1/17. Perinatal renal ischemia resulting in hypertensive cardiomyopathy.Three neonates presented with malignant hypertension during the first week of life; 2 of them had congestive heart failure. Although none had indwelling umbilical artery catheters, unilateral renovascular lesions were diagnosed by nuclear perfusion scans. Angiotensin-converting enzyme inhibitor therapy produced rapid recovery. Hypertension must be included in the differential diagnosis of infants presenting with congestive heart failure and acidosis. ultrasonography is not sensitive enough to exclude renovascular lesions. We emphasize the importance of early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/17. Segmental renal vein renin assay and segmental nephrectomy for correction of renal hypertension.Selective segmental renal vein catheterization was used to obtain venous blood samples for renin assay. With this technique a localized source of hypersecretion of renin was identified in 2 patients. Using samples from the main renal veins we found no significant difference in renin activity and, therefore, the etiology of the hypertension in these 2 patients would have been missed. Segmental nephrectomy resulted in a cure of the hypertension in both patients who were followed for a minimum of 14 months.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
3/17. Presentation of idiopathic retroperitoneal fibrosis in the pediatric population.Idiopathic fibrosis of the retroperitoneum is rare in childhood. The authors describe an 11-year-old boy who presented with progressive renal failure, bilateral hydronephrosis, hypertension, and elevated erythrocyte sedimentation rate (ESR) owing to retroperitoneal fibrosis. Ureterolysis was performed with improvement in his creatinine level and blood pressure. The soft tissue mass consisted of dense collagenous fibers consistent with retroperitoneal fibrosis. Postoperatively, he received steroids and azathioprine. retroperitoneal fibrosis in the pediatric population is rare with only 23 cases reported in the English-language literature. Treatment includes pulsed steroid regimens, ureteral catheterization, and retroperitoneal exploration with ureterolysis. If allowed to progress, renal failure can result and lead to death. The etiology of retroperitoneal fibrosis in the pediatric patient may include autoimmune diseases, infection, and neoplasm, but most cases are idiopathic. retroperitoneal fibrosis should be considered in patients with an elevated ESR, hypertension, renal failure, and hydronephrosis. Evaluation also should include a search for autoimmune diseases and malignancy.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/17. Radionuclide evaluation of renal function.The renal scintillation camera study and the excretory urogram should be considered to be complementary studies. The renal scintillation camera study provides an accurate evaluation of changes in total, differential, and segmental renal function but affords only a gross assessment of anatomic changes. The excretory urogram provides superior information about renal anatomic changes but only inferior information about functional changes of the kidney. The advantages of a renal scintillation camera study with regard to the patient are that it is done in a state of normal hydration, it requires no bowel preparation, it is not associated with allergic reactions, it provides a low radiation exposure, and it is a noninvasive procedure for differential renal function which requires no ureteral catheters.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/17. Successful renal revascularization after prolonged nonfunction.Surgical teaching has suggested that renal nonfunction of more than a few days' duration usually precludes success of revascularization procedures. The efficacy of delayed renal revascularization in selected cases has been reported. In this case, the intravenous pyelogram, renal scan, and ureteral catheterization verified nonfunction 30 days before surgical correction of essentially complete atheromatous occlusion of the renal artery. Postoperative studies conducted six weeks and 18 months postoperatively showed normal bilateral renal function. Current temporal limitations on attempts to preserve renal tissue may be too stringent. Revascularization of kidneys may be successful after prolonged periods of ischemia.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
6/17. Screening for transplant renal artery stenosis in hypertensive recipients using digital subtraction angiography.Digital subtraction angiography was used in 10 renal allograft recipients with sustained hypertension after transplantation to detect transplant renal artery stenosis. Recipients with end-to-end vascular anastomoses were visualized adequately in the anteroposterior projection. Two cases of transplant renal artery stenosis were identified by digital subtraction angiography and then verified by catheter angiography. patients with end-to-side vascular anastomoses may require additional oblique projections. Digital subtraction angiography is a safe, noninvasive and cost-effective screening procedure to diagnose transplant renal artery stenosis in most recipients. Catheter angiography can be applied more selectively to those recipients with stenosis observed by digital subtraction angiography or when more detailed imaging is required.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/17. Nonsurgical management of renovascular hypertension in the neonate.Over an 18-month period nine infants in a neonatal intensive care unit developed hypertension (blood pressure, 115/88 to 280/140 mm Hg) at 2 to 45 days of age. Eight of the nine infants had indwelling umbilical artery catheters prior to onset of hypertension; six of the nine infants had evidence of a patent ductus arteriosus. Peripheral plasma renin activity was greater than 300 ng/ml/3 hr in six of eight infants. Angiograms were abnormal in six of seven infants and computerized renal scans were abnormal in all nine infants. One infant had congenital renal artery stenosis. Eight of nine infants had evidence of unilateral or bilateral renal artery thrombi which were felt to have emanated from an umbilical artery catheter or a ductus arteriosus. Hypertension in all infants was successfully controlled medically (follow-up of 3 to 27 months; mean, 14.4 months). Blood pressures remained normal when medication was discontinued. In our experience, neonatal renovascular hypertension is no longer uncommon, responds to aggressive medical management, and rarely requires early nephrectomy. Neonatal renovascular hypertension was usually associated with umbilical artery catheters positioned above the level of the renal arteries.- - - - - - - - - - ranking = 3keywords = catheter (Clic here for more details about this article) |
8/17. renal artery stenosis with normal angiotensin ii values. Relationship between angiotensin ii and body sodium and potassium on correction of hypertension by captopril and subsequent surgery.The case is reported of a young woman with severe hypertension, unilateral renal artery stenosis, variously normal or marginally high plasma concentrations of active renin, angiotensin ii, aldosterone, sodium, and potassium; and normal total exchangeable and total body sodium and potassium. Arteriograms and ureter catheterization showed the stenosis to be severe, but the unstimulated renal vein renin and angiotensin ii differential to be modest. captopril caused an initial fall in angiotensin ii and arterial pressure. During prolonged captopril treatment, plasma angiotensin ii and aldosterone remained depressed; exchangeable and total body sodium and potassium were unaltered. blood pressure fell further to normal levels during prolonged captopril treatment, while subsequent surgical correction of the renal artery stenosis was curative; absolute values of blood pressure and plasma angiotensin ii were similar in both situations. The findings support, without proving, the concept that chronic modest elevation of angiotensin ii may be responsible for sustained hypertension in unilateral renal artery stenosis. patients of this type contrast sharply with those, also with severe renal artery stenosis or occlusion, who have gross elevation of renin, angiotensin ii, and aldosterone, with sodium and potassium deficiency. captopril or surgery are effective in both syndromes, but the manner of response to treatment differs markedly.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
9/17. Hypertensive crisis managed by bilateral renal artery reconstruction.In hypertensive emergencies the physician is obligated to reduce arterial pressure immediately. This is best done with intravenous antihypertensive agents. If renal artery occlusion is demonstrated and the patient is refractory to appropriate medications, renal artery reconstruction may be necessary. In the poor risk patient, an attempt at transcatheter thromboembolectomy may be worthwhile. If this maneuver is unsuccessful, emergent aorto-renal reconstruction is indicated. A case of bilateral renal artery thromboses causing a hypertensive crisis which was successfully managed by aorto-renal bypass grafting is reported.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/17. Neonatal renovascular hypertension - a complication of aortic monitoring catheters.Two critically ill neonates with severe renovascular hypertension as a complication of aortic monitoring catheter are presented. They did not respond to intensive medical therapy for hypertension. In spite of their precarious general condition, nephrectomy was undertaken with complete relief of symptoms.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
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