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)

131I-labeled autologous fibrinogen was used to detect acute renal allograft rejection in the early postoperative period. Ratios of radioactive counts over transplanted kidneys to those over the heart increased with deposition of radioactive fibrinogen in kidneys undergoing rejection. The test was positive in all instances of acute rejection twelve to twenty-four hours prior to clinical ro biochemical changes. False-positive test results were noted in instances of perinephric hematoma, seroma, and wound abscess and in one patient with urinary tract infection. The test was negative in cases of renal failure secondary to acute tubular necrosis, uric acid nephropathy (in the absence of acute rejection), and chronic rejection. This test is simple, rapid, and practical. It can be performed at the bedside and is free from complications, particularly serum hepatitis.
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PMID:Early detection of acute rejection in renal allografts using radioiodinated autologous fibrinogen. 109 6

From June 1963 to December 1988 aseptic necrosis of the femoral head has been treated surgically in 84 renal transplant recipients (150 surgical procedures). The long-term results of drilling of the neck and head of the femur (16), cup arthroplasty (32), cemented cup (1) and hemiarthroplasty (8) were unsatisfactory, as 23 of these 57 hips underwent a secondary procedure. Total hip arthroplasty progressively became the standard procedure for treatment of hip disease in transplanted patients. Since 1971, 63 renal transplant recipients underwent 92 cemented total hip replacement (THR) as a primary (73), secondary (16) or third (3) surgical procedure for severely symptomatic femoral head necrosis. Hospital stay averaged 22 days, and follow-up averaged 53 months. Two deaths related to the surgical procedure occurred in the first 4 years of our experience (one major local sepsis, one pulmonary infection). Other postoperative complications were urinary tract infection (12), pulmonary infection 1, transient sciatic nerve irritation (3), wound hematoma (6), reversible deterioration of renal function (3) and rejection of the graft (2). Thromboembolic complications did not occur. All operated hips showed a marked symptomatic improvement. Loosening of one or both components was definite in one, probable in two and possible in three of the 33 hips followed up more than 5 years. Other late complications included dislocation (6), painful class III heterotopic ossification (4), recurrence of previous sepsis (1) and late hematogenous sepsis. Late hip revision was required in 5 cases (recurrent dislocation, 1, ossification, 2, sepsis, 2). Two renal complications (one graft infarction and one reversible acute tubular necrosis) occurred after these revisions. The functional results of THR compare favourably with the results of other surgical procedures used in our early experience. We conclude that THR has become the treatment of choice for symptomatic established osteonecrosis of the femoral head in renal transplant patients. A relatively high rate of early and late complications is nevertheless to be expected.
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PMID:[Aseptic necrosis of the femoral head following renal transplantation: assessment of a 25-year experience]. 148 99

Koolen, M.I. et al. (1984) measured urinary kallikrein (UKal) in renal transplant recipients using 2 methods, S-2266 amidolytic assay and radioimmunoassay, and reported that the values by the former method showed an increase in amount at the time of acute rejection episode (ARE) despite of no variation in those by the latter. To clear the discrepancy, 24 hours excretion of UKal was measured by the amidolytic assay using Pro-Phe-Arg-MCA under 2 conditions, with and without soybean trypsin inhibitor (STI), in 10 living related kidney recipients (LR), their donors (LD), and 8 cadaver kidney recipients (CR), Furthermore, gel filtration chromatography (Sephacryl S-200) was performed in some recipients and LD to confirm whether the amidolytic activity (ALA) indicates exclusively UKal or not. The results were as follows. In LD, there were no statistical differences in ALA between not only before and after uninephrectomy but also with and without STI. On the post-operative course, some recipients showed a tendency of decrease in ALA with STI, and some kept a constant level. There occasionally appeared a difference between ALA with and without STI just after the transplantation, and at the time of ARE, acute tubular necrosis (ATN) or urinary tract infection (UTI). There was no fixed characteristic variation in ALA, both with and without STI, at the time of ARE. ALA with STI was lower in LR than in LD, and the lowest in CR, From the second week of transplantation and afterward, ALA with STI showed a positive correlation not with creatinine clearance but with urinary aldosterone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Urinary kallikrein-like activity in renal transplant recipients]. 235 63

