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Query: UMLS:C0022116 (ischemia)
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Efficient urine production after kidney transplantation is often evidence of good graft function. If severe organ injury occurs, we have oliguria or anuria and the patient requires postoperative hemodialysis. In most cases, graft function recovers after a few hemodialysis treatments-delayed graft function (DGF). Therefore, recognition of factors influencing the onset of DGF is crucial. We examined the state of the circulatory system by a thermodilution method in 101 organ donors, taking into account mean arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index. We also examined 232 kidney recipients, based on age, gender, panel-reactive antibody, cold ischemia time, and reason for renal insufficiency. We defined DGF as at least one hemodialysis after kidney transplantation. In logistic regression analysis, we showed that donor MAP, CVP, and PCWP of the substantially influenced the occurrence of DGF among kidney transplant recipients. Maintaining an adequate MAP and a sufficient volume in the donor circulatory system substantially decreased the occurrence of DGF after kidney transplantation.
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PMID:Influence of selected factors on occurrence of delayed kidney graft function: a multivariate analysis. 1802 63

To determine the incidence and management of urological complications after live-donor renal transplantations at our center, we studied the medical records of 122 patients who underwent live kidney transplantation with a stented Lich-Gregoire anastomosis for ureteric reimplantation. The overall incidence of urological complications was 7.3 %. The early complications included four cases of ureteric stenosis, two cases of urinary leaks (one vesical fistula and one ureterovesical fistula) and one case of lymphocele causing ureteric obstruction. On the other hand, the late complications (> 6 months after surgery) included two cases of vesicoureteral reflux. No graft was lost and there was no urinary complication-related mortality. There was no association with recipient age, related or non-related donor or cold ischemic time. The urinary complications were mostly caused by ureteral ischemia and extrinsic compression by lymphocele; the stent caused vesicular fistula in one patient and clot anuria caused ureteral obstruction in another. In conclusion, the Lich-Gregoire technique has low complication rate and technical ease to perform compared with Barry's extravesical technique.
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PMID:The management of urological complications in renal transplant patients. 1820 95

A 50-year-old male with anuria, creatinine of 5.5 and potassium of 6.5 was referred to our hospital for hemodialysis. Before hemodialysis could be initiated, his blood pressure dropped and liver function tests were found to be increasing rapidly. This prompted us to look for cardiac causes of liver ischemia. An echocardiogram was non-diagnostic due to the patient's obese body habitus. Pericardial fluid was documented on CT scan. Pericardiocentesis was performed and nearly 1500 ml of bloody pericardial fluid was removed. This resulted in immediate urine output, with 80 ml in the first hour, and an increase in blood pressure.
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PMID:Pericardial effusion presenting with anuric acute renal failure and hepatocellular damage. 1914 Jan 98

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.
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PMID:Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. 2131 59

Arterial thromboses are rare in newborns, mostly caused by arterial catheters. Neonatal arterial thrombosis occurring in other contexts is much rare. We report arterial thrombosis, not caused by catheterisation in 4 neonates hospitalised in the neonatology department of the Farhat Hached de Sousse hospital in Tunisia. The diagnosis of arterial thrombosis was made based on signs of ischemia in 2 patients affected by thrombosis of the iliac arteries. The symptoms were less clear: anuria associated with arterial high blood pressure in 1 patient affected by thrombosis of the abdominal aorta and by anuria with melena in a newborn with aortic and mesenteric thrombosis. Diagnosis was confirmed by Doppler sonography in 3 patients and based on autopsy data in 1 patient. A delay to consultation was noted in 3 patients, whose outcome was fatal. The progression was favourable after thrombolysis and anticoagulation using heparin in 1 patient with major aortic thrombosis. A review of the literature on the epidemiological, clinical, therapeutic and outcome data of the arterial thrombosis in the newborn child is provided.
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PMID:[Spontaneous neonatal arterial thrombosis: a report of 4 neonates]. 2238 68

Renal transplant is the preferred treatment for patients with uremia. The renal transplant procedure is well established with a high success rate, but surgical complications are encountered occasionally. We report a case of sudden onset of anuria of the graft kidney owing to acute external iliac artery dissection diagnosed by Doppler sonography. Urgent endarterectomy with thrombus removal of false lumen prevented ischemia and occlusion of the right femoral artery. Without accurate diagnosis and management, this complication could have caused graft loss and death. We believe that renal transplant requires attentive teamwork to keep the graft functioning well.
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PMID:Salvage of external iliac artery dissection immediately after renal transplant. 2376 44

