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

Glomerulocystic kidney characterized by dilatation of Bowman's space occurs primarily in infants and children. We treated a normally developed 29-year-old Japanese man for hypertension and renal failure, who had been well up to 6 months before admission. Extrarenal malformations were not determined. A biopsy of both kidneys was done at the time of interdialysis, and the histology revealed diffuse glomerular cystic lesions. Electron-dense deposits were also observed in the mesangial area. Radiological studies of the kidneys showed numerous minute cysts in the cortical area, a normal architecture of the arterial trees, and negative evidence of urinary tract obstruction. This may be the first documentation of glomerulocystic kidney in an adult, without extrarenal anomalies.
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PMID:Glomerulocystic kidneys. Report of an adult case. 373 41

Review of a large renal transplant experience revealed a 17.3% incidence of posttransplant erythrocytosis. The influence of kidney source, pretransplant hematocrit, duration of pretransplant dialysis, renal transplant function, acute rejection, transplant renal artery stenosis, urinary tract obstruction, smoking, diabetes, retention of native kidneys, splenectomy, parathyroidectomy, immunosuppression, hypertension, and liver enzyme abnormalities on the development of erythrocytosis in 53 recipients was determined. Comparison was made with 49 control recipients matched for kidney function, time after grafting, age, and sex. Erythrocytosis occurred 3 to 90 months after transplantation and persisted for 1 to over 84 months. Risk factors for the development of erythrocytosis were smoking, diabetes, and a rejection free course. In contradistinction to previous smaller series, erythrocytosis occurred in patients with good renal function (serum creatinine 1.62 +/- 0.43 mg/dl) without prominence of graft rejection, transplant artery stenosis or obstruction. Despite therapeutic phlebotomy, 11 thromboembolic events occurred in 10 of the 53 patients with erythrocytosis, but in none of the controls (P less than 0.001). The high incidence of erythrocytosis following renal transplantation and the risk of associated thromboembolic events should encourage awareness and controlled evaluation of therapeutic modalities.
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PMID:Postrenal transplant erythrocytosis: a review of 53 patients. 634 69

Chronic renal infection (Chronic bacterial pyelonephritis) is a cause of tubulo-interstitial nephropathy (nephritis); TIN. The disorder causes end-stage renal failure in about 2% of the patients who are treated by dialysis. However, Chronic bacterial pyelonephritis is a relatively benign condition that seldom leads to renal function loss. The affected kidney shows non-specific histological pictures similar to that seen with other diseases producing TIN. Clinical symptoms are of ten vague. Obstructive uropathy (eg, stones, benign prostatic hyperplasia) is frequently present. The affected kidney, which is almost unilateral, shows atrophy and scarring of variable degree. Significant pyuria and bacteriuria may or may not be found. Depending on the stage of the disease, the serum creatinine and blood urea nitrogen may be normal or elevated. Contributing obstructive uropathy should be corrected. The patients must be followed closely, urinary tract infection must be controlled and complications (eg, hypertension, azotemia) must be identified promptly and treated adequately.
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PMID:[Interstitial nephropathy due to chronic bacterial pyelonephritis]. 756 35

This review will address five selected conditions associated with variable degrees of renal insufficiency or renal failure. Early diagnosis, usually possible in the office setting, should encourage early treatment and/or referral that will be rewarded by substantial improvement or return of normal renal function. Hypertensive nephrosclerosis, particularly among black Americans, is now the second leading cause of end stage disease (ESRD) in the United States. Aggressive treatment of hypertension can prevent progression to renal failure. Obstructive uropathy is relatively common at all ages; if not corrected, it can progress insidiously, often without symptoms, to destruction of a kidney. Glomerulonephritis may involve the kidneys primarily or in association with a multisystem disorder. Early renal biopsy will help establish the pathologic diagnosis and guide subsequent therapy. The kidney is vulnerable to the nephrotoxic effects of numerous pharmacologic agents used commonly in the diagnosis and treatment of illness. Potential nephrotoxicity to a given class of agents must be recognized if progressive nephrotoxicity is to be avoided. Finally, the frequency of occlusive renovascular disease and ischemic nephropathy is on the rise as the US population increases in age. Several interventions are available for the treatment of ischemic nephropathy and for the prevention of ESRD associated with bilateral renal artery occlusion.
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PMID:Recognition and management of reversible renal failure. 793 14

We examined the involvement of the renin-angiotensin system in the maintenance of hypertension of the rat with congenital hydronephrosis having no urinary tract obstruction. The congenital hydronephrosis rat (HNR) had a significantly higher systolic blood pressure (181 +/- 9.5 mm Hg in the male bilateral hydronephrosis rat, BHN, at 13 weeks of age, n = 10) than control Wistar-Imamichi rats (126 +/- 5.8 mm Hg). The plasma renin activity and plasma angiotensin-II concentration of BHN were decreased to 20.1 and 24.6% of those of control rats, respectively. There was a negative correlation between plasma angiotensin-II concentration and blood pressure. In addition, the effect of captopril and indomethacin on the high blood pressure of BHNs was similar to that of human low-renin essential hypertension. These findings suggest that the renin-angiotensin system activity was markedly lowered and that the involvement of the system in the maintenance of hypertension in HNRs is small.
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PMID:Hypertension and the renin-angiotensin system in the congenital hydronephrosis rat with non-obstructive pelviureteric junction abnormalities. 878 2