Exocrine secretions of 16 of 22 pancreas allografts were drained into the urinary tract. Seven of these 16 patients have functioning allografts, six with pancreaticocystostomies and one with duct-to-ureter anastomosis. A notable problem has been a chronic metabolic acidosis, along with weight loss and hypotension, secondary to chronic bicarbonate loss and volume depletion through the urinary pancreatic fistula. This occurred as early as one week posttransplant, and intermittently thereafter up to four years. The syndrome was aggravated by episodes of renal dysfunction (acute tubular necrosis or rejection), and febrile syndromes. An inverse relationship between serum and urine bicarbonate concentrations existed, with a correlation coefficient, r = -0.746, (P less than 0.05). A negative correlation was also noted between serum bicarbonate and serum creatinine, r = 0.726, (P less than 0.05). Hyperchloremic metabolic acidosis with normal anion gap occurred despite periods of marginal pancreas allograft function resulting from ongoing rejection. Treatment consisted of intravenous and/or oral bicarbonate supplementation, and bicarbonate dialysis for uremic patients. In addition, one patient was first seen with severe balanitis and urethritis due to documented activation of trypsinogen and chymotrypsinogen, presumably caused by recurrent episodes of urinary tract infection. Urinary assay revealed a 10(2-3) increase in activated trypsin and chymotrypsin in comparison with other asymptomatic allograft recipients. Conversion to ductal enteric drainage led to resolution of both the balanitis and bicarbonate wasting. Measurement of urinary amylase levels were gross indicators of graft viability since no correlation could be found between these levels, onset of hyperglycemia, and eventual graft rejection confirmed by pathological examination.
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PMID:Pancreatic allograft exocrine urinary tract diversion. Pathophysiology. 243 6

A sandwich ELISA assay has been formatted from two commercially available murine monoclonal antibodies, URO-4 and URO-4a, directed against a 120,000 dalton glycoprotein, the adenosine deaminase binding protein (ABP), found on the brush border of the renal proximal tubular epithelial cell. Untimed urine samples from 37 normal individuals and urinary ABP less than 0.1 AU; 37 patients with pure glomerular disease had ABP less than 0.4 AU (with 29, or 76% less than 0.2 AU); 10 patients with pre-renal azotaemia had ABP less than 0.6 (with 8, or 80% less than 0.3 AU). In contrast, 79 patients with post-ischaemic acute tubular necrosis had ABP greater than 0.6 AU. Acute renal failure due to myoglobinuria, contrast dye, and aminoglycoside toxicity were all associated with urinary ABP greater than 1.0 AU. In addition, all six patients with acute bacteraemic pyelonephritis had ABP greater than 0.7 AU, as opposed to ABP less than 0.2 AU in the urines of 12 women with acute cystitis. We conclude that this monoclonal antibody based urinary assay is a sensitive measure of renal proximal tubular injury, reliably distinguishes acute tubular from glomerular disease, and may be helpful in differentiating forms of urinary tract infection.
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PMID:Diagnosis of renal proximal tubular injury by urinary immunoassay for a proximal tubular antigen, the adenosine deaminase binding protein. 288 57

Eleven cases of sonographically visualized thickening of the wall of the renal collecting system were reviewed and the clinical diagnoses compiled. In only three of these patients was acute rejection after renal transplantation considered responsible for the finding. The remaining eight had acute tubular necrosis, urinary tract infection complicating hydronephrosis, congenital hydronephrosis after pyeloplasty, congenital hydronephrosis due to reflux, and one was on total parenteral nutrition. It was seen to resolve after therapy in five patients, including all three renal transplants, one patient with hydronephrosis and infection, and one patient with hydronephrosis after surgery. Sonographically visible thickening of the wall of the renal collecting system is a nonspecific finding and can be seen in a variety of renal diseases.
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PMID:Sonography of wall thickening of the renal collecting system. A nonspecific finding. 354 20

