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

A 63-year-old woman presented with progressive congestive heart failure and unexplained cardiomegaly. Diagnostic workup revealed large arteriovenous fistulae in the lower pole of the left kidney. A total left nephrectomy was performed and microscopic exam revealed renal cell carcinoma. Following surgery, the congestive heart failure cleared and the patient has been asymptomatic for one year. The pertinent findings of the 22 patients who have been reported previously in the literature with arteriovenous fistulae complicating renal cell carcinoma are reviewed. Thirty percent of the patients presented with cardiovascular complaints, and 60% had significant cardiovascular findings during the course of evaluation. An abdominal bruit was the most discriminating finding on physical exam, and it occurred in 72% of the reported cases. The diagnosis was unexpectedly established by surgery in 13%, and by angiography in 87% -- usually in the course of a workup for hypertension, abdominal pain, hematuria, or during search for an occult malignancy. An extensive evaluation is required for early diagnosis of this correctible cause of hypertension and heart failure.
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PMID:Arteriovenous fistulae secondary to renal cell carcinoma. Clinical and cardiovascular manifestations: report of a case. 12 58

The authors present a group of patients with renal carcinoma in whom there were paraneoplastic signs such as fever, liver failure, hypertension and polycythemia. They noted, moreover, the most important clinical aspects, evaluating the incidence of these signs in relation to the course and diagnosis. They discuss also the frequency of presentation of each of these paraneoplastic manifestations, commenting on the various theories which have been suggested to explain them.
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PMID:[Paraneoplastic syndromes in carcinoma of the kidney (author's transl)]. 21 99

1. A patient presented with mild hypertension, a raised plasma total renin concentration but a normal plasma angiotensin II concentration. The discrepancy was due to a high concentration of inactive renin in the plasma. 2. A renal carcinoma was detected and removed. The tumour contained a higher proportion of inactive renin than was found in uninvolved areas of the kidney. After unilateral nephrectomy, the plasma concentration of inactive renin fell to normal. 3. Six months later, plasma inactive renin concentration again increased and a metastasis was detected in a rib. Excision of the rib together with radiotherapy resulted in a fall in plasma inactive renin to normal. 4. The inactive renin in plasma and tumour extracts was activated to the same extent by acid treatment and by trypsin.
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PMID:A renal carcinoma secreting inactive renin. 28 45

Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included several ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.
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PMID:Renal autotransplantation: current perspectives. 33 29

31 patients with renovascular hypertension, calculous disease, short ureter or renal carcinoma (single kidney) were treated with renal autotransplantation, in 3 patients bilaterally. There were 2 deaths due to cardiac arrest and myocardial infarction. Secondary nephrectomy was performed in 2 patients, and thus 29 of 31 autotransplanted kidneys were salvaged.
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PMID:Preliminary experience with extracorporeal renal surgery and autotransplantation. 33 50

Arteriovenous fistulas commonly occur in cases of renal cell carcinoma, but they rarely produce sufficient left-to-right shunting to cause decompensation of the cardiovascular system. A case of refractory hypertension and congestive heart failure secondary to arteriovenous shunting in bilateral renal cell carcinoma is presented. Renal blood flow studies at the time of staged nephrectomy, together with measurements of cardiac output, established parenchymal arteriovenous shunting as the cause of the patient's cardiovascular symptoms. Subsequent nephrectomy achieved a marked clinical and symptomatic improvement. The causes, diagnosis, and treatment of arteriovenous fistulas are discussed. Although nephrectomy offers dramatic resolution of clinical symptoms, long-term survival depends on the behavior of the neoplasm.
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PMID:Renal arteriovenous fistulas secondary to bilateral renal cell carcinoma. 44 78

The observation of a non-metastatic reactive hepatopathy associated with a hypernephroma in a 39-year-old man who had had fever for 4 months led to a review of the literature and an analysis of basically three aspects of the disorder: a) The various manifestations of carcinoma of the kidney, which include a large number of paraneoplastic clinical symptoms (polycythemia, anemia, prolonged fever, hypercalcemia, hypertension, nefropathy, loss of salt, peripheral neuropathy, and amyloidosis); b) an alteracion of hepatic function known since 1961 which is characterized by an abnormal retention of sulfobromophthalein, increase of alkaline phosphatase, prothrombin decrease, dysproteinemia with hypoalbuminemia, and alpha2-globulin increase. It may or may not be accompanied by enlargement of the liver. c) Criteria of operability of the primary tumor.
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PMID:[Liver disease associated with hypernephroma. A case report (author's transl)]. 45 99

Of 276 patients who underwent evaluation to determine the cause of hypertension 2 were found to have unsuspected renal cell carcinoma. This prevalence of 0.73 per cent is 16 times higher than expected for an age-matched population. Both patients exhibited abnormalities of plasma renin activity before radical nephrectomy but they remained hypertensive postoperatively. The data suggest an unexplained association between hypertension and renal cell carcinoma. Furthermore, abnormalities on excretory urograms in hypertensive people should be defined by selective renal arteriography.
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PMID:Increased incidence of renal cell carcinoma with hypertension. 59 63

In the group of 111 patients treated for hypernephroma, 24 have shown in addition to their usual symptoms a more systolic an elevated blood pressure up to 22 mm Hg and higher. In two cases was hypertension the only symptom. In the hypertensive group, 20 patients underwent nephrectomy and blood pressure returned to normal in all but one. Four pathophysiologic mechanisms of blood pressure elevation in hypernephroma are discussed: (1) AV shunts; (2) Compression of the renal artery or its branches due to tumor expansion; (3) Polycythemia; (4) Hypernephroma with hormonal activity. The hypertension of 6 of our patients was due to AV shunts, of 7, to renal vessels compression, and of 6 others, to a polycythemia.
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PMID:[Hypernephroma as a cause of high blood pressure (author's transl)]. 63 20

Manifestations of xanthogranulomatous pyelonephritis in 26 patients closely mimicked those of neoplastic and other inflammatory renal parenchymal diseases. Middle-aged or older women were affected most often. Most patients presented with anemia, chronic febrile illness, a painful tender flank mass and recurrent urosepsis. Some features of nephrogenic hepatic dysfunction were present in 13 patients. Bacterial cultures of renal tissue were almost always positive but the spectrum differed considerably from that of the bladder urine. Urographically, a renal mass lesion was encountered in 62% of the patients, nephrolithiasis in 38% and a functionless kidney in 27%. Angiographically, none of the 4 mass lesions studied was distinguished from hypernephroma. Indeed, a correct preoperative diagnosis was made in only 1 instance. There were 3 stages of xanthogranulomatous pyelonephritis recognized. Treatment consisted of nephrectomy for diffuse or advanced stage disease or both (21 patients), excision of the diseased renal segment for localized and low stage disease (2 patients) and renal biopsy (3 patients). Xanthogranulomatous pyelonephritis did not recur but in some patients bacteriuria continued or hypertension developed.
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PMID:Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. 66 Jul 25


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