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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The renal vascular response to graded doses of acetylcholine, dopamine and phentolamine, assessed by xenon washout and selective arteriography was used to define the relative contribution of fixed and reversible vascular abnormalities to increased renal vascular resistance in patients with essential or secondary hypertension. The increase in blood flow induced by acetylcholine and dopamine was blunted strikingly in patients with advanced nephrosclerosis, chronic pyelonephritis and polycystic kidney disease and was normal in the kidney contralateral to a significant renal artery stenosis. Conversely, the response to both was potentiated in 9 of 13 (69%) patients with mild essential hypertension. Equivalent potentiation of the response to acetylcholine was induced in normal subjects by increasing renal vascular tone pharmacologically with angiotensin. Phentolamine infused into the renal artery also increased renal blood flow significantly in 6 of 9 (67%) patients with mild essential hypertension, but in none of 15 normal subjects, over a dose reange that paralleled that for alpha-adrenergic blockade. Changes in the selective renal arteriogram were in excellent accord: potentiated response to acetylcholine, phentolamine or dopamine was associated with reversal of the small vessel abnormalities visualized in the arteriogram. The reduced blood flow response in advanced nephrosclerosis or parenchymal disease was associated with a reduced angiographic change during dilator infusion. The results suggest a quantitatively important, functional renal vascular abnormality--perhaps mediated by the sympathetic nervous system--in many patients with mild essential hypertension. Conversely the renal vascular abnormality associated with advanced nephrosclerosis or renal parenchymal disease is largely fixed and is probably due to organic changes.
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PMID:Renal vascular tone in essential and secondary hypertension: hemodynamic and angiographic responses to vasodilators. 23 62

The results of 76 selective renal angiographies in 33 patients with the use of adrenalin and acetylcholine are presented (17 cases of renovascular hypertension, 7-chronic pyelonephritis, 5-essential hypertension, 2-nephroptosis, 1-kidney tumor). The pecularities of the method essential for the success of the examination and prevention of complications are described. The importance of pharmacoangiography with adrenalin for the determination of the length of renal vessels lesion in cases of fibrous dysplasia was demonstrated, as well as that of the acetylcholine test for examining the state of the vascular bed of the contralateral kidney, the same procedures being applied in cases of chronic pyelonephritis. Typical pharmacoangiographic symptoms of different forms of nephrogenic hypertension are described.
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PMID:[Renal angiography with the use of vasoactive drugs and its value in the diagnosis of vasorenal hypertension]. 88 99

The nature of the original renal disease was determined in 403 consecutive cases of end-stage renal failure, in 317 of which the clinical diagnosis was corroborated by histological examination of the kidney. Five diseases accounted for 20 or more cases--glomerulonephritis (31% of the total), analgesic nephropathy (29%), primary vesicoureteral reflux (8%), essential hypertension (6%), and polycystic kidneys (5%). In only four cases did renal failure result from chronic pyelonephritis without a demonstrable primary cause. Greater use of micturating cystography and cystoscopy and routine urine testing for salicylate are advocated for earlier diagnosis of the major causes of "pyelonephritis". The incidence of end-stage renal failure in people aged 15-55 in New South Wales was estimated to be at least 34 new cases per million of total population each year.
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PMID:Diseases causing end-stage renal failure in New South Wales. 109 Mar 38

