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

In 101 consecutive patients with renal allograft dysfunction a correlation of Duplex Doppler sonography (DDS) with histopathologic reports of simultaneously performed biopsies was made. Renal vascular impedance was estimated by calculating the resistive index (RI). A total of 290 different specific histologic diagnoses (mean 2.1 +/- 0.84 diagnoses/biopsy) was noted. With increasing time interval to transplantation, single diagnoses as cause of allograft dysfunction decreased. DDS could not reliably differentiate, exclude, or grade any of the common causes of renal allograft dysfunction like vascular and/or cellular rejection, chronic rejection, acute tubular necrosis, cyclosporin nephrotoxicity, relapse of glomerulonephritis and infection. Follow-up studies after established histologic diagnosis in 19 patients with persisting allograft dysfunction demonstrated a lack of sensitivity of DDS to significant superimposed causes of transplant malfunction. We conclude that biopsy is still necessary to direct proper therapy of renal allograft dysfunction.
Acta Radiol 1992 Sep
PMID:Polyetiology of renal allograft dysfunction. Does calculation of the resistive index still make sense? 138 51

261 patients who received a kidney transplant under cyclosporin-A immunosuppression were reviewed in order evaluate the benefits and the risks of renal graft biopsies. 240 graft biopsies were performed in 124 of the 261 patients. The biopsy diagnoses were 103x rejection, 90x cyclosporin-A toxicity, 8x acute tubular necrosis, 8x glomerulonephritis, 9x different biopsy results, and 12 cases of normal renal tissue. In 214 cases the clinical course was well explained by the biopsy result. The histological results led to therapeutical changes in 199 cases. 221 of the 240 biopsies were performed without any complications. There was only one biopsy with irreversible and there were 19 biopsies with reversible complications.
Clin Nephrol 1992 Sep
PMID:Risks and benefits of graft biopsy in renal transplantation under cyclosporin-A. 139 64

A total of 201 consecutive cadaveric kidney transplantations were performed in 188 patients at the Chinese Great Wall Hospital, Beijing, from October 1977 to May 1990. The overall 1-, 2-, 5-, and 10-year graft survival rates were 75.5%, 64.5%, 37.0%, and 32.9%, respectively. In the last 5 years, these figures have risen to 83.7% at 1 year, 69.5% at 2 years, and 40.8% at 5 years, respectively. The 14 variables correlating to graft survival in the present study were analyzed using the log rank test for univariate analysis and the Cox proportional hazard model for multivariate analysis. The results show that immunosuppressive drug therapy, cold ischemia time, acute tubular necrosis, and infection were significant factors affecting the survival of cadaveric kidney grafts. Triple therapy with low-dose cyclosporin, as compared to conventional immunosuppressive drug therapy, significantly increased the 1-year graft survival rate (90.3% vs 31.3%) but did not influence the long-term graft survival rate after 3 years. The incidence of acute tubular necrosis significantly correlated to the cold ischemia time and influenced the 1-year graft survival. Analysis showed that the lymphocytotoxic crossmatch affected graft survival after 3 years and that most late graft losses were due to chronic rejection, suggesting that histocompatibility is the strongest factor affecting long-term graft survival. A beneficial effect of pretransplant blood transfusions on long-term graft survival was seen in patients treated with conventional immunosuppressive drugs but not in cyclosporin-treated patients.
Transpl Int 1992 Sep
PMID:Analysis of prognostic factors affecting renal allograft survival. 141 14

This essay illustrates the spectrum of sonographic findings of various renal manifestations of AIDS. The most common renal abnormality in patients with AIDS is nephropathy, which is manifested by deterioration of renal function and proteinuria. Acute tubular necrosis, intrarenal infections, focal nephrocalcinosis, hydronephrosis, and neoplasms also may occur.
AJR Am J Roentgenol 1992 Sep
PMID:Renal diseases in patients with AIDS: sonographic findings. 847 Jun 3

Sepsis and aminoglycoside administration remain leading causes of clinical acute renal failure (ARF). In recent years, a number of experimental studies from different laboratories have indicated that specific components of the septic state, most notably fever, endotoxemia, and renal hypoperfusion, can interact to induce synergistic renal damage, acting in concert to produce acute tubular necrosis and ARF. If sepsis-associated ARF has a multifactorial basis, then a number of interventions directed at one or more of its etiologic components could confer protection. In this brief review, evidence to support these pathophysiological and therapeutic considerations are presented.
Am J Kidney Dis 1992 Sep
PMID:Endotoxemia, renal hypoperfusion, and fever: interactive risk factors for aminoglycoside and sepsis-associated acute renal failure. 151 3

