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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical studies have long suggested the presence of a specific cardiomyopathy in sickle cell anemia secondary to intracoronary thrombosis and subsequent infarction. Fifty-two autopsy patients were studied (48 with SS hemoglobin, 4 with S-C or S-Thal hemoglobin) to ascertain the range of cardiac pathologic abnormalities associated with this disease. The average age was 17 years (range 1 month to 48 years). Renal failure and infection were the most common causes of death; the former was a more common cause in adults than in children. Right and left ventricular hypertrophy and dilatation were the most common abnormal pathologic findings. No evidence of recent or remote myocardial infarction, coronary thrombosis or arteritis was noted in any patient. Eight patients who were studied with postmortem coronary arteriograms exhibited markedly increased coronary arterial caliber with no evidence of atherosclerosis. Seventeen of the 52 patients studied had clinical evidence of congestive heart failure before death. Of these 17 patients, 7 had moderate to severe left ventricular hypertrophy associated with chronic renal failure and hypertension, 2 had right ventricular hypertrophy with organized pulmonary thrombosis, 2 had rheumatic mitral valve disease and 2 died during the second trimester of pregnancy. Two of the 17 patients thought to have pulmonary edema before death in fact had aspiration pneumonia and hemorrhagic pneumonitis, respectively. The data suggest that cardiac dysfunction in sickle cell anemia can usually be explained by the adverse effect of coexisting disease on the diminished cardiac reserve of chronic anemia. The data do not support the concept of a specific "sickle cell cardiomyopathy".
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PMID:Clinicopathologic analysis of cardiac dysfunction in 52 patients with sickle cell anemia. 15 Jul 86

Hypercalcemia calls first for supportive measures, eg, adequate hydration, movement or mobilization of the patient to the greatest amount tolerated, and reevaluation of drugs being taken. When immediate lowering of the serum calcium level is not clinically mandatory, oral administration of furosemide, corticosteroid, or phosphorus should be considered. In acute emergencies, saline loading and parenteral furosemide therapy should be tried first, except in a patient with renal failure and congestive heart failure, in whom peritoneal dialysis or hemodialysis should be used instead. Calcitonin can be given for the first 12 to 24 hours to lower serum calcium concentration until a definitive management plan is formulated. Corticosteroid, if not contraindicated, should be started as soon as possible. In severe primary hyperparathyroidism with hypophosphatemia, phosphorus can be given intravenously until oral phosphate therapy can be established. Surgery, of course, should be performed as soon as possible. In most cases of neoplasia, mithramycin given according to a recommended schedule is safe and frequently effective. In desperate cases, additional use of prostaglandin synthesis inhibitors probably now is justified by empirical observations. All of these therapeutic measures are used only to stabilize electrolyte balance so that the primary cause of the hypercalcemia can be treated.
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PMID:Management of hypercalcemia. 15 84

Twelve patients with clinical and hemodynamic evidence of severe congestive heart failure, unresponsive to the usual therapy of salt restriction, oxygen, bed rest, digitalis, and massive doses of diuretics, were studied during a control period and after intravenous dopamine. Seven patients survived and 5 died with intractable failure and shock despite transiently improved hemodynamic indices. At control period and after optimal dose of dopamine, there were no significant changes in heart rate (HR) and mean systemic arterial pressure. The mean pulmonary artery (PA) and pulmonary capillary wedge (PCW) pressures decreased slightly. Cardiac index (CI), stroke volume (SVI), and stroke work indices (SWI) rose (p less than 0.005) from the control values of 1.4 +/- 0.1, 15.3 +/- 5, and 13.6 +/- 1.7 to 2.2 +/- 0.1, 24.1 +/- 4, and 24 +/- 2.3, respectively; pulmonary arteriolar (PAR), total pulmonary vascular (TPVR), and systemic vascular (SVR) resistances fell (p less than 0.01). Urine output increased from 13.5 ml/hr before to 58.2 ml/hr after dopamine (p less than 0.005). After 24 and 48 hr of dopamine, in addition to the above hemodynamic changes, PA pressure fell from 38 +/- 4 to 33 +/- 3 and 28 +/- 2, and PCW from 30 +/- 2 to 24 +/- 3 and 18 +/- 3 (p less than 0.05). Compared with nonsurvivors, survivors had significant decreases in PA and PCW pressures, PAR, and TPVR and an increase in SWI. These data indicate that dopamine is effective in some patients with refractive congestive heart failure associated with acute oliguric renal failure and that the prognosis may be improved.
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PMID:Hemodynamic effects of dopamine in patients with resistant congestive heart failure. 35 38

The complications of mild hypertension especially involve progression to moderate or severe hypertension, coronary events, strokes, and congestive heart failure. Less often, other complications such as rupture of a dissecting aneurysm, retinal hemorrhages, hypertensive encephalopathy, and renal failure may occur. Total mortality clearly rises with progressive increases in systolic or diastolic blood pressures even in ranges previously considered acceptable. It should not however be overlooked that some complications may be iatrogenic.
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PMID:Complications of mild hypertension. 36 Sep 31

