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Objective To retrospectively summarize the diagnosis and treatment experience of acute renal failure caused by urinary calculi obstruction in infants under the age of 6 months in order to improve the level of treat-ment. Methods Between January 2010 and December 2014,15 infants under the age of 6 months with bilateral urinary tract calculi obstruction leading to acute renal failure were treated in West China Hospital,Sichuan University. All cases were Tibetan(10 males,5 females). The ages ranged from 1 month 15 days to 5 months 24 days. The weights ranged from 3. 5 to 7. 0 kg. The clinical characteristics,treatment and clinical outcome were analyzed. Results A total of 9 infants(5 males,4 females)were assessed to be able to tolerate general anesthesia surgery and received positive conservative treatment before operation,and obstruction relief within 6 hours of admission. Six infants (5 males, 1 female)with serious internal milieu disorder,pneumonia,and shock,were assessed as critical cases,who could not tolerate general anesthesia surgery temporarily. Under the emergency blood purification support,they received anti -infection,spasmolysis,rehydration,to correct the internal milieu disorder and obstruction relief within 12 hours of admis-sion. Serum potassium,creatinine returned to normal 12 - 48 hours after obstruction relief. Stone specimens were obtained from 5 cases,and the stone compositions were calcium oxalate stone in 3 cases,calcium oxalate and carbonate apatite mixed stone in 2 cases. A total of 13 cases need further urolithiasis treatment. Conclusions The infants under the age of 6 months with bilateral urinary tract calculi obstruction are more severe with more complications. The emergency treatment principle is to save lives,then relieve the obstruction;surgery should be as brief as possible,since removing the stones is not the primary purpose. If the infants are in critical,life - threatening circumstances,and cannot tolerate general anesthesia surgery,the blood purification will be helpful to gain time and create conditions for treatment.
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La arteritis de Takayasu (AT) es una enfermedad inflamatoria infrecuente de vasos grandes. A menudo, el daño crónico originado en las grandes arterias requiere de revascularización mediante prótesis vasculares. Excepcionalmente la implantación de las prótesis origina lesiones en otros órganos, como los uréteres, los cuales pueden obstruirse por compresión extrínseca por el tejido fibroso retroperitoneal originado como reacción a la presencia de la prótesis vascular.Se comunica el caso de una mujer que presentó hidronefrosis bilateral en forma asincrónica después de los 2 años de la instalación de una prótesis aorto-ilíaca con insuficiencia renal aguda, la cual pudo revertirse mediante. (AU)
Takayasu's arteritis is a rare inflammatory disease of large vessels. Often, chronic damage resulting in large arteries stenosis requires revascularization with vascular prostheses. Exceptionally, the presence of prostheses causes lesions in other organs, such as ureters, which are subject to extrinsic compression caused by retroperitoneal fibrous tissue originated as a reaction to the presence of vascular prostheses. We report the case of a woman who presented bilateral asynchronous hydronephrosis after 2 years of the installation of an aorto- iliac graft with acute renal failure, which could be reversed by releasing the ureter from the periprosthetic fibrous retroperitoneal tissue.(AU)
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Female , Ureteral Obstruction , Retroperitoneal Fibrosis , Takayasu Arteritis , Renal Insufficiency , HydronephrosisABSTRACT
Objective To investigate the risk factors associated with acute renal failure (ARF)after surgery in patients with simple abdominal trauma. Methods A retrospective case-control study was carried out in patients with simple abdominal trauma after surgery from January 2003 through May 2008 in our hospital. Twenty patients with ARF were set as study group and 68 patients without ARF as control group. Clinical data including age, gender, injury type, number of injured organs, blood transfusion volume, intra-abdominal pressure, abdominal infection, shock and related factors were analyzed by using univariate and Logistic regression to identify the independent risk factors of ARF after surgery in patients with simple abdominal trauma. Results Univariate analysis revealed statistical difference in aspects of blood transfusion volume ( ＞ 1 600 ml), operation timing ( interval between trauma and operation ＞12 h), preoperative shock duration ( ＞6 h), postoperative abdominal infection and intra-abdominal hypertension ( ＞ 12 mm Hg) between two groups ( P ＜ 0. 05 ). Logistic regression analysis showed that these five indices were the independent risk factors of ARF after surgery in patients with simple abdominal trauma ( P ＜ 0. 05 ). Conclusions Massive blood transfusion, delayed operation, long preoperative duration of shock, postoperative abdominal infection or intra-abdominal hypertension are the risk factors of ARF after surgery in patients with simple abdominal trauma. We should pay attention to these factors and take effective measures to prevent occurrence of ARF.
