1/17. Repeated transient anuria following losartan administration in a patient with a solitary kidney.We report the case of a 70-year-old hypertensive man with a solitary kidney and chronic renal insufficiency who developed two episodes of transient anuria after losartan administration. He was hospitalized for a myocardial infarction with pulmonary edema, treated with high-dose diuretics. Due to severe systolic dysfunction losartan was prescribed. Surprisingly, the first dose of 50 mg of losartan resulted in a sudden anuria, which lasted eight hours despite high-dose furosemide and amine infusion. One week later, by mistake, losartan was prescribed again and after the second dose of 50 mg, the patient developed a second episode of transient anuria lasting 10 hours. During these two episodes, his blood pressure diminished but no severe hypotension was noted. Ultimately, an arteriography showed a 70-80% renal artery stenosis. In this patient, renal artery stenosis combined with heart failure and diuretic therapy certainly resulted in a strong activation of the renin-angiotensin system (RAS). Under such conditions, angiotensin ii receptor blockade by losartan probably induced a critical fall in glomerular filtration pressure. This case report highlights the fact that the angiotensin ii receptor antagonist losartan can cause serious unexpected complications in patients with renovascular disease and should be used with extreme caution in this setting.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/17. Subdural spinal granuloma resulting from candida albicans without immunosufficiency: case report.STUDY DESIGN: This was a case of spinal subdural granuloma of candida albicans. A high cerebrospinal fluid protein level without pleocytosis (albuminocytologic dissociation) was observed. This case proved difficult to diagnose and treat. OBJECTIVES: To clarify the important issues in regard to the diagnosis and treatment of possible spinal subdural granuloma resulting from C. albicans. SUMMARY OF BACKGROUND DATA: Reports on subdural infection of C. albicans are very rare. Moreover, there are no reports of cases in which patients have survived this type of infection. methods: A 66-year-old man developed paralysis in the lower limbs, as well as vesicorectal disorder (anuresis). There were no obvious causes. Signs of meningeal irritation later appeared. A high cerebrospinal fluid protein level without pleocytosis was observed through a laboratory test. The cause of these disorders was unclear, and a final diagnosis could not be made on the basis of the test results and angiograph. Possible diagnoses included tumor, infection, and others such as guillain-barre syndrome. The authors therefore carried out surgery to reduce the pressure on the spinal cord and ultimately make a definitive diagnosis. RESULTS: The final diagnosis was spinal subdural granuloma of C. albicans. granuloma was widespread (T3-T10). Surgery, various drug treatments, and hyperbaric oxygen therapy all contributed to saving the patient's life. CONCLUSION: This was a very rare case of spinal subdural granuloma resulting from C. albicans, and the authors had difficulty diagnosing and treating the patient. A distinctive gadolinium-enhanced MRI was obtained. The effect of treatment by drugs alone was limited. An intraoperative ultrasonography proved useful. The authors concluded that a combination of early surgery and hyperbaric oxygen therapy was effective.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/17. Two episodes of anuria and acute pulmonary edema in a losartan-treated patient with solitary kidney.Atherosclerotic renal artery stenosis (RAS) is an increasingly important cause of end-stage kidney disease, and may cause hypertension, progressive renal failure, and recurrent pulmonary edema. Herein, we report two episodes of anuria and acute pulmonary edema associated with losartan treatment in a hypertensive patient with preexisting severe renal artery stenosis in a solitary kidney. After successful percutaneous renal balloon angioplasty procedure, urine flow was started immediately, despite 10 days of anuria. blood pressure measurements were still at acceptable levels with a low dose Beta blocker, and serum creatinine levels were normal even after eight months. PTRA should be done in such patients, even with prolonged anuria. physicians who recommend angiotensin receptor blockers in patients with RAS, especially in patients wih hypovolemia or a solitary kidney, should be careful about this complication.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/17. A transplanted kidney surviving total vessel occlusion and anuria.We report a case of a 46-year-old white male with renal graft artery stenosis who developed acute renal shutdown with total anuria while on the ACE inhibitor lisinopril, one week following the discontinuation of aspirin. The serum creatinine was 8.5 mg/dl. Doppler ultrasound and MAG3 scintigraphy of the grafted kidney were highly suggestive of a viable but nonfunctioning kidney. A femoro-femoral bypass for total thrombosis of the right common iliac artery was performed distal to the occlusion. Immediate diuresis was obtained after establishing the bypass. serum creatinine dropped to 1.35 mg/dl three days later. In this case we believe that the collateral circulation played a significant role in immediate recovery of kidney function by maintaining renal perfusion pressure and preventing acute tubular necrosis (ATN). We also believe that the ACE inhibitor might have contributed to salvaging the kidney by improving medullary oxygen balance and maintaining adequate medullary blood flow.