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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a patient suffering from obstructive cardiomyopathy (IHSS), the onset of septicaemia due to staphylococus aureus was accompanied: 1. by the appearance of massive mitral incompetence and of cardiac failure; 2. by a marked reduction in the left intra-ventricular pressure gradient; 3. by acute reversible renal failure (interstitial nephritis); 4. by a glomerulonephritis with immune complexes deposits. After the septicaemia had been treated, replacement of the mitral valve by a disc prosthesis of Lillehei was carried out. Twenty months after the operation, the patient was completely asymptomatic, and catheterisation showed that the left intra-venticular pressure gradient had disappeared, as had the haemodynamic signs of cardiac failure.
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PMID:[Endocarditis due to staphylococcus aureus during cardiomyopathy]. 41 81

Two children with congenital fibroelastosis and recurrent episodes of heart failure had overt proteinuria and hematuria; one also had a reversible nephrotic syndrome. Urinary manifestations persisted during periods of cardiac compensation. Renal biopsies revealed mesangial hyperplasia by light microscopy, identical ultrastructural lesions in the glomerular basement membrane, and deposits of fibrin in one of the biopsy specimens studied by immunofluorscence. These changes detected by electron microscopy may result in an increase in glomerular permeability independent of the renal hemodynamic disturbances associated with cardiac insufficiency. The progression of the lesions appears to be slow, although urinary manifestations may simulate an intercurrent glomerulonephritis. Pulmonary hypertension and renal venous stasis with glomerular intravascular coagulation were discussed as possible pathogenic mechanisms.
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PMID:Glomerular lesions in congenital endocardial fibroelastosis: clinical manifestations and ultrastructural studies in two patients. 58 Aug 81

A 65 year old man developed endocarditis and septicemia due to Hemophilus aphrophilus, a Gram-negative coccobacillus. Renal rather than cardiac failure was the principal feature of his illness and renal biopsy was compatible with glomerulonephritis secondary to septicemia. Rapid recovery of renal function and improvement of the glomerular lesion followed antibiotic treatment of the septicemia. This case illustrates the renal damage that can occur in association with septicemia due to rarer infectious agents. As with more common organisms, specific antimicrobial therapy leads to rapid improvement of the nephropathy.
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PMID:Glomerulonephritis associated with Hemophilus aphrophilus endocarditis. 63 69

A series of cases is presented which illustrates unusual aspects in the presentation, diagnosis, and management of renal cell carcinoma. The entire "classic triad" of flank pain, gross hematuria, and palpable mass was not present at the time of diagnosis in any of the patients. Moreover, in only three patients did the initial clinical findings raise the suspicion of renal cell carcinoma. A diagnosis of polycystic kidney disease, cardiac failure, glomerulonephritis, analgesic abuse, and perirenal hemorrhage obscured the primary diagnosis in the other five patients. In four patients the tumor was probably present from 3 to 12 years before detection. These findings emphasize that knowledge of the hematologic, humoral, immunologic and vascular abnormalities induced by this tumor may provide a clue to early diagnosis. The systematic use of excretion urography, nephrotomography, ultrasonography, renal scanning, renal arteriography and cyst puncture then may allow the accuracy of radiologic diagnosis of this tumor to approach 100%. Lastly, the therapy of choice for this tumor is radical nephrectomy. Excision of apparently solitary metastases also may sometimes be feasible. However, partial nephrectomy to remove tumor in a solitary kidney was performed in one patient to avoid the need for end-stage kidney treatment. Where nephrectomy renders the patient anephric, chronic hemodialysis and renal transplantation should be considered as potential measures to sustain life. While hormonal agents, chemotherapy, and radiation therapy sometimes provide palliation, their use generally has been disappointing.
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PMID:Renal cell carcinoma: unusual systemic manifestations. 78 64

In order to evaluate the effects of acute glomerulonephritis on the circulation, 6 patients were investigated at rest and during moderate exercise. With the patients in a state of rest the cardiac index and the stroke volume index were significantly higher in acute glomerulonephritis than normal, despite significantly raised right and left atrial pressures. Oxygen consumption was significantly increased (P less than 0.01) and the arteriovenous oxygen difference was narrowed significantly (P less than 0.001) in acute glomerulonephritis as compared to normal subjects. The calculated increase in cardiac output was due to both a rise in oxygen consumption and a narrowing of arteriovenous oxygen difference, the latter being more significant. The exercise-induced changes in cardiac output in the patients with glomerulonephritis were not different from those in normal subjects. These results showed that the circulatory changes in the oliguric stage of acute glomerulonephritis resemble those in the hyperkinetic states; the raised mean right atrial and pulmonary wedge pressures do not indicate the presence of heart failure when resting cardiac output is above normal level and response to exercise is normal.
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PMID:Circulatory changes in acute glomerulonephritis at rest and during exercise. 119 44