Initial evaluation of patients with chronic renal failure demands a careful search to exclude reversible causes such as dehydration, obstruction and nephrotoxins. Subsequently, strict management of sodium and fluid intake is necessary to avoid either dehydration or congestive heart failure. As renal failure advances, restriction of dietary protein and potassium and binding of phosphate are indicated. Referral to an end-stage renal disease center should be accomplished early, before and appearance of uremic symptoms, to facilitate a smooth transfer to the next phase of rehabilitative therapy.
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PMID:Practical management of chronic renal failure. 42 68

We report on six patients in whom hypothermia secondary to acute illnesses, including pneumonia, congestive heart failure, renal failure, drug overdose, and hypoglycemia, developed. Complications that occurred were metabolic acidosis in six patients, altered sensorium in five, bradyarrhythmia in three, and hyperamylasemia in two. All patients failed to demonstrate a shivering response and represent cases of acute thermoregulatory failure. Five of the six patients survived. In the course of treatment, the choice of active or passive rewarming should be based on whether or not normal thermoregulatory mechanisms are intact.
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PMID:Thermoregulatory failure secondary to acute illness: complications and treatment. 43 95

The effect of abrupt versus gradual discontinuation of lidocaine hydrochloride infusion on the incidence of recurrent ventricular arrhythmia and on lidocaine pharmacokinetics was studied. Twenty-nine patients with documented myocardial infarction receiving no other antiarrhythmic drugs and having no evidence of congestive heart failure, liver disease or renal failure were randomly assigned to one or two groups: Group 1--lidocaine infusion was abruptly discontinued after a course of therapy, and Group 2--lidocaine infusion was tapered over a three-hour period. Lidocaine blood levels were measured at the abrupt discontinuation of an infusion or the initiation of tapering and three hours later. Cardiac rhythms were monitored until patients were transferred from the coronary care unit. Three of 18 patients in Group I and two of 11 patients in Group 2 had recurrent ventricular arrhythmias at least 12 hours after idocaine infusion was stopped. The duration of infusion did not correlate with the recurrence of ventricular arrhythmia. In patients infused with lidocaine for 36 hours or less, apparent body clearance was significantly faster than that in patients infused with lidocaine for longer than 36 hours (p less than 0.01). There was no difference in the incidence of recurrent ventricular arrhythmias when comparing abrupt cessation of lidocaine with three-hour tapering. Lidocaine infusion rates may have to be decreased after 36 hours to avoid accumulation of the drug.
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PMID:Lidocaine infusions: effect of duration and method of discontinuation on recurrence of arrhythmias and pharmacokinetic variables. 46 93

Congenital hepatic fibrosis is nearly always associated with ectasia of collecting tubules of the kidneys. This abnormality usually remains silent. In this study we report three cases of adult's CHF with associated renal failure treated by hemodialysis. In all three cases, renal injuries were indistinguishable from those found in adult-type of polycystic disease. The kidneys of our third patient, who underwent two nephrectomies at a 14-years interval, showed ectasia of the collecting tubules with only a few cortical cysts. The second one showed numerous large cysts and only a few ectatic tubules. Our data indicate that: renal failure can complicate the CHF course in adults. Uremia can be the pressenting feature; polycystic kidneys in CHF are microscopically different from those found in adult-type, they might be considered as the final stage in ectasia of collecting tubules.
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PMID:[Kidney polycystic disease as the major feature in three adults with congenital hepatic fibrosis. 3 cases (author's transl)]. 49 94

With improvements in the techniques of microvascular surgery, the Blalock-Taussig shunt has been applied to smaller infants. We report our experience in 17 neonates (mean age 9 days, mean weight 3.2 kg) who underwent emergency shung operations. The early mortality was 17.6% (3 of 17), with only 1 death (7%) from renal failure and sepsis, in the last 14 patients. Three shunts were patent but inadequate and required a secondary procedure, which was successful in all 3. There were 3 patients with late shunt failures at a mean of 15 months postoperatively, while 2 are still doing well at 15 and 18 months. No patients developed congestive cardiac failure. The late mortality was high (5 of 14), but was due to late shunt failure and was preventable in only 1 patient. These results are encouraging, and we continue to perform the Blalock-Taussig shung in neonates. It is hoped that improvements in technique will reduce the incidence of inadequate shunts.
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PMID:The Blalock-Taussig shunt in the neonate. 63

A total of 87 cases of pericardial heart disease (73 of pericarditis and 14 of hemopericardium) among 870 consecutive autopsies of aged patients was studied. Fibrinofibrouspericarditis was found in 80.8% of pericarditis, neoplastic in 13.7% and purulent in 5.5%. Representative cases of each type of pericarditis were illustrated. Among fibrinofibrous pericarditis, idiopathic was the most common and the other causes included irradiation, myocardial infarction, renal failure, rheumatoid arthritis and hypothyroidism. Frequent association of congestive heart failure or anasarca with mild to moderate fibrinofibrous pericarditis was noted. Clinical and morphologic evidences of pulmonary tuberculosis were present in nearly one third of cases with fibrinofibrious pericarditis, but actual incidence of tuberculous pericarditis could not be determined. Incidence of clinical signs and symptoms of acute pericarditis was evaluated with the stress on the relatively high incidence of supraventricular tachyarrhythmias, especially in cases with histological evidence of sinus node involvement in aged cases.
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PMID:A clinicopathological study on pericardial heart disease in the aged. 64 89


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