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AIM: To investigate the expression pattern of apolipoprotein M (apoM) protein in renal cortex of a-cute renal failure ( ARF) rats with reperfusion. METHODS: Seventy - five male rats were randomly divided into sham operation group (re =25) , ARF group (n =25) and pyrrolidine dithiocarbamat (PDTC) group (n =25) , five subgroups at time points of 3 h, 6 h, 12 h, 24 h and 48 h after reperfusion were set up in each group. The expressions of apoM in cytoplasm and NF - κB p65 in nucleus of renal cortex were detected at the indicated time points. RESULTS: The expression of apoM in ARF group was obviously higher than that in sham operation group ( P <0.01 ) , and two peaks were detected, the first peak was at 6 h after reperfusion, while the second one was from 24 h to 48 h. The tendency of apoM expression in PDTC group was similar to that in ARF group, while the expression in every subgroup was prevalently lower than that in ARF group (P < 0.01). Otherwise, a significant correlation ( r = 0.852, P < 0.01) was found between the expression of apoM and NF -κB p65.CONCLUSION: The results indicate that apoM feasibly take part in the pathogenesis of ARF through the inflammatory reaction mediated by NF - κB.
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Objective To improve diagnose and therapy of post-traumatic acute renal failure induced by rhabdomyolysis. Methods A total of 20 patients with post-traumatic acute renal failure induced by rhabdomyolysis were analyzed retrospectively in aspects of clinical manifestation, laboratory examination and treatment. Of all, there were 9 patients treated with continuous renal replacement therapy (CRRT), while the other 11 were set as control, receiving no CRRT. Results After treatment with CRRT, 7 patients obtained clinical curing, with 2 deaths. As for control patients, there were 5 patients with secondary chronic renal insufficiency, 1 with clinical curing and 5 deaths. Conclusions Early diagnosis, CRRT, sufficient hydration, hematedialysis and supportive treatment are key points to improve the cure rate. It is important to apply CRRT for patients with renal inadequacy.
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Objective To discuss the application of the hemodialysis and filtration(HDF) in children with acute renal failure(ARF).Methods By Branc Dialog hemodialysis machine of double-pump,HDF for 19 times and hemodialysis(HD) for 21 times were given to the children with ARF.The serum blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),?_2 microglobulin(?_2-MG) and the rate of the heart,blood pressure,temperature were observed before and after HD and HDF.Results The clearance rates of BUN,Cr,UA,(?_2-)MG of HDF were markedly higher than those of HD(P
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Objective To observe the renal lesion caused by aristolochia manshuriensis kom(AMK) through 2 infants who had used AMK before hospitalization.Method Retrospecting the 2 cases of infants caused by AMK from 2002 to 2003,and evaluating their pathogenesis,treatment,and prognosis.Result Two infants both presented with symptoms of acute renal failure(ARF),and poor outcome.Conclusions Renal lesion in infant caused by AMK is serious.Some medcines,such as glucocorticosteroid,may be useful for its treatment and prognosis.
