Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Six male patients withhistologically characterised, decompensated liver disease who had not previously received spironolactone, were given orally Aldactone 7 mg/kg with 3H-spironolactone 100muCi. The kinetics of the drug were studied in plasma and urine for 6 days. Then, Aldactone 7 mg/kg was given daily for 12 consecutive days, and the pharmacokinetics of a single dose of 3H-spironolactone were re-examined. The kinetics of total radioactivity, as well as of fluorigenic metabolites in plasma, after the first single dose of spironolactone did not differ in patients and normal test subjects; similar percentages of the dose given were excreted within 6 days in urine from patients (47.47 +- 4.88%) and from controls (53.68 +- 2.04%). The kinetics of CH2CI2/H2O distribution coefficients of labelled material in plasma and urine, as well as TLC analysis of the CH2CI2 soluble fraction, revealed no significant differences from controls. After treatment for 12 days with spironolactone, 4 out of 6 patients showed marked acceleration in the rate of elimination of radioactivity from plasma and a corresponding increase in excretion of labelled compounds in urine. Analysis of the excretion products in urine revealed proportionally increased excretion and no evidence of selective induction of a single degradation step. In contrast, delayed elimination was observed in the 2 other patients after 12 days' treatment. However, this was due to dehydration and oliguria caused by over-treatment with the diuretic.
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PMID:Disposition kinetics of spironolactone in hepatic failure after single doses and prolonged treatment. 85 2

Postoperative acute renal failure, especially associated with oliguria, carries a high rate of mortality and morbidity. This complication can frequently be avoided if physicians are knowledgeable about preventable or modifiable risk factors. Patients who have underlying renal disease, sepsis, volume depletion or other conditions associated with renal hypoperfusion, or who have severe liver disease, are at particular risk. Exposure to nephrotoxic agents and wide fluctuations of intravascular volume are key conditions that can usually be minimized. Managing patients with chronic advanced renal failure (creatinine clearance 10 to 25 ml per minute) requires close interaction between the internists, anesthesiologists and surgeons. Understanding associated metabolic and organ system disorders is necessary to prevent complications and preserve remaining renal function. Chronic renal failure should not be a contraindication to an elective or emergent surgical procedure.
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PMID:Preserving renal function in surgical patients. 357 22

The hepato-renal syndrome is defined as potentially reversible functional renal failure associated with acute fulminant hepatitis or, more often, with advanced chronic liver failure. It is characterized by oliguria, azotemia, retention of sodium and water with formation of ascites, and hyponatremia. While urinary sodium concentration of less than 10 mEq/l reflects intact tubular sodium absorption, the kidney lacks the ability for adequate free-water generation. This condition must be separated from specific renal diseases which may arise during the course of intra-or extrahepatic diseases and which must be classified accordingly. Pathophysiological aspects of the hepa-to-renal syndrome include hemodynamic factors, such as changes in intrarenal blood flow distribution in the presence of elevated intrarenal and reduced peripheral vascular resistance. The functional relationship of vasoconstrictor, sodium retaining, and anti-diuretic hormones (e.g., renin-angiotensin, aldosterone, and vasopressin) to vasodilator, diuretic, and natriuretic hormonal factors (e.g., prostaglandins, kinins, and natriuretic hormone) may be altered as well. Finally, a pre- and intrahepatic spillover resulting in decreased endotoxin clearance must be considered. Due to the lack of understanding of their complex interactions, so far pharmacological and therapeutic approaches remained ineffective to correct at least some of these factors. Today, recovery from hepato-renal syndrome will, therefore, mainly depend on the course of the underlying liver disease.
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PMID:[Hepato-renal syndrome (author's transl)]. 727 84

Renal dysfunction and abnormal sodium-water handling are frequent in liver disease. The term hepatorenal syndrome (HRS) denotes a functional type of renal failure characterized by a progressive decrease in the glomerular filtration rate (GFR), greatly increased sodium retention, a high urine/plasma ratio of solutes, azotaemia, and oliguria. The main pathogenic feature is reduced renal blood flow (RBF), especially in the cortex. The kidney is morphologically intact and has been shown to rapidly regain normal function after transplantation to a recipient with a healthy liver. Three factors should be considered in the pathogenesis of HRS: 1) decreased liver function; 2) deranged haemodynamics, including abnormal blood pressure, blood volume, and blood flow distribution; and 3) deranged neuro-humoral regulation. The prognosis in HRS is very poor, and therapy for HRS has proved disappointing. However future studies should be directed towards the reduced liver function and the haemodynamic abnormalities, especially the abnormal renal vasoconstriction. Implantation of a peritoneovenous shunt, paracentesis with plasma expansion, certain "blockers", and normalization of arterial blood pressure have reversed the HRS only in the more early stages. Liver transplantation is the ultimate treatment for the HRS.
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PMID:[The hepatorenal syndrome]. 748 58

