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

Nephrosclerosis is literally defined as hardening of the kidneys (Greek derivation: nephros, kidney; sklerosis, hardening). It is the result of scarring or replacement of the normal renal parenchyma by dense collagenous tissue. In practice, nephrosclerosis refers to diseases with predominant pathologic changes occurring in the preglomerular microvasculature and secondarily involving the glomeruli and interstitium. The relationship between mild to moderate hypertension and either nephrosclerosis or end-stage renal disease (ESRD) remains circumstantial, although these syndromes have long been associated in the medical literature. Nephrologists credit hypertension as the etiology of nephrosclerosis in 25% of patients initiating Medicare-supported renal replacement therapy, even though other processes may cause similar renal pathologic findings. Strikingly, serum creatinine values infrequently increase in patients with long-standing mild to moderate hypertension. Patients classified as having hypertensive ESRD typically present with advanced disease, making the processes that initiated the renal disease difficult to detect. Nephrologists are twice as likely to label an African-American patient as having hypertensive nephrosclerosis, compared with a white patient, when presented with identical clinical histories. This review proposes that many patients classified as having hypertensive nephrosclerosis actually have intrinsic renal parenchymal diseases, renal artery stenosis, unrecognized episodes of accelerated hypertension, or a primary renal microvascular disease. The familial clustering of ESRD attributed to hypertension in African-Americans and the identification of genes associated with renal injury in animals support the concept that inherited factors may predispose to renal failure. African-American families often have members with ESRD from disparate etiologies, including hypertensive ESRD. This suggests that common mechanisms, be they inherited or environmental, underlie the development of progressive renal failure in diverse forms of nephropathy. Identification of the mechanisms producing susceptibility to progressive renal disease would support the concept that mild to moderate elevations in blood pressure per se are uncommon causes of nephrosclerosis.
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PMID:The link between hypertension and nephrosclerosis. 784 47

A 43 year old man with inoperable aortic coarctation and severe hypertension requiring near maximal anti-hypertensive treatment was admitted in severe heart failure. After 2 weeks of treatment the heart failure and blood pressure were incompletely controlled and angiotensin converting enzyme (ACE) inhibitor was started. Serum creatinine was normal before starting the ACE inhibitor and on discharge from hospital. The patient was re-admitted a week later with gross fluid retention and in renal failure. In the absence of alternative causes, a diagnosis of ACE inhibitor-induced renal failure was made and treatment was stopped. The patient required haemodialysis for 2 days and within 1 week the renal function had reverted to normal and has remained so for 1 year. We propose that the renal haemodynamics in severe aortic coarctation are similar to those in bilateral severe renal artery stenosis and advise caution in the use of ACE inhibitors for adults with aortic coarctation.
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PMID:Acute renal failure with ACE inhibition in aortic coarctation. 787 Jun 44

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension--clinical observations and long-term follow-up]. 787 Dec

Atherosclerotic renovascular disease (ARD) is an increasingly important cause of renal failure. However, important features of the clinical presentation are not fully described, and the outcome after intervention by angioplasty remains controversial. Ninety-four patients with ARD diagnosed at angiography were reviewed. Twenty-four patients were diabetic. Thirty-nine patients had unilateral renal artery stenosis or occlusion (group A), 28 had bilateral stenosis (group B), and 27 had unilateral occlusion plus contralateral occlusion or stenosis (group C). Two years after presentation, actuarial patient survival was 96%, 74.3% and 47.1% in groups A, B and C, respectively (p < 0.001 for all differences); actuarial renal survival in surviving patients was 97.3%, 82.4% and 44.7%, respectively (p < 0.001 for all differences). Percutaneous transluminal balloon angioplasty (PCTA) was performed in 74 patients. Renal function improved in only a minority of cases, but was stable in 73% of nondiabetic patients 12 months after PCTA. Angioplasty was less effective in diabetic subjects, with only 53.3% having stable renal function at 12 months follow-up. Renal and patient survival were strongly related to the initial angiographic findings. In non-diabetic subjects, PCTA resulted in stabilization of renal function for at least one year in nearly three-quarters of cases, which suggests a benefit from intervention in this disease whose natural history is otherwise of progression.
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PMID:Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. 792 93

Renal artery stenosis secondary to atherosclerosis is a cause of both hypertension and renal failure. Since ultrasonic duplex scanning can be used to detect the presence of renal artery stenosis, it is possible to use this modality for follow-up purposes. This study was designed to determine the relationship between the degree of renal artery narrowing and its effects on kidney size. Serial measurements of renal length were taken as a part of the prospective duplex ultrasound measurements of renal artery narrowing. Fifty-four patients (22 men and 32 women with a mean age of 65.8 years) were included in the study. There were 101 renal arteries and kidneys available for follow-up (average, 14.4 months; range, 4 to 24 months). The patients had repeat duplex studies every 6 months. There were no kidneys with normal renal arteries or a less than 60% diameter-reducing stenosis that had a decrease in renal length of more than 1 cm during follow-up. In those kidneys with a > or = 60% diameter-reducing stenosis, 26% had a decrease in renal length of greater than 1 cm. The average decrease in length was 1.9 cm (range, 1.2 to 3.4 cm). The estimated risk of a loss of more than 1 cm length was 19% at 1 year. Loss of renal mass is an important consequence of high-grade renal artery stenosis.
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PMID:Natural history of renal artery stenosis. 794 21