Plasma aldosterone, plasma renin activity, sodium and potassium in the plasma and the urine were determinated under acute stimulation with saline-depletion (furosemide) and under acute suppression with saline infusion in 40 patients with primary hypertension stage I, 19 patients with primary hypertension stages II and III, and 11 patients with renal hypertension (chronic glomerulonephritis and chronic pyelonephritis). The majority of the patients with primary hypertension stage I showed a good stimulation of the plasma aldosterone and the plasma renin activity under acute salt depletion. Three out of the 40 patients with primary hypertension stage I, and 13 of the 19 patients with primary hypertension stages II and III did not show any stimulation of the renin secretion ("low renin hypertension"). In all these patients the plasma aldosterone stimulation remained intact. With infusion of saline all the groups showed suppression of the plasma aldosterone and the plasma renin activity. A good stimulation of the plasma renin activity, demonstrates that in our experiments the renin-angiotensin system cannot be responsible for the increase in aldosterone secretion under salt depletion. Most likely the increase of the plasma aldosterone, in spite of the fixed renin activity, is stimulated by the sodium depletion due to diuretics. In all patients with primary hypertension we did not find an inadequate reaction of the aldosterone secretion under saline infusion. The patients with renal hypertension showed a minimal stimulation and suppression of the plasma renin activity. The plasma aldosterone secretion increased only slightly under sodium depletion and the decrease under saline infusion was statistically not significant. Thus we conclude that these patients show an inadequate reaction of the plasma aldosterone and renin secretion under salt infusion and depletion.
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PMID:[Plasma aldosterone and plasma renin activity in patients with essential and renal hypertension under acute stimulation with saline depletion and acute suppression with saline infusion]. 115 49

It is apparent that the split function study and renal vein renin determination are complementary and afford valuable information for selecting patients with potentially curable renovascular hypertension. The split function study, when interpreted with the recently defined split function ratio, offers the clinician a highly accurate means of diagnosing significant renal ischemia. Because the split function ratio shows the disparity between the ischemic and contralateral kidney to a greater degree, the chance of misdiagnosis due to laboratory or physician error is minimized. The split function study, however, is of limited value in patients with pyelonephritis since the water- and salt-losing characteristics of the pyelonephritic kidney may mask significant renal ischemia. In these patients, as well as those with a nonfunctioning kidney or hydronephrosis, the renal vein renin determination is the test of choice. In addition, the added morbidity of the split function study is not warranted in a patient with an elevated peripheral renin which, for interpretation, requires an accurate 24 hour urine for sodium, a renal vein renin ratio outside the range of patients with essential hypertension (renal vein renin ratio greater than 1.7) and evidence of suppression of renin secretion from the contralateral kidney. If, however, the renin determination does not afford convincing evidence of significant renal ischemia in a patient with radiographic evidence of renal arterial stenosis, a split function ratio definitely should be determined to more completely define the pathology. The attendant morbidity of a carefully performed split renal function study does not approach the morbidity and mortality associated with unnecessary surgery or inadequately treated hypertension.
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PMID:Ureteral catheterization studies. 115 55

Results are presented on the treatment with Inderal of 57 patients with essential hypertension and symptomatic renal hypertension in whom the changes in central and renal haemodynamics were carefully traced. In all the patients with renal hypertension (chronic pyelonephritis, chronic glomerulonephritis) the function of the kidneys was adequate. Inderal when used in a daily dose of 120--160 mg produces a hypotensive effect in patients with stage IB and IIA essential hypertension with unstable symptomatic renal hypertension who have a predominantly hyperkinetic type of the circulation. In such cases the haemodynamic changes manifest themselves in a considerable reduction of the cardiac output at the expense of a slower pulse rate and decreased stroke volume; the total peripheral resistance was moderately elevated. In patients with stage IIB of essential hypertension and in those with persistent and severe symptomatic renal hypertension the hypotensive effect of Inderal given in a daily dose of 480 mg and sometimes even higher was accompanied by a statistically significant decrease in the total peripheral resistance and a moderate reduction of the cardiac output and cardiac index at the expense of a slower pulse rate.
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PMID:[Use of inderal for the treatment of different forms of arterial hypertension]. 119 58