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Objective To expolre the clinical characteristic of hospital acquired acute renal failure(HA-ARF).Methods To retrospectively analyse the clinical datas of 103 patients who were suffered from acute renal failure in the duration of hospital stay within 5 years,which was compared with the homeochronous community-acquired acute renal failure(CA-ARF).Results In the 103 cases of HA-ARF,the incidence rate was 32.04% in the major age range from 60 to 74 years old,infection was the most important factor(33.01%),then other factors were cardial and cerebrovascular diseases(17.48%),acute hypovolemia(14.56%) and operation(9.71%);The complicating other organ nonfunction(34.95%),and the mortality rate was 39.80%,all the factors in HA-ARF were higher than that in CA-ARF.Conclusion The main factors of origin in HA-ARF are infection,cardial and cerebrovascular disease,acute hypovolemia and operation.The mortality rate of this disease is higher.Etilogical treatment promptly and dialysis regimen are the main means to rescue these patients.
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Objective To understand the clinical features of acute renal failure(ARF)as the initial presentation of systemic lupus erythematosus(SLE).Methods Eight cases of ARF in SLE from Jan 1995 to Apt 2006 were investigated,descriptive analysis and literature review were performed.Results①The symp- tom of ARF in SLE was mainly oliguria,with severe accompany symptoms and complications.②The level of leucocyte and hemoglobin was low in laboratory tests,also the complement level decreased significantly.The most frequent renal pathology was typeⅣ,Ⅳ+ⅤLN.③Large dose steroid and CTX were the mainstay of treatment.In addition,SCUF,CVVHDF and hemodialysis could be used for lethal conditions.Conclusion ARF can be the first manifestation of SLE and it usually represents more severe disease and more complica- tions.Large dose steroid and CTX can improve prognois.In cases refractory to steroid and if the effect is obso- lete,CTX treatment SCUF,CVVHDF and hemodialysis can be use.
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Objective To research the pathogenesis,clinical types and therapeutic effects of acute renal failure.Method All eighty-eight patients with acute renal failure(ARF) treated by hemodialysis were analyzed retrospectively in our hospital for last more than 4 years,and the etiology,clinical types of ARF and the clinical outcome of treatment were summarized.Results ARF patients with pre-renal reasons were 78 41%,single renal cortex and/or medullary disease leading to ARF were 20 45%,post-renal reason was only 1.14%;ARF induced by drugs were 20 45%,the main drugs were aminoglycosides(13/18);mortality rate was 30 97%,but the complete recovery rate was only 37 5%.Conclusion Clinical doctors must be careful observe the patients complications decrasing signs of the blood volume and supplementing blood volume in timely to avoid renal ischemia,these treatment may prevent ARF and kidney lesion induced by drugs,but the prognosis of patients with hemodialysis in ARF is not good.
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AIM:To investigate the expression pattern of apolipoprotein M (apoM) protein in renal cortex of acute renal failure (ARF) rats with reperfusion. METHODS:Seventy-five male rats were randomly divided into sham operation group (n=25),ARF group (n=25) and pyrrolidine dithiocarbamat (PDTC) group (n=25),five subgroups at time points of 3 h,6 h,12 h,24 h and 48 h after reperfusion were set up in each group. The expressions of apoM in cytoplasm and NF-?B p65 in nucleus of renal cortex were detected at the indicated time points. RESULTS:The expression of apoM in ARF group was obviously higher than that in sham operation group (P
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It was reported that use of aprotinin in elderly patients undergoing hypothermic circulatory arrest was associated with an increased risk of renal dysfunction, and myocardial infarction as a result of intravascular coagulation. We reviewed 20 patients who received high-dose aprotinin under deep hypothermic circulatory arrest with(NP group, n=11) or without selective cerebral perfusion(SP group, n=9). The activated clotting time was exceeded 750 seconds in all but 1 patient. After opening aortic arch, retrograde low flow perfusion was maintained through femoral artery to prevent air embolization to the visceral arteries. Four patients among 20 died during hospitalization due to bleeding, coronary artery dissection, pulmonary hemorrhage and multiple cerebral infarction. Postoperatively, cerebrovascular accidents occurred in two patients; one with preoperative carotid artery dissection and the other with unknown multiple cerebral infarction. In conclusion, use of aprotinin in young patients undergoing hypothermic circulatory arrest did not increase the risk of renal dysfunction or intravascular coagulation if ACT during circulatory arrest is maintained to exceed 750 seconds with low-flow perfusion.
