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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraoperative vascular surgical consultation may be necessary if venous or arterial injury occurs during transabdominal urologic operations. Loss of blood usually can be controlled by simple digital compression until the consultant arrives, but urologists should be familiar with the principles of vascular reconstruction. Adequate exposure of the injured segment is essential, and the repair of major vessels must preserve patency as well as provide hemostasis. In this regard, patch angioplasty is sometimes necessary, and formal replacement with autogenous or prosthetic grafts may rarely be required. Blunt arterial trauma can precipitate distal arterial embolization, a complication that usually is not suspected until the immediate postoperative period. Although salvage should be managed by a vascular surgeon, urologists must be alert for the early signs of acute extremity ischemia after extensive retraction has been used deep in the pelvis, particularly in elderly or atherosclerotic patients. Considering the established diagnostic accuracy of roentgenographic studies presently employed in the fields of urology and vascular surgery, preoperative planning should limit the number of urgent intraoperative consultations between members of these two specialties. Each may have valuable advice to offer the other concerning the treatment of unusual problems involving obstructive uropathy, aortic aneurysms, and occlusive arterial disease, and their cooperative effort is especially important in the management of renal revascularization.
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PMID:Vascular problems in urologic patients. 402 86

Between May 1, 1986 and May 31, 1992 at the University of Minnesota, we interpreted 129 renal allograft biopsy specimens (done in 48 grafts during the first 6 months posttransplant) as showing changes consistent with chronic rejection. For this retrospective analysis, we reexamined these biopsies together with clinical information to determine: (a) whether a diagnosis other than chronic rejection would have been more appropriate, (b) how early posttransplant any chronic rejection changes occurred, and (c) if the diagnosis correlated with outcome. We found that (1) chronic rejection is uncommon in the first 6 months posttransplant; it was documented in only 27 (2.4%) of 1117 renal allografts and was preceded by acute rejection in all but 3 recipients (for these 3, the first biopsy specimen showed both acute and chronic rejection). (2) Chronic vascular rejection was seen in 1 recipient as early as 1 month posttransplant; the incidence increased over time and was associated with an actual graft survival rate of only 35%. (3) The most frequent cause of arterial intimal fibrosis in the first 6 months posttransplant was arteriosclerotic nephrosclerosis (ASNS) of donor origin. Long-term graft function for recipients with ASNS was 67%. (4) Early-onset ischemia or thrombosis was seen in 14 recipients and predicted poor outcome: only 35.7% of these recipients had long-term graft function. (5) Cyclosporine (CsA) toxicity was implicated in only 3 recipients, who had mild diffuse interstitial fibrosis in association with elevated CsA levels. Other variables (including systemic hypertension, urinary tract infection, obstructive uropathy, neurogenic bladder, cobalt therapy, and recurrent disease) were not significantly associated with chronic renal lesions in the first 6 months posttransplant. A significant number of biopsies were originally interpreted as showing chronic rejection, but the diagnosis was changed upon reevaluation in conjunction with clinical data. We conclude that many factors coexist to produce chronic lesions in biopsies during the first 6 months posttransplant, so clinical correlation is needed before establishing a diagnosis of chronic rejection.
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PMID:Chronic renal allograft rejection in the first 6 months posttransplant. 854 66

Renal infiltration with macrophages and monocytes is a well-recognized feature of not only immune, but also nonimmune kidney disease. This review focuses on the investigations that have shown accumulation of immunocompetent cells in experimental models of acute and chronic ischemia, protein overload, hypercholesterolemia, renal ablation, obstructive uropathy, polycystic kidney disease, diabetes, aging, murine hypertension, and nephrotoxicity. We examine the mechanisms of infiltration of immunocompetent cells and their participation in the self-perpetuating cycle of activation of the angiotensin system, generation of reactive oxygen species, and further recruitment of monocytes and lymphocytes. We also discuss the possibility of antigen-dependent and antigen-independent mechanisms of immune cell activation in these animal models. Finally, we review the recent studies in which suppression of cellular immunity with mycophenolate mofetil has proven beneficial in attenuating or preventing the progression of renal functional and histologic damage in experimental conditions of nonimmune nature.
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PMID:Role of immunocompetent cells in nonimmune renal diseases. 1131 33

Despite improving overall results of pediatric renal transplantation children under 5 years of age remain a high-risk group with poorer outcomes often because of a higher rate of surgical complications. This retrospective report details a 12-year experience at a single center and examines the outcome in this high-risk group of patients. We reviewed the medical records of 21 children under 5 years of age who received renal transplantation at Loma Linda University Medical Center between July 1988 and August 2000. The patients were evaluated regularly by the same pediatric nephrologist throughout the study period at our outpatient clinic. Mean recipient age was 3 +/- 1.2 (range 2-5) years; weight at transplantation was 13.3 +/- 5.4 kg. Ten (48%) patients received living related donor (LRD) kidneys and 11 (52%) received cadaver (CAD) kidneys. Mean donor ages for CAD and LRD were 14.4 +/- 10 years and 26.6 +/- 4.9 years, respectively. The mean cold ischemia time (CAD only) was 23.3 +/- 10.6 hours. Renal dysplasia (n = 8) and obstructive uropathy (n = 5) were the most common primary diagnoses. Maintenance immunosuppression consisted of Azathioprine or mycophenolate mofetil (MMF), cyclosporine or tacrolimus and prednisone. Mean follow-up was 80.1 +/- 51.4 months. Twelve (57%) grafts have a follow-up >5 years. Patient survival was 100 per cent. Overall graft survival at one, 3, 5, and 10 years were 95, 95, 88, and 88 per cent respectively. Graft survival for LRD recipients was 100 per cent. No graft was lost as a result of a technical problem or vascular thrombosis. One graft each was lost because of delayed graft function complicated by severe cytomegalovirus infection and chronic rejection. At one year the mean serum creatinine was 0.6 +/- 0.2 mg/dL with a mean calculated glomerular filtration rate of 93 +/- 32 mL/min. All 17 children who are now of school age are attending school. We conclude that excellent rehabilitation and superior long-term patient and graft survival can be achieved with renal transplantation in children of this age group with the use of good surgical techniques and close follow-up.
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PMID:Superior long-term results of renal transplantation in children under 5 years of age. 1251 21