Renal cystic disease, ranging from simple cysts to autosomal dominant polycystic kidney disease (ADPKD), can lead to significant complications such as pain, hypertension, infection, upper urinary tract obstruction, and even renal failure. For patients with preserved renal function, laparoscopic ablation of renal cysts is a recent, though safe and effective alternative to open surgery in patients who have failed conservative measures. Likewise, for symptomatic patients with renal failure, laparoscopic nephrectomy offers a less invasive option to open nephrectomy. Both laparoscopic cyst decortication and laparoscopic nephrectomy offer patients the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay, and rapid convalescence while offering a short-term outcome equivalent to open surgery. Further study and follow-up are indicated to assess the long-term effect of these procedures on the outcome of ADPKD with regard to durability of pain relief, preservation of renal function, and impact on renal hypertension.
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PMID:Laparoscopic management of renal cystic disease. 1100 Mar 10

We describe a female neonate in whom a urinoma was first diagnosed at 20 weeks of gestation without any evidence of underlying urinary tract obstruction. The urinoma became apparent following the performance of a "bloody tap" amniocentesis. Sequential ultrasonography, both fetal and up to 3 months after birth, showed eventual resorption of the urinoma in parallel with the development of a shrunken, non-functioning kidney. Except for the onset of high-renin hypertension, which spontaneously remitted at 1 year of age, the baby's postnatal course was uneventful. Renal function was normal. The presence of a fetal urinoma as a sign of a dysplastic kidney is discussed.
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PMID:Fetal urinoma as a sign of a dysplastic kidney. 1248 94

Renal damage in children has been found to be more congenital in origin than was previously thought. Congenital anomalies of the kidney and urinary tract (CAKUT) involve renal dysplasia, renal hypoplasia, urinary tract obstruction and vesicoureteral reflux. CAKUT are sometimes bilateral and different types often coexist. Depending on their types and severity, children with CAKUT often have varying degrees of a reduced number of nephrons at birth. CAKUTare now the leading cause of renal failure in children. Children with renal dysplasia or obstructive uropathy may have abnormal renal tubules, and tend to lose essential water and sodium in urine. This can lead to poor body growth unless they are supplemented with water and sodium. Children with severe ureteric reflux often develop urinary infection and renal scarring. Renal scarring can further increase the risk of renal failure in children who already have other CAKUTand fewer nephrons than normal. Hypertension and proteinuria may develop in children with renal dysplasia and further aggravate renal function unless they are treated. Recent advances in the understanding and management of CAKUT make it possible for children with CAKUT to grow normally, have fewer complications such as urinary infection, have longer renal survival, and survive even with end-stage renal diseases through renal replacement therapy.
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PMID:Medical management of congenital anomalies of the kidney and urinary tract. 1452 48

Significant advances have been made recently in elucidating the cellular consequences of urinary tract obstruction during renal development. Urinary tract obstruction impairs growth and maturation of the kidney, and can also cause renal maldevelopment. This includes a reduction in the number of nephrons, tubular atrophy, and progressive interstitial fibrosis. Apoptosis (programmed cell death) accounts for much of the loss of tubular epithelial cells. Factors contributing to apoptosis include stretching of cells in dilated tubules, altered renal production of growth factors, and infiltration of the renal interstitium by macrophages. Two major controversies remain regarding the surgical management of congenital obstructive nephropathy: first, which fetuses with bladder outlet obstruction should undergo prenatal intervention, and second, which infants should undergo early pyeloplasty for ureteropelvic junction obstruction? Even after successful surgery for congential obstructive nephropathy, all patients should be followed for hypertension, proteinuria, or renal deterioration.
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PMID:Perinatal obstructive nephropathy. 1520 Feb 51

The acute renal failure is a grave pathology, of rapid establishment and relatively frequent in the hospital environment. We can describe three etiological groupS, which are responsible for it, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increases with the age. It is described the case of a 67-yr-old patient who was admitted in the Nephrology Service because of abrupt decline of the renal function. Among the initial symptoms, he presented arterial hypertension (190/90) and preserved diuresis. Blood analysis: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reported a bilateral ureteral hydronephrosis with simple cyst of possible ischemic origin. In view of the absence of previous biochemical data of renal failure, we considered possible reasons which start with an acute pattern. In initial evaluation, pre-renal etiology was not seen (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery did not justify a diagnosis of urinary tract obstruction. Finally, abdominal-pelvic scan showed a periaortic retroperitoneal mass which included both ureters and appeared to trigger the obstruction. Combined efforts were pursued with the Urology Service, which implanted a bilateral "double J" catheter and later operated surgically on the patient, carrying out an alternating ureterolysis of both ureters. The biopsy manifested a retroperitoneal fibrosis, and the renogram showed a residual renal function of 20% in the right kidney and 80% in the left kidney. Due to the failure of the previous measures and as a last therapeutic recourse when one year had passed from the diagnosis, a continuous regimen with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours was started, which began a progressive remission in the size of the observed mass by scan (CT) and magnetic resonance (MR). The treatment was completed during 12 months and in this time, the levels of blood urea nitrogen and creatinine were reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis.
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PMID:[Acute obstructive renal failure secondary to retroperitoneal mass]. 1521 69


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