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

The case is reported of a young woman with severe hypertension, unilateral renal artery stenosis, variously normal or marginally high plasma concentrations of active renin, angiotensin II, aldosterone, sodium, and potassium; and normal total exchangeable and total body sodium and potassium. Arteriograms and ureter catheterization showed the stenosis to be severe, but the unstimulated renal vein renin and angiotensin II differential to be modest. Captopril caused an initial fall in angiotensin II and arterial pressure. During prolonged captopril treatment, plasma angiotensin II and aldosterone remained depressed; exchangeable and total body sodium and potassium were unaltered. Blood pressure fell further to normal levels during prolonged captopril treatment, while subsequent surgical correction of the renal artery stenosis was curative; absolute values of blood pressure and plasma angiotensin II were similar in both situations. The findings support, without proving, the concept that chronic modest elevation of angiotensin II may be responsible for sustained hypertension in unilateral renal artery stenosis. Patients of this type contrast sharply with those, also with severe renal artery stenosis or occlusion, who have gross elevation of renin, angiotensin II, and aldosterone, with sodium and potassium deficiency. Captopril or surgery are effective in both syndromes, but the manner of response to treatment differs markedly.
Hypertension
PMID:Renal artery stenosis with normal angiotensin II values. Relationship between angiotensin II and body sodium and potassium on correction of hypertension by captopril and subsequent surgery. 700 27

Twelve kidneys were autotransplanted to the internal iliac vessels in 11 patients for the treatment of renovascular hypertension. The ureter had been left unresected in all but one case, where a transuretero-ureterostomy was performed. A radiographic study of the ureteral motility was obtained during the postoperative period recording images every 1.5 s with a spot-camera system. The ureters appeared to follow different courses, due to the different surgical procedures. In all but two cases the transport of urine was obtained through separate boluses, frequency and direction of peristalsis were within normal ranges, and significant dilation was never observed.
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PMID:Ureteral motility after renal autotransplantation. 703 15

Specific features of antihypertensive action of two new isoprenoid compounds, i.e. 5-nicotinooxymethyl -gamma - tocopherylnicotinate (NNT) and decaprenoic ethylester (EDP) were studied in rats. NNT and EDP were very similar to each other in their pharmacological features as far as we studied. Both NNT and EDP did not affect blood pressure in normotensive animals but significantly reduced blood pressure in SHR and DOCA/salt hypertensive animals in the acute studies with single dosing of 1 to 10 mg/kg (p.o.). Their antihypertensive action was mild but long-lasting and cumulated by the repeated administration. The chronic administration of NNT and EDP at oral doses of 0.2 and 2 mg/kg once a day completely suppressed the development of hypertension in rats unilaterally nephrectomized and treated with DOCA/salt and in SHR which were unilaterally ureter-ligated to accelerate the progress of their genetic hypertension. The mechanism of their antihypertensive action remains to be solved.
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PMID:Antihypertensive actions of isoprenoids. 707 84

The authors present the long-term results in the kidney functioning of 13 patients operated upon to replace the ureter with small intestine. There is an introduction containing a summary of the functions which the intestine must assume in the urinary circuit as a urine conductor. In the description of the results, they make a separate analysis of the factors in our statistics which have contributed to a worsening of the kidney functioning: reflux, stenosis, secondary subcervical stenosis, infections, lithiasis and hypertension. In view of the results, the authors end by justifying this surgery even in cases of extremely bad kidney functioning, particularly when one can expect an improvement in the functioning after the removal of the obstruction.
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PMID:[Long-term results of uretero-ileoplasty with respect to renal function]. 722 79

