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)

Three children treated for appendicitis developed anuria and acute renal insufficiency several days after appendicectomy. Associated hydronephrosis or hydroureters were present in two. At cystoscopy, marked swelling of the trigonum and ureteric orifices was seen. One patient developed unilateral acute tubular necrosis, a complication not reported before. Recognition of this rare complication of acute appendicitis, which need not be accompanied by hydronephrosis, should lead to prompt decompression by the introduction of ureteric stents.
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PMID:A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction. 798 Jul 94

Acute anuria due to bilateral distal ureteral obstruction developed in two boys, ages 7 and 13, several days after appendectomy, without sonographic signs of hydronephrosis or hydroureters. Decompression was achieved after introduction of ureteric stents. This failed on the left side in one patient, and unilateral acute tubular necrosis (ATN) subsequently developed on that side. Although bilateral decompression was successful in the second patient, ATN had already developed on the left side. In both patients, Tc-99m MAG3 renal scintigraphy proved to be an important tool in diagnosing unilateral ATN and for evaluating the recovery from this rare complication.
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PMID:The role of renal scintigraphy in the diagnosis and follow-up of unilateral ATN after complete bilateral distal ureteral obstruction as a complication of acute appendicitis. 950 25

Acute Renal Failure (ARF) is characterized by a rapid decline of the glomerular filtration rate, due to hypotension (prerenal ARF), obstruction of the urinary tract (post-renal ARF) or renal parenchymal disease (renal ARF). The differential diagnosis among different causes of ARF is based on anamnesis, clinical symptoms and laboratory data. Usually ultrasound (US) is the only imaging examination performed in these patients, because it is safe and readily available. In patients with ARF gray scale US is usually performed to rule out obstruction since it is highly sensitive to recognize hydronephrosis. Patients with renal ARF have no specific changes in renal morphology. The size of the kidneys is usually normal or increased, with smooth margins. Detection of small kidneys suggests underlying chronic renal pathology and worse prognosis. Echogenicity and parenchymal thickness are usually normal, but in some cases there are hyperechogenic kidneys, increased parenchymal thickness and increased cortico-medullary differentiation. Evaluation of renal vasculature with pulsed Doppler US is useful in the differential diagnosis between prerenal ARF and acute tubular necrosis (ATN), and in the diagnosis of renal obstruction. Latest generation US apparatus allow color Doppler and power Doppler evaluation of renal vasculature up to the interlobular vessels. A significant, but non specific, reduction in renal perfusion is usually appreciable in the patients with ARF. There are renal pathologic conditions presenting with ARF in which color Doppler US provides more specific morphologic and functional information. In particular, color Doppler US often provides direct or indirect signs which can lead to the right diagnosis in old patients with chronic renal insufficiency complicated with ARF, in patients with acute pyelonephritis, hepatic disease, vasculitis, thrombotic microangiopathies, and in patients with acute thrombosis of the renal artery and vein. Contrast enhanced US is another useful diagnostic tool in patients with ARF which has been recently introduced in clinical practice. Microbubble administration may reduce technical failure in the evaluation of the renal artery. Moreover, perfusion defects due to stenosis or thrombosis of the renal segmentary vessels are better recognized. New diagnostic possibilities of enhanced US include evaluation of both cortical and medullar vessels, and functional evaluation of renal perfusion. Measuring the transit time of the microbubbles is useful for the diagnosis of renal artery stenosis and, in transplanted kidneys, for differential diagnosis between ATN and acute rejection.
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PMID:[Current role of color Doppler ultrasound in acute renal failure]. 1177 81

In this article, we present an overview of renal transplantation with its complications and discuss the abilities and limitations of ultrasound in evaluating these complications. We included renal transplants performed at our institution between 1993 and 2006 and gathered data on more than 1,000 patients who developed graft dysfunction. We analyzed the ultrasound findings in different posttransplant complications and compared our findings with those in published literature. We present this review article that elaborates and categorizes various transplant complications from an ultrasound perspective. Based on imaging evaluation, the complications of renal transplantation can be divided into four major categories: peri-renal, renal parenchymal, renal collecting system, and renal vascular complications. Common complications included acute tubular necrosis, graft rejection, drug nephrotoxicity, hematoma, lymphocele, urinoma, hydronephrosis, and vascular complications. Ultrasound has a key role in identification and management of most of these complications. However, some parenchymal complications may only be diagnosed on renal biopsy. Ultrasound is a very powerful screening tool to assess renal transplant dysfunction and has a primary role in early diagnosis and management of structural and vascular complications, which may need surgical intervention to save the graft.
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PMID:A review of sonographic evaluation of renal transplant complications. 1829 78

A 75-year-old woman developed renal failure 1 week after elective aortobifemoral bypass surgery. Postoperative computed tomography showed right hydronephrosis. Tc-99m mercaptoacetyltriglycerine (MAG3) scintigraphy was performed to exclude renal obstruction or acute tubular necrosis. Planar MAG3 images demonstrated right hydronephrosis and unusual accumulation of tracer between the kidneys and the right upper quadrant of abdomen, with new areas of activity in the right lower quadrant on delayed images. SPECT/CT demonstrated MAG3 activity within fluid collections adjacent to the aorta and right iliac/inguinal arteries, consistent with a urine leak. The right upper quadrant activity represented MAG3 accumulation within the gallbladder.
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PMID:Peri-aortofemoral prosthesis urinoma: diagnosis by Tc-99m MAG3 SPECT/CT and differentiation from simultaneous hepatobiliary excretion. 1843 Nov 49

To determine the conditions that result in pediatric nephrology consultations in an academic hospital setting, we studied 178 prospective consecutive consultations for 125 inpatients (69 boys and 56 girls) at the Jordan University Hospital, Amman, Jordan from January 2006 to December 2006. The mean age at the time of consultation was 3.1 years (median of 1 year, and range from 1 day to 16 years). Of the 125 patients, 87 (69.6%) patients had a single consultation, while 38 (30.4%) patients had multiple encounters (range from 1-4 consultations). The reasons for consultations included fluids and electrolytes imbalances (29.0%), hydronephrosis (15.7%), urinary tract infections (14.2%), acute renal failure (ARF) (14.2%), hypertension (8.40%), and miscellaneous conditions (18.5%). The most frequent fluids and electrolyte disorders were polyuria, hypocalcemia, and hyponatremia. Routine administration of hypotonic intravenous fluids was a major contributory factor to hyponatremia. The most frequent cause of ARF was acute tubular necrosis in association with multiple organ dysfunction and antibiotic nephrotoxicity. Hypertension was mostly neurogenic in origin.
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PMID:Pediatric nephrology consultations in a tertiary academic center in Jordan. 1844 13

Renal transplantation has emerged as the most cost-effective and patient-supportive way to treat chronic renal failure, with excellent graft survival rates thanks to improved surgical techniques and rejection management. Its success has placed a heavy burden on imaging, especially ultrasound, which is used in the selection of live donors and in monitoring each stage of the postoperative care of the recipient. Ultrasound is particularly useful for detecting vascular complications such as early occlusions and arterial stenosis. It can detect and monitor perinephric complications and transplant hydronephrosis, all clinically significant complications that affect management. Ultrasound can detect many of the late acquired diseases, especially intercurrent tumors that require surgery. It is the best method to guide interventions such as aspiration of collections and insertion of nephrostomy drains. It can also detect postbiopsy arteriovenous shunts and the end-stage kidney of chronic rejection. These, however, are of no great clinical significance, and the findings rarely affect clinical decisions. Ultrasound fails to discriminate between the important causes of early graft dysfunction, especially acute tubular necrosis, rejection, and drug toxicity: these important distinctions still rely on biopsy. There is hope that some of the newer ultrasound methods, especially the functional data from microbubble contrast agent dynamics, might supply useful information for their detection and differentiation.
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PMID:Renal transplants: what ultrasound can and cannot do. 1852 43

