME

    Directory of Open Access Journals (Sweden)

    Anusha Harihara Gopalan

    2017-04-01

    Full Text Available BACKGROUND HELLP is the acronym for haemolysis, elevated liver enzymes and low platelet count. HELLP syndrome is a form of severe preeclampsia with an incidence of 0.2-0.6% of all pregnancies. The aim of our study is to evaluate the trend of renal dysfunction in HELLP syndrome patients. MATERIALS AND METHODS This is a cross-sectional observational study conducted in Department of Obstetrics and Gynaecology, Institute of Maternal and Child Health, Government Medical College, Kozhikode, during the period of 12 months from January 2013 to December 2013. All patients with HELLP syndrome were included in the study and their renal function tests monitored. RESULTS Results were renal dysfunction prevalence in HELLP syndrome patients is 77%. The renal impairment recovered by 6 days on an average. All had normal renal function tests at the time of discharge. Patients with renal function derangement had a mean duration of hospital stay and transfusion requirements more than the patients without renal function derangement, which was statistically significant (p value 0.036. Haemodialysis required for one out of 60 patients. One maternal mortality due to acute renal failure. CONCLUSION As the prevalence of renal dysfunction is high, some amount of renal impairment maybe a part of the HELLP syndrome disease spectrum itself. Though the incidence of progression to acute renal failure and dialysis is less, this is the important cause of morbidity and mortality in HELLP syndrome patients.

  5. Urinary hemosiderin: role in evaluation of chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Ashish Lal Shrestha

    2012-08-01

    Full Text Available Chronic venous insufficiency (CVI leads to skin changes with dermal hemosiderin deposition. We studied the presence of hemosiderin in the urine to assess if this could be used as a biochemical marker for CVI. Hereby we present a case control study conducted in a tertiary care centre in South India. There were 100 cases with evidence of advanced CVI (the Clinical-Etiology-Anatomy-Pathophysiology classification: C5, C6 confirmed by duplex scanning. Controls were 50 patients with leg ulcers due to other etiologies. All patients were subjected to urinary hemosiderin testing. In all 100 patients with CVI (C5 and C6 disease axial venous reflux was confirmed by duplex ultrasound. Superficial venous reflux was noted in 71% of patients and deep venous reflux in 54.%. Primary venous insufficiency was the etiology in 81% of patients. Only 4/100 patients had detectable amounts of hemosiderin in the urine. Urine hemosiderin testing to determine presence or absence of CVI yielded the following values: positive predictive value-80%; negative predictive value-33%; sensitivity-4% and specificity-98%. The test could not be recommended as a marker of CVI. In Indian patients urinary hemosiderin is not a useful screening test in CVI.

  6. Adrenal insufficiency and adrenal replacement therapy. Current status in Spain.

    Science.gov (United States)

    Aulinas, Anna; Casanueva, Felipe; Goñi, Fernando; Monereo, Susana; Moreno, Basilio; Picó, Antonio; Puig-Domingo, Manel; Salvador, Javier; Tinahones, Francisco J; Webb, Susan M

    2013-03-01

    Adrenal insufficiency (AI) is a rare endocrine disease, associated to increased mortality if left untreated. It can be due to a primary failure of the adrenal glands (primary AI) or malfunctioning of the hypothalamic-pituitary-adrenal axis (HPA) (secondary AI). The lack of data on incidence/prevalence of adrenal insufficiency in Spain complicates any evaluation of the magnitude of the problem in our country. Initial symptoms are non-specific, so often there is a delay in diagnosis. Current therapy with available glucocorticoids is associated with decreased quality of life in patients with treated AI, as well as with increased mortality and morbidity, probably related to both over-treatment and lack of hydrocortisone, associated with non-physiological peaks and troughs of the drug over the 24 hours. The availability of a new drug with a modified dual release (immediate and retarded), that requires one only daily dose, improves and simplifies the treatment, increases compliance as well as quality of life, morbidity and possibly mortality. This revision deals with the knowledge on the situation both globally and in Spain, prior to the availability of this new drug.

  7. [Transcranial electrostimulation in chronic cerebral vascular insufficiency].

    Science.gov (United States)

    Voropaev, A A; Mochalov, A D

    2006-01-01

    The method of transcranial electrostimulation (TCES) has been used for treatment of 68 patients with chronic cerebral vascular insufficiency, stages I and II. A treatment course included 7 daily procedures. The influence of TCES was evaluated clinically, by EEG, transcranial ultrasonic Doppler study and hemodynamic indices in arteries and veins as well as by expression of trait and state anxiety. All the parameters were compared to those of the control group which was treated using conventional methods. TCES resulted in normalization of cerebral vascular reactivity, a decrease of venous circulation disturbances, positive influence on cerebral blood flow and EEG parameters, that corresponded to global improvement of the patients' state, regress of cephalgic syndrome and reduction of trait and state anxiety. The method is simple and safety and can be recommended for wide application including outpatient setting.

  8. Pregnancy in renal transplant recipients.

    Science.gov (United States)

    Fuchs, Karin M; Wu, Danny; Ebcioglu, Zeynep

    2007-12-01

    Women with renal disease face increasing infertility and high-risk pregnancy as they approach end-stage renal disease due to uremia. Renal transplantation has provided these patients the ability to return to a better quality of life, and for a number of women who are of child bearing age with renal disease, it has restored their fertility and provided the opportunity to have children. But, although fertility is restored, pregnancy in these women still harbors risk to the mother, graft, and fetus. Selected patients who have stable graft function can have successful pregnancies under the supervision of a multidisciplinary team involving maternal fetal medicine specialists and transplant nephrologists. Careful observation and management are required to optimize outcome for mother and fetus.

  9. Renale Osteopathie

    OpenAIRE

    Horn S

    2001-01-01

    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  10. Renale Knochenerkrankungen

    Directory of Open Access Journals (Sweden)

    Mayer G

    2008-01-01

    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  11. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  12. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  13. Emergency intervention therapy for renal vascular injury

    Institute of Scientific and Technical Information of China (English)

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; WANG Zhi-jun; DUAN Feng; SONG