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

Atheromatous renal disease is the major cause of renal insufficiency in the elderly, and cholesterol embolism is a manifestation of this disease. Cholesterol embolism occurs in patients suffering from diffuse erosive atherosclerosis, usually after triggering causes, such as aortic surgery, arterial invasive procedures (angiography, left heart catheterization and coronary angioplasty) and anticoagulant or thrombolytic therapy. It is characterized by occlusion of small arteries with cholesterol emboli deriving from eroded atheromatous plaques of the aorta or large feeder arteries. The proximity of the kidneys to the abdominal aorta and the large renal blood supply make the kidney a frequent target organ for cholesterol atheroembolism. The exact incidence of atheroembolic renal disease (AERD) is not known. The reported incidence AERD varied in the literature because of the differences in study design and the different criteria used for making the diagnosis. Retrospective data derived from autopsy or biopsy studies may exaggerate the frequency by including many subclinical cases. Clinical observations that are based on a short duration of follow-up after an invasive vascular procedure and the infrequency of the confirmatory renal biopsies can lead to an underestimation of the true incidence of AERD. The initial signs and symptoms in patients diagnosed with cholesterol embolism were blue toes syndrome, livedo reticularis, gangrene, leg, toe or foot pain, abdominal pain and flank or back pain, gross haematuria, accelerated hypertension and renal failure. Cholesterol embolism may also be associated with fever, increased erythrocyte sedimentation rate and eosinophilia. Thus, in the cases of spontaneous cholesterol embolism, differential diagnosis includes, polyarteritis nodosa, allergic vasculitis and subacute bacterial endocarditis. Skin and renal biopsy specimens are the best sample for histologic diagnosis. There is, at present, no pharmacological treatments shown to be effective in altering the course of the disease. Management is limited to supportive therapy and avoidance of anticoagulation; aortic procedures should be postponed.
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PMID:[Atheroembolism renal disease: diagnosis and etiologic factors]. 2300 16

Acute aortic dissection is a rare, life-threatening condition. Clinical manifestations generally include the acute onset of severe chest or back pain. Aortic dissection presenting with signs and symptoms of acute spinal cord damage is the most severe complication and is particularly rare. This paper reports a case of aortic dissection in a 50-year-old man with a 10-year history of hypertension manifesting as acute spinal cord damage (bilateral lower extremity weakness and loss of all types of sensation), acute skeletal muscle ischaemic necrosis with increased levels of creatine kinase, and acute kidney failure with increased levels of serum creatinine and decreased glomerular filtration rate. The patient refused surgical treatment. His clinical condition progressively worsened and he died 3 days later. This case indicates the importance of considering aortic dissection in patients presenting with acute spinal cord damage, acute skeletal muscle necrosis or acute kidney failure, which may allow early diagnosis and reduce the mortality rate.
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PMID:Aortic dissection presenting primarily as acute spinal cord damage: a case report and literature review. 2320 86

Multiple myeloma is a plasma cell malignancy that leads to bone pain, pathological fracture, anaemia, renal failure and recurrent bacterial infections. Recently, thalidomide has demonstrated significant activity in the treatment of multiple myeloma in various western studies. In India there are very minimal studies about multiple myeloma. To study the clinical profile of multiple myeloma and the effect of thalidomide based treatment on its outcome in the Indian scenario are the aims and objective of the study. A total of 25 multiple myeloma cases were enrolled in the study. The diagnosis of multiple myeloma was made based on the presence of greater than 10% plasma cells on bone marrow, an M band in serum electrophoresis and/or a skeletal survey revealing osteolytic lesions. All the above patients were treated with tablet thalidomide 200 mg once daily on all days and tablet dexamethasone 40 mg once daily on days 1-4, 9-12, 17-20 in a 28 days cycle for 4 cycles. At the end of four cycles, all patients were re-evaluated and the response rate was assessed. The most common clinical presentation (56%) was bone related like bony swelling, bone pain, low backache and pathological fractures. The overall response rate to thal-dexa regimen was 72% (n=18). Out of these, 10 patients (56%) had complete response and 8 patients (44%) had partial response. The mean bone marrow plasma cell percentage at the end of therapy was 2% compared to 56% before therapy which was significant (p < 0.0001). None of the patients developed neutropenia or thrombocytopenia during treatment. Although multiple myeloma has remained an incurable disease to date, presently available thalidomide based combination chemotherapy represents an active inductive regimen to improve the outcome and achieve eventual cure.
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PMID:Clinical profile of multiple myeloma and effect of thalidomide based treatment on its outcome. 2346 67

