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)

ARF will continue to occur as more severely traumatized patients survive with better resuscitation. The incidence of ARF, however, appears to be steadily decreasing and ARF occurs only in patients with severe injury and multiple organ failure. ARF developing for the past three years in MIEMS was a nonoliguric variety in the majority of patients. Management of ORF with dialysis has been disappointing. Prevention of oliguria in ARF appears possible and may be one of the most important steps to decrease the morbidity and fatality rate. Further investigation is required to find the cause and optimum management of NORF.
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PMID:Changing patterns of posttraumatic acute renal failure. 43 16

Studies showing diminished cortical perfusion and reduced glomerular filtration in acute renal failure are apparently at odds with reports of a persistent nephrogram during urography in this disease. We followed the progression of nephrograms in eight dehydrated normal rats, in seven dehydrated rats treated with 12 mg/kg of mercuric chloride (nephrotoxic acute renal failure), and in nine dehydrated rats receiving 5 g/kg of IM-glycerol (myoglobinuric acute renal failure). To assess the capacity of our technique to identify a persistent, dense nephrogram, hemorrhagic hypotension (mean arterial pressure, 55-70 mm Hg) was induced in three rats. All rats showed nephrograms on magnification radiographs 1 minute following the injection of 1 cc/lb of sodium diatrizoate. Duplicate coded readings showed no prolongation of nephrograms in ARF-affected animals. Only the hypotensive rats manifested nephrograms on 2-hour radiographs. Some differing characteristics of nephrograms among the groups are explainable on the basis of differences in renal blood flow, as determined in separate experiments. Our findings would favor a preglomerular mechanism as the cause of oliguria in acute renal failure.
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PMID:Absence of a persistent nephrogram in experimental acute renal failure. 50 Mar 6

Oliguric ARF occurred in 0.5% of battle casualties who reached the field medical care system and raised their mortality expectancy from less than 5% to nearly 90%, due primarily to fluid volume overload and/or myocardial potassium intoxication. For their effective treatment the Renal Insufficiency Center with laboratory and a Brigham-Kolff rotating drum dialyzer began operations in 1952, as depicted in a videotape prepared for this presentation from motion picture footage filmed in early 1953. Our Surgical Research Team's major findings relevant to ARF were: (1) Renal function was depressed in most battle casualties in proportion to the severity of their wounds and blood loss. (2) Among the more severely wounded some developed nonoliguric; others, oliguric ARF. (3) Oliguria lasted from 3 days to 3 weeks without a discernible peak frequency of beginning diuresis at 10 days. (4) During oliguria, posttraumatic catabolism greatly accelerated extracellular accumulations of nitrogen, potassium, phosphate, and hydrogen ion with rapid, concurrent clinical deterioration. (5) Dialysis "on indication" produced an oscillating clinical and chemical course. (6) ARF was then revealed as a wasting disease complicated by infections, poor wound healing until diuresis occurred, anemia and bleeding, and hypertension during dialyses and in early diuresis. (7) The overall mortality rate was reduced.
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PMID:Acute renal failure during the Korean War. 150 54

Renal function in the newborn infant varies with conceptual age and should be evaluated in this context. Very preterm infants less than 34 weeks' conceptual age have reduced GFR and tubular immaturity in the handling of filtered solutes when compared to term infants. Premature infants between 34 and 37 weeks' conceptual age undergo rapid maturation of renal function similar to term infants, with establishment of glomerulotubular balance early in the postnatal period. ARF in neonates differs from that seen in older children and adults in that ischemic (e.g., hypoxic) insults and congenital malformations constitute the major pathophysiologic mechanisms responsible for clinically observed oliguria and azotemia. Principles of conservative management are similar to those used in older children except for the greatly increased insensible water loss requirements of the very preterm and premature infant. Technical advances have added peritoneal dialysis and CAVH to the therapeutic regimen for persistent ARF or life-threatening complications of reduced renal function.
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PMID:Renal function and renal failure in the newborn. 265 61

