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

Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95% after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.
Am J Surg 1991 Dec
PMID:The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions. 167 Feb 41

A case of lymphocele after an allograft renal transplant at the National Taiwan University Hospital is reported. A 32-year-old female patient received a kidney transplant from a cadaver donor on 23 November 1990 after a 10-year course of hemodialysis. Acute tubular necrosis of 31 days duration developed on the 6th postoperative day after a severe episode of acute rejection. On the 44th POD, sonographic examination showed an echo-free space between the graft and the urinary bladder. Emergent marsupialization through an intraperitoneal window of the lymphocele was performed on the 45th POD due to a sudden decrease in urine output. After releasing the compression of the lymphocele, the urine output returned to over 2,500 mL on the following day. The patient was discharged on the 63rd POD with normal renal function. Repeated sonographic examination showed no reaccumulation of lymphocele. The literature concerning lymphocele is reviewed.
J Formos Med Assoc 1991 Dec
PMID:Lymphocele after renal transplantation: a case report. 168 92

The hepatorenal syndrome (HRS) is a well-known complication of liver failure, and medical treatment is usually not successful unless liver function can be improved. The authors review their experience with 130 adults undergoing orthotopic liver transplantation (OLT) over a 20-month period to determine the incidence of HRS and its effects on patient outcome, need for hemodialysis (HD), and the degree of recovery of renal function. The clinical diagnosis of HRS preoperatively was made by using criteria to exclude prerenal azotemia, acute tubular necrosis, and primary renal diseases. Nineteen patients were identified as having the HRS for a preoperative incidence of 15.1 per cent. Overall, 41 of the 126 patients reviewed required postoperative HD, and the mortality in this group was 54 per cent. Fifty-eight per cent of the HRS patients were dialyzed postoperatively vs 28 per cent of non-HRS patients. The mean posttransplant creatinine improved over time in the HRS patients while it worsened slightly in the non-HRS group. At 12 weeks posttransplant, there was a significant difference in the mean creatinine levels (1.8 +/- 0.3 mg/dl vs 1.2 +/- 0.04 mg/dl, P = .001). However, at 24 weeks the small difference was not statistically significant between the two groups (1.6 +/- 0.15 mg/dl vs 1.3 +/- 0.06 mg/dl, P = NS). The current survival of the hepatorenal group is comparable to the nonhepatorenal patients at a follow-up of 6 to 25 months: 68 per cent vs 78 per cent, P = NS. The authors conclude that liver transplantation reverses the HRS, and that hepatorenal patients can undergo liver transplantation with outcomes comparable to nonhepatorenal patients.
Am Surg 1991 Dec
PMID:The hepatorenal syndrome in liver transplant recipients. 174 99

The combination of fetal hydrops and sacrococcygeal teratoma (SCT), is considered to be lethal. We report two such babies who survived. Case 1 exhibited oliguric acute renal failure (ARF) immediately after birth, and severe respiratory insufficiency despite maximal ventilatory support and vasodilator infusions. Tumor resection on the 2nd day of life resulted in an immediate improvement in pulmonary function as reflected by the ratio of arterial to alveolar oxygen. Renal function returned in a pattern typical of recovery from acute tubular necrosis. Case 2, less desperately ill, developed nonoliguric ARF, in part due to deliberate fluid restriction during the 7 days that followed birth and preceded surgery. This resolved following liberalization of fluid intake that occurred at the time of tumor removal on the 7th day of life. The baby also had respiratory insufficiency that improved after surgery. Respiratory insufficiency may be a severe and life-threatening complication of SCT and hydrops fetalis. Pulmonary function may improve dramatically by removal of the tumor. Why this improvement occurs is unclear. Improvement of respiratory function may result from the elimination of excess tumor blood volume with an improvement of the ventilation-perfusion ratio. Alternatively, the tumor may be a source of vasoactive substances or extremely desaturated blood that leads to pulmonary hypertension and right-to-left shunting. Uncertainties in postnatal fluid shifts and exaggerated fluid compartment volumes demand close attention to details of renal function.
J Pediatr Surg 1991 Dec
PMID:The newborn with hydrops and sacrococcygeal teratoma. 176 33

Renal transplantation in infants has been associated with a high incidence of acute tubular necrosis and of renal artery thrombosis. Since 1978, 24 infants who received an adult kidney transplant at the University of Minnesota have had aggressive administration of intravenous colloids to increase the central venous pressure to 16-20 mm Hg before renal reperfusion. Acute tubular necrosis developed in only two infants, and there were no cases of renal artery thrombosis. Chest radiographic evidence of pulmonary edema was present in the recovery room in seven patients (29%) and within the first four postoperative days in five patients (21%). Yet, only two infants (8.3%) required postoperative mechanical ventilation beyond 24 h to manage fluid overload. With aggressive intravenous colloid administration, infants in renal failure can receive an adult kidney transplant with a low incidence of active tubular necrosis or renal artery thrombosis, but pulmonary edema may develop requiring ventilatory support.
Anesth Analg 1991 Dec
PMID:Anesthetic management of infants receiving an adult kidney transplant. 195 73

