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

Most perioperative ARF is ischemic in origin. The kidney is in a unique position to monitor the status of the cardiovascular system. The effects of anesthesia and operation on the kidney are due primarily to changes in hemodynamic function. When cardiovascular performance is inadequate, powerful forces tend to reduce renal blood flow. These effects are mediated by the sympathetic nervous system, the renin-angiotensin system, prostaglandins, vasopressin, and aldosterone. Therefore, careful monitoring of kidney and cardiovascular function coupled with appropriate therapy will prevent most perioperative renal failure.
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PMID:Acute renal failure. 700 8

The functional capacity of the kidney decreases with advancing age. We not only find a reduced glomerular filtration rate but also disturbances in the functioning of the tubules which influence the capacity to dilute and concentrate the urine and the renal electrolyte excretion. In addition, the plasma-renin activity shows decreased response to stimulation; the aldosterone and vasopressin secretions are also decreased in old age. Disturbances of the water-, electrolyte and acid-base equilibrium often cause secondary renal failure. On the other hand, as the renal capacity is limited, renal disorders occurring in old age may lead to quicker decompensation.
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PMID:[Water-, electrolyte- and acid-base equilibrium in the aged]. 702 36

Abnormalities in neurohypophyseal function have been postulated to contribute to the alterations in fluid and electrolyte balance observed during aging. In this study, parameters of fluid and electrolyte balance were evaluated during chronic water deprivation in old (30 months) and young (3 months) Fischer 344 rats. The increase in serum vasopressin (VP) and renin concentrations observed in the 3 month animals following chronic water deprivation were absent in the aged rats (p less than 0.05 and p less than 0.02, respectively). This occurred in spite of apparently comparable alterations in fluid volume and osmolality (assessed by changes in body weight, hematocrit and plasma osmolality). Relative to body weight, VP content of the neural lobe was significantly reduced and was more severely depleted by dehydration in aged rats than in young rats. Thus, inadequate neurohypophyseal hormone stores may contribute to the inability of the aged animals to attain elevated serum VP concentrations during chronic stimulation. Several parameters of renal function were examined in the aged rats. Although none of the old rats were in renal failure, they all showed some indication of reduced renal function. In spite of renal abnormalities including reduced concentrating capabilities, the old rats did demonstrate a significant antidiuretic response to dehydration. However, with prolonged fluid deprivation, they were unable to attain serum VP or renin concentrations comparable to that achieved by the young rats.
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PMID:Vasopressin and renin response to dehydration in aged rats. 703 29

The operative management of stress ulcer in children is controversial. Between the years 1969 and 1981, ten children were operated on at the Babies Hospital for stress ulcer. Their illnesses included connective tissue disorders (3), sepsis (2), Reye's syndrome (1), hemolytic uremic syndrome (1), leukemia (1), closed head injury (1), and renal failure (1). In those with bleeding (8), aggressive conventional medical management was attempted prior to operation. Four children also received intravenous cimetidine. Four patients underwent embolization of a feeding artery and/or selective vasopressin infusion. In those patients who perforated (2), operation was performed after a brief period of resuscitation. Ten patients underwent 11 operations. In those who bled, multiple ulcerations were the most common finding. Operative procedures consisted of partial gastrectomy and vagotomy (4), partial gastrectomy alone (2), and vagotomy and pyloroplasty (2). One child who underwent vagotomy and pyloroplasty required partial gastrectomy for recurrent bleeding. Of the two children who perforated, one was managed by plication and the other by partial gastrectomy. There were two deaths (20%), both occurring in patients who had undergone gastrectomy. One survivor has mild dumping. This experience suggests that in children (1) stress ulcers are commonly multiple when associated with major medical illnesses; (2) partial gastrectomy with or without vagotomy affords maximum protection against recurrent bleeding; (3) lesser procedures are effective for solitary bleeding duodenal ulcers or perforation; and (4) selective arterial embolization or vasopressin infusion are unreliable methods for controlling bleeding.
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PMID:Operative management of stress ulcers in children. 709 47

