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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report on a patient with renal artery stenosis who had only 1 kidney and in whom acute renal impairment developed with transient anuria after the administration of captopril. Although inhibition of the angiotensin-converting enzyme is considered to be efficient treatment for hypertension associated with chronic renal failure, care should be taken when captopril is administered initially to a patient with decreased renal function, under the conditions of sodium and water depletion. The renovascular hypertension in this patient was treated successfully by renal autotransplantation.
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PMID:Transient anuria following administration of angiotensin I-converting enzyme inhibitor (SQ 14225) in a patient with renal artery stenosis of the solitary kidney successfully treated with renal autotransplantation. 703 91

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.
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PMID:Successful surgical treatment of anuria caused by renal artery occlusion. 705 45

After an upper respiratory tract infection an eight months old infant developed a severe hemolytic uremic syndrome with anemia, thrombocytopenia and anuria. Remarkable was a lesion of the erythrocytes by neuraminidase producing microorganisms. By early hemodialysis, blood transfusions and accurate fluid therapy the acute stage could be managed. The proceeding course was complicated by hypertension, seizures, coma, abdominal pain attacks and a fibrinous hemorrhagic pericarditis, which made an incomplete pericardectomy necessary. Although it came again to diuresis a severe chronic renal failure with its concluding effects as anemia, acidosis, hypertension and inanition resulted. After a four months period the patient died of biventricular congestive heart failure.
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PMID:[Severe course of a hemolytic-uremic syndrome]. 715 51

A 48-year-old woman with generalised atheromatous disease had a right nephrectomy for a renal artery occlusion in 1977. Fourteen months later she presented with severe hypertension and anuria, caused by occlusion of the left renal artery. Emergency reconstructive surgery was successful in bringing about recovery of renal function and lowering of her blood pressure. Because renal function had deteriorated slightly after the first operation and improved after the second, a comparison was made of the effects of unilateral nephrectomy and reconstructive surgery on renal function in a further 26 patients with renal artery stenosis. In 15 patients having nephrectomy, renal function deteriorated in most, while in 11 having reconstruction it improved in nine and remained constant in two.
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PMID:Recovery of renal function after renovascular surgery. 726 85

Five patients had anuric renal failure caused by occlusion of the main renal arteries. All had a background of controlled hypertension, but in three patients, hypertension accelerated in the months before anuria. Extensive atherosclerotic disease was clinically evident in the peripheral (3/5), coronary (4/5), and cerebral (1/5) vessels. Identifiable precipitating events preceded the development of anuria in four patients. Although the use of renal ultrasonogram and scintiscan was suggestive, angiography was essential to establish the diagnosis after a brief period of maintenance hemodialysis. Renal artery revascularization performed as long as 38 days after the onset of anuria resulted in restoration of kidney function.
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PMID:Restoration of renal function after bilateral renal artery occlusion. 730 72

The long-term clinical course of 11 adults with hemolytic-uremic syndrome (HUS) is reported. All patients were treated with heparin and antiplatelet drugs, and ten required dialysis. One patient died after 38 days; the others recovered from anuria after seven to 400 days. One patient was resubmitted to regular dialysis five years later, and another died because of cerebral hemorrhage. Among the remaining eight patients, four show renal failure and four have normal renal function after one to ten years of observation. All but three require vigorous antihypertensive therapy. It is concluded that in adults with HUS (1) recovery may occur even after a prolonged anuria; (2) severe hypertension and progressive renal failure may appear later in apparently recovered patients; and (3) heparin and antiplatelet drugs seem to be beneficial in reversing acute renal failure.
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PMID:Hemolytic uremic syndrome in adults. 736 54

Angiotensin converting enzyme (ACE) inhibitors are extensively used for the treatment of hypertension, to decrease proteinuria, and to mitigate hyperfiltration. These drugs now have been shown to be fetotoxic causing profound fetal hypotension, renal tubular dysplasia, anuria-oligohydramnios, growth restriction, hypocalvaria, and death when used in the second and third trimesters of pregnancy. We recommend that ACE inhibitors not be used in pregnancy. However, if a child is born with ACE inhibitor fetopathy, aggressive therapy with dialysis to remove the inhibitor may mitigate the profound hypotensive effects. Therapy will depend on the specific ACE inhibitor, and care recommendations cannot be generalized for the entire class of drugs as their protein binding and volume of distribution differ substantially.
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PMID:Recognition and management of angiotensin converting enzyme inhibitor fetopathy. 763 38