Hepatocyte growth factor and its receptor, Met, activate biological pathways necessary for repair and regeneration following kidney injury. The Met receptor is expressed in multiple cell types within the kidney, each of which is capable of regulating fibrotic responses. To specifically address the role of the Met receptor in the adult collecting duct during renal injury, a conditional knockout mouse (Met(fl/fl);HoxB7-Cre) was generated and tested using unilateral ureteral obstruction, a model of nephron injury, fibrosis, and repair. Following obstruction in these mice there was increased expression of collagens I and IV along with plasminogen activator inhibitor 1, a known regulator of matrix degradation, compared to ureteral obstructed non-flox littermates. There were trends toward increased interstitial fibrosis, infiltration of the interstitium, and acute tubular necrosis in the knockout mice despite similar degrees of hydronephrosis to the control littermates. The Met(fl/fl);HoxB7-Cre mice; however, had reduced tubular cell proliferation and kidney regenerative capacity after release of the obstruction, thus leading to diminished functional recovery. We suggest that Met receptor signaling in the collecting duct acts as a major regulator of cell survival and propagation of the repair process with a possible secondary role to diminish inflammatory and fibrotic responses.
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PMID:Deletion of the Met receptor in the collecting duct decreases renal repair following ureteral obstruction. 1967 27

Prior to 2002, the incidence of acute renal failure (ARF) varied as there was no standard definition. To better understand its incidence and etiology and to develop treatment and prevention strategies, while moving research forward, the Acute Dialysis Quality Initiative workgroup developed the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification. After continued data suggesting that even small increases in serum creatinine lead to worse outcomes, the Acute Kidney Injury Network (AKIN) modified the RIFLE criteria and used the term acute kidney injury (AKI) instead of ARF. These classification and staging systems provide the clinician and researcher a starting point for refining the understanding and treatment of AKI. An important initial step in evaluating AKI is determining the likely location of injury, generally classified as prerenal, renal, or postrenal. There is no single biomarker or test that definitively defines the mechanism of the injury. Identifying the insult(s) requires a thorough assessment of the patient and their medical and medication histories. Prerenal injuries arise primarily due to renal hypoperfusion. This may be the result of systemic or focal conditions or secondary to the effects of drugs such as nonsteroidal anti-inflammatory drugs, calcineurin inhibitors (CIs), and modulators of the renin-angiotensin-aldosterone system. Renal, or intrinsic, injury is an overarching term that represents complex conditions leading to considerable damage to a component of the intrinsic renal system (renal tubules, glomerulus, vascular structures, inter-stitium, or renal tubule obstruction). Acute tubular necrosis and acute interstitial nephritis are the more common types of intrinsic renal injury. Each type of injury has several drugs that are implicated as a possible cause, with antiinfectives being the most common. Postrenal injuries that result from obstruction block the flow of urine, leading to hydronephrosis and subsequent damage to the renal parenchyma. Drugs associated with tubular obstruction include acyclovir, methotrexate, and several antiretrovirals. Renal recovery from drug-induced AKI begins once the offending agent has been removed, if clinically possible, and is complete in most cases. It is uncommon that renal replacement therapy will be needed while recovery occurs. Pharmacists can play a pivotal role in identifying possible causes of drug-induced AKI and limit their toxic effect by identifying those most likely to cause or contribute to injury. Dose adjustment is critical during changes in renal function, and the pharmacist can ensure that optimal therapy is provided during this critical time.
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PMID:The role of medications and their management in acute kidney injury. 2935 17

Crystalluria can involve the kidney and lower urinary tract, can produce acute and chronic effects, and occurs in all mammalian species. Most commonly urinary crystals contain calcium. Numerous other endogenous and exogenous substances can produce crystalluria. Crystals are identified in kidneys of many species, up to 100% in certain rat strains. More severe renal disease (acute tubular necrosis and chronic renal disease) can be secondary to crystal accumulation, such as observed with melamine-cyanuric acid in cats and dogs. Aggregation of crystals leads to calculi that act as urothelial abrasives with consequent regenerative proliferation. Accumulation in the kidney pelvis or bladder can lead to partial or complete obstruction and hydronephrosis. Long-term presence of urinary tract calculi in rodents leads to increased risk of urothelial tumors, but not in humans. Crystals in the lower urinary tract can act as irritants in rodents, but not in humans. It is critical that specific procedures are followed to optimize the presence of crystals in urine for diagnosis, including not fasting the animals. Numerous factors have been identified which can enhance or inhibit crystal formation. Extrapolation from animals for the threshold toxicity of crystals/calculi is appropriate but is not relevant for cancer risk assessment.
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PMID:Crystalluria and Chronic Kidney Disease. 3027 Jul 58


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