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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Retroperitoneal fibrosis (RPF) is an uncommon disease of unclear aetiology. The review of the literature over the past 20 years revealed 160 published cases. Till now, no accepted diagnostic or therapeutic strategy exist. Most of patients diseases progress to end-stage renal failure without pharmacological treatment. In the paper we report a case of a 58-year old man admitted to the department of urology due to body mass loss, lower-back pain, vomiting, development of oliguria and anuria and intermittent claudication. On physical examination arterial hypertension (180/100 mm Hg), peripheral oedema, tenderness of the enlarged kidneys and lower limbs ischemia were found. Creatinine serum level (Pcr) was 232 micromol/l (2.69 mg/dl). On ultrasonography, symmetrical hydronephrosis and the existence of a hypoechogenic mass along of the aorta and below of renal arteries was found. The diagnosis of RPF was confirmed with MRI. Ureteral catheters were inserted with subsequent decompression of both kidneys and the patient was discharged from the hospital. Seven months later he still presented symptoms of lower limbs ischemia, arterial pressure was high and Per decreased to 138 micromol/l (1.55 mg/dl). The patient was admitted to the department of internal diseases. The treatment with prednisone at the dose of 40 mg/d during 6 weeks was introduced, and the dose was decreased gradually to 10 mg/d within 6 months. Simultaneously, the patient received intravenous therapy with cyclophosphamide 600 mg/infusion once monthly during 6 months. Two month after starting immunosuppressive treatment the intermittent claudication disappeared and after six months MRI examination demonstrated the regression of RPF. The ureteral catheters were removed. After 18 months of follow up, no recurrence of RPF is observed and the kidney function is normal.
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PMID:[Outcome of immunosuppressive treatment of a patient with renal failure due to retroperitoneal fibrosis]. 1552 46

Rhabdomyolysis is an uncommon event in bariatric surgery. It can be caused by ischemia, crush injury, alcohol ingestion and drug intake, and as a consequence renal failure can develop. A few reports indicate that patients undergoing bariatric surgical intervention are at risk for rhabdomyolysis. A super-obese male (BMI 52 kg/m2) is reported, who underwent laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS). Operative time was 265 minutes, and the BPD/DS operation was uneventful. Post-operatively, the patient complained of pain in both hips and the left shoulder, and suffered oliguria. He was treated with fluids (isotonic saline), bicarbonate, and mannitol. Despite this, he developed renal failure, which subsequently required hemodialysis. The patient died from arrhythmia and cardiac arrest on the 8th postoperative day. Obese patients undergoing bariatric surgery are at risk of rhabdomyolysis. Prolonged compression of the muscles during the surgical intervention, in long laparoscopic procedures, predisposes to this complication.
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PMID:Rhabdomyolysis after biliopancreatic diversion with duodenal switch. 1625 2

The abdominal compartment syndrome (ACS) is a life threatening disorder in critically ill patients caused by rapidly decreasing intra-abdominal pressure (IAP) > 12 mm Hg, which may result in multiple organ dysfunctions with a possibly fatal outcome. Under various causes for the development of an ACS, pelvic trauma, volume resuscitation after severe hemorrhage and reperfusion after aortic aneurysm repair as well as intra-abdominal packing figure at the first place. An increased BMI is a risk factor for patients to suffer from ACS. In addition, excessive volume requirement and significantly increasing airway pressures within the first 24 hrs after admission in the ICU are indicators for an impending ACS. Increased IAP causes venous stasis and arterial malperfusion of all intra- and extra-abdominal organs thus resulting in ischemia, hypoxia and necrosis. In parallel, respiratory, cardiocirculatory, renal, intestinal and cerebral decompensation can be registered. Final multiorgan failure has a mortality around 60-70 %. Timely diagnosis of ACS remains sometimes difficult in spite of clinical indicators such as increased airway pressure, hypoxia, oliguria, shock and acidosis. For the early recognition of intra-abdominal hypertension repetitive measurement of the intra-vesical pressure (> 20 mm Hg) can be helpful. Besides intensive care treatment with artificial ventilation, circulatory support with volume and catecholamines, the decision for a prompt abdominal decompression and open abdominal treatment is life-saving and can preserve further functional damage to vital organ systems.
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PMID:[Abdominal compartment syndrome. A still underestimated problem?]. 1766 Dec 59