A 46-year-old female patient presenting with unspecific lower back pain, diffuse abdominal pain, and slightly elevated body temperature was referred to the hospital. The X-ray of the spine detected an unspecific sclerotic lesion of the third lumbar vertebra; an abdominal computed tomography (CT) scan was performed. In this scan, a sheeting of the infrarenal abdominal aorta, a streaky densification of the periaortal fatty tissue, and a nearly complete thrombotic occlusion of the inferior vena cava and both iliac veins was detected. As these findings are typical for acute aortitis and this is a life-threatening disease, the patient was transferred to a university hospital. Imaging work-up including ultrasound, magnetic resonance imaging, and 18-flourodeoxyglucose positron emission tomography were performed after transfer. These examinations showed acute aortitis due to Ormond's disease. Furthermore, there was a thrombotic occlusion of the inferior vena cava due to a compression of the vein by inflamed connective tissue. This is a rare finding in Ormond's disease. We decided to treat our patient with a combined therapy including glucocorticoids and tamoxifen for 2 years. During these 2 years and the further follow-up period, the patient showed no relapse of the inflammatory disease. Retroperitoneal fibrosis is a rare but increasingly recognized disease characterized by the presence of fibro-inflammatory tissue, usually surrounding the abdominal aorta and the iliac arteries. This fibrotic tissue extends into the retroperitoneum and thus encases structures, for example, the ureters. Retroperitoneal fibrosis is generally idiopathic. It can also be secondary to certain drugs, malignant diseases, infections, surgery, and other triggering factors. Ormond's disease may lead to serious complications like renal failure. This can be avoided by successful treatment when diagnosed early.
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PMID:Thrombosis of the inferior vena cava related to Ormond's disease. 2359 47

We describe the case of a man who presented with back pain and acute kidney injury and was found to have bilateral ureteral obstruction, which initially corrected with ureteral stents. Imaging studies showed thickening of the bladder. Shortly thereafter, he developed obstructive jaundice, pancreatitis, recurrence of renal failure, and was diagnosed with advanced gastric cancer after a laparotomy revealed peritoneal carcinomatosis. The patient deteriorated rapidly after diagnosis. While peritoneal carcinomatosis, ureteral metastases, and extrinsic ureteral compression have been recognized in gastric cancer, obstructive renal failure due to tumor infiltration of the bladder wall is seldom described. We present this case as an unusual cause of acute renal failure and presentation of gastric cancer.
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PMID:A Rare Presentation of AKI: Gastric Infiltration of the Bladder Wall. 2453 90

We present an atypical case of tuberculosis in an immunocompetent man from west Africa living in Europe. The patient entered the hospital with a painful lump of 3 cm on his right clavicule which he noticed 2 weeks before and back pain. During the examinations for further evaluation his condition deteriorated within short time. Tuberculosis was diagnosed, treatment started but he needed mechanical ventilation at the intensive care unit and had kidney failure. The further evolvement was favourable in the end but needed intensive treatment for over 4 weeks. Tuberculosis cases with such severe evolution are rather known with immunodeficient patients. Extrapulmonary tuberculosis, especially skeletal tuberculosis is seen more frequent in young immunocompetent migrants. The migrating persons seem to be more at risk to get sick than the ones staying in their origin country. We suppose the course of our patient's disease is miliary or septic, of which both are rather rare entities.
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PMID:Miliary tuberculosis with atypical presentation in an immunocompetent young African man. 2465 36

Retroperitoneal fibrosis is a rare disease manifesting as chronic soft tissue fibrosis in the retroperitoneum, with potential anatomic and/or functional compromise of adjacent organs. It can be primary (idiopathic) or secondary to other conditions such as cancers, autoimmune disorders, or drugs. We report herein a 66-year-old patient with symptomatic retroperitoneal fibrosis leading to bilateral hydronephrosis and renal failure, in whom, after a complex diagnostic work-up and protracted clinical course, a B-cell non-Hodgkin lymphoma in the retroperitoneal space and several vertebral bodies was identified. The patient was treated with radiation therapy and weekly rituximab infusions, with resolution of hydronephrosis and lower back pain. We include a thorough literature review on etiopathogenesis, diagnosis, therapy, and prognosis of retroperitoneal fibrosis. A meticulous search for malignancy is necessary in this rare condition that, if positive, may have significant therapeutic and prognostic implications.
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PMID:Retroperitoneal fibrosis due to B-cell non-Hodgkin lymphoma: Responding to rituximab! 2501 86

Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on examination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.
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PMID:Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant. 2537 56

IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs.
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PMID:Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis. 2546 23

Hemodialysis (HD) is one of the important modalities of renal replacement therapy in acute renal failure (ARF) as well as chronic renal failure (CRF). This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients) were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%), nausea and vomiting seen in 1125 sessions (26.4%), fever and chills seen in 818 sessions (19.2%), headache seen in 665 sessions (15.6%), cramps seen in 85 sessions (2.0%), chest pain and back pain seen in 82 sessions (1.92%), hypoglycemia seen in 77 sessions (1.8%), first-use syndrome seen in 72 sessions (1.7%) and femoral hematoma seen in 31 sessions (0.73%). In the CRF group, common complications were hypotension in 2230 sessions (26.1%), nausea and vomiting in 1211 sessions (14.2%), fever and chills in 1228 sessions (14.4%), chest pain and back pain in 1108 cases (13.0%), hypertension in 886 sessions (10.4%), headache in 886 sessions (10.4%), cramps in 256 sessions (3.0%), hematoma in 55 sessions (0.64%), intracerebral hemorrhage in three sessions (0.03%) and catheter tip migration in three sessions (0.03%). There is a need for special attention for the diagnosis and management of intradialytic complications of HD because such complications could be managed successfully without the need for termination of the dialysis procedure.
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PMID:Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience. 2557 43


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