Case Of Acute Renal Failure Research Articles

Focal segmental glomerulosclerosis and nephrotic syndrome in a child with embryonal rhabdomyosarcoma

A case of nephrotic syndrome (NS) and acute renal failure (ARF) associated with embryonal rhabdomyosarcoma (RMS) in a 10-year-old boy is reported. Ultrasound revealed irