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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
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PMID:Clinical use of the total artificial heart. 1476 80

Two patients developed acute oliguric renal failure following paraphenylene-diamine intoxication. The associated clinical features included vomiting, angioneurotic edema, cyanosis, intravascular hemolysis and methemoglobinemia. Therapeutic dialysis and symptomatic management was followed by complete recovery in one, and death due to septicemia during the oliguric phase in the other patient. Renal histology in both cases revealed acute tubular necrosis. The pathogenetic mechanisms involved in the development of acute renal failure following paraphenylene-diamine have been discussed.
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PMID:Acute renal failure following paraphenylene diamine [hair dye] poisoning: report of two cases. 695 50

The use of 131I-orthiodohippurate (OIH) scintigraphy combined with the estimated renal plasma flow (ERPF) and excretion index (EI) has been beneficial in separating impaired renal function due to graft rejection from acute tubular necrosis, ureteral obstruction, urinary extravasation and in some instances renal artery occlusion. The radionuclide data accurately identified acute and chronic rejection, confirmed by the clinical course, increase in BUN and serum creatinine and on occasion renal biopsy. Reversible and irreversible acute tubular necrosis (ATN) were clearly differentiated from acute rejection. When the ERPF and EI were plotted on a graph, multiple sequential radionuclide studies accurately predicted graft survival when chronic rejection existed. The limitation of this technique was the inability to discriminate between renal artery stenosis, ureteral obstruction and inflammatory disease. Scintigraphic studies did not distinguish between renal artery stenosis and chronic rejection. In these circumstances arteriography was the diagnostic procedure of choice. Although ureteral obstruction often can be correctly diagnosed by scintigrams, the ERPF, EI and intravenous pyelogram remained the most accurate diagnostic procedures. Recurrent glomerulonephritis, gram negative septicemia and generalized viral illness (herpes zoster or cytomegalovirus) simulated acute rejection and had to be separated by renal biopsy or the clinical course. The most valuable features of the radionuclide technique included: 1) the noninvasive method, 2) the simplicity, 3) the rapidity and 4) the reproducibility.
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PMID:Diagnosis of impaired renal function after kidney transplantation using renal scintigraphy, renal plasma flow and urinary excretion of hippurate. 698 32

The kidneys of rhesus monkeys, infused either with a single bolus of endotoxin(10 mg per KG) or continuously at the rate of 10 mg per kg per hour for periods of up to 22 hours, have been examined by light and electron microscopy. Monkeys infused continuously with Ringer's lactate were used as controls. Only minor morphologic changes were observed in those animals receiving a bolus of endotoxin. In the animals continuously infused, sequestration of neutrophils and monocytes was observed in the peritubular capillaries and, to a lesser extent, in the glomeruli. These changes were associated with phagocytosis of endotoxin, occasional fibrinous deposits, and extensive endothelial damage with focal capillary disruption. In the advanced stages, interstitial edema and early necrosis of tubular epithelium were observed. Our data indicate that endothelial damage and associated events relating to the sequestration of phagocytic leukocytes involve the peritubular capillaries primarily and that this process plays a role in the genesis of acute tubular necrosis associated with endotoxemia. In preliminary studies involving the study of kidneys from patients dying with documented Gram negative sepsis and acute renal failure, sequestered nucleated cells have been observed in the peritubular capillaries of the renal cortex and upper medulla. This suggests that similar patterns of endotoxin mediated vascular injury may be occurring in human sepsis.
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PMID:New Concepts in the pathogenesis of acute tubular necrosis associated with sepsis. 701 67

Simple mechanical swelling of the renal parenchyma against an unyielding renal capsule may be responsible in part for the development of oliguria and acute tubular necrosis. However, until now, renal swelling was difficult to measure, except by postmortem gravimetric techniques. A new in vivo technique, the thermal dye double indicator dilution technique, was used to assess renal swelling by measuring extravascular renal water. Ice cold indocyanine green dye solution was injected rapidly into the renal artery of 5 mongrel dogs, and the thermal dilution and dye dilution curves were recorded simultaneously by means of a thermistor catheter in the renal vein. The curves were corrected for the response time of the measuring systems, then the extravascular renal water was compared (renal blood flow multiplied by the difference in mean transit times of the thermal dilution and dye dilution curves). The results were compared to the gravimetrically determined extravascular renal water. A high correlation was found to exist between the thermal dye dilution method and the gravimetric method (r = 0.92, X = 0.65 Y + 19.8, p less than 0.05). These preliminary results are encouraging and warrant further trials, inasmuch as this technique would allow the sequential in vivo measurement of renal edema. It is therefore feasible to quantitate the effect of clinical insults, such as hypovolemic shock or sepsis, on the kidney, and to assess the value of different therapeutic interventions. A small body of evidence attempts to relate the role of simple mechanical swelling of the kidney to the pathogenesis of acute renal failure.
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PMID:Measurement of extravascular renal water by the thermal dye indicator dilution technique. 705 Apr 16