An increasing number of patients with severe liver dysfunction are admitted to the ICU for stabilization and organ-specific support, including liver transplantation. Global impairment of hepatic performance frequently results in pathologic organ interactions that limit the potential for recovery. One of the most notable of these interactions is the hepatorenal syndrome, an otherwise uniformly fatal complication of end-stage liver disease characterized by the progressive development of oliguria and low urine sodium excretion. The syndrome can occur in the setting of either acute or chronic liver disease, and portal hypertension may be important in the pathogenesis. The patient with the hepatorenal syndrome also has a number of systemic circulatory abnormalities induced by liver disease and/or portal hypertension, but the exact pathologic role of these abnormalities in the development of oliguria is uncertain. It is reasonably well established that diminished systemic BP characteristic of liver failure is not the primary cause of renal insufficiency. Rather, intrarenal preglomerular vasoconstriction mediated by unknown stimuli is the major defect in the hepatorenal syndrome, manifested by relative ischemia. Current data point to abnormal renal sympathetic innervation as one of the more likely major causes of this vasoconstriction. After exclusion of systemic intravascular volume depletion and other causes of oliguria, dialytic therapy is indicated when liver transplantation or recovery of liver function is anticipated; terminal supportive care is appropriate when these outcomes are not options.
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PMID:Organ interactions in the hepatorenal syndrome. 780 2

The pathogenesis of renal function alteration associated with liver disease remains to be elucidated. Although different experimental animal models have been utilized in order to explain such pathophysiological state, none of them have completely explained the mechanisms involved. In this study we performed differential hemodynamic, hepatic and renal function alteration studies after induction of acute liver damage via intragastric administration of a single dose of CCl4 to cirrhotic and non-cirrhotic rats. Cirrhotic rats with acute liver damage exhibited a significant decrease in mean arterial pressure followed by a decreased glomerular filtration rate, urinary sodium concentration and an induction of plasma renin concentration and activity. At the same time, a significant association between oliguria and mortality was observed. The renal histopathological studies revealed glomeruli with mesangial hypercellularity and thickening of capillary wall, but not tubular epithelial injury. All these alterations were not detected in the control group, i.e. by non-cirrhotic rats with acute liver damage. This study suggests that the effect of CCl4 on kidney structure and function depends on the functional state of the liver. Since this experimental model of acute liver damage in cirrhotic rats presents hemodynamics and renal function alterations similar to those observed in the hepatorenal syndrome in man, it could be utilized to study the pathogenesis of renal function alterations associated with liver damage.
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PMID:Differential effect of CCl4 on renal function in cirrhotic and non-cirrhotic rats. 1033 58

Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and high mortality. We have prospectively analyzed patients with liver disease and ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Other than hepatorenal syndrome patients, out of 221 cases, 66 developed ARF secondary to various liver disease like cirrhosis (n = 29, mortality 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.05), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), drugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemia. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatinine p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, oliguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortality 5, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), acute pancreatitis (n = 12, mortality 4, risk factors-higher bilirubin p < 0.001, higher SGPT p < 0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), CuSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors higher creatinine p < 0.05 and SGPT p < 0.01), ARF following delivery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bilirubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n= 14 mortality 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or peritoneal dialysis. ARF associated with liver disease is having high mortality (42.5%). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, with promote dialytic support are necessary to reduce mortality and morbidity.
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PMID:Acute renal failure associated with liver disease in India: etiology and outcome. 1104 Dec 94

