Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five patients with major (Grade IV) renal trauma required ureteral stent placement to facilitate urinary drainage. Three of these patients had stents placed for recurrent gross hematuria with flank pain. All three had obstructing blood clots present at the time of stent placement. The fourth patient had a stent placed because of persistent extravasation at 2 weeks postinjury. The last patient was considered at risk for persistent urinary extravasation because of a partial ureteropelvic junction obstruction and had a ureteral stent placed as part of the initial management. All patients were followed radiographically for resolution of extravasation. Long-term clinical follow-up consisted of serum creatinine evaluation and blood pressure monitoring. Urinary extravasation resolved in all five patients, as determined by radiologic evaluation, at a mean of 8 days after stent placement. Ureteral stents were left indwelling an average of 4 weeks. No patient developed hypertension, and all serum creatinine values were normal at a mean 26 months' follow-up. No patient developed urinoma or abscess, and none required open surgical exploration. Ureteral stents may be used safely and effectively to treat persistent or recurrent urinary extravasation resulting from major blunt renal trauma in appropriately selected patients. In addition, ureteral stents may avoid the need for surgical exploration in patients with Grade IV renal trauma who develop recurrent gross hematuria, flank pain, and persistent or recurrent extravasation secondary to clot obstruction.
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PMID:Use of ureteral stents in the management of major renal trauma with urinary extravasation: is there a role? 989 60

Here we present an 83-year-old woman who was referred to our hospital and had had left flank pain and oligouria for 3 days. Plain abdominal film and ultrasonography revealed left ureteropelvic junction stone with obstructive uropathy. The serum level of creatinine fell to 3.1 mg/dl from 7.6 mg/dl after ureteral catheter drainage was given 5 days after admission. Then a left pyelolithotomy was performed and a tumor of 2 x 1 x 1 cm over the lower pole of the left kidney was found incidentally. Partial nephrectomy was performed in consideration of her age and poor renal function although the biopsy result showed it to be carcinoma. The final pathological report and immunohistochemical study results proved that it was neuroendocrine carcinoma. To our knowledge, this is the first case of primary renal neuroendocrine carcinoma to be treated using conservative surgery. The clinical course was acceptable, since she had been found to be free of disease during regular follow-up of 2.5 years with the creatinine level of about 2.5 mg/dl.
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PMID:Partial nephrectomy for incidental primary renal neuroendocrine carcinoma: case report. 1049 35

The aim of this study was to evaluate the effectiveness of ureteral stent placement in diagnosing ureteropelvic junction (UPJ) obstruction in patients with negative or equivocal radiographic/nuclear studies and to assess relief of symptoms following definitive surgical procedures to relieve the obstruction. Patients undergoing ureteral stent placements performed by two attending urologists over an 18-month period were reviewed. All patients with equivocal or negative radiographic evaluations for ureteral obstruction in whom the stent was placed for diagnostic purposes were selected. Preoperative and postoperative information was obtained from the medical record or by telephone interview. Five patients were found who had equivocal radiographic studies along with symptoms of flank pain and who underwent diagnostic stent placement. All patients were female (average age 40 years, range 20-52). All had pain relief following stent placement and, on this basis, underwent an operative procedure to remove the presumed ureteral obstruction. Three underwent Acucise endopyelotomy, one had laparoscopic resection of the right ovarian vein, and one underwent nephrectomy. The average preoperative creatinine level was 0.9 mg/dL (range 0.8-1.0), and the average postoperative creatinine level was 1.0 mg/dL (range 0.9-1.1). All patients had relief of flank pain at a mean of 17 months following the surgical procedure. Relief of pain following stent placement in patients with clinical suspicion of ureteral obstruction portends a favorable outcome from procedures to relieve the presumed obstruction. In unusual cases where ureteral obstruction is suspected despite negative or equivocal radiographic findings, diagnostic stent placement appears to be useful.
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PMID:Stent placement for the diagnosis of upper tract obstruction. 1059 Dec 60