A 34-year-old woman died of left-heart failure due to combinated aortic-valve disease three years after manifestation of Cogan's syndrome characterized by sudden inner-ear deafness, loss of equilibrium, interstitial keratitis, and progressive loss of vision during pregnancy. At necropsy there was evidence of recurrent endocarditis of the aortic valves with stenosis and regurgitation, severe angitis of the thoracic aorta with marked secondary sclerosing changes as the cause of the heart failure. Angitis within the optical fasciculus and stato-acoustic nerve was the cause of the vestibular and optical defects. Primary changes in the visual and auditory cortices, the retina and inner ear were excluded as causes. There was also acute membrano-proliferative glomerulonephritis, which may have been coincidental.
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PMID:[Cogan's syndrome with angitis of cranial nerves, aortitis, endocarditis, and glomerulonephritis (author's transl)]. 124 75

A 68-year-old man presented with renal failure, heart failure, gastrointestinal bleeding, and a pulmonary infiltrate. Serologic evaluation revealed a perinuclear antineutrophil cytoplasmic antibody (ANCA) at a titer of 1:1280, which on immunoblot and enzyme immunoassay showed antimyeloperoxidase specificity. Autopsy showed microscopic polyarteritis based on the presence of necrotizing alveolitis and crescentic glomerulonephritis. The extent and activity of the glomerular disease was modified by a right renal artery stenosis (RAS). Twenty percent of glomeruli on the right and 82% glomeruli on the left contained crescentic lesions. Furthermore, predominantly active lesions were associated with renal artery stenosis, while the contralateral kidney contained mostly organized crescents. This observation suggests that hemodynamic factors or its sequelae can influence the onset and severity of ANCA-associated disease.
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PMID:Renal artery stenosis modifies glomerular injury in antineutrophil cytoplasmic antibody-associated disease. 135 84

Four years after an HIV infection and without any preceding illness characteristic of AIDS, a 24-year-old woman developed dyspnoea on exertion and peripheral oedema. She had for several years been an intravenous drug addict and contracted hepatitis A and B. There were no symptoms of the HIV infection. Clinical, radiological and echocardiographic examination demonstrated right ventricular failure caused by pulmonary hypertension not due to pulmonary embolism or another known aetiology. The patient died suddenly 9 months after the diagnosis from heart failure. Autopsy established primary pulmonary hypertension with pathognomonic plexogenic pulmonary arterial disease which had led to cor pulmonale with overload myocarditis. Although there had been no clinical signs of renal failure, there was histological evidence of mesangioproliferative glomerulonephritis and non-destructive interstitial nephritis. This case demonstrates that, in addition to the typical AIDS-associated diseases, other rarer syndromes may, in uncertain ways but connected with the HIV infection, decide the prognosis of such patients.
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PMID:[Primary pulmonary hypertension and mesangioproliferative glomerulonephritis in HIV infection]. 158 15

An analysis of 4 cases of the thrombotic thrombocytopenia in children of 4 to 10 years of age is performed. The disease was characterized by fever, purpura, headache and abdominal pains, arterial hypertension, microangiopathic haemolytic anemia, thrombocytopenia, increase of blood urea and serum creatinine, micro-haematuria and proteinuria. The duration of the disease was from 4 days to 7 months. Anuria, gangrene of the ears, scrotum, penis and soft tissues of legs and feet were registered in a 5-year-old patient with a fulminant disease. The cause of death of other patients was heart failure with acute lung oedema, brain haemorrhages and haemorrhagic pancreonecrosis. The diagnosis of the thrombotic thrombocytopenia was confirmed by the finding in the autopsy material of thrombotic microangiopathy of small arteries, veins, arterioles, venules and capillaries in kidneys and other organs and tissues. Kidney damage in fulminant disease is complicated by segmentary cortical necrosis, in a more prolonged disease--by glomerulosclerosis or mesangio-capillary glomerulonephritis.
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PMID:[Thrombotic thrombocytopenic purpura in children]. 180 69

There have been only a few investigations that have considered renal disease or any disturbance of renal function in the calculation of risk in cardiac surgery. Risks of cardiac surgery have to be considered for renal disease without direct connection to heart disease (e.g., infections of the kidney and of the urinary tract, primary and secondary glomerulonephritis, parenchymal renal disease, and impaired renal function of unknown origin), as well as in renal disease with concomitant influence on heart and kidney (e.g., infective endocarditis, arterial hypertension, systemic disease of heart and kidney such as with diabetes mellitus, disturbance of kidney function or electrolyte balance due to heart failure). In most cases, the problem is solved by therapeutic intervention and postponement of cardiac surgery. A limited or negative operative indication is found with untreatable infection of the kidney or urinary tract, with untreatable nephrotic syndrome, in advanced renal disease with heart transplantation, as well as in case of severe arterial hypertension with possible organ complications, and in advanced diabetes mellitus with ESRD and multiorgan involvement. After cardiac surgery, acute renal failure represents a critically important complication. Primary therapeutic procedures must include prophylaxis of hemodynamic unstable situations, as well as prophylaxis of infectious complications. Cardiac surgery in dialysis patients and post-transplant patients is basically possible and only has a slightly increased risk compared to patients with normal renal function. Seventy-seven dialysis patients were operated (49 aorto-coronary bypass operations, 19 single-valve and multiple-valve replacements, five patients with valve replacement and aorto-coronary bypass, and four other cardiac surgical operations). Only in valve replacement, was mortality significantly higher than in renal healthy persons, the main causes of death being cerebrovascular complications and septicemia.
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PMID:[Extracardiac risk factors in heart surgery--the kidney]. 208 10


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