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

Fifty-three symptomatic adults with autosomal dominant polycystic kidney disease were studied retrospectively for a mean follow-up of 12 years (range 10 months to 33 years). Diagnosis was confirmed by either x-ray, ultrasound, laparotomy, or autopsy. Commonest presenting clinical findings were flank pain (30%), hypertension (21%), symptomatic urinary tract infection (UTI) (19%), gross hematuria (19%), and palpable masses (15%). A total of nine patients (17%) progressed to end-stage renal disease. Change in renal function measured using the reciprocal of plasma creatinine plotted against time was linear for each individual patient with a maximum functional decline of 0.7 mg/dL/yr (slope = -0.07). Past the age of sixty renal failure was uncommon. Easily controlled hypertension developed in 64% attended by mild retinopathy. UTIs were common (53%), often recurrent (61%), precipitated by instrumentation in 6 of 14 patients (43%), leading to death in two (33%). Renal calculi were extremely common (34%) and had no defined metabolic cause. The presence of hematuria (64%), gross or microscopic, bore no relationship to the decline in renal function. Pregnancy was normal in these patients with no increase in fetal or maternal morbidity or mortality. We conclude the following: Renal functional deterioration is linear, less than previously reported, and bears no relationship to hematuria. Hypertension is common, easily treated, and causes minor end-organ damage. Renal calculi are frequent. Urinary tract instrumentation often induces infection with considerable morbidity and mortality and must be avoided. Pregnancy is not contraindicated if renal function is normal. The prognosis for survival in this disease is better than previously reported.
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PMID:Autosomal dominant polycystic kidney disease: presentation, complications, and prognosis. 397 15

Five cases of renal arteriovenous fistulae are described: four after needle biopsy of the kidney, one due to intrarenal aneurysmal rupture. One fistula closed spontaneously, the other four patients were operated on and treated by nephrectomy. 243 other cases from the literature were reviewed. The clinical manifestations involve the cardiovascular (arterial hypertension, congestive heart failure) or the urologic (hematuria, renal colic, flank pain) systems. The diagnosis is usually made by flank auscultation (which detects a continuous sound) and by use of renal arteriograms. The causes of these fistulae are numerous: congenital or acquired from biopsy examinations, trauma, surgery, neoplasia, infection, aneurysmal rupture. The usual treatment of these fistulae is a nephrectomy but selective embolization or direct surgical repair make possible, with greater frequency now, renal parenchymal preservation.
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PMID:[Renal arteriovenous fistulae (author's transl)]. 626 50

Renal infarction is most frequently due to emboli from the heart or aorta. Other causes include atheromatous disease, renal artery aneurysm, vasculitis, hypotension, hypercoagulable states, aortic dissection, and major trauma. Most renal infarctions are segmental. The extent of disease is dependent upon the size and number of renal vessels involved, coexistent renal disease, and collateral circulation. Flank pain, fever, leukocytosis, hematuria, renal failure, or hypertension may suggest the diagnosis, but these findings are nonspecific and diagnosis will depend not only on history and physical examination, but also on the appropriate imaging tests. The type of treatment is dictated by the etiology of the infarction.
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PMID:Renal infarction after aerobics. 639 75

Isolated nontraumatic renal artery dissection is rare. In this communication, 35 cases are presented; 24 cases (group 1) (22 male, 2 female) were diagnosed angiographically, and 11 (group 2) (10 male, 1 female) were observed at autopsy. In group 1, 23 of the patients were hypertensive when they were first seen, and in 17 of them the hypertension was of recent onset. Additional presenting signs and symptoms included flank pain (10 patients), gross hematuria (5), and headaches (6). Renal function was satisfactory. Renal vein renin levels could be lateralized in 8 of 16 patients. Isotope renograms performed in 18 patients, showed unilateral abnormalities in 7, bilateral abnormalities in 6, and normal results in 5. Angiograms showed that the dissection was unilateral in 18 cases and bilateral in 6 cases. Fibromuscular dysplasia was observed radiographically in 22 cases and was bilateral in 12. In group 1, 13 patients were treated with antihypertensive medication only, and 11 underwent operation. At follow-up (mean 52.0 months), the mean blood pressure were 128/88 mm Hg and 139/89 mm Hg for the medical and surgical groups, respectively. Eleven medical and nine surgical patients continued to require antihypertensive drugs at follow-up. Among the 11 patients in group 2, only 4 were hypertensive. In only one case the dissection may have contributed significantly to the patient's death. These studies indicate that isolated nontraumatic renal artery dissection most commonly occurs in young men with coexistent fibromuscular dysplasia. Hypertension is commonly present and therapy should be directed toward its control. In this study, blood pressure control was effectively accomplished with medical therapy.
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PMID:Isolated renal artery dissection, presentation, evaluation, management, and pathology. 710 85