We report a case of bilateral renal infarction in a patient with medial fibrous dysplasia of both renal arteries and a thrombosed aneurysmal dilatation of the right renal artery. A previously healthy 40-year-old black man presented to the emergency department with acute onset of bilateral flank pain. Computerized tomography of the abdomen showed bilateral renal infarction, predominantly affecting the anterior distribution of both renal arteries. Estimated loss of renal mass was 50% on the right and 25% on the left. The patient was treated with intravenous heparin, oral warfarin, and antihypertensive therapy with labetolol and long-acting nifedipine. By day 3, his abdominal pain resolved; however, the serum creatinine level increased to a maximum value of 2.6 mg/dL. The serum creatinine level slowly improved and stabilized at 1.9 mg/dL, and he was subsequently discharged on the seventh hospital day. Magnetic resonance angiography performed 2 months later showed "beading2 of both renal arteries consistent with medial fibromuscular dysplasia, a finding confirmed by conventional angiography. To our knowledge, bilateral renal infarction complicating medial fibrous dysplasia of the renal arteries has not been previously reported, nor has medial fibrous dysplasia been reported in blacks.
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PMID:Bilateral renal infarction in a black man with medial fibromuscular dysplasia. 1087 89

The extensive use of selective histamine H2 receptor antagonists provides a unique opportunity to describe very rare adverse drug reactions. Although mild elevation of serum creatinine level following the administration of cimetidine is relatively common, acute interstitial nephritis (AIN) is a rare hypersensitivity reaction. There have been 25 published reports of AIN associated with H2 antagonist therapy and we also identified 16 cases from the Australian Adverse Drug Reaction Advisory Committee (ADRAC) database. AIN was reported most commonly following cimetidine administration. AIN was supported by renal biopsy in 28 patients and by rechallenge in 6. H2 antagonist-induced AIN was more commonly reported in men older than 50 years. In the majority of cases the onset was within 2 weeks of initiation of therapy (1 day to 11 months). The clinical manifestations were nonspecific including sterile pyuria, elevated erythrocyte sedimentation rate, fatigue, proteinuria and leucocytosis whereas rash, arthralgia and flank pain were rarely reported. There were 170 cases of hepatotoxicity following H2 antagonist administration reported to ADRAC. These were more common following ranitidine and included cholestatic, hepatocellular and mixed reactions. Hepatotoxicity was proven following liver biopsy in several cases published in the literature and in 15 cases reported to ADRAC. Hepatotoxicity recurred upon rechallenge in 6 cases. Generally, renal and hepatic adverse effects resolved quickly after cessation of H2 antagonist therapy and did not require specific treatment. Nephrotoxicity and hepatotoxicity following administration of an H2 antagonist is rare and a high index of suspicion is necessary for early detection. Now that many H2 antagonists are available over the counter, awareness of these conditions and early detection with cessation of H2 antagonist therapy would appear paramount.
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PMID:Nephrotoxicity and hepatotoxicity of histamine H2 receptor antagonists. 1121 86

This case report describes a 32-year-old woman treated with indinavir who developed mild to moderate flank pain, malaise, and low-grade fever. Sterile pyuria preceded increased serum creatinine levels. Workup revealed persistent pyuria, normal-sized kidneys, a normal intravenous pyelography, and negative urinary cultures. Renal biopsy showed interstitial nephritis and chronic inflammation. Collecting ducts contained crystals. Two months after treatment with indinavir was discontinued, serum creatinine levels returned to normal and pyuria disappeared. Sterile pyuria in patients taking indinavir may help to identify patients at risk for renal dysfunction and interstitial nephritis. Markedly increasing the fluid intake above the recommended dosage may ameliorate or even reverse the process of tubulointerstitial disease.
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PMID:Persistent flank pain, low-grade fever, and malaise in a woman treated with indinavir. 1136 24

Indinavir is a well-known cause of crystal-induced acute renal failure, dysuria and flank pain, and nephrolithiasis. Recently a more insidious tubulointerstitial lesion has been recognized as secondary to the drug. We report a case of a hepatitis C-positive patient on long-term indinavir therapy for human immunodeficiency virus (HIV) who developed a slowly progressive rise in serum creatinine. Renal biopsy revealed a diffuse interstitial infiltrate with numerous eosinophils and scarring. The tubules showed focal necrosis and dilation with elongated crystals present within their lumina. The elevated serum creatinine decreased to a new baseline over several months with the discontinuation of indinavir. We review the literature of renal syndromes associated with indinavir focusing on chronic progressive tubulointerstitial injury and speculate on risk factors and potential mechanisms of indinavir-induced renal injury.
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PMID:Indinavir nephropathy revisited: a pattern of insidious renal failure with identifiable risk factors. 1157 10