In a prospective study the diagnostic value of urinary thromboxane B2 (TXB2) and beta 2-microglobulin (beta MG) in renal allograft rejection was studied in 34 patients after transplantation. Twenty-four episodes of rejection were diagnosed by clinical symptoms. The clinical diagnosis of rejection was confirmed by an increase of urinary TXB2 in 21 (88%) cases. The augmented renal excretion of TXB2 proceded the clinical signs of rejection for 2.0 +/- 0.75 days. The symptoms in the remaining three (12%) cases of supposed allograft rejection without increased urinary TXB2 were caused by non-immunological events (urinary tract infection, acute tubular necrosis). No elevated TXB2 excretion was observed during urinary tract infection, sepsis, and acute tubular necrosis whereas urinary beta MG increased during these events as during transplant rejection. Urinary TXB2 was found to be an early, specific, and sensitive marker of renal allograft rejection with greater reliability than beta MG excretion or clinical signs of rejection.
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PMID:Thromboxane B2 and beta 2-microglobulin as early indicators of renal allograft rejection. 388 70

Immunoreactive thromboxane B2 (i-TXB2) was measured in daily urine samples from twelve patients after renal transplantation. In 21 of 30 rejection episodes, the increase in i-TXB2 preceded both the increase in serum beta 2-microglobulin (beta 2-MG) and the clinical diagnosis of rejection. In 26 of 30 rejection episodes, the increase in urine i-TXB2 preceded the increase in serum creatinine. The degree of change in i-TXB2 is greater than that of either serum beta 2-MG or creatinine. Urinary i-TXB2 was very high in one patient with deep venous thrombosis, but it did not rise in patients with urinary tract infection, pneumonia, or acute tubular necrosis. Thus, urinary i-TXB2 seems to be an early indicator of clinical renal allograft rejection.
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PMID:Urine i-TXB2 in renal allograft rejection. 611 99

We have serially measured serum beta 2 M microglobulin in a series of transplant recipients along with other standard clinical parameters. Independent comparison of the beta 2 M results leads to the following conclusions: 1. Beta 2 M is superior to the Scr in detecting acute rejection, with diagnostic elevations occurring 2 to 7 days before Scr increase. The observation is valid for all rejection episodes. 2. Beta 2 M decreases prior to or simultaneously with the Scr following successful rejection therapy or beginning resolution of acute tubular necrosis. 3. Abnormal beta 2 M following rejection therapy invariably heralds another rejection episode within 10-20 days, despite the Scr having returned to baseline. 4. Beta 2 M remains normal in high grade ureteral obstruction despite increased Scr. 5. Beta 2 M is remarkably increased in patients with viremia, despite minimal change in Scr. Beta 2 M remains normal in lower UTI from bacterial origin. Beta 2 M appears to be a major contribution in the monitoring of the renal transplant recipient which may have significant impact on therapeutic decisions in the future. In addition, it provides a reliable in vitro parameter which can be used to further assess specific treatment variables in a prospective controlled protocol approach.
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PMID:Serum beta-2-microglobulin: an adjunctive monitoring test in renal transplantation. 618 Apr 32

Twenty-five patients underwent bilateral native nephrectomy one to 68 months (mean, 15.6 months) following renal transplantation. The indications were erythrocytosis in two patients, recurrent urinary tract infection in three, medically uncontrolled hypertension in 18, and hypertension and urinary tract infection in two. One patient died two months after the nephrectomy, and one allograft was lost because of acute tubular necrosis. Both patients with erythrocytosis had prompt return of the hematocrit level and RBC mass to normal. Native nephrectomy eradicated the infection in each of the five patients with recurrent urinary tract infections. Results of nephrectomy for hypertension were classified as excellent in six patients, good in nine, and poor in four. Native renal-vein renin ratios of patients with excellent or good responses were not statistically different when compared with those of poor responders.
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PMID:Selective posttransplantation bilateral native nephrectomy. Indications and results. 635 7


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