Two college students who developed reversible acute deterioration in renal function following binge drinking of beer and the use of nonsteroidal antiinflammatory drugs (NSAIDs) are reported. Both patients presented with back and flank pain with muscle tenderness, but showed no evidence of overt rhabdomyolysis. The first case had marked renal failure, with a peak serum creatinine reaching 575 mumol/L (6.5 mg/dL), and acute tubular necrosis was documented by renal biopsy. The second case had only modest elevation in serum creatinine, and renal function rapidly improved on rehydration. The contribution of the potential muscle damage associated with alcohol ingestion to the changes in renal function in these two cases is not clear. However, the major mechanism for the acute renal failure was thought to be related to inhibition of renal prostaglandin synthesis in the face of compromised renal hemodynamics secondary to alcohol-induced volume depletion.
Am J Kidney Dis 1992 Sep
PMID:Acute renal failure following binge drinking and nonsteroidal antiinflammatory drugs. 151 10

During the last 6 years, 7 healthy individuals who were reasonably well acclimatised to physical exertion came under observation with acute renal failure due to exercise induced myoglobinuria. Their mean age was 20 years, and renal failure resulted after cross country run of 10-15 km in 6 cases and long route march of 90 km in 3 days in one case. There was no evidence of effects of heat, dehydration or hypotension. Apart from myoglobinuria and significant urinary sediments, serum aldolase (mean 69.0 SL u/ml) and serum creatinine phosphokinase (mean 120.0 Sigma u/ml) were also elevated. Maximum blood urea and creatinine were 224 mg/dl and 13.9 mg/dl respectively. Hypocalcaemia was noticed in 3 cases, hyperkalaemia in 4 cases and hyperuricaemia in one case during the oliguric phase. One case had features of non-oliguric acute renal failure. All cases recovered though 4 cases required dialysis support. Kidney biopsy in 3 cases showed recovering acute tubular necrosis with eosinophilic material in tubules. Lactate studies in the convalescent period revealed normal response and repeat physical exertion of same severity after 6 months did not reproduce the syndrome. It is concluded that exertional rhabdomyolysis unassociated with heat stress is a rare entity, and with prompt diagnosis and energic management results are rewarding.
J Assoc Physicians India 1991 Sep
PMID:Acute renal failure in severe exertional rhabdomyolysis. 824 Apr 94

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.
Clin Lab Med 1988 Sep
PMID:Eosinophiluria. 245 85

During the February 1983-February 1988 period, 172 patients (113 men and 59 women, mean age 36 years) were admitted to the Ibn-Rochd hospital for acute renal failure (ARF). Oliguria or anuria were present on admission in 131 patients (76.2 per cent). ARF occurred in a medical context in more than two thirds of the cases (73.8 per cent) post-operatively or in a surgical context in 11 per cent in an obstetrical context, notably post-partum, in 15 per cent. The causes of ARF were varied: prerenal in 12 cases, obstructive in 15 cases and renal parenchymal in 141 cases; in the remaining 4 patients no cause could be found. Acute tubular necrosis was the most frequent lesion (104 cases) and it was due to infection in 72 per cent of the cases; acute glomerular lesions were present in 27 patients. In the 108 patients treated by haemodialysis, 4 sessions on average were required for each patient; the main duration of peritoneal dialysis was 6 days. The most frequent complication observed was infection. The mortality rate was 21 per cent (36 deaths).
Presse Med 1989 Sep 16
PMID:[Acute kidney failure in Morocco]. 252 5

Traditional methods of noninvasively evaluating patients for renal injury do not accomplish the following tasks: reliably distinguish potentially treatable forms of acute renal failure from acute tubular necrosis; provide a sensitive indicator of early allograft rejection in renal transplant recipients, particularly those in the pediatric age group; provide an early warning of incipient drug-induced nephrotoxicity; or serve as an adequate screening test for renal injury due to exposure to occupational or environmental toxins, especially heavy metals. Because of this, considerable effort has been devoted to the development of assays to satisfy these needs. Three approaches include measurement in the urine of low-molecular-weight plasma proteins such as beta 2-microglobulin; a variety of kidney-derived enzymes, such as L-alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase; and specific renal antigens using immunologic detection. The first two of these have not proved to be adequately sensitive or specific, complicated by the frequent loss of activity associated with the physicochemical characteristics of the urine or the presence of pyuria. Despite this, useful information has been obtained. In particular, assays of beta 2-microglobulin urinary excretion and retinol binding protein appear to have clinical utility that should be pursued. Recent experience with a monoclonal antibody-based assay for a unique proximal tubular antigen, the adenosine deaminase binding protein, suggests that a battery of such assays, each directed against an antigen localized to a particular segment of the nephron, may be particularly useful.
Clin Lab Med 1988 Sep
PMID:Noninvasive renal diagnostic studies. 290 37


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