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

Hypokalemia is an uncommon cause of rhabdomyolysis with acute tubular necrosis. We recently treated a patient in whom severe hypokalemia attributed to diuretic therapy antedated acute myoglobinuric renal failure by six months. After recovery, hypokalemia persisted and subsequent evaluation disclosed primary aldosteronism. This case is a unique presentation for primary aldosteronism and illustrates the importance of diagnosis before treatment in hypertension as well as the hazards of hypokalemia.
 ...
PMID:Primary aldosteronism presenting as myoglobinuric acute renal failure. 68 40

To date angiography has been the most precise diagnostic modality for the evaluation of a transplanted kidney. In the immediate postoperative period angiography can clearly demonstrate the integrity of the vascular anastomoses, and in most cases helps to differentiate between acute tubular necrosis and acute rejection. It is also helpful in the evaluation of the transplant kidney later in the postoperative period, since it can provide some estimate of the vascular effects of chronic rejection and distinguish between hypertension secondary to chronic rejection or renal artery stenosis. Serial isotope techniques may play a more important role in the evaluation of the transplanted kidney in the future, but at present angiography is the diagnostic modality of choice at the Cleveland Clinic.
 ...
PMID:Selective renal angiography: its value in renal transplantation. 79 Jul 34

Thirty-four renal transplant recipients received drip infusion urograms from 2-24 days post-transplantation. Twenty-two patients exhibited changes in renal function within 1-4 days of the urogram that were indistinguishable from allograft rejection: a tender, swollen kidney, elevation of serum creatinine, oliguria, decreased urine sodium concentration, weight gain, and hypertension. Two patients developed acute tubular necrosis and required hemodialysis, but renal function in the remaining 20 patients improved after therapy for "graft rejection" with i.v. methyprednisolone sodium succinnate. Kidneys from older-age donors that were functioning suboptimally and kidneys which exhibited subsequent clinical allograft rejection were more at risk for contrast media toxicity. This suggests that occult vascular lesions may have been present in the allograft which were exacerbated when exposed to the irritant vascular effects of contrast media, producing a mild, reversible toxic nephritis. However, several kidneys with normal function and several kidneys which never exhibited rejection activity were also adversely affected by exposure to contrast media. It appears these agents should be used cautiously, if at all, in the early post-transplant period.
 ...
PMID:Adverse effects of meglumine diatrizoate on renal function in the early post-transplant period. 110 14

During a 4-year period, acute renal failure was observed in 27 patients (mean age 65 years) treated by various angiotensin-converting-enzyme (ACE) inhibitors for hypertension, heart failure, or a combination of both. None had significant renal artery stenosis on angiography. Overt volume depletion was present in 21 and hypotension in 12 cases. All patients received diuretic therapy and/or a low-salt diet. Other facilitating factors included cardiac failure, pre-existing chronic renal insufficiency, combined therapy with non-steroidal anti-inflammatory drugs, and diabetes mellitus. Twenty-two patients had two or more of these factors at presentation. A renal biopsy performed in 10 cases showed severe arteriosclerosis of small renal arteries in eight and acute tubular necrosis in five instances. Therapy comprised volume expansion, and withdrawal of diuretics and, except in two patients, of ACE inhibitors. Twenty-one patients recovered normal renal function, two died, and permanent renal damage remained in four. These results suggest that sodium depletion has a critical role in inducing acute renal failure, whose outcome is not always benign. A combination of diuretics and ACE inhibitors should be prescribed with caution, especially in older patients with small as well as with large renal vessel disease.
 ...
PMID:Acute renal failure after the use of angiotensin-converting-enzyme inhibitors in patients without renal artery stenosis. 131 66

Doppler techniques (echo Doppler, Color Doppler) may be useful in many urologic and nephrologic applications. Renal vein thrombosis can be determined by discovering a combination of a distended, thrombus-filled renal vein and the absence of detectable flow. The use of Doppler as screening technique for suspected renal artery hypertension remains controversial. Although patency of the renal artery can be assessed by Doppler, it is difficult to evaluate always the entire course of the vessel and it is impossible to detect multiple renal arteries. In the renal masses Doppler can investigate the vascularity: most malignant lesions gives rise to abnormal, high frequency, Doppler shifted signals that can aid the differential diagnosis of benign and malignant conditions. Doppler has recently been shown to help distinguish between the dilated renal pelvis and renal obstruction. A Resistive Index (RI) of 0.70 or greater is suspicious for obstruction, while a value of less than this virtually rules out the diagnosis in most cases. The use of Doppler techniques in renal transplants has become routine. Doppler assesses the presence of blood flow in the main renal arteries and veins, the presence of post-surgical abnormalities such as pseudo-aneurysms, stenoses, A-V fistulas and has proven useful in the evaluation of flow waveforms associated with variety of different abnormalities which can produce a decrease in renal function. Acute vascular rejection produces an increased resistance to flow with decreased, absent or reversed diastolic flow within the transplant kidney. Severe rejection produces abnormalities of the RI which are non-specific; severe acute tubular necrosis, infections, obstructions, peri-renal collections can also produce elevated RI.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Utility of the Doppler technique in the uro-nephrologic field]. 183 59