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.
Can Assoc Radiol J 1990 Dec
PMID:Spontaneous return of renal flow and function on technetium-99m scan in a patient with renal artery thrombosis following angioplasty. 214 69

In a prospective analysis we performed 182 colour duplex US studies in 60 patients with renal transplants to determine the effects of different causes of graft dysfunction on the resistive index (RI) and the colour imaging pattern of the transplant arteries. Allografts with normal function, cyclosporin toxicity, cytomegaly infection, acute tubular necrosis, glomerulonephritis and postoperative functional nephrotoxicity showed normal RI (less than 0.7) and normal pattern of the arteries in colour duplex. Grafts with acute and chronic rejection, obstructive uropathy and arteriolosclerosis showed significant elevated RI and in colour duplex always a characteristic blinking of the arteries and a numerical reduction of the peripheral arteries. It seems that the assessment of an increase of vascular impedance is possible also with colour duplex US.
Rofo 1990 Dec
PMID:[Color-coded duplex sonography and the resistive index in dysfunctional kidney transplants]. 217 24

In 61 patients (167 examinations) the pulsatile flow index (PFI) was used to diagnose the cause of renal transplant dysfunction. The results were correlated with histology and clinical course and outcome, angiography or quantitative radionuclide renography. Renal transplant rejection was diagnosed by PFI with a sensitivity of 85%. The specificity was 81% and the diagnostic accuracy 83%. The positive predictive value was found to be 76%, whereas the negative predictive value was 89%. In presence of acute tubular necrosis (ATN) the PFI was normal in 89% of examinations and therefore distinguishable from acute rejection.
Rofo 1990 Dec
PMID:[The pulsatile flow index (PFI) in the diagnosis of dysfunctional kidney transplants]. 217 25

Concentrations of interleukin 2 receptor (sIL-2R) have been suggested as a marker of rejection episodes after organ transplantation. To evaluate the analytical performance of a "sandwich-type" enzyme immunoassay method for sIL-2R and to verify whether increased concentrations of sIL-2R might be a useful marker of allograft rejection, we quantified sIL-2R in serum samples from heart- or kidney-transplant patients. The mean (+/- SD) pre-transplant value of sIL-2R (592 +/- 209 kilo-units/L) in heart-transplant patients was significantly higher (P less than 0.01) than that observed in controls (350 +/- 101 kilo-units/L). After heart transplantation, the concentrations of sIL-2R slowly decreased to baseline in successfully treated patients but increased significantly (1129 +/- 215 kilo-units/L; P less than 0.01) during acute rejection crisis. However, severe infections were also associated with a significant increase of sIL-2R, so the sIL-2R test is not specific for allograft rejection. The mean pre-transplant concentration of sIL-2R was also increased (1943 +/- 878 kilo-units/L) in 26 renal-transplant patients; after transplantation, this value returned to normal, as did that for creatinine, but persisted steadily high in five patients who experienced acute tubular necrosis. In this group of patients, the sIL-2R concentration increased by 1.5- to fourfold, both during acute rejection episodes and in clinically evident infection; thus measurement of creatinine and sIL-2R concentrations can help to distinguish between rejection, infection, and cyclosporine toxicity. In two episodes of mild cyclosporine-induced nephrotoxicity, we observed slight increases in serum creatinine (which returned to baseline when the cyclosporine dose was decreased) not associated with an increase in sIL-2R. We conclude that systematic monitoring of sIL-2R together with other biochemical and clinical markers may be useful in the management of kidney-transplant patients.
Clin Chem 1990 Dec
PMID:Increased circulating concentrations of interleukin 2 receptor during rejection episodes in heart- or kidney-transplant recipients. 225 54

Medullary tubules in renal biopsies from twelve patients suffering from ischemic acute tubular necrosis (ATN) and nine patients with allergic, drug-induced acute interstitial nephritis (AIN) were investigated by electron microscopy using quantitative and semiquantitative methods. For comparison, 12 biopsies from patients without renal disease or with minimal change nephropathy were studied. The mean scores for reduction of brush border and basolateral infoldings of the cell surface were significantly increased in the straight part of the proximal tubule and the thick ascending loop of Henle (straight part of the distal tubule) compared with medullary controls, and these changes were significantly greater than the scores for the corresponding convoluted tubules in the cortex. The numbers of missing tubular epithelial cells (indicating sites of cellular desquamation) were significantly increased in the thick ascending loop of Henle in ATN as well as in AIN and in the straight proximal tubule in ATN. This single cell lesion also occurred in the collecting duct. These findings are discussed in the light of recent experimental data indicating the importance of medullary tubules for the pathogenesis of ATN.
APMIS 1990 Dec
PMID:Ultrastructure of medullary tubules in ischemic acute tubular necrosis and acute interstitial nephritis in man. 228 9


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