The hepato-renal syndrome is defined as potentially reversible functional renal failure associated with acute fulminant hepatitis or, more often, with advanced chronic liver failure. It is characterized by oliguria, azotemia, retention of sodium and water with formation of ascites, and hyponatremia. While urinary sodium concentration of less than 10 mEq/l reflects intact tubular sodium absorption, the kidney lacks the ability for adequate free-water generation. This condition must be separated from specific renal diseases which may arise during the course of intra-or extrahepatic diseases and which must be classified accordingly. Pathophysiological aspects of the hepa-to-renal syndrome include hemodynamic factors, such as changes in intrarenal blood flow distribution in the presence of elevated intrarenal and reduced peripheral vascular resistance. The functional relationship of vasoconstrictor, sodium retaining, and anti-diuretic hormones (e.g., renin-angiotensin, aldosterone, and vasopressin) to vasodilator, diuretic, and natriuretic hormonal factors (e.g., prostaglandins, kinins, and natriuretic hormone) may be altered as well. Finally, a pre- and intrahepatic spillover resulting in decreased endotoxin clearance must be considered. Due to the lack of understanding of their complex interactions, so far pharmacological and therapeutic approaches remained ineffective to correct at least some of these factors. Today, recovery from hepato-renal syndrome will, therefore, mainly depend on the course of the underlying liver disease.
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PMID:[Hepato-renal syndrome (author's transl)]. 727 84

The role of normocapnic hypoxemia (arterial PO2 33 +/- 7 torr for 30 minutes) in asphyxial renal failure and its modification by maturation of renal function was studied in 50 chronically catheterized, unanesthetized lambs of 2-38 days postnatal age. Arterial pH and PCO2 did not change significantly in response to hypoxemia in these lambs. Normocapnic hypoxemia was associated with (1) significant percent increases in arterial serum osmolality (1.82 +/- 2.96%, P = 0.0001), arterial blood lactate concentration (1009 +/- 2092%, P = 0.0018), arterial blood hematocrit (6 +/- 12%, P = 0.0016), arterial hemoglobin concentration (4.6 +/- 6.5%, P = 0.0004), arterial plasma vasopressin (2370 +/- 3340%, P = 0.0001), arterial plasma renin activity (153 +/- 230%, P = 0.0001), arterial plasma aldosterone (91.3 +/- 143%, P = 0.0001), and fractional sodium excretion rate (120 +/- 240%, P = 0.007); and (2) significant percent decline in glomerular filtration rate (-22.6 +/- 32.6%, P = 0.0003). Several responses to hypoxemia correlated significantly with postnatal age, including (1) positive correlation of postnatal age with percent change in blood osmolality (r = 0.36, P = 0.010), hematocrit (r = 0.48, P = 0.0005), hemoglobin (r = 0.59, P = 0.0004), and lactate (r = 0.72, P = 0.0001), suggesting greater water movement from the intravascular compartment in response to hypoxemia in more mature lambs; and (2) positive correlation of postnatal age with change in urinary flow rate (r = 0.66, P = 0.0001), urinary sodium excretion rate (r = 0.65, P = 0.0001), and osmolar clearance rate (r = 0.60, P = 0.0002), suggesting a greater effect of hypoxemia on the renal tubules to decrease sodium reabsorption in more mature kidneys. Thus, normocapnic hypoxemia may play a role in asphyxial renal failure, and the immature kidney does not have increased susceptibility to this condition.
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PMID:Postnatal age-related renal responses to hypoxemia in lambs. 730 47

Although acute renal failure, caused either by renal ischemia or nephrotoxic agents, is usually characterized by oliguria, a severe fall in glomerular filtration rate, and a fall in renal blood flow, some patients and experimental models display a non-oliguric pattern of renal injury. The present study was designed to evaluate the mechanism of preservation of high urinary flow rate under this condition. Following the administration of the aminoglycoside gentamicin to rats for five days, a decrease in concentrating ability was demonstrated, caused by impaired vasopressin-mediated water transport. Further treatment resulted in a fall in Cin to 15 percent of control, although RBF was reduced to only 67 percent of control, and urine flow rate rose above control levels. Induction of acute and renal failure with dichromate was associated with variable high or low urinary flow rates according to pre-injury intake of sodium. Urine volume correlated directly with cortical blood flow. These data suggest that the non-oliguric pattern of acute renal injury is caused by preservation of cortical perfusion in the setting of severe tubular injury.
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PMID:Studies on the mechanism of non-oliguric experimental acute renal failure. 732 6

Quantative data on plasma levels of antidiuretic hormone (ADH) in renal failure are limited. We measured predialysis plasma ADH levels using a double antibody radioimmunoassay in 14 patients with end-stage renal failure. Plasma ADH was inappropriately elevated in the majority of tested patients despite normal plasma osmolality, moderately elevated blood pressure, and hypervolemia. The etiology of increased plasma ADH in our population is unclear.
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PMID:Antidiuretic hormone in end-stage renal disease. 744 Aug 45

Clonidine, an antihypertensive drug that inhibits renin release and causes a water diuresis in normal animals, was tested for its ability to reduce the severity of post-ischemic acute renal failure produced in rabbits by clamping the left renal pedicle for 1 hour and removing the opposite kidney. Clonidine significantly lessened renal failure when given during, or 1 hours after, the ischemic insult in dehydrated rabbits. It was also effective when given during the ischemic insult in vasopressin-treated water-drinking rabbits but not in control water-drinking rabbits. In vasopressin-treated rabbits, clonidine lessened renal failure observed 2 days after the ischemic insult despite the fact that in the immediate postischemic period it lowered total renal blood flow, produced hypotension, and did not bring about lower plasma renin levels. Clonidine treatment resulted in less outer medullary microvascular damage (demonstrated by colloidal carbon staining), higher outer medullary blood flow 1 to 2 hours after unclamping, fewer casts, and higher creatinine clearance and free water clearance/creatinine clearance 4 to 6 hours after unclamping compared with controls. The effect of clonidine was unrelated to plasma renin activity. Clonidine did not alter plasma vasopressin concentration. Demeclocycline and lithium, two agents that blunt renal responsiveness to vasopressin, had a beneficial effect in dehydrated animals similar to that of clonidine, but the angiotensin II antagonist saralasin and the angiotensin converting enzyme inhibitor SQ20881 did not. Normal rabbits given a large dose of vasopressin in oil plus clonidine had significantly greater urine output and free water clearance and lower urine osmolality than did rabbits given vasopressin in oil alone. These results suggest that clonidine may be beneficial because it prevents ischemic microvascular injury in the renal outer medulla, an effect that may decrease tubular obstruction by lessening desquamation of damaged tubular cells or cell constituents into the tubular lumen. Clonidine may also decrease formation of obstructive hyaline casts in collecting ducts by blunting the kidney's response to vasopressin and increasing tubular fluid flow rate.
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PMID:Clonidine after renal ischemia to lessen acute renal failure and microvascular damage. 746 46

Diagnostic and therapeutic angiography has demonstrated an important role in gastrointestinal hemorrhage. During the past 2 years, we performed angiography in the management of 20 patients with uncontrolled gastrointestinal bleeding. Conservative management including medication and transfusion would not appear to suffice in these patients and most patients had been evaluated to have a high operative risk in our series. Ten of the 20 patients had renal dysfunction (creatinine > 1.7 mg/dl) before angiography. The role of angiography in the management of patients with renal dysfunction remains controversial because angiography is likely to produce acute renal failure. We performed angiography to stop bleeding in these patients with renal dysfunction because they could die of blood loss. In our 20 cases, bleeding sites were identified in 14 patients. The detection rate was 70%. Thirteen of the 14 with the use of either vasopressin infusion or arterial embolization showed complete cessation of bleeding in 10 patients. Three cases failed to be controlled. One received an operation after a bleeding site was located by angiography. In our study, sepsis with renal failure was the leading cause of mortality (6 cases). Ten patients with pre-existing renal dysfunction had angiography performed and only one showed abrupt elevation of creatinine levels after angiography. He also developed sepsis. Deterioration of renal function was possibly due to angiography or more likely due to sepsis and hypovolemia. Six patients died of sepsis after angiography although 4 of these patients showed cessation of bleeding. Four cases with pre-existing renal dysfunction and without evidence of infection survived after angiographic management.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Angiography for the management of poorly controlled gastrointestinal hemorrhage--20 cases clinical observation]. 770 50


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