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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From November 1998 to March 2000, two hundred patients over the age of 60 years (Elderly) with clinical renal disease were studied. 144 patients were between ages of 60-69 years, 46 between 70-79 years and 10 were above 80 years. The elderly patients (Male 165; Female 35) with renal disease constituted 11% (200/1816) of the total nephrology consultation during the study period. The clinical presentation included chronic renal failure (42.5%); acute renal failure (28%); nephrotic syndrome (14.5%); acute glomerulonephritis (7.5%); renal vascular disease (5%) and renal cystic disease (2.5%). Diabetic nephropathy, obstructive uropathy and hypertensive nephrosclerosis were the major causes of CRF, accounting for 80% of total CRF in the elderly. Chronic glomerulonephritis and chronic pyelonephritis (CPN) were less common and etiology of CRF was uncertain in 5.9% of cases. However, diabetic nephropathy was the commonest (49.4%) cause of chronic renal failure. We did not see a single case of ischemic nephropathy causing CRF in the present study. Prerenal ARF, obstructive uropathy and sepsis were contributing factors for ARF in 82% of the cases. Volume depletion due to gastrointestinal fluid loss and urinary tract obstruction on account of enlarged prostate were the leading causes of ARF in 20 (35.7%) and 8 (14.3%) cases respectively. Sepsis with or without multiorgan failure was the major (46.7%) cause of mortality in patients with ARF and overall mortality was 26.8%. The commonest (31%) cause of nephrotic syndrome was the idiopathic membranous nephropathy. Diabetic nephropathy related to type-2 diabetes mellitus was the second most common (24.1%) cause of nephrotic syndrome. Diffuse endocapillary proliferative GN of post infectious etiology was the commonest (73.3%) type of acute GN in our elderly patients. Renal cystic diseases were noted in 5 (ADPKD 3; Simple cyst-2) patients. Thus, overall spectrum of renal disease in our elderly patients is similar to that of developed nations except in two ways: (i) Endocapillary proliferative GN of post infectious origin was the commonest type of acute GN and (ii) Rarity or absence of ischemic nephropathy and atherosclerotic renal artery occlusive disease.
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PMID:Spectrum of renal diseases in the elderly: single center experience from a developing country. 1209 35

A case of retroperitoneal perforation of the appendix presenting with a thigh abscess is described. The patient presented with pyrexia (38 degrees C) and abdominal and right thigh pain. There was tenderness in the right loin. His white blood cell count was 22 x 10(9)/L. An intravenous urogram revealed tapering of the right ureter at the L2/L3 level and suggested an infected obstructive uropathy. The patient failed to respond to drainage and antibiotics, so we performed a computed tomography scan, which showed a retroperitoneal abscess extending to the gluteal region and thigh, with signs of small bowel obstruction. This precipitated surgery. The route of extension of infection was through the sacrosciatic notch, which is considered to be a rare way of spread. The patient made a slow but eventual recovery. The overall mortality of this condition is high, but early recognition of an abdominal source of sepsis with appropriate treatment can improve survival.
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PMID:Retroperitoneal perforation of the appendix presenting as right thigh abscess. 1222 17

Acute renal failure (ARF) is a challenging problem in nephrology. To evaluate the pattern, management and outcome of ARF in our tertiary hospital, we analyzed the data of all 81 patients admitted with or developing ARF in hospital between January 2002 and June 2003. The 45 men and 36 women of mean age 56.2 +/- 21 (range 13 to 91) years were managed either on the ward (n = 48; 59%) and or in the ICU (n = 33; 41%) 10% were direct admissions to the nephrology service with ARF, and 90% developed ARF in hospital. Thirty percent were referred by oncology services and 15% by general medicine. Sepsis was the cause of ARF in 36 (44%) patients, followed by drug nephrotoxicity in 11 (14%), and obstructive uropathy in 9 (11%). Comorbid conditions were hypertension in 28 (35%); diabetes in 27 (33%); chronic renal failure, 19 (23%); ischemic heart disease 19 (23%); and liver disease 12 (15%). The most common predisposing factor was hypotension in 42 (52%), dehydration in 32 (40%), and drug nephrotoxicity in 20 (25%). Sixty patients (74%) were managed conservatively, and 21 (26%) required renal replacement therapy. The length of hospital stay was 29.5 +/- 38.4 (range 2 to 279) days. Patient survival for those managed on the ward was 71% compared to 33% for ICU patients (P <.00001). Renal survival was 83% for ward patients, compared to 48% for those in the ICU (P <.001). This study showed that majority of ARF developed in-hospital with oncology patients constituting the greatest proportion. Sepsis was the leading cause of ARF and hypotension, the main predisposing factor. Patients treated in the ICU showed a worse prognosis for both patient and renal survival.
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PMID:Pattern of acute renal failure in a tertiary hospital in the United Arab Emirates. 1535 Apr 76

Children with pyometrocolpos due to distal vaginal atresia may present as acutely ill, with severe obstructive uropathy and septicemia. In such patients the clinical course is markedly improved by urgent drainage of the infected cystic mass, and a temporary drainage procedure is required to allow local findings of infection to subside before definitive surgery. We present two children with pyometrocolpos with the above-mentioned clinical course, in whom percutaneous drainage with computed tomography-guided catheter placement through the lower abdominal wall was performed because of the high risks of complex drainage procedures and general anesthesia. This drainage did result in dramatically improved clinical status, and findings of local inflammation resolved within 4-6 weeks, which facilitated a later successful definitive surgical procedure.
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PMID:Two cases of pyometrocolpos due to distal vaginal atresia. 1560 70

The aim of this study was to describe the clinical spectrum of chronic renal failure (CRF) in the elderly. The diagnosis of CRF was made using standard clinical criteria. The elderly was defined as person with over 60 years of age. In total, 200 elderly patients with CRF were evaluated between July 2002 and February 2004. Their age (male: 146; female: 54) ranged between 60 and 90 (mean 64.31+/-4.18) years. Diabetic nephropathy was the most common (46%) cause of CRF. Hypertensive nephrosclerosis, chronic interstitial nephritis and obstructive uropathy were responsible for CRF in 18%, 14% and 13% of patients, respectively. We observed chronic glomerulonephritis in 7% of elderly CRF. Urinary tract infection (55.5%), hypovolemia (22.2%), accelerated hypertension (11.1%) and sepsis (11.1%) were responsible for acute exacerbation of renal failure in 36 (18%) patients. Associated co-morbid conditions were noted in 93 (46.5%) patients. They included; coronary artery disease 46 (49.46%), cerebrovascular disease 20 (21.50%), osteoarthritis 13 (13.97%), chronic obstructive pulmonary disease 6 (6.45%), dilated cardiomyopathy 5 (5.37%), and malignancy in 3 (3.22%) patients. Acute dialytic support was required in 164 (82%) cases and remaining 36 (18%) patients received conservative management. Mortality was noted in 25 (12.5%) cases. The coronary artery disease (48%), acute pulmonary edema (20%) and hyperkalemia (12%) were the main causes of death. Subsequent evaluation revealed that 102 (51%) patients had ESRD of which only 3 (2.94%) patients could afford CAPD. A total of 11 (10.7%) patients underwent chronic maintenance hemodialysis for 3-4 months and then discontinue dialysis mainly because of financial constraints. Remaining 88 (86.27 %) patients with ESRD were discharged from hospital after symptomatic improvement with acute dialysis. Thus, diabetic nephropathy related to type-2 diabetes was the commonest cause of CRF in our elderly patients. Chronic renal failure in elderly was associated with a number of co-morbid conditions, which contributed significantly to morbidity and mortality. Acute on chronic renal failure with severe uremic complications were an important cause of hospitalization. The financial constraint was the major limiting factor for the management of elderly ESRD patients.
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PMID:Clinical spectrum of chronic renal failure in the elderly: a hospital based study from eastern India. 1709 77

Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-acquired or nosocomial urinary tract infection (UTI). Nevertheless, the underlying UTI is almost exclusively a complicated one with involvement of the parenchymatous urogenital organs (e.g. kidneys, prostate) and mostly associated with any kind of obstructive uropathy. If urosepsis originates from a nosocomial infection, a broad spectrum of Gram-negative and Gram-positive pathogens have to be expected, which are often multiresistant. In urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The treatment of urosepsis follows the generally accepted rules of the 'Surviving Sepsis' campaign guidelines. Early normalisation of blood pressure and early adequate empirical antibacterial therapy with optimised dosing are equally important to meet the requirements of early goal-directed therapy. In most cases of urosepsis, early control of the infectious focus is possible and as important. Optimal supportive measures need to follow the early phase of resuscitation. To lower mortality from urosepsis, an optimal interdisciplinary approach between intensive care, anti-infective therapy and urology is essential, assisted by easy access to the necessary laboratory and imaging diagnostic procedures. Although most antibacterials achieve high urinary concentrations, there are several unique features of complicated UTI, and thus urosepsis, that influence the activity of antibacterial substances: (i) renal pharmacokinetics differ in unilateral and bilateral renal impairment and in unilateral and bilateral renal obstruction; (ii) variations in pH may influence the activity of certain antibacterials; and (iii) biofilm infection is frequently found under these conditions, which may increase the minimal inhibitory concentrations (MIC) of the antibacterials at the site of infection by several hundred folds. Assessment of antibacterial pharmacodynamic properties in such situations should take into account not only the MIC as determined in vitro and the plasma concentrations of the free (unbound) drug, which are the guiding principles for many infections, but also the actual renal excretion and urinary bactericidal activity of the antibacterial substance. In the treatment of urosepsis, it is important to achieve optimal exposure to antibacterials both in plasma and in the urinary tract. The role of drugs with low renal excretion rates is therefore limited. Since urosepsis quite often originates from catheter-associated UTI and urological interventions, optimal catheter care and optimal strategies to prevent nosocomial UTI may be able to reduce the frequency of urosepsis.
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PMID:Pharmacokinetic characteristics of antimicrobials and optimal treatment of urosepsis. 1737 81

Urosepsis in adults comprises approximately 25% of all sepsis cases and in most cases is due to complicated urinary tract infections (UTIs). In this paper we review the optimal management of urosepsis from the urological point of view. Urosepsis is often due to obstructed uropathy of the upper or lower urinary tract. The treatment of urosepsis comprises four major aspects: 1. Early goal-directed therapy; 2. Optimal pharmacodynamic exposure to antimicrobials both in blood and in the urinary tract; 3. Control of complicating factors in the urinary tract; 4. Specific sepsis therapy. Early tissue oxygenation, appropriate initial antibiotic therapy and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with severe urosepsis. To achieve this goal an optimal interdisciplinary approach encompassing the emergency unit, urological specialties and intensive-care medicine is necessary.
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PMID:Optimal management of urosepsis from the urological perspective. 1772 7

Fifty consecutive patients of acute renal failure (ARF) seen over a period of two years at the Dammam Central Hospital, Dammam were studied. The mean age of the patients was 39.3 years ranging from 14 to 90 years. The main etiological factors for ARF were acute tubular necrosis (67.5%) and obstructive uropathy (30%). The mortality rate was 26% and the poor prognostic factors included sepsis, acidosis, shock and the need for emergency hemodialysis.
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PMID:Clinical spectrum of acute renal failure in dammam central hospital, dammam, saudi arabia. 1820 51

We evaluated 215 patients with acute renal failure (ARF) in three centers in Jordan over an 18 months period. Their ages ranged between 12-90 years, and 120 of them were males. Parenchymal renal insult was the commonest cause of ARF as it was seen in 125 patients (58%). Pre-renal azotemia was seen in 60 patients (28%) and acute obstructive uropathy in 30 patients (14%). At presentation, 152 patients (70.7%) were oligo-anuric, while 63 (29.3%) were non-oliguric. Forty patients (18.6%) required dialysis support; 30 of them were in the renal failure group (75%). Thirty-two of the 40 patients were oliguric-aruric. Complete recovery of renal function was achieved in 80% for the whole group, and in 64% of those with parenchymal renal insult. Forty-seven patients (21.9%) died; 35 of them (63.9%) were in the renal group, and 37 patients (78%) were oligo-anuric. Sepsis and cardiac complications were together responsible for almost 75% of the deaths.
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PMID:Acute renal failure in jordan. 1840 5

A 65-year-old white female patient with normal baseline renal function was referred to our hospital with nonoliguric renal failure requiring hemodialysis after progressive deterioration over the previous 6 months. Her past medical history was remarkable for easy fatigability, weight loss, low-grade fever, hypogammaglobulinemia and mild hepatosplenomegaly manifested over the past 6 years. Several liver and bone marrow biopsies during that period had shown a nonspecific polyclonal T-cell infiltration, and she was administered low-dose steroids for symptomatic relief. Physical examination, laboratory workup and imaging studies at presentation showed pancytopenia, hepatosplenomegaly, large symmetric kidneys with normal cortices and no evidence of obstructive uropathy, aseptic pyuria with neutrophils and lymphocytes and mild proteinuria. On biopsy the renal interstitium was infiltrated by large, granular CD3+CD8+CD56-CD57+ lymphocytes, clonal by molecular analysis, which established the diagnosis of T-cell large granular lymphocyte leukemia. Most urinary and peripheral blood lymphocytes bore the same T-LGL surface markers and were also clonal, as shown by flow-cytometry and PCR amplification of the T-cell receptor g-chain genes. A subsequent bone marrow biopsy revealed infiltration by lymphoma cells and excluded a myelodysplastic or hemophagocytic syndrome. After exclusion of an underlying EBV, CMV, HBV, HCV or HIV infection with negative serology and blood PCR the patient received one cycle of chemotherapy with cyclophosphamide, vincristine and prednisone. No improvement of renal function was achieved, while complication with a prolonged pulmonary infection and severe sepsis precluded further treatment. Our report indicates that the T-LGL leukemia should be considered in the differential diagnosis of renal failure with large-sized kidneys, especially when hepatosplenomegaly, pancytopenia and aseptic pyuria are also present. In the latter case, flow-cytometric and clonality analysis of the urine sediment can aid in establishing a diagnosis. Since renal function may deteriorate rapidly, chemotherapy should not be delayed.
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PMID:T-cell large granular lymphocyte leukemia presenting as end-stage renal disease: the diagnostic role of flow-cytometric and clonality analysis of the urine sediment. 1920 16


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