Management of acute renal artery occlusion in patients with a solitary kidney has a poorly defined prognosis. Loss of renal function is reported by some when acute warm ischemia reaches 2 hours. We report a unique case of a patient that had a 24-hour onset of anuria and acute renal failure upon arrival to the hospital. Nuclear imaging showed trace uptake of the right kidney, without evidence of excretion. Conventional digital subtraction angiography was performed; however, evidence of nephrogram or distal filling of the renal artery was not demonstrated. Secondary to conflicting studies, a computed tomography of the abdomen and pelvis with intravenous contrast revealed only minimal cortical perfusion despite complete occlusion of the previously grafted right renal artery. Patient was taken for urgent hepatorenal bypass surgery. Intraoperative return of urine output occurred immediately after completion of the bypass. Hemodialysis, which was required preoperatively, was stopped after <30 days of bypass procedure. Over 2 years following successful renal salvage, the patient has maintained a normal glomerular filtration rate and patency of her bypass by duplex follow-up.
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PMID:Surgical salvage of acute renal artery occlusion in the setting of a solitary kidney. 2434 78

Purpose. To describe the treatment of renal artery thrombosis with ultrasound-accelerated thrombolysis and discuss the management of prolonged renal ischemia. Case. A 76-year-old patient with a single functional kidney, mild chronic renal impairment, and a recent history of endovascular repair of a thoracoabdominal aneurysm with an aortic branch graft presented with acute flank pain, anuria, and renal failure. The side branch from the aortic stent graft to his single, right, functional kidney appeared to be completely thrombosed. Symptoms had started after cessation of oral anticoagulants because of a planned mastectomy for breast cancer. After identification of the occlusion, ultrasound-accelerated thrombolysis was started 19 hours after the onset of anuria. Angiography, 4 hours after beginning of therapy, already showed partial dissolution of the thrombus and angiographic control after 18 hours showed complete patency of the renal artery side branch. Despite a long period of ischemia, renal function was completely recovered. Conclusion. In patients with acute renal ischemia due to thrombosis of the renal artery, complete recovery of function can be achieved with ultrasound-accelerated thrombolysis, even after prolonged periods of ischemia.
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PMID:Successful reversal of acute kidney failure by ultrasound-accelerated thrombolysis of an occluded renal artery. 2527 40

Metformin is a common medication used for the treatment of type 2 diabetes, especially in obese subjects. Clinical studies show that, in addition to the lowering effect of blood glucose, metformin reduces cardiovascular risk, does not induce weight gain and additionally, provides a unique safety strategy and efficacy in patients with diabetes and heart disease. However, this treatment is not without risks. The most feared metabolic complication is lactic acidosis that often occurs with complex and severe clinical symptoms and is associated with a high mortality risk. We detail our experience, during one year, regarding four patients with diabetes treated with metformin who developed such acute renal failure and lactic acidosis as to require hemodialysis treatment. The patients selected had previous normal renal function but a history of serious cardiovascular disease (hypertensive cardiomiopathy, ischemic revascularized and/or dilated, chronic obstructive arterial disease). We observed in all four of our patients an onset of non-related symptoms (fever, fatigue, vomiting and gastrointestinal disorders), a rapid deterioration in renal function, anuria and very high levels of lactic acid. In two patients we found acute pancreatitis. In addition to rehydration therapy, hemodialysis was started instantly with progressive rebalancing of the biohumoral status, effective recovery of spontaneous diuresis and improvement of the clinical status in three patients. Unfortunately, we had a failure during the initial hours of ward admittance, with an important clinical situation complicated by acute cardiac ischemia, abnormal heart rhythm, ending in death. Our experience provides us with elements to reflect on. Lactic acidosis is a serious metabolic disorder because it is associated with a high mortality risk. So a rapid diagnosis and a complete recognition of all the fundamental elements are important for its management. Starting hemodialysis early and prolonged treatment can solve complicated clinical status, correct acidosis and restore kidney function in patients with serious comorbidity.
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PMID:[Lactic acidosis, acute renal failure and heart failure during treatment with metformin: what do we know?]. 2648 Feb 56

Acute suprarenal aortic occlusion is a rare but often catastrophic event. Despite immediate treatment, mortality and morbidity are high. We present a case of acute suprarenal aortic occlusion presenting with renal failure and dyspnea but without lower limb ischemia. Diagnosis was initially not taken in consideration. The patient required hemodialysis and temporary mechanical ventilation. After 13 days, an abdominal ultrasound was performed which revealed thrombosis of the suprarenal abdominal aorta. Suprarenal aortic thrombectomy was performed followed by aortobi-iliac bypass grafting. Diuresis returned 4 hr after surgery, and the patient fully recovered. Thorough review of the literature revealed only 8 cases of acute suprarenal aortic occlusion. Only 3 patients survived. To our knowledge, this is the first reported case of acute suprarenal occlusion, in which renal function could be restored after a 14-day period of anuria. The case illustrates that in select cases with prolonged acute renal failure aortorenal revascularization can be performed successfully.
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PMID:Recovery of Renal Function after Prolonged Anuria in Acute Suprarenal Aortic Occlusion. 2652 Apr 21


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