The measurement of intra-abdominal pressure (IAP) is gaining importance in critical care units because of its prognostic value. The standard method of measurement is intravesical. When the IAP is high, the condition is referred to as intra-abdominal hypertension. The elevation may be compensated for if it is not excessive or if the increase was not rapid, or it might have various repercussions, in which case abdominal compartment syndrome (ACS) is diagnosed. The pathogenic mechanism that underlies ACS is the response of a territory predisposed to a process of ischemia and reperfusion, with release of inflammatory cytokines and formation of free radicals (anaerobic metabolism). Clinical manifestations comprise elevated IAP, oliguria, difficult mechanical ventilation with hypoxia and hypercapnia, and diminished cardiac output. ACS leads to multisystem dysfunction and, if not treated, to multiple organ failure and death. The rapid establishment of appropriate treatment measures is important. The first line of treatment is medical but definitive surgical treatment should not be delayed.
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PMID:[Abdominal compartment syndrome]. 1769 47

Pneumatosis intestinalis (PI), the presence of gas within the bowel wall, is a rare condition. To our knowledge, only two cases of PI secondary to acute appendicitis have been reported in the literature. We present a new case of a 46-year-old man who complained of abdominal pain and progressive abdominal distension for 4 days and oliguria for 1 day. In the Emergency Department, his abdomen was markedly distended and showed peritoneal signs. Preoperative blood culture grew Bacteroides fragilis. Abdominal computed tomography scan revealed marked bowel distension, bubble-like intramural gas scattered in the proximal small bowel, and localized fluid accumulation in the right lower quadrant of the abdomen. Small bowel ischemia was interpreted preoperatively. Emergency laparotomy revealed that the appendix was gangrenous and perforated, with local abscess formation but no bowel infarction. Hence, only appendectomy was performed, with subsequent uneventful patient recovery. The presence of PI may not always be an ominous sign; rather, it depends on the severity of any underlying diseases.
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PMID:Pneumatosis intestinalis: a rare manifestation of acute appendicitis. 1796 64

Efficient urine production after kidney transplantation is often evidence of good graft function. If severe organ injury occurs, we have oliguria or anuria and the patient requires postoperative hemodialysis. In most cases, graft function recovers after a few hemodialysis treatments-delayed graft function (DGF). Therefore, recognition of factors influencing the onset of DGF is crucial. We examined the state of the circulatory system by a thermodilution method in 101 organ donors, taking into account mean arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index. We also examined 232 kidney recipients, based on age, gender, panel-reactive antibody, cold ischemia time, and reason for renal insufficiency. We defined DGF as at least one hemodialysis after kidney transplantation. In logistic regression analysis, we showed that donor MAP, CVP, and PCWP of the substantially influenced the occurrence of DGF among kidney transplant recipients. Maintaining an adequate MAP and a sufficient volume in the donor circulatory system substantially decreased the occurrence of DGF after kidney transplantation.
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PMID:Influence of selected factors on occurrence of delayed kidney graft function: a multivariate analysis. 1802 63

Over a period of six months, 55 patients out of 11,216 (0.49%) admitted to the hospital developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria, a sudden rise in blood urea nitrogen and creatinine with or without oliguria. Patients age ranged between 15 and 81 years with a mean of 51.9 years. Renal ischemia (69%) and nephrotoxic drugs (16.3%) were the two main etiologic factors. Among the causes of ischemia, septic shock was the commonest (29%), followed by severe hypotension due to several causes such as hemorrhage, burns, severe diarrhea and cardiogenic shock (25.4%), and ACE inhibitors (10.9%). ARF was associated with an average of 15.8 days stay in hospital versus 5.1 days for the overall hospital admissions. Immediate management of hypotension by intravenous fluid replacement, vasopressor agents and the necessary surgical intervention was appropriately considered. Intravenous frusemide was used for oliguric patients. Intermittent hemodialysis was used in 18 patients and continuous venovenous hemofiltration in six patients. Twelve patients with ARF due to ischemia died, while there were no deaths in the nephrotoxic group (p < 0.05). The overall mortality was (21.8%), which had no correlation with patient age. All non-oliguric patients survived with the mortality being exclusively in the oliguric group.
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PMID:Acute renal failure: six months pilot study in qatar. 1840 4

In the first stage of labor, pain is caused by distension of the cervix and low uterine segments in combination with isometric contraction of the uterus. Pain in the second stage of labor is dominated by tissue damage in the pelvis and perineum. Labor pain is due to an activation of nociceptors partly resulting from ischemia. The impulses thus generated are conducted into the spinal cord by afferent C fibers from the cervix and lower uterine segments, and by afferent Adelta and C fibers from the pelvis, pelvic organs and perineum. Labor pain is referred to the dermatomes T(11) and T(12) in the early stage of labor. It spreads to the neighboring dermatomes T(10) and L(1) and eventually involves the dermatomes S(2-4) during the second stage of labor and delivery. As in any other type of pain, labor pain stimulates respiration. This reduces the CO(2) concentration in the blood so that, in pain-free periods, respiratory stimulation is lacking and, in consequence, oxygen concentration in maternal and fetal blood is lowered. Pain-induced sympathetic activation will increase cardiac output in a way that may be deleterious in parturients with heart disease, eclampsia and anemia. Moreover, slowing of gastric emptying may cause nausea and vomiting, and slowing of intestinal propulsive movements may result in ileus and oliguria. An increase in plasma catecholamines and glucocorticoids influences uterine contractions. The amount of beta-endorphin released from the pituitary and placenta into the blood is relatively high but obviously not sufficient to depress pain effectively. Adequate nerve block and epidural anesthesia, as well as measures to relieve anxiety, will help markedly to reduce the risks associated with labor pain.
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PMID:[Labor pain-causes, pathways and issues.]. 1841 27