In order to evaluate the clinical usefulness of serum and urinary beta 2 microglobulin (beta 2-m) determination as a marker of renal damage following perinatal asphyxia, twenty asphyxiated and twenty healthy full term newborns were studied. Renal function was monitored on the first and third day after birth by traditional tests such as creatinine (Cr), endogenous creatinine clearance (Ccr), and fractional Na excretion (FeNa), as well as by serum and urinary beta 2 microglobulin. The value of different tests for the diagnosis of oliguria and of acute renal failure was determined. Eleven asphyxiated neonates developed oliguria and five ARF in contrast to none of the controls. Both traditional tests of renal function, and determinations of beta 2-m with the exception of serum beta 2-m, were significantly different (p less than 0.01) between controls and asphyxiated neonates. When stratified analysis was performed, only serum cr, urinary beta 2-m/cr ratio, and Fe beta 2-m were able to discriminate oliguria from preserved diuresis on the first day of life. For ARF, only Ccr and Fe beta 2-m were different, again on the first day of life. Urinary beta 2-m/creatinine ratio and Fe beta 2-m appear to be more sensitive and specific for the early detection of proximal tubular renal dysfunction following perinatal asphyxia than usual tests of renal function.
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PMID:Beta-2-microglobulin in the assessment of renal function in full term newborns following perinatal asphyxia. 269 47

Acute oliguria in the critically ill postoperative patient, or in the trauma victim after resuscitation, is a substantial clinical problem. The mortality associated with ARF in these settings remains unacceptably high. Evaluation of the oliguric patient must include thorough monitoring for, and correction of, prerenal and postrenal causes of oliguria. In this sense, diagnosis of ARF is one of exclusion. Differential diagnosis is facilitated by microscopic examination of urine and by biochemical analyses of blood and urine for calculating indices of tubular function (urinary-to-plasma ratios of blood urea nitrogen and creatinine, sodium excretion, and clearances of sodium, creatinine, solute, and water). The early detection of an intrarenal defect, as accomplished by using serial measurements of free water clearance, may allow interruption of the process and prevention of ARF. Preventive measures include optimization of hemodynamic status and the use of osmotic diuretic agents (mannitol) and loop diuretics (furosemide, ethacrynic acid, and bumetanide). Dopamine is useful for increasing both renal blood flow and urine flow and may be useful for preventing ARF, but this is not firmly established. Experimentally, other approaches such as modulating the renin-angiotensin system, prostaglandin system, and cellular calcium fluxes have been attempted, but the clinical applicability of these measures is not established. The best approach to ARF is preventing it by knowing which patients are at high risk, by studiously preventing renal insults, and by aggressively treating early indications of renal malfunction using established therapies.
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PMID:Acute renal failure following traumatic injury or major operation. 355 12

In order to determine the prevalence of rhabdomyolysis-associated acute renal failure (RM-ARF) and assess the effect of oliguria on biochemical features in this condition, 127 cases of ARF seen over 18 months were reviewed. Eleven cases of RM-ARF were seen, a prevalence of 8.6% of all cases of ARF. There were ten males and one female (age range 15-72 years) with precipitating events being trauma in three, coma in two, infection in two and other causes in five. Ten had concurrent clinical or historical evidence of dehydration, two had mild hypokalemia, and one abused alcohol. Serum and urine myoglobin by radioimmunoassay were greater than 800 ng/l in all cases tested. False negative tests for urine myoglobin by o-tolidine reaction after (NH4)2SO4 extraction occurred in four cases. Despite attempted forced saline diuresis and urinary alkalinisation, seven became oliguric and required dialysis for 12-81 days. Initially (pre-dialysis) oliguric patients had significantly higher maximum serum levels of potassium, phosphate, and rate of rise of creatinine, significantly lower trough levels of calcium, and no significant difference in peak creatine phosphokinase or uric acid levels than non-oliguric patients. Two subjects developed recovery phase hypercalcemia, four required fasciotomy for compartment syndromes, three sustained permanent nerve damage, and three required limb amputation. Ten survived, with a mean creatinine clearance of 96 ml/min after nine to 30 months. RM-ARF is common, may be clinically occult and show false negative urine myoglobin tests. Hyperkalemia, hyperphosphatemia, and hypocalcemia are more common in oliguric than in non-oliguric RM-ARF, but both have a good prognosis with appropriate medical and surgical management.
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PMID:Rhabdomyolysis and acute renal failure. 386 39

In 16 patients with ARF and in three with hepatorenal syndrome we infused dopamine (3 micrograms/kg/min) and frusemide (10-15 mg/kg/day) for 6-24 hours. This treatment produced in all patients a significant diuresis and natriuresis without any modification of blood pressure, pulse rate, and central venous pressure. In three patients with hepatorenal syndrome diuresis was established during dopamine and frusemide infusion, but severe oliguria again reappeared when drug infusion was stopped. This experience suggests that this therapy may avoid fluid overload and hyperkalaemia in oliguric patients reducing the need for dialysis. It is also the first successful approach in the treatment of hepatorenal syndrome although its effect is transient.
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PMID:Dopamine-frusemide therapy in acute renal failure. 687 48