The maternal mortality rate associated with eclampsia ranges from 100 to 6000 per 100,000, and the perinatal mortality rate ranges from 150 to 400 per 1000. Both eclampsia and its preceding condition, pregnancy-induced hypertension, occur in varying degrees in different parts of India. The warning signs of imminent eclampsia are 1) systolic blood pressure of 160 mmHg or more on two occasions six hours apart when the patient is on bed rest; 2) proteinuria of 5 g or more in 24 hours or 3 + or more by semiquantitative assay; 3) oliguria or anuria; 4) cerebral or visual disturbances; 5) pulmonary edema or cyanosis; and 6) epigastric/right hypochondriac pain, impaired liver function, and thrombocytopenia and coagulation disorders. Eclampsia is classified as the acute fulminating type, which can occur without warning, and the insidious type. Most cases (61%) show onset of eclampsia during the prenatal period. Treatment of eclampsia involves 1) control of convulsions (through an injection of magnesium sulphate or diazepam or the intravenous administration of phenytoin); 2) correction of hypoxia and acidosis; 3) a gradual lowering of blood pressure with hydralazine hydrochloride, nifedipine, atenolol, labetalol, oxprenolol, or metoprolol); and 4) steps to effect delivery. Diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) requires a complete blood count, blood film for platelet count and red blood cell fragmentation, and a coagulation screen for diagnosis of disseminated intravascular coagulation. Efforts to induce delivery in cases of prenatal eclampsia can take place 12-24 hours after convulsions have stopped. There is no reason to prolong pregnancy in the interests of the fetus, and in some cases Cesarean section may be required. Adequate prenatal care should allow the identification of almost every potential case of eclampsia and allow the prompt treatment of pre-eclampsia or termination of pregnancy when necessary. Medical staff must receive proper training to diagnose pre-eclampsia and treat the condition.
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PMID:Eclampsia. 765 39

We present a pregnant patient with a transplanted kidney experiencing chronic rejection, with chronic kidney failure and arterial hypertension. During the third trimester the patient's kidney function deteriorated somewhat and hypertension worsened. In the thirty-second week of pregnancy uterine activity increased, fetal movement decreased and oliguria progressed rapidly to anuria, leading to an emergency cesarean section. Surgery was performed under epidural anesthesia; after removal of the fetus diuresis immediately began and was maintained. Both mother and infant recovered, but after three months the patient entered a hemodialysis program due to terminal kidney failure. The risk of acute kidney failure is greater in the parturient who has been the recipient of a transplanted kidney because of the functional overload that pregnancy involves, the possible exacerbation of acute or chronic rejection, and the higher incidence of pyelonephritis and preeclampsia. The extraperitoneal location of the transplanted organ in the iliac fossa may cause obstructive anuria. Our patient's recovery of diuresis immediately after removal of the fetus suggests that the excretory channel coming from the kidney was compressed by the uterus.
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PMID:[Anuria in the third trimester of pregnancy in a patient with renal transplant]. 778 90

Thirty-one children with diarrhea-associated hemolytic uremic syndrome were retrospectively studied to determine if expression of the P1 blood type was related to the severity of the acute illness or to the prognosis. No differences were found in the clinical variables studied in the patients who were P1 positive compared to the patients who were P1 negative. The clinical variables studied included the age, hemoglobin, white blood cell count (WBC), and presence of central nervous system involvement at presentation, the duration of elevated WBC, thrombocytopenia, hemorrhagic colitis, and anuria, and the follow-up incidence of proteinuria, hypertension and decreased GFR. Expression of the P1 phenotype does not appear to exert a protective influence in patients with D+ HUS.
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PMID:The P1 blood group and the severity of diarrhea-associated hemolytic uremic syndrome. 785 Oct 28


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