We conducted a phase I-II study of the safety, tolerance, and plasma pharmacokinetics of liposomal amphotericin B (L-AMB; AmBisome) in order to determine its maximally tolerated dosage (MTD) in patients with infections due to Aspergillus spp. and other filamentous fungi. Dosage cohorts consisted of 7.5, 10.0, 12.5, and 15.0 mg/kg of body weight/day; a total of 44 patients were enrolled, of which 21 had a proven or probable infection (13 aspergillosis, 5 zygomycosis, 3 fusariosis). The MTD of L-AMB was at least 15 mg/kg/day. Infusion-related reactions of fever occurred in 8 (19%) and chills and/or rigors occurred in 5 (12%) of 43 patients. Three patients developed a syndrome of substernal chest tightness, dyspnea, and flank pain, which was relieved by diphenhydramine. Serum creatinine increased two times above baseline in 32% of the patients, but this was not dose related. Hepatotoxicity developed in one patient. Steady-state plasma pharmacokinetics were achieved by day 7. The maximum concentration of drug in plasma (C(max)) of L-AMB in the dosage cohorts of 7.5, 10.0, 12.5, and 15.0 mg/kg/day changed to 76, 120, 116, and 105 microg/ml, respectively, and the mean area under the concentration-time curve at 24 h (AUC(24)) changed to 692, 1,062, 860, and 554 microg x h/ml, respectively, while mean CL changed to 23, 18, 16, and 25 ml/h/kg, respectively. These data indicate that L-AMB follows dose-related changes in disposition processing (e.g., clearance) at dosages of >or=7.5 mg/kg/day. Because several extremely ill patients had early death, success was determined for both the modified intent-to-treat and evaluable (7 days of therapy) populations. Response rates (defined as complete response and partial response) were similar for proven and probable infections. Response and stabilization, respectively, were achieved in 36 and 16% of the patients in the modified intent-to-treat population (n = 43) and in 52 and 13% of the patients in the 7-day evaluable population (n = 31). These findings indicate that L-AMB at dosages as high as 15 mg/kg/day follows nonlinear saturation-like kinetics, is well tolerated, and can provide effective therapy for aspergillosis and other filamentous fungal infections.
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PMID:Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. 1170 29

Renal function is usually normal or only marginally affected in patients with unilateral ureteral obstruction due to the vicarious function of the contralateral kidney. Few reports exist in which unilateral renal obstruction is associated with anuria (reflex anuria, RA) and acute renal failure. We report the clinical case of a female patient who was referred to the emergency department due to anuria of 72 h duration and acute renal failure (serum creatinine 9 mg/dl) associated with several episodes of violent right flank pain with hematuria following extracorporeal shock wave lithotripsy (ESWL). A few weeks before ESWL, urography showed a 2-cm stone located in the right pelvis whilst the left kidney was functionally normal. On admission, renal ultrasound documented a normal left kidney, whilst the right pelvis was hydronephrotic and there were two indwelling stones at the right pyeloureteral junction. After the patient passed a urinary stone, diuresis restarted and acute renal failure was resolved. Thereafter, urography confirmed that the left kidney, the left ureter and bladder were functionally and morphologically normal. RA with acute renal failure has been so scarcely documented that it is considered to be legend by many clinicians. Major textbooks do not discuss RA with acute renal failure. Vascular or ureteral spasm related in part to a peculiar hyperexcitability of the autonomic nervous system may explain RA. We suggest that nephrologists should always consider RA when evaluating acute renal failure. On the other hand, RA might be relatively common and we cannot rule out that only the most severe and/or better-documented cases have been reported in the medical literature.
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PMID:Reflex anuria from unilateral ureteral obstruction. 1186 59

Clinical presentation of unilateral renal cystic disease (URCD) is characterized by multiple simple cysts in only 1 kidney. Involvement of other intra-abdominal organs is not found. Renal function is usually preserved despite the existence of multiple cysts. No genetic background can be delineated up to the present. We present 1 patient with URCD, who was evaluated for his right flank pain. Urinalysis and biochemical tests showed normal renal function (BUN 5.03 mmol/l, creatinine 110.5 micromol/l). Ultrasonographic examination was done and it revealed 2 right renal stones. Furthermore, multiple renal cysts over the juxta-medullary area were noted. His left kidney was intact. Computed tomography (CT) of both kidneys confirmed this finding. 99mTc-DTPA renal scan showed that the glomerular filtration rate of both kidneys was not significantly different. There was no family history of renal diseases. His parents, grandparents and siblings were examined for possible kidney lesions, but none of them had any renal cystic lesion. This patient was followed for only a relatively short period of time (3 years) and his renal function did not deteriorate. Follow-up image studies with sonography and CT were not different from the previous ones.
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PMID:Unilateral renal cystic disease--report of one case and review of literature. 1200 50


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