The development of acute renal failure (ARF) in the ICU setting carries a high morbidity and mortality. To assess the outcomes and its predictive factors in our ICU, we analyzed the data of patients with ARF treated during 18 months. The 33 patients included 21 men and 12 women of mean age 51 +/- 21.7 years (13 to 87). Sepsis with multi-organ dysfunction (MOD) was the leading cause of ARF (58%). Comorbid conditions were malignancy in 30% of patients, diabetes mellitus in 24%, hypertension in 21%, ischemic heart disease in 21%, liver disease in 15%, and chronic renal failure in 15%. Predisposing factors were hypotension in 67% of cases, dehydration in 36%, drug related in 33%, congestive heart failure in 24%, and liver cirrhosis in 6%. Twenty-five (76%) patients needed mechanical ventilation, 22 (67%) were anuric, 18 (55%) had MODS, and 15 (45%) needed inotropic support. Length of stay in hospital was 27.2 +/- 28.0 days (2 to 94). Nineteen patients (58%) were managed conservatively and 14 (42%) by renal replacement therapy. Patient mortality was 67% and renal mortality 52%. The impact of the following factor: was assessed on patient and renal outcome was assessed ventilation support, presence of oliguria, need for inotropes, and presence of MOD. Patient mortality was significantly influenced by an elevated odds ratios (OR) (95% CI): mechanical ventilation [OR = 34 (95% CI 1.95 to 538)], and presence of MODS [OR = 12.3 (95% CI 2 to 75)]. Renal mortality was influenced by mechanical ventilation [OR = 12.3 (95% CI 1.6 to 119)], oliguria [OR = 12 (95% CI 2 to 72)], inotrope support [OR = 10 (95% CI 2 to 52), and MOD [OR = 35 (95% CI 3.5 to 35.0)]. This study confirms the high patient and renal mortality of ARF among patients to ICU. The four parameters were excellent predictors of renal outcome, while only the need for mechanical ventilation and the presence of MOD were predictors for patient survival.
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PMID:Outcome and predictive factors of acute renal failure in the intensive care unit. 1535 Apr 77

Acute renal failure (ARF) incidence varies depending on whether the intensive care unit only or also general and specialist medicine departments are considered. In some cases, however, such as after major cardiosurgical operations, ARF can occur in up to 30% of patients. Most of ARFs in intensive care units are secondary to acute tubular necrosis occurring because of a multi-organ dysfunction syndrome. Factors most often associated with acute renal damage are: advanced age, volume depletion, arterial hypotension, massive bleeding, and sepsis. ARF often leads to complications for the following pathologies: serious liver disease, pancreatitis, pre-existing renal dysfunction, great burns, and cardiosurgical and vascular operations on large vessels. Among the so-called 'iatrogenic factors', contrast media and aminoglycosides are definitely the main cause of a rapid deterioration of renal function. Mortality is low for the isolated forms of ARF,whereas it peaks to 0-80% in multi-organ failures where co-existing pathologies often dominate. The mortality rate over the past 20 years has not changed, although pharmacological supports and especially dialysis instruments have improved. Patients are now older and older, affected by multiple pathologies and with poor recovery capacity. Mortality is higher among elderly patients, while toxic forms (from contrast media or from myoglobinuria) result generally in better outcomes. Patients with acute renal damage and oliguria have a worse prognosis than non-oliguric patients. Finally, some unfavorable prognostic factors include the prolonged use of high dose inotropic drugs, mechanical ventilation, cardiac failure and a septic state.
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PMID:[Epidemiology of acute renal failure]. 1706 24

There has been a progressive increase in the number of intensive care patients being transferred to nephrology units because of improper dosage of drugs, especially patients with chronic kidney disease (CKD). Voriconazole is a new synthetic triazole derivative with stronger therapeutic activity against fungal infections than fluconazole or itraconazole. Its effectiveness is associated with high nephrotoxicity, affecting patients with CKD in particular. The adverse effects of voriconazole involve several segments of the nephron, particularly the proximal tubule, medullary thick ascending limb, and collecting duct, causing loss of potassium and magnesium and backdiffusion of hydrogen ions. We report the case of an 86-year-old man with moderate CKD who developed acute renal failure as a result of inadequate dosage of voriconazole. He developed oliguria, electrolyte imbalance and fluid overload requiring hemodialysis. Vericonazole withdrawal associated with short daily hemodialysis treatment led to the recovery of diuresis, kidney function, and electrolyte balance. In conclusion, in elderly patients with liver disease and moderate CKD, thorough evaluation is needed before the administration of voriconazole in order to establish the most appropriate dose.
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PMID:[Voriconazole compromises renal function in an elderly CDK patient with Candida albicans infection]. 2054 25


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