By means of techniques derived mainly from renal transplant surgical experience, several pathologic conditions of the renal artery, the kidney and the ureter have been made accessible to surgical therapy in the course of the past two decades. This therapy is basically composed of nephrectomy, workbench surgery and reimplantation of the kidney, in this order, and called "extracorporeal renal surgery'. Indications for its use are proposed and discussed, and the operative technique is described. Results are presented of 27 extracorporeal vascular reconstructions in 25 patients with severe renovascular hypertension on the basis of fibromuscular dysplasia located predominantly peripherally in the renal artery and its branches. Of these procedures, 25 were actually completed since in two patients reconstruction of the renal artery was technically impossible and reimplantation of their kidneys had to be discarded. One out of the other 23 patients died because of haemorrhagic and septic complications. In the remaining group of 22 patients, operation-associated complications were observed in one patient, who had to be reoperated because of bleeding at the operation site. At a mean follow-up period of 4.5 years, all these 22 patients had normal blood pressures, and 16 were off medication ("cured') whereas six needed only moderate anti-hypertensive medication ("improved'). Results are also presented of extracorporeal procedures performed in one patient with a carcinoma in a solitary kidney and in one patient with a ruptured aneurysm of the abdominal aorta in which both renal arteries were involved. Both patients are well at one and more than five years postoperatively, respectively.
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PMID:Extracorporeal renal surgery. 730 Nov 58

The aorta was exposed by a standard "nephrectomy" incision through the eleventh interspace in 53 patients with aneurysmal or occlusive disease. The plane posterior to the kidney and ureter was developed easily, enabling exposure of the aorta above the level of the celiac axis to its bifurcation by dividing only the crus of the diaphragm and the lumbar branch of the left renal vein. Twenty-five patients with abdominal aortic aneurysms were treated in this fashion. In all but four there were significant risk factors, including extension of the aneurysm to or above the level of the renal arteries in eight and coexisting renal artery stenosis with hypertension in two. Twenty-eight patients with occlusive vascular disease were treated surgically. In eight, this was the second operation on the aorta while in 11, major occlusive disease involved the aorta as well as the renal/visceral arteries. The operative mortality rate was 8%. Eighty-nine percent of the patients were alive at this writing. Of 18 hypertensive patients, 9 were not taking medication and only 3 have not improved significantly. We recommend this approach for reoperations on the aorta and for patients who have extensive aneurysmal and/or occlusive disease of the aorta, renal, and visceral arteries.
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PMID:The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels. 744 65

We performed treatment of urolithiasis on 7 patients with spinal cord injury (6 males and one female, with a mean age of 41 years old) by extracorporeal shock wave lithotripsy (ESWL) using a Lithostar (Siemens). The level of injury was cervical in 3 patients and lower thoracic in 4. The treated stones were renal in 6 patients, including one staghorn caliculus, ureteral in 2, and bladder stones in 2 patients. ESWL was performed under general anesthesia in 2 patients, and in another patient, epidural anaesthesia was employed in the first several sessions, but thereafter treatment was safely continued with no anesthesia. The other 4 patients were treated without anesthesia. In most patients, the stones (9 stones in 6 cases) were easily disintegrated after treatment of from one to 14 sessions, except one case of staghorn caliculus, and the clearance of fragments was also satisfactory. In one patient, hypertension and bradycardia due to autonomic hyperreflexia were observed during ESWL, and the treatment was discontinued, but the stone was successfully disintegrated and the fragments were voided. In another patient, autonomic hyperreflexia was observed while the fragments passed through the ureter, although no signs of this reflexia were seen during the ESWL procedure.
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PMID:[Extracorporeal shock wave lithotripsy on patients with spinal cord injury with special reference to autonomic hyperreflexia]. 770 1