In addition to its role in secondary hypertension, ischemic renal disease is becoming recognized as a significant cause of renal insufficiency. The prevalence and natural history of this disease remain unknown due to difficulty in identification of the process. There are several scenarios that may help alert the clinician to the presence of atherosclerotic renovascular disease. In hypertensive patients, poorly controlled blood pressure on several medications or rapid acceleration of hypertension can suggest renovascular disease. In addition, high-grade retinopathy or abdominal bruits seem to be associated with this condition: bruits have the highest positive predictive value of the clinical signs. Renal artery stenosis also may be related to rapidly progressive renal failure. The classic association is renal failure after use of angiotensin-converting enzyme inhibitors; however, acute renal failure induced through any sudden therapeutic decrease in blood pressure may imply the presence of renal artery stenosis. Unexplained azotemia in the elderly patient also has been associated with renovascular disease. It is possible that the majority of patients with renal artery stenosis are those with a clinically silent process. Advanced age, peripheral atherosclerotic vascular disease, and coronary artery disease may all have a high association with stenosis of one or both renal arteries. It is nevertheless unknown whether a radiographically detected lesion implies current or future clinical complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical characteristics of atherosclerotic renovascular disease. 794 22

Thirty of 118 cases of childhood onset systemic lupus erythematosus collected in the Parisian area had an unfavorable outcome. Thirteen patients evolved to end-stage renal failure. Seven survived with renal substitution therapy, and 6 other patients subsequently died. Most had diffuse proliferative glomerulonephritis, the pattern of glomerular disease classically responsible for end-stage renal failure. Three patients had membranous nephropathy with segmental lesions, a form of glomerulonephritis whose severe prognosis should be emphasized. In another patient, end-stage renal failure was precipitated by thrombotic microangiopathy. Seventeen other patients died and in most, the causes of death were multiple. In 7, death could be attributed to complications secondary to an infection and in 4 other cases to SLE exacerbation with severe organ involvement. Two patients died suddenly, another showed cardiac failure and another had malignant hypertension. Of the remaining 2 patients, one suffered anticoagulant therapy complications after treatment for renal artery stenosis and the second, an urothelial carcinoma. Unfavorable evolutions were high among patients coming from French departments and territories, and among North African patients. One may speculate that poor outcome is associated with ethnic characteristics or with socioeconomic factors. However, the problem of compliance with treatment is clearly an extremely important factor in the prognosis. Both end-stage renal failure and death were in some of our cases precipitated by treatment interruption, indicating an insufficient understanding of the importance of treatment in this chronic disease.
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PMID:Unfavorable outcomes (end-stage renal failure/death) in childhood onset systemic lupus erythematosus. A multicenter study in Paris and its environs. 795 30

Renal artery stenotic disease is the most common form of surgically correctable hypertension. Occlusive lesions of the renal artery are categorized as: arteriosclerotic, fibrodysplastic (intimal fibroplasia, medial fibrodysplasia, perimedial dysplasia) and developmental. The incidence of stroke, heart disease and renal failure has been reduced with contemporary drug management of hypertensive vascular disease, but similar salutary outcomes have not accompanied the medical treatment of renin-mediated renovascular hypertension. Selection of patients for operation implies documentation that a renal artery stenosis is of functional importance. Advances in the surgical management of renovascular hypertension have evolved over the past 50 years, such that carefully performed reconstructions benefit 85-95% of properly selected patients.
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PMID:The evolution of surgery for renovascular occlusive disease. 804 46

Renal artery disease is an important cause of both renal failure and hypertension. Duplex ultrasound is a reliable noninvasive method for classifying the severity of renal artery lesions and can be repeated to follow the course of the disease over time. The purpose of this study was to determine the changes in kidney size associated with various degrees of renal artery disease. Serial kidney lengths were measured as part of a prospective duplex ultrasound study of patients with renal artery narrowing. Fifty-four patients (22 men, 32 women; mean age, 65.8 years) with 101 renal artery and kidney sides eligible for follow-up were evaluated at 6-month intervals for an average of 14.4 months (range, 4 to 24 months). No kidneys with renal arteries classified as normal or less than 60% diameter stenosis by duplex criteria were found to have a decrease in length of greater than 1 cm during follow-up. In kidneys with a high-grade renal artery stenosis (> or = 60% diameter reduction), 26% (13 of 49 sides) were found to have a decrease in length of greater than 1 cm. The average decrease in length was 1.9 cm (range, 1.2 to 3.4 cm). By life table analysis, the estimated risk of a decrease in length of greater than 1 cm for kidneys with 60% stenosis or greater was 19% at 1 year. Loss of renal mass, as documented by ultrasound measurement of kidney length, is an important consequence of high-grade renal artery stenosis.
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PMID:Renal atrophy and arterial stenosis. A prospective study with duplex ultrasound. 812 61

Renal failure following transplantation can be classified in two groups: initial non function characterized by the absence of renal function after transplantation and delayed secondary non function after an initial improvement. In the first group, the most frequent etiology is an acute tubular necrosis (30 to 50% of the cases) which usually heals within three weeks. Arterial thrombosis are rare but of very bad prognosis. In the second group, the most frequent cases are acute rejection, urological complications, renal artery stenosis, urinary infections and cyclosporine, intoxication. Diagnostic imaging, and especially the color Doppler flow, is very effective in obtaining diagnosis. Vascular or urological complications are to be confirmed by contrasted opacifications. In the absence of vascular or urological obstruction renal failure must be related to a renal parenchymal disease. This may be acute tubular necrosis, a rejection, a pyelonephritis or a medicinal intoxication depending on clinical symptoms, the time of their apparition and the results of biological examinations.
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PMID:[The transplanted kidney. Role of imaging in early non-functioning grafts]. 815 35


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