Fourteen patients with severe hypertension have been given i.v. diazoxide in a dosage of 5 mg/kg b.wt. The material comprised 2 patients with malignant nephrosclerosis, 4 with chronic nephropathy and severe reduction of renal function, 1 patient with chronic pyelonephritis, 1 with renovascular hypertension and 6 patients with essential hypertension and in malignant phase. All patients attained a controllable blood pressure. Eight patients remaining needed only one injection, while the remaining patients required 2-5 injections, and concomitant furosemide therapy. The retinopathy improved in most patients and renal function was unchanged in the azotemic patients. No serious adverse effects were seen, except one hypotensive episode. Diazoxide is easy to handle, dosage can be predetermined, monitoring is simple and we find diazoxide to be a valuable drug in severe hypertension.
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PMID:Diazoxide in the management of severe hypertension. 119 11

Study of intrarenal vasculature was carried out by using the metallic impregnation technique on whole kidney sections in 31 [corrected] cases of (primary and secondary) hypertension and 10 normal controls. Distinct patterns of intrarenal vasculature were noted in controls and in cases of hypertension. Gradual tapering of vessels, absence of tortuosity and good peripheral vascularisation were noted in controls. Abrupt tapering, tortuosity of vessels and poor peripheral vascularisation were noted in hypertensive cases. In essential hypertension moderate to severe changes of dilatation of the segmental and/or arcuate arteries was noted. The degree of dilatation was related to the level of systolic BP rather than diastolic in cases of essential hypertension. Secondary hypertension even if severe, rarely showed significant dilatation lesions. Avascular zones and conglomeration of vessels at poles was seen only in cases of pyelonephritis. This helped in distinguishing these, from cases of glomerulonephritis.
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PMID:Study of intrarenal vasculature in cases of primary and secondary hypertension (by metallic impregnation technique on whole kidney section) 130 86

One hundred and forty-seven patients with essential hypertension (EH) and 126 patients with secondary arterial hypertension (AH) on the basis of chronic pyelonephritis were studied by means of radiocardiography with 131I-albumin and M-mode echocardiography. The importance of the haemodynamic type of circulation for the development of left ventricular hypertrophy (LVH) was established. Correlative analysis revealed that the influence of arterial pressure (AP) on LVH is increased by stabilization of AH, especially in patients with the normo- and hypokinetic types of circulation; interestingly, the relation between LVH and systolic pressure was closer than that between LVH and diastolic pressure, especially in patients with secondary AH. Moreover, it was shown that the development of LVH is due to a preferential increase in posterior wall thickness in essential hypertensives and in ventricular septal thickness in secondary hypertensives, although all patients with LVH had dilatation of the left ventricular cavity.
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PMID:The influence of the haemodynamic factor on the development of left ventricular hypertrophy in patients with arterial hypertension. 133 11

The major target organs that become damaged as a consequence of long-standing arterial hypertension are the kidneys, heart, and brain. Left ventricular hypertrophy (LVH) cannot be considered only as an adaptive process to elevated blood pressure (BP), and the heart is also a major target organ in malignant arterial hypertension (MH). Magnetic resonance (MR) was used as a method for visualization of the heart in 68 patients with MH including 18 with essential hypertension, 16 with chronic glomerulonephritis, 13 with chronic pyelonephritis, 16 with renovascular hypertension, eight with adrenal tumors, and in 20 healthy volunteers (as a comparison group). Electrocardiogram-gated, double spin-echo magnetic resonance imaging was performed to image the right and left ventricles (RV and LV), interventricular septum, apex and LV posterior wall, left atrium, and aortic root. In all the patients, symmetric LV hypertrophy was registered and in the most severe cases LV wall thickness was more than 20 mm. There was no LV cavity enlargement or local contractility abnormalities. There was close correlation of LVH and diastolic BP. The degree of LVH and diastolic dimensions of the LV differed between etiologies of MH. These findings show that different pathophysiologic mechanisms of development of MH influence the processes of myocardial hypertrophy. The highly informative yield of MR tomography for evaluating structural and functional changes of the heart under MH must be underlined.
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PMID:Magnetic resonance imaging of cardiac hypertrophy in malignant arterial hypertension. 138 64


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