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/17. PTFE mesh in renal allograft compartment syndrome.We report a case of anuria in a 42-year-old female kidney transplant patient that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft with restoration of kidney function. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartment pressure within the iliac fossa sufficiently to allow the renal vein patency and the kidney perfusion. We think that this tension-free surgical technique should be applied in those cases in which the retroperitoneal space is less than the size of the kidney to avoid renal allograft compartment syndrome or incisional hernia.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/17. Increased intraabdominal pressure and anuria in the newborn.Elevated intraabdominal pressure as a cause of anuria in the critically ill newborn with ascites should be considered after hypovolemia and other causes of intrinsic renal disease or obstruction have been excluded. In the rare patient with ascites who develops anuria, paracentesis should be considered if urine output cannot be established.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
7/17. Renal revascularization in anuric patients: determinants of outcome.We describe three patients who recently had surgical revascularization for prolonged anuria due to renal artery occlusion. A review of the literature revealed 31 similar patients with sufficient data to allow comparison. There was no correlation between the interval of anuria and the surgical outcome regarding survival, renal function, and blood pressure. On renal angiography, 16 patients had nephrogram as evidence of collateral circulation. Seven patients had no renal perfusion. There was no significant difference in renal function, blood pressure, or survival after renal reperfusion in patients with or without nephrogram. In patients who received vascular grafts, the postoperative serum creatinine level and blood pressure were significantly lower than those of patients who had thromboendarterectomy (P less than .05). In contradistinction to commonly held concepts, these findings are independent of collateral circulation.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
8/17. Successful revascularization of an occluded renal artery after prolonged anuria.Renal atherosclerosis and fibromuscular dysplasia are the most common causes of curable human renovascular hypertension and renal failure. Vascular reconstruction often preserves renal function, but renal failure is rarely reversed, especially after days of anuria. We report a case of a 23-year-old woman who as a child underwent a nephrectomy for congenital hydroureter and renal hypoplasia. She later experienced fibromuscular dysplasia of the remaining renal artery, which ultimately progressed to a complete occlusion and 31 days of total anuria. The patient was revascularized, and within 2 months renal function returned with a blood urea nitrogen and creatinine of 9.0 and 1.0 mg/dl, respectively. After a follow-up of 6 months the patient's blood pressure remained 120/80 to 130/80 mm Hg without administration of hypertension medication. In this report we emphasize that under selected circumstances a kidney can survive prolonged ischemia and that delayed revascularization may reestablish renal function.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/17. Reversal of postoperative anuria by decompressive celiotomy.Postoperative oliguria or anuria can rarely be attributed to an increase in intra-abdominal pressure. In this documented case, postoperative anuria responded to reduction in abdominal pressure by celiotomy. Actual abdominal pressure measurements are not available but probably would not be useful. However, hemodynamic measurements that were not consistent with diminished renal blood flow in a middle-aged patient were nevertheless associated with anuria, which responded to release of the abdominal pressure. Because of the association of regional pressure and acute renal decompensation, release of abdominal tension should be considered as a therapeutic option when hemodynamic measurements cannot explain a rapid decline in urine production.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
10/17. oliguria from high intra-abdominal pressure secondary to ovarian mass.oliguria in association with elevated intra-abdominal pressure developed in a patient with an ovarian mass. Operative decompression of the abdomen reversed the oliguric state. Clinically, laparotomy may be indicated in the presence of decreasing urinary output and elevated intra-abdominal pressure.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
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