Hydronephrosis, "distension in varying degrees of pelvis and calyces, accompanied by progressive atrophy of renal parenchyma due to obstruction in urinary flow", is an apparently simple reno-urinary disease, but, in reality, by association of its own characters with those conferred by causative lesions, becomes of a significant complexity. The purpose of this paper is to demonstrate the plurivalent character of this entity on a batch of cases with congenital hydronephrosis, by identification of lesional features correlated with cause of disease. The etiology of hydronephrosis in analyzed cases was characterized by heterogeneity: polar inferior artery, horseshoe kidney, extrarenal pelvis, transverse valves of pelviureteral junction (PUJ), adhesion of ureter to PUJ, intrinsic stenosis of PUJ, vesico-ureteral reflux, posterior urethral valves, stenosis of urethral meatus. The way of intervention of urinary obstruction and the uni- or bilateral character of damage were definitory for the macroscopical appearance of the hydronephrotic kidney, renal pelvis demonstrating its role of expansion room for kidney protection. In analyzed cases of congenital hydronephrosis, correlation specific cause-pelvic lesion evidenced histopathological differences related to etiology. Anatomical preparations obtained by injection followed by corrosion have revealed that renal vessels appear elongated, distanced from each other and even reduced in density, which explains the appearance of ischemia accompanying pathogenetic changes of obstructive uropathy. Regardless of etiology, all cases of congenital hydronephrosis were characterized by varying degrees of fibrosis in chorion of renal pelvis, accompanied by active chronic inflammation, observation that support the idea of connection between the two pathological changes.
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PMID:Etio-pathogenic and morphological correlations in congenital hydronephrosis. 2142 44

Renal transplantation confers substantial benefits on children with end-stage renal disease (ESRD), including improved growth as well as longer and better quality of life. The aim of this study was to report our experience with 134 pediatric renal transplantations. Epidemiological and clinical data of all patients transplanted who were younger than 18 years between January 1984 and May 2012 were collected from our prospective database. One hundred twenty-four patients (44% female) underwent 134 renal transplantations. Renal insufficiency was secondary to urological obstructive uropathy (46%), nephropathy (34%), and other causes (20%). Mean age at the time of the surgery was 13 years. Mean time of ESRD was 25 months. One hundred seventeen patients (95%) received cadaveric renal allografts. Mean cold ischemia time was 1302 minutes. Mean donor age was 19.7 years. Mean length of hospital stay was 17 days. Mean follow-up was 122 months. Graft survivals at 5 and 10 years were 84.1 and 71.9%, respectively. Ninety-six percent of kidney recipients were alive; 71% with functioning allografts. Mean current glomerular filtration rate among functioning kidneys is 55 mL/min. Renal transplantation in the pediatric population is a good option for ESRD patients.
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PMID:Pediatric kidney transplantation: a single center experience with 134 procedures. 2362 24

Chronic tubulointerstitial diseases are a common final pathway toward chronic renal failure regardless the primary damage (glomerular, vascular or directly the tubulointerstitium). Chronic tubulointerstitial nephritis (CTN) is characterized by interstitial scarring, fibrosis and tubule atrophy, resulting in progressive chronic kidney disease. Most frequent causes of CTN are drugs, heavy metals, obstructive uropathy, nephrolithiasis, reflux disease, immunologic diseases, neoplasia, ischemia, metabolic diseases, genetics and miscellaneous. At ultrasound (US), kidneys' morphological aspect is similar in all forms of chronic interstitial nephropathy and only chronic pyelonephritis with or without reflux shows distinguishing characteristics. In interstitial nephropathy, kidneys' profiles are finely irregular and corticomedullary differentiation is altered because of a diffused hyperechogenicity. The only indirect sign of chronic interstitial damage can be derived from the value of intrarenal resistive indexes that hardly overcome 0.75. US is mandatory in clinical chronic pyelonephritis work-up because it provides information on kidney's diameter and on growth nomogram in children. Renal profiles can be more or less altered depending on the number of cortical scars and the presence of pseudonodular areas of segmental compensatory hypertrophy. In the early stages, US diagnosis of renal tuberculosis is difficult because parenchymal lesions are non-specific. US sensitivity in the diagnosis of hydronephrosis is very high, close to 100% and, finally, US is the first choice imaging technique in the diagnosis of urinary lithiasis.
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PMID:Clinical Scenarios in Chronic Kidney Disease: Chronic Tubulointerstitial Diseases. 2716 8