We compared the effect of the renal nerves on renal function, plasma renin activity, and renal renin and angiotensinogen mRNA contents in Wistar rats and spontaneously hypertensive rats (SHR). Rats were anesthetized with sodium pentobarbital, the left kidney was exposed, its nerves were sectioned, the ureter was cannulated, and a flow probe was placed on the renal artery. The renal nerves were stimulated for 1 hour to reduce renal blood flow by 15% and 30%, after which blood was removed for measurement of plasma renin activity, and kidneys were analyzed for renal renin and angiotensinogen mRNA. Frequency-related reductions in filtration rate were similar, from 15% to 50%, as was sodium excretion, from 30% to 70%, in both SHR and Wistar rats. Basal plasma renin activity and responses to nerve stimulation in SHR were approximately half those of Wistar rats (all P < .001). SHR renal renin mRNA concentrations were approximately three quarters those of Wistar rats and were unchanged by either low- or high-level renal nerve stimulation, whereas the higher rate increased renin mRNA approximately threefold (P < .05) in the Wistar rats. SHR renal angiotensinogen mRNA was one quarter that of the Wistar rats and was unaffected by nerve stimulation, whereas in the Wistar rats it was increased threefold (P < .05) by the low but not high level of nerve stimulation. These findings show that whereas the renal nerves are able to modulate hemodynamic and tubular functions relatively normally in SHR, their ability to increase renin release, renal renin, and angiotensinogen mRNA levels is depressed.
Hypertension 1995 Apr
PMID:Renal nerves, renin, and angiotensinogen gene expression in spontaneously hypertensive rats. 772 1

A 39-year-old male presented with gross hematuria and left lower abdominal discomfort. Excretory urography showed a left ureteral stone and hydronephrosis. CT scans and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. Angiography revealed a hypervascular lesion at this area. The laboratory data showed a slightly decreased serum potassium level. In the endocrinological study, the serum deoxycorticosterone (DOC) level was markedly elevated. There was, however, no evidence of hypertension. The operation was performed on November 13, 1992. The tumor was almost separated from the left kidney, but an aberrant artery which divided from the renal artery and penetrated the renal parenchyma was found. Therefore, we had to carry out en bloc removal of the tumor together with the left kidney and the ureter which contained the ureteral stone. Pathological diagnosis was adrenocortical carcinoma. After the operation, hypokalemia and the serum concentration of DOC returned to normal range. Therefore, the tumor was diagnosed as DOC producing adrenocortical carcinoma. The patient was discharged 30 days after the operation with uneventful postoperative course. He received 2.5 g of op'-DDD a day. There was no evidence of distant metastasis or local recurrence 12 months after the operation. Nineteen cases of DOC producing adrenocortical tumor have been reported in the world literature. A case and a review of the literature are herein reported.
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PMID:[Deoxycorticosterone-producing adrenocortical carcinoma--a case report]. 777 67

Six institutions throughout the United States participated in this study. Each center used a multifunctional flat table lithotriptor (Dornier MFL-5000) to treat 658 patients with kidney and upper ureteral stones (766 treatments) and 323 with middle and lower ureteral stones (391 treatments), for a total of 925 patients (1,157 treatments). Some patients received more than 1 treatment (that is the kidney and ureter), for a total of 981 patient events. Complete followup was available for 81% of the patients. The overall stone-free rate at followup of approximately 90 days was greater in the middle and lower ureter group (83%) than in the kidney and upper ureter group (67%). The proportion of single stones treated was greater for the former group (89.5%) than for the latter group (72%). A larger proportion (18%) of the middle and lower ureter group required 2 or more treatments to the targeted stone than did the kidney and upper ureter group (13%). Anesthesia was required or selected in only 26.7% of the kidney and upper ureteral stone patients and in 18.5% of those with middle and lower ureteral calculi, usually at the request of the patient or physician, or for performance of an adjunctive procedure. The relative safety of this treatment is demonstrated by a low overall rate of complications reported during and after treatment, including a ureteral obstruction rate of 2.1% for kidney and upper ureteral stones and 2.5% for middle and lower ureteral stones. There were no demonstrated trends in a review of laboratory data to suggest significant treatment side effects. The diastolic blood pressure increased to more than 95 mm. Hg after extracorporeal shock wave lithotripsy (ESWL*) in 6% of the kidney and upper ureteral and 4% of the middle and lower ureteral stone patients, while pretreatment hypertension resolved after ESWL in 11% of both groups. The results of this clinical evaluation indicate somewhat greater effectiveness for the specified indications of ESWL of stones in the ureter below the upper rim of the bony pelvis, as opposed to those in the kidney and upper ureter, with a low incidence of complications and side effects.
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PMID:Extracorporeal shock wave lithotripsy: multicenter study of kidney and upper ureter versus middle and lower ureter treatments. 793 64


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