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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 evaluate the diagnostic role of ultrasound in spontaneous renal allograft rupture we reviewed 18 cases observed in our centre in 10 years. Ultrasound studies were performed immediately before surgery in 15 cases. Renal allograft rupture occurred during the first 3 weeks after transplantation in 17 cases (94%). Clinical findings were consistent with previous reports. The diagnosis was confirmed by surgical exploration in 17 cases, and by necropsy in the remaining one. Nine patients were treated by corsetage and eight by graft nephrectomy, while one patient died before surgery. Acute rejection was present in nine cases, and severe acute tubular necrosis in five; no renal tissue was available for histological study in four patients. On ultrasound examination, perirenal haematoma was the most frequent finding, while subcapsular/intrarenal haematoma or findings suggesting rejection or urinary tract obstruction were less frequently observed. In six cases, disruption of the white linear echoes of the capsule of the graft could be seen; this finding has not been described previously. Ultrasound has a definite role in presurgical evaluation of suspected renal transplant rupture.
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PMID:Renal allograft rupture: diagnostic role of ultrasound. 132 23

Failure to visualize a kidney on radionuclide scanning using technetium-99m (99mTc) chelates and other renal radiopharmaceuticals such as iodine-131 hippuran has been described as potentially misleading in patients who have acute renal failure due to acute tubular necrosis and urinary tract obstruction. Such failure has not been described in a single kidney nor following angioplasty. The authors report a patient in whom a kidney was not visualized on 99mTc diethylenetriamine penta-acetic acid dynamic and serial scanning 3 days after renal angioplasty. The kidney was believed to be infarcted. Three months later there was almost complete recovery of renal function.
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PMID:Spontaneous return of renal flow and function on technetium-99m scan in a patient with renal artery thrombosis following angioplasty. 214 69

Hansel's stain is a simple technique that can easily be performed in a clinical or office setting. It allows for improved detection of the eosinophiluria when compared with conventional Wright's stain. The mechanism underlying the superiority of the Hansel's stain remains to be elucidated. Eosinophiluria demonstrated by Hansel's stain appears to be a sensitive marker for drug-induced acute interstitial nephritis and probably allows differentiation from acute tubular necrosis. However, the spectrum of eosinophiluria also includes acute glomerulonephritis, rapidly progressive glomerulonephritis, prostatitis, and urinary tract obstruction. Therefore, the finding of eosinophiluria on Hansel's stain clearly cannot be considered diagnostic of acute interstitial nephritis. In the absence of renal biopsy or other clinical clues to suggest the diagnosis, eosinophiluria should not be used as the sole criterion for the diagnosis of acute interstitial nephritis or a a justification for empiric steroid therapy.
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PMID:Eosinophiluria. 245 85

Acute renal failure following retrograde pyelography is a rare occurrence. The mechanisms reported have focused upon urinary tract obstruction either at an intrarenal or ureteric level. This report describes the first biopsy-proven case of acute tubular necrosis complicating retrograde pyelography. We propose the etiology to be direct tubular toxicity resulting from pyelolymphatic reflux of contrast.
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PMID:Acute tubular necrosis complicating bilateral retrograde pyelography. 344 67

Determining the cause of acutely deteriorating renal function is a common problem in clinical nephrology. The fractional excretion of filtered sodium (FENa) has been demonstrated to be a reliably discriminating test between prerenal azotemia and acute tubular necrosis. However, with increasing clinical use of the FENa, numerous reports of low FENa (less than 1%) have appeared. The clinical settings of these reports include oliguric and nonoliguric acute tubular necrosis, urinary tract obstruction, acute glomerulonephritis, hepatorenal syndrome, renal allograft rejection, sepsis, and drug-related alterations in renal hemodynamics. One particular urinary index cannot be expected to reliably discriminate between prerenal azotemia and acute renal failure in all cases. The utility of the FENa test in the differential diagnosis of acute renal failure must be interpreted in conjunction with the patient's clinical course and the use of additional urinary and serum tests.
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PMID:Fractional excretion of sodium. Exceptions to its diagnostic value. 397 Jun 21