The resistive index (RI), calculated from the duplex Doppler waveform, was compared with clinical and laboratory findings and the results of renal biopsy in 41 patients with nonobstructive (medical) renal disease. Kidneys with active disease in the tubulointerstitial compartment had a mean RI of 0.75 +/- 0.07. This was statistically significantly different (p less than .01) from the RI in kidneys with disease limited to the glomeruli (mean RI of 0.58 +/- 0.05). Acute tubular necrosis resulted in an elevated RI (mean RI = 0.78 +/- 0.03) as did vasculitis/vasculopathy (mean RI = 0.82 +/- 0.05). Patients with hypertension, proteinuria, or hematuria did not have kidneys with a significantly higher RI than did patients without these clinical factors. Kidneys found to be abnormally echogenic did not have an RI significantly different from kidneys of normal echogenicity. There was a weak correlation between creatinine level and RI value, reflected by a linear correlation coefficient of 0.34. In patients with normal renal RIs, the mean creatinine level was 1.7 +/- 1.7, whereas in those with abnormal RI values (greater than or equal to 0.70), the mean creatinine level was 3.7 +/- 3.6. We conclude that some forms of nonobstructive renal disease can produce changes in the Doppler waveform detectable by RI measurement. The production of Doppler waveform changes is strongly influenced by the site of the main disease within the kidneys. Active disease within the tubulointerstitial compartment (acute tubular necrosis, interstitial nephritis) or vasculitis/vasculopathy generally resulted in an elevated RI, whereas disease limited to the glomeruli, no matter how severe, did not significantly elevate the RI. Degree of renal dysfunction as indicated by serum creatinine level probably affects the Doppler waveform to some degree, but the relationship is weak.
 ...
PMID:Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. 211 Jul 32

The purpose of this study is to report short-term pregnancy outcome, subsequent pregnancy outcome, and remote prognosis (follow-up from 0.3 to 9.8 years) in 31 cases complicated by acute renal failure. Eighteen patients had "pure" preeclampsia and 12 patients (13 pregnancies) had chronic hypertension, parenchymal renal disease, or both before pregnancy. All patients had serial evaluation of renal function, urine microscopy, and electrolyte studies at the onset of acute renal failure and on follow-up. There were three immediate maternal deaths (two in the pure preeclampsia group and one in the other group). Nine patients (50%) in the "pure" group required dialysis during hospitalization and all 18 patients had acute tubular necrosis. Five patients (42%) in the other group required immediate dialysis and three patients had bilateral cortical necrosis. The majority of pregnancies in both groups were complicated by abruptio placentae and hemorrhage. All 16 surviving patients in the pure preeclampsia group had normal renal function on long-term follow-up (average 4.0 +/- 3.1 years). Conversely, nine of the 11 surviving patients in the second group required long-term dialysis on follow-up and four of them ultimately died of end-stage renal disease. We conclude that proper management of acute renal failure in patients with pure preeclampsia-eclampsia does not result in residual function impairment.
 ...
PMID:Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases. 231 88

Acute renal failure is a most challenging clinical problem when it occurs in pregnancy. It requires an understanding of the normal physiology of the kidney in pregnancy and the natural history of different underlying renal diseases when pregnancy occurs. Because patients with chronic renal disease may present with worsening proteinuria, hypertension, and renal function, these disorders must be excluded from those conditions that cause acute deterioration of renal failure in otherwise normal women during pregnancy. As in all patients who develop acute renal failure, prerenal and obstructive causes must be excluded. Particularly important causes of prerenal azotemia in pregnancy include hyperemesis gravidarum and uterine hemorrhage, especially if it is unsuspected as in abruptio placentae. Infectious causes of acute renal failure in the pregnant woman include acute pyelonephritis and septic abortion. The clinical presentation of both these conditions should be apparent, and appropriate diagnosis and treatment can then be promptly instituted. Renal cortical necrosis is another cause of renal failure that occurs more frequently in pregnancy, and it must be differentiated from the many causes of acute tubular necrosis that may be associated with pregnancy. Those conditions that cause renal failure unique to pregnancy must always be considered when renal function deteriorates in the last trimester or the postpartum period. Severe preeclampsia, acute fatty liver of pregnancy, and idiopathic postpartum acute renal failure may all present similar complications, but the approach to each of these clinical disorders must be individualized. By understanding the causes of renal functional deterioration in pregnancy, a logical differential diagnosis can be established, allowing appropriate therapeutic decisions to preserve both maternal and fetal well-being.
 ...
PMID:Acute renal failure in pregnancy. 305 11

The results of percutaneous transluminal angioplasty of renal arteries (PTA) were evaluated in 43 patients followed up for 2-39 months (mean: 14 months). The benefit of PTA was higher (82%) in hypertensives with arterial fibrodysplasia (n = 11) than in atherosclerotic vascular lesions (53%, n = 19). Of 15 patients with reduced renal function before PTA, the glomerular filtration rate rose in seven. A major complication was in one patient arterial dissection and in another one loss of function of the transplanted kidney due to acute tubular necrosis. The results confirm that PTA is an important contribution to the treatment of renovascular hypertension.
 ...
PMID:Percutaneous transluminal angioplasty in renovascular hypertension. 316 1

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.
 ...
PMID:[Renal disease associated with heroin abuse]. 321 43


1 2 3 4 5 6 7 8 Next >>