There are very limited data on overall epidemiology of ARF. It is crucial to know the incidence, etiology and clinical feature of ARF to promote prevention strategies and to implement adequate resources for the management of this entity. During a nine month period, a collaborative prospective protocol with 98 variables was developed to assess all ARF episodes encountered in the 13 tertiary-care hospitals in Madrid, Spain (covering 4.2 million people of over 14 years of age). ARF was considered when a sudden rise in serum creatinine concentration (SCr) to more than 177 mumol/liter was found in patients with normal renal function, or when the sudden rise (50% or more) was observed in patients with previous mild-to-moderate chronic renal failure (SCr < 264 mumol/liter). Of the 748 cases of ARF studied, 665 episodes presented in inhabitants from the Madrid area. This gives an overall incidence of ARF of 209 cases per million population (p.m.p.; 95% CJ 195 to 223). The incidence of acute tubular necrosis (ATN) was 88 cases p.m.p. (95% CI 79 to 97), prerenal ARF 46 p.m.p (95% CI 40 to 52), acute-onset chronic ARF 29 p.m.p. (95% CI 24 to 34), and obstructive ARF 23 p.m.p. (95% CI 19 to 27). The mean age was 63 +/- 17 years. The most frequent causes of ARF were ATN (45%), prerenal (21%), acute-onset chronic renal failure (12.7%) and obstructive ARF (10%). Renal function was normal at admission in 48% of patients who later developed ARF. Mortality (45%) was much higher than that of the other patients admitted (5.4%, P < 0.001). This real outcome correlated extremely well with the expected outcome calculated through out the severity index of ARF (SI) 0.433 +/- 0.246 (mean +/- SD). In 187 cases, mortality was attributed to underlying disease, thus corrected mortality due to ARF was 26.7%. Dialysis was required in 36% of patients, and was associated with a significantly higher SI of ARF (0.57 +/- 0.23 vs. 0.35 +/- 0.19, P < 0.001) and mortality (65.9 vs. 33.2%, P < 0.001). Mortality in patients hemodialyzed with biocompatible synthetic membranes (N = 50) was similar to that observed with cellulosic ones (N = 84; 66% vs. 59.5%, NS). Mortality was higher in patients with coma, assisted respiration, hypotension, jaundice (all P < 0.001) and oliguria (P < 0.02). This study gives, for the first time, the incidence of all forms of ARF in a developed country. ARF is iatrogenically induced at a high rate by modern medicine. Prevention strategies, particularly in the perioperative period, are needed to decrease its impact.
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PMID:Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. 887 55

Previous experimental and human data suggests a detrimental effect on the course of acute renal failure related to exposure of blood to artificial dialysis membranes of poor biocompatibility. We performed a 2.5-year prospective randomized trial to compare the clinical course of acute renal failure (post-operative ischemic acute tubular necrosis, ATN) in patients receiving a cadaveric renal transplant requiring supportive hemodialysis in the immediate post-transplant setting. Patients were randomized to either a cuprophane or polymethylmethacrylate (PMMA) conventional hollow fiber dialyzer. All patients received a standard immunosuppressive regimen which included induction therapy with either horse anti-thymocyte gamma globulin (ATGAM) or the murine anti-CD3 monoclonal antibody (OKT3). Of 53 patients randomized, 17 were excluded (2 for intervening biopsy-proven rejection prior to recovery from ATN, 10 for primary graft nonfunction and 5 for other reasons), leaving 36 evaluable cases of uncomplicated ATN, 18 in each group. There was no difference by age, race, gender, cause of ESRD, immunosuppressive regimen, cold or warm ischemia time, use of pre-transplant dialysis, percent oliguria or the incidence of intra-dialytic hypotension between the 2 groups. There was no difference in the mean time to recovery from ATN posttransplant (8.9 days in the cuprophane group vs 9.5 days in the PMMA group, p = NS) or in the average number of hemodialysis treatments required (3.6 in both groups, p = NS). There was also no difference in long term allograft outcome in terms of the nadir serum creatinine, the number of episodes of subsequent acute rejection or in the development of chronic rejection. An intent-to-treat analysis of all 53 originally randomized patients similarly yielded no significant differences. A subsequent, non-randomized study using a membrane of intermediate biocompatibility (Hemophan) also showed no difference in recovery time from ATN. Bioincompatible membranes do not seem to have a significant clinical impact on the course of recovery of this form of acute renal failure. The striking benefits of biocompatibility in the course of ARF seen in other human trials may relate more to the non-renal systemic toxic effects of bioincompatibility.
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PMID:Biocompatible dialysis membranes and acute renal failure: a study in post-operative acute tubular necrosis in cadaveric renal transplant recipients. 898 57


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