Survival rates and various prognostic factors were studied in 89 patients between 20 and 40 years old who underwent nephrectomy for renal adenocarcinoma between 1950 and 1978. Although rare, renal carcinoma in young adults seems to follow a course similar to the disease seen in older patients. Among 18 suspected prognostic factors 2 are strongly and independently associated with survival. These are the pathologic stage of the tumor and preoperative weight loss. Several other prognostic variables show a statistically significant association with survival. These include the presence of preoperative fever, duration of symptoms, tumor cell type, microhematuria on admission to the hospital, tumor grade and sex. However, advanced statistical techniques demonstrate that the association of these variables with survival can be accounted for mostly by their close correlation with the stage of the tumor. Certain variables show no prognostic significance. These included the diameter of the tumor, age of the patient, presence or absence of gross hematuria, flank pain, palpable mass, arterial hypertension, sedimentation rate and side or site of the tumor.
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PMID:Renal adenocarcinoma in young adults: survival and variables affecting prognosis. 720 45

Congenital renal arteriovenous malformations are rare, but their incidence are frequency of recognition are rising. Six cases of both cirsoid and idiopathic varieties are described. Patients were either asymptomatic or presented with gross hematuria and flank pain. Physical findings included hypertension, cardiomegaly, flank tenderness, and an abdominal bruit. IVP findings included filling defects in the renal pelvis from blood clots, irregular mucosal pattersn, or mass effect. Angiography demonstrated either single, simple, vascular channels or multiple, complex, varix-like communications. In both there was early filling of the renal vein, a normal caliber to the feeding artery and draining vein, and no displacement of parenchymal vessles. Asymptomatic patients required no treatment. Surgical procedures that spare renal parenchyma are preferred.
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PMID:Congenital renal arteriovenous malformations. 745 91

High dosages of nephrotoxic drugs in elderly patients might be correlated with an increase in the number of patients with tubulo-interstitial nephritis (TIN). In patients with acute TIN, marked fever, back or flank pain, CVA tenderness, skin rash, arthralgia, eosinophilia, and eosinouria are observed. Clinical symptoms might be induced by glomerular, proximal tubular or distal tubular dysfunction in chronic TIN. Mild to moderate proteinuria, edema, hypertension, azotemia, glucosuria, aminoaciduria, polyuria and polydipsia are characteristic findings in patients with chronic TIN. These findings are slowly progressive in such patients. It appears that the marked fibrosis with lymphocyte infiltration in the interstitium is a poor clinical marker in patients with TIN. Furthermore, it is important to differentiate TIN from glomerulonephritis.
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PMID:[Symptoms in patients with tubulo-interstitial nephritis]. 756 29

To reduce renal cyst size in autosomal dominant polycystic kidney disease (ADPKD), minocycline hydrochloride solution was instilled into the enlarged cysts in three ADPKD patients. In one patient with reduced renal function, such sclerotherapy apparently diminished cyst size, but without apparent improving effect on renal function at 7 months of follow-up. The second patient, who needed the replacement therapy on admission, had been free from hemodialysis over 4 months after the therapy. Persistent flank pain disappeared in both patients. In the third patient with normal renal function, sclerotherapy was done to get a better control of hypertension. Initially blood pressure decreased, but it returned up to the pre-therapy level irrespective of definite reduction of the enlarged cysts at 8 months of follow-up. The therapy with minocycline hydrochloride did not appear harmful, and may be helpful in the management of ADPKD.
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PMID:Effects of topical instillation of minocycline hydrochloride on cyst size and renal function in polycystic kidney disease. 846 1

Autosomal dominant polycystic kidney disease is one of the most commonly inherited diseases in the United States. It affects nearly 500,000 Americans and accounts for 5 to 10 percent of patients with end-stage renal disease. Diagnosis is usually made in middle age, when complications such as hypertension, pain and hematuria develop. Renal complications include hypertension, cyst infection and hemorrhage, hematuria and flank pain. Other manifestations and related conditions include polycystic liver disease, cerebral aneurysm, cardiac valve abnormalities and diverticulosis. The severity and course of the disease vary in individual patients. Management involves the control of hypertension and treatment of complications. Genetic counseling is important. Dialysis and renal transplantation often are successful treatments in patients who develop renal failure.
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PMID:Autosomal dominant polycystic kidney disease. 859 59

Benign renal cysts are usually asymptomatic: They require a minimally invasive treatment if they cause complaints such as flank pain or other compressive complications. During a 6 month period, 14 patients were treated for benign renal cyst using an ultrasound guided puncture. Presenting complaints were flank pain (12 cases), hypertension (1 case), polycythaemia (1 case). Only cyst of 5 centimeters diameter or more were assigned to this treatment. After needle puncture, the cyst was evacuated and then filled with sterile 95% alcohol. Clinical and anatomical results, after 6 months, were good in 9 cases, 2 cases showed good anatomical results with persistence of initial symptoms, and there were 3 failures corresponding to large cysts of 10 cm diameter or more. Percutaneous alcoholization of moderate benign cysts is a safe, simple and reliable method.
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PMID:[Percutaneous alcoholization of simple serous cysts of the kidney]. 863 8


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