A hippuran renogram pattern of the type usually interpreted as indicating urinary tract obstruction was seen in acute tubular necrosis and was present both in the oliguric and in the diuretic phase. It seems that in acute renal failure the renogram does not distinguish urinary tract obstruction from intrinsic renal disease.
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PMID:131-I hippuran renogram in acute renal failure. 556 19

The retrospective review of 115 case-histories of patients with acute renal failure (ARF) seen over the last two years showed that etiologies were distributed as follows: acute tubular necrosis in 65% of cases, urinary tract obstruction in 16%, acute glomerulonephritis in 3,5%, acute interstitial nephritis (AIN) in 8% and acute microvascular nephropathy in 3,5%. The diagnostic value of renal biopsy in ARF is discussed. In spite of recent advances in the treatment of ARF, the mortality rate remains as high as 48%. This is mainly due to current etiologic circumstances, to the age of the patients and to the complications of ARF, with infectious complications being the most serious. Urea nitrogen accumulation is not a poor prognosis factor. Furosemide in high doses does not alter the prognosis but reduces the total number of dialysis indications (81% in 1970, 60% in 1980), the number of dialysis sessions per patient (1 only in 62% of patients), and the duration of the ARF episode (mean duration: 10,7 days).
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PMID:[Current aspects of acute renal failure]. 629 41

A study was conducted in oliguric and acutely azotemic patients, measuring: (i) the fractional excretion of sodium (FENa) using creatinine clearance as a measure of glomerular filtration rate, and (ii) sodium clearance relative to urea clearance, designated as the sodium/urea clearance ratio (Na:urea CR). It was found that FENa discriminated between "tubular" and "non-tubular" disorders in 96% of patients. Further, Na:urea CR was as discriminating as FENa. Patients with Na:urea CR above 2.5% can be reliably diagnosed as having acute tubular necrosis or acute urinary tract obstruction; those with a value less than 2.5% will have acute glomerulonephritis or pre-renal azotemia. As urea and sodium measurements are so readily available, this test can now be applied in the assessment of the oliguric or acutely azotemic patient in any hospital practice.
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PMID:A simple aid to the differential diagnosis of oliguria. 658 51

A retrospective review of 27 patients with nonvisualization on 131I-orthoiodohippurate (Hippuran) renal scan during 1972--1977 was carried out. 5 patients had renal failure caused by urinary tract obstruction and of these, 4 were submitted to surgical relief. Varying levels of life-sustaining renal function were recovered in all 4 patients. 16 had chronic intrinsic renal disease, of whom 7 were admitted for reasons not directly related to renal failure. All of these required chronic dialysis within 3--6 months. The remaining 7 patients had acute renal failure (clinically, acute tubular necrosis) and none of them survived. It had been well established that the prognosis for recoverability of renal function is extremely poor in patients with nonvisualization on hippuran scan. It is important, therefore, to emphasize that nonvisualization on 131I-orthoiodohippurate renal scan in patients with urinary tract obstruction does not exclude the potential for recoverable renal function. Therefore, even in the absence of renal visualization, the need to definitively rule out urinary tract obstruction remains.
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PMID:Obstructive uropathy in patients with nonvisualization on renal scan. 735 84

This prospective study compares the fractional excretion of sodium, FENa, urinary sodium concentration, UNa, urine osmolality, Uosm, and the U/P creatinine ratio in their diagnostic effectiveness in 87 patients with acute renal failure: 22 acute tubular necrosis, 18 non-oliguric acute tubular necrosis, 12 acute urinary tract obstruction, 14 acute glomerulonephritis, and 21 pre-renal azotemia. Discriminant analysis demonstrated a correct diagnostic classification in 86 of 87 patients using FENa, and only 46, 60 and 65 correct using Uosm, UNa, and U/P Cr, respectively. FENa is identified as the most effective non-invasive test for the differential diagnosis of acute renal failure. An FENa of 1 classifies all entities into two groups: FENa more than 1; acute tubular necrosis, non-oliguric acute tubular necrosis and urinary tract obstruction and less than 1; pre-renal azotemia and acute glomerulonephritis (P less than 0.001).
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PMID:Differential diagnosis of acute renal failure. 736 17


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