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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Selective renal angiography: its value in renal transplantation. 79 Jul 34

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.
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PMID:Acute renal failure after the use of angiotensin-converting-enzyme inhibitors in patients without renal artery stenosis. 131 66

Seventy-eight recipients, average age 36 years, of cadaver kidneys were studied to evaluate the usefulness of Doppler ultrasonography for diagnosis of common complications in renal transplant patients. The patients were divided in five groups: Control (normal renal function), acute rejection (AR), acute tubular necrosis (ATN), obstructive uropathy (OU) and pathological vasculature (PV); renal artery stenosis (RAS) and renal artery thrombosis (RAT). Pulsed Doppler ultrasonography (PDUS) was an effective method to diagnose RAS and RAT, but did not sufficiently differentiate between AR and ATN. Despite this, PDUS may be useful for follow-up of renal transplant patients as specific changes in the PDUS curves or differences in successively recorded patterns indicate abnormality, which may initiate more specific diagnostic methods.
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PMID:Pulsed and continuous Doppler evaluation of renal dysfunction after kidney transplantation. 203 96

A total of 420 sonograms of renal transplants in 80 children were obtained because of decreased renal function or to establish a baseline after surgery. We describe normal anatomy of a renal transplant on sonograms, including duplex Doppler and color flow images, and a spectrum of complications. The complications are categorized as follows: parenchymal (drug toxicity rejection, acute tubular necrosis, infection), vascular (pseudoaneurysm, arteriovenous fistula, renal artery stenosis and occlusion), obstructive uropathy, and postoperative fluid collections.
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PMID:Sonography of complications in pediatric renal allografts. 219 34

99mTc-mercaptoacetyltriglycine (MAG3) has recently been introduced for imaging kidney function. Due to the much lower radiation dose per MBq, the total administered activity can be much higher than in the case of 131I-ortho-iodo-hippurate (OIH). The improved counting statistics make this tracer useful for parametric imaging of the kidneys. To investigate this potential of MAG3, its kinetics was compared with that of the reference tracer OIH in 38 patients. Parameters of extrarenal tracer kinetics such as the distribution volumes, the whole-body elimination times and the clearance rates showed a good correlation; however, the clearance rate of MAG3 was always lower than that of OIH. The intrarenal kinetics was investigated using the transfer function which was calculated by deconvolution analysis of the renographic curves. Parameters of the transfer function such as the amplitude, extraction fraction and mean transport time demonstrated a high correlation between the two tracers. Since MAG3 seems to be suitable for parametric imaging of kidney function, parametric images of perfusion, uptake, extraction and transport times were calculated by deconvolution analysis of the MAG3 pixel-renograms in various renal disorders. The parameters were distributed homogeneously throughout the parenchyma of normal kidneys. In a kidney with a hemodynamically significant renal artery stenosis the perfusion parameter was decreased and the time parameter was prolonged. Further examples of a renal graft acute tubular necrosis, an obstructive uropathy, an obstructive nephropathy and of a horse-shoe kidney demonstrate that the parametric images are useful for quantitative investigation of regional renal function.
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PMID:[Parametric representation of kidney function using 99mTc-mercaptoacetyltriglycine (MAG3)]. 252 3

Well-established roles for Doppler ultrasound assessment of renal transplants include postoperative evaluation for vascular occlusion and detection of renal artery stenosis. Doppler studies can often differentiate rejecting transplants from those that normally function. While very high Doppler indices are specific for rejection, waveforms in acute tubular necrosis may be abnormal. Mild cases of rejection may have normal waveforms. Further investigation is needed to determine the role of Doppler methods in graft dysfunction and to establish methods to improve their specificity.
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PMID:Doppler evaluation of the renal transplant. 311 71

Renal transplantation is the treatment of choice for adults and children with end-stage renal disease. More than 7500 kidney transplants are performed in the United States each year with an average 2-year graft survival rate of 95, 85, and 75 per cent for HLA-identical, living related, and cadaver donor recipients, respectively. New immunosuppressive modalities including donor specific transfusions and cyclosporine have resulted in improved results with fewer infectious complications. Careful attention to hemostasis, minimization of tissue injury, and aseptic technique is necessary in uremic and immunosuppressed patients. The most common complications requiring radiologic evaluation and treatment after renal transplantation include acute tubular necrosis, renal artery or renal vein thrombosis, lymphocele, ureteral necrosis, bladder disruption, bleeding, ureteral obstruction or stricture, and renal artery stenosis. The most useful radiologic studies are renograms, echograms, computed axial tomograms, cystograms, arteriograms, percutaneous nephrostograms, and intravenous or retrograde pyelograms.
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PMID:Renal transplantation: clinical considerations. 354 72

Ex vivo renal artery surgery has been reported by several investigators and has extended the role of revascularization in the treatment of lesions previously managed by nephrectomy alone. Several techniques are available for use, and selection of the most appropriate method can be tailored to the specific anatomy being managed. Our total experience included 27 kidneys that have been managed by ex vivo renal artery reconstruction. Lesions managed in this manner include two kidneys with renal artery stenosis and renal tumors, one kidney with a congenital branch arteriovenous malformation, and 24 kidneys with branch occlusive or aneurysmal disease from fibromuscular dysplasia. Postoperative angiography was performed in 22 cases and defined successful revascularization without technical error in 20 cases. One operative death occurred as a result of myocardial infarction. One patient required reoperation to control bleeding, and two patients had temporary acute tubular necrosis during the postoperative period. Techniques employed included ex vivo repair with autotransplantation to the iliac system (six kidneys), mobilization and perfusion without transection of the renal vein (10 kidneys), and ex vivo perfusion and repair with replacement into the original renal fossa (11 kidneys). The authors believe this latter technique of reconstruction to be preferable to autotransplantation for the usual patient undergoing ex vivo repair of complex renovascular lesions.
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PMID:Ex vivo renal artery reconstructions: indications and techniques. 378 29

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131I OIH, 67gallium, 99mTcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.
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PMID:Nuclear medicine in acute and chronic renal failure. 628 57

A study of the magnetic resonance imaging (MRI) appearances of the kidneys in six normal volunteers and 52 patients is reported. Corticomedullary differentiation was seen with the inversion-recovery (IR 1400/400) sequence in the normal volunteers and in patients with functioning transplanted kidneys and acute tubular necrosis. Partial or total loss of corticomedullary differentiation was seen in glomerulonephritis, acute and chronic renal failure, renal artery stenosis, and transplant rejection. The T1 of the kidneys was increased in glomerulonephritis with nephrotic syndrome, but the T1 was within the normal range for renal medulla in glomerulonephritis without nephrotic syndrome, renal artery stenosis, and chronic renal failure. A large staghorn calculus was demonstrated with MRI, but small calculi were not seen. Fluid within the hydronephrosis, simple renal cysts, and polycystic kidneys displayed very low signal intensity and long T1 values. Evidence of recent hemorrhage into cysts was seen in polycystic kidneys. Tumors displayed varied appearances. Hypernephromas were shown to be hypo- or hyperintense with the renal medulla on the IR 1400/400 sequence. After intravenous injection of gadolinium-DTPA, there was marked decrease in the tumor T1.
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PMID:Magnetic resonance imaging of the kidneys. 638 80


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