Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renovascular disease in a solitary kidney is a difficult and challenging problem. In six patients, with a mean age of 62 years, revascularisation was undertaken. In four of them, one to three attempts at PTA were made before the operation but all were unsuccessful. The preoperative mean serum creatine (Cr) was 3.52 mg% (range 2.5-5.5). The stenoses were caused by atherosclerosis in five cases and fibromuscular dysplasia (FMD) in one. Two methods of revascularisation were used: aortorenal bypass with saphenous vein (three patients) or PTFE (two patients), and transaortic renal endarterectomy with a venous patch (one patient). One patient with an aortic aneurysm underwent simultaneous aortic repair with a PTFE graft. There was no mortality or major complications in our series and no patient suffered acute tubular necrosis (ATN) after surgery. The mean follow-up period was 51 months (15-84 months). Postoperative Cr and blood pressure improved in all patients. Four patients no longer required any medication and the other two only needed reduced doses of antihypertensive drugs. Based on our experience of patients with poor single kidney function, we do not recommend PTA in this specific group of patients and suggest an aggressive surgical approach, which can effectively improve solitary kidney function, thus eliminating further haemodialysis.
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PMID:Revascularisation for a poorly functioning solitary kidney. 191 7

Four patients are presented aged over 65 years in whom a state of cardiogenic shock was present due to myocardial infarction of the following localization: anterior in two and posterior in two. According to the parameters all patients satisfied the criteria of cardiogenic shock. Of the four patients three died. In all patients parameters of renal lesion were analyzed after establishment of diureses: sodium in urine, creatinine quotient in urine and plasma, osmolality of urine, osmolality quotient of urine and plasma, the renal failure index and the excretional fraction of filtered sodium. The parameters quoted were analyzed the day after diuresis was established. All parameters, apart from sodium in urine, indicated functional oliguria. In corroboration of this were the values of creatinine clearance which were determined the day after establishing diuresis, amounting in all patients to more than 20 ml/min./1.73 m2, i.e. ranging from 20.6 to 59.0 ml/min./1.73 m2. Of the cases which ended fatally all had fibroses and myocardial scars, apart from recent infarction of the myocardium, generalized atherosclerosis particularly of the coronary arteries, and in all patients hypertrophy of the left ventricle and dilatation of the whole heart. In one patient anaemic infarction of one kidney was found and in another acute tubular necrosis (with the renal failure index of 0.3 and the excretional fraction of filtered sodium of 0.2), while in third patient no renal changes were found.
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PMID:The characteristics of acute renal failure in cardiogenic shock in the elderly. 378 19

Calcium antagonists block calcium entry into cells, resulting in relaxation of smooth muscle and limitation of the cytotoxic effects of ischaemia in various organ systems. They are most frequently used for clinical conditions requiring vasodilatation, i.e. hypertension and Raynaud's phenomenon, and this also suggests that the most common adverse effect of these drugs for noncardiovascular indications is an unwanted decline in blood pressure. Other uses include treatment of supraventricular arrhythmias and angina. There is some evidence that these drugs retard the development of atherosclerosis. Calcium channel blockers also improve renal reperfusion and may reduce renal insufficiency due to various nephrotoxins, and are particularly useful in renal transplantation for protection against cyclosporin toxicity and post-transplant acute tubular necrosis. These drugs are also useful in pregnancy-induced hypertension and unwanted uterine contraction. Affective disorders and malignancies may be other conditions which benefit from calcium antagonist therapy. Calcium antagonists, in particular nimodipine which is most selective for the cerebral vasculature, have been approved for treating vasospasm after subarachnoid haemorrhage. They are probably also effective for treatment of migraine. Calcium channel blockers may be effective for treating acute cerebral infarction, but results of clinical trials to date have been equivocal, largely because it has been difficult to recruit patients within the short interval after the onset of stroke when these drugs would be most effective, and because of the unwanted hypotensive effect of high doses.
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PMID:New uses for calcium channel blockers. Therapeutic implications. 751 Jun 13

Heme proteins transport oxygen and facilitate redox reactions. Heme, however, may be dangerous, especially when free in biologic systems. For example, iron released from hemoglobin-derived heme can catalyze oxidative injury to neuronal cell membranes and may be a factor in post-traumatic damage to the central nervous system. We have shown that heme catalyzes the oxidation of low density lipoproteins which can damage vascular endothelial cells. The endothelium is susceptible to damage by oxidants generated by activated phagocytes, and this has been invoked as an important mechanism in a number of pathologies including the Adulte Respiratory Distress Syndrome (ARDS), acute tubular necrosis, reperfusion injury and atherosclerosis. Because of its highly hydrophobic nature, heme readily intercalates into endothelial membranes and potentiates oxidant-mediated damage. This injury is dependent on the iron content of heme and is completely blocked when concomitant hemopexin is added. Ferrohemoglobin, when added to cultured endothelial cells, is without deleterious effects, but if oxidized to ferrihemoglobin (methemoglobin), it greatly amplifies oxidant damage. Methemoglobin, but not ferrohemoglobin, releases its hemes which can then be incorporated into endothelial cells. Cultured endothelial cells, when exposed to methemoglobin but not ferrohemoglobin, cytochrome c or metmyoglobin, potentiate this oxidant injury. Stabilization of the methemoglobin by cyanide, haptoglobin or capture of the heme by hemopexin abrogates this effect. Paradoxically, more prolonged exposure of endothelium to heme or methemoglobin renders them remarkably resistant to oxidant challenge. Endothelium defends itself from heme by induction of the heme degrading enzyme heme oxygenase and the concomitant production of large amounts of the iron binding protein ferritin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heme and the vasculature: an oxidative hazard that induces antioxidant defenses in the endothelium. 808 43

Elderly individuals comprise the faster growing patient population group and acute renal failure (ARF) is quite common among them, although exact numbers are not known. We reviewed the literature with regards to the characteristics of ARF in elderly patients and describe some useful guidelines. The ageing kidney is characterized by many structural and functional changes, which are mainly due to various chronic disorders, such as hypertension, diabetes and atherosclerosis, which are highly prevalent in these patients. A number of structural and functional changes characteristic of the ageing kidney make elderly people especially prone to renal damage. ARF in the elderly is frequently of multifactorial origin and often with an atypical presentation, like the "intermediate syndrome", which combines characteristics of pre-renal azotemia and acute tubular necrosis. Physical examination and laboratory blood and urine indices may sometimes be misleading occasionally leading to misdiagnosis. Prophylaxis remains the preferred approach to therapy: one should avoid nephrotoxic drugs and poly-pharmacy, adjust drug doses and achieve adequate hydration of the patient as cautiously as possible. Dialysis therapies can be used for treatment of ARF irrespective of age and carry a good prognosis.
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PMID:Acute renal failure in the elderly: particular characteristics. 1716 Jun 31