Ischemia- or toxin-induced acute kidney injury is generally thought to affect the cells of the proximal tubule, but it has been difficult to define the involvement of other tubular segments because of the widespread damage caused by ischemia/reperfusion or toxin-induced injury in experimental models. For evaluation of whether thick ascending limb (TAL)-specific epithelial injury results in acute kidney injury, a novel transgenic mouse model that expresses the herpes simplex virus 1 thymidine kinase gene under the direction of the TAL-specific Tamm-Horsfall protein promoter was generated. After administration of gancyclovir, these mice demonstrated apoptosis only in TAL cells, with little evidence of neutrophil infiltration. Compared with control mice, blood urea nitrogen and creatinine levels were at least five-fold higher in the transgenic mice, which also developed oliguria and impaired urinary concentrating ability. These findings suggest that acute injury targeted only to the TAL is sufficient to cause severe acute kidney injury in mice with features similar to those observed in humans.
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PMID:Apoptosis of the thick ascending limb results in acute kidney injury. 1849 62

Acute rhabdomyolysis is a syndrome characterized by the lesion of skeletal muscle resulting in subsequent release of intracellular contents into the circulatory system, which can cause potentially lethal complications. These contents include myoglobin, creatine phosphokinase, potassium, aldolase, lactate dehydrogenase and glutamic-oxaloacetic transaminase. There are numerous causes that can lead to acute rhabdomyolysis and many of patients present with multiple causes. The most common potentially lethal complication of rhabdomyoloysis is acute renal failure. In this article we present a case of a patient that developed clinical signs of acute rhabdomyolysis after consumption of heroin and alcohol. After approximately nine hours of alcohol and heroin induced coma he had acute compartment syndrome of the right arm, and clinical and laboratory signs of acute rhabdomyolysis with acute renal failure as a complication of rhabdomyolysis. Acute rhabdomyolysis developed in the patient as the result of acute compartment syndrome, with direct toxic activity of alcohol and diamorphine. During the period of coma, due to lying in particular position over a long period of time, pressure upon the certain part of the body caused muscle compression and capillary occlusion in fascial compartments, which led to ischemia. Upon pressure relief and beginning of tissue recovery, post ischemic compartment syndrome occurred with subsequent rhabdomyolysis. Getting out of coma the patient started to complain of severe pain in the right arm, which clinically worsened on passive stretching of the limb, with the loss of sensation and weakness. Laboratory findings showed high levels of creatine phosphokinase as the most sensitive marker of muscular damage. The peak of creatine phosphokinase level can be predictive for the development of acute renal failure because myoglobin level may return to normal within 6 hours after muscle injury. The peak of creatine phosphokinase (186.080 U/L; normal range 0-177) was recorded at 12 hours of admission. Other pertinent laboratory results such as urea, creatinine, prothrombin time, alanine aminotransferase and aspartate aminotransferase were also changed significantly. The peak of potassium level before dialysis was 6.8 mmol/L. Emergency fasciotomy of the anterior and posterior compartment syndrome was performed by a team of physicians after clinical examination. The second look debridement was performed at 48 and 72 hours. The plastic surgical procedure was performed 4 weeks later. On admission the patient also had oliguria with dark brown pigment in his urine. Arterial blood gases revealed metabolic and respiratory acidosis. The patient was hypovolemic and IV rehydratation with crystalloids, sodium bicarbonate and mannitol started immediately upon admission. Despite therapy his urine output decreased. Hemodialysis was initiated at serum potassium level of 6.8 mm/L and continued until his urine output returned to normal in three weeks. The patient was discharged from the hospital after six weeks, with normal urine output, without functional abnormality in his upper right limb. Acute rhabdomyolysis should be considered as a possibility in any patient with prolonged imobilization while in coma as well as in any intoxicated patient. Of course, creatine phosphokinase is the most sensitive indicator of muscle injury and the degree of creatine phosphokinase elevation correlates with the amount of muscle injury and disease severity. Other laboratory findings can help identify common complications of rhabdomyolysis such as acute renal failure, metabolic derangements and disseminated intravascular coagulopathy.
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PMID:[Acute rhabdomyolysis: a case report and literature review]. 1884 54


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