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Aged , Humans , Acute Kidney Injury , Aorta, Thoracic , Aprotinin , Arteries , Carotid Arteries , Cerebral Infarction , Circulatory Arrest, Deep Hypothermia Induced , Coronary Vessels , Femoral Artery , Hemorrhage , Hospitalization , Myocardial Infarction , Perfusion , StrokeABSTRACT
Objective To investigate the incidence and clinicopathological characteristics of acute-on-chronic renal failure (A/C) . Methods Clinical data from all patients diagnosed as A/C by clinical materials and renal biopsy for a 12-year period (Jan, 1990 to Dec, 2001) were collected, and the cause of acute renal failure (ARF), relationship between cause and underlying renal diseases and factors affecting prognosis were analyzed. Results One hundred and four A/C patients accounted for 35. 5% of biopsied ARF cases during the same period. Acute interstitial Aubulointerstitial disease, increased activity of lupus nephritis (LN) and idiopathic ARF in nephrotic syndrome (NS) were the most common causes of ARF in A/C. And 39 A/C cases (35.6% ) were drug-related. Offending drugs were mostly antibiotics, non-steroid anti- inflammatory drugs or combination of them. Idiopathic ARF was commonly seen in minimal change diseases with ARF. Flare-up of underlying diseases was mostly occurred in LN patients. The causes of 9 malignant hypertension cases were IgA nephropathy, sclerotic nephritis and so on. The mortality of this group was 1. 9% (2 cases): one patient died of multiple organ failure resulted from basal disease; the other suffered from sudden death of unknown reason. Thirty-nine cases needed renal replacement therapy, and after 28. 5 days' treatment on the average, 23 of them did not need dialysis any more. Serum creatinine (Scr) returned to normal level in 48 patients (46. 2% ) when discharged. Twenty-one cases had been diagnosed before consulting to our department. Among them, 15 cases (71. 4% ) were diagnosed as "chronic renal failure . Multivariate Logistic regressive analysis showed that hypertension, dialysis therapy and high Scr level indicated poor renal prognosis. Conclusions A/C is an common part of ARF. Being aware of adverse effects of drugs (especially for elders), decreasing the activity of connective tissue diseases, controlling the blood pressure and keeping proper circulating volume are very important for patients with chronic renal diseases. After reasonable therapy, most patients' renal function can be improved. Early correct diagnosis and treatment are important.
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Objective To evaluate the clinical characteristics and prognostic factors in patients with acute renal failure (ARF) due to sepsis. Methods A case-control retrospective study was carried out in patients with acute renal failure due to sepsis and non-sepsis. Univariate and multivariate logistic regression analysis was performed to find the correlation among prognosis, clinico-biochemical parameters and scoring indexes of APACHE II and ATN-ISI. Results The incidence of septic ARF was 15. 6% in all ARF patients. Multiple organ failure was most common (87.9% ) in these patients with a high mortality (69. 7% ). Single-variable analysis showed that surgery, respiratory failure, hepatic failure, mechanical ventilation, oliguria, coma, multiple organ failure, ARF occurred during ICU stay and chronic health points were factors influencing prognosis. Multivariate logistic regression analysis showed that oliguria, ARF occurred during ICU stay, chronic health points, and multiple organ failure were the independent predictors of hospital mortality. Conclusion Outcome of septic ARF is correlated with factors including oliguria, ARF occurred during ICU stay, chronic health points and multiple organ failure.
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This paper reports the clinical course in the treatment of 5 cases of acute renal failure due to obstetrical diseases by using heparin. The mechanism of acute renal failure easily occurring in pregnacny and the use of heparin are discussed.