Accepted causes (acute insults) and risk factors for the development of acute renal failure were defined, quantitatively assessed, and tested for statistical significance in 143 patients with acute tubular necrosis. Sixty-two percent of patients had more than one acute insult, and 48 percent had more than one suspected risk factor. Hypotension, excessive aminoglycoside exposure, pigmenturia, and dehydration were identified as highly significant acute insults, while it was concluded that sepsis and administration of radiocontrast material could not be incriminated as causes of acute tubular necrosis. An additive interaction between acute insults was demonstrated, and the severity of acute renal failure was related to the number and severity of acute insults. Patients with oliguric renal failure had more severe acute insults than patients with nonoliguric renal failure. Preexisting renal disease and chronic hypertension were significant risk factors, the latter only when hypotension had been one of the acute insults. An age of more than 59 years, gout and/or chronic hyperuricemia, diabetes, and long-term diuretic administration were not found to be significant risk factors.
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PMID:Acute renal failure. Multivariate analysis of causes and risk factors. 711 78

This report describes light and transmission electron microscopy (LM and EM, respectively) studies of kidneys from five cases of hepatorenal syndrome. The kidneys were removed and fixed for LM and EM between 30 and 120 min after death. All patients had progressive renal failure after admission to the hospital. All cases were jaundiced, had ascites, and exhibited features of hepatic encephalopathy. LM study revealed severe acute tubular lesions (ATL) or, more conventionally, acute tubular necrosis (ATN). EM study demonstrated necrosis of the proximal tubules characterized by swelling, disorganization of the cristae and appearance of dark bodies in the mitochondria, coalescence, fragmentation or displacement of the microvilli, loss of plasma membranes, rupture of the basement membranes, and separation of the cells from the basement membranes. Rupture of tubular basement membranes (tubulorrhexis) and mitochondrial dark bodies suggest an ATN due to ischemia or induced by vasoconstrictor substance(s). Glomerular lesions were infrequent (one in five) and therefore, do not seem to have contributed to renal failure. All cases terminally had extremely low urinary sodium (11 mEq/liter), high urinary potassium (50 mEq/liter), a remarkably low urinary sodium/potassium ratio (0.26, normal = 4.27), and a low urinary osmolality (less than 400 mOsm/kg). From this study we conclude that an ATN of variable severity may be associated with the hepatorenal syndrome. Since this ATN developed without preceding shock, sepsis, or hypotension it is possible that this ATN like that in ischemic acute renal failure may be due to reduced renal blood flow and intense cortical vasoconstriction which has been reported in hepatorenal syndrome. Finally, our data imply that low urinary sodium is consistent with this pathologic lesion in this clinical setting.
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PMID:Acute tubular necrosis in hepatorenal syndrome: an electron microscopy study. 714 28

Endosulphan is a chlorinated hydrocarbon insecticide with potential toxicity for the respiratory and central nervous systems. Renal toxicity has been rarely reported. We describe a man who developed renal failure due to acute tubular necrosis following a suicidal attempt with endosulphan in the absence of significant hypotension or sepsis.
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PMID:Acute tubular necrosis following endosulphan insecticide poisoning. 762 9

Among a spectrum of renal disorders encountered in patients infected with the human immunodeficiency virus (HIV), the lesion studied most often has been the glomerular disease known as HIV-associated nephropathy. Of the other coincidental renal perturbations reported, the most significant are a heterogenous group encompassing potentially reversible acute renal failure (ARF), primarily acute tubular necrosis. While HIV-associated nephropathy may frequently be seen in asymptomatic HIV-seropositive individuals, acute tubular necrosis almost always is encountered in patients with clinical acquired immunodeficiency syndrome (AIDS). We analyzed our decade's experience in the management of 146 HIV disease patients with ARF (132 AIDS patients and 14 HIV-seropositive patients) and compared it with a contemporaneous group of 306 non-HIV subjects with ARF. All patients evaluated for ARF between January 1984 and December 1993 by the Renal Division at Kings County Hospital Center, Brooklyn, NY, were reviewed. Only those patients with ARF who reached a serum creatinine concentration of 530 mumol/L or higher were included in the analysis. Ninety-one percent of 146 HIV disease patients with ARF were less than 50 years old compared with only 33% of the 306 non-HIV subjects (P < 0.001). Septicemia was directly or indirectly responsible for 75% of patients with ARF in the AIDS group and for 39% in the non-HIV subjects (P < 0.006). Urinary tract obstruction was the cause of ARF in 54 of 306 (17%) non-HIV patients compared with none in the HIV group (P < 0.00001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. 787 16

Etidronate-induced toxicity has not been well documented in humans. This is a detailed account of a case of acute renal failure believed to be due to etidronate. The patient inadvertently received an overdose of etidronate by the intravenous route and subsequently developed acute renal failure as evidenced by a rapid and sustained rise in serum creatinine. The temporal relationship was strongly suggestive of etidronate-induced nephrotoxicity. Other possible causes, such as postrenal obstruction, acute tubular necrosis due to hypotension or sepsis, and other nephrotoxic drugs were excluded through diagnostic and laboratory tests.
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PMID:Acute renal failure associated with the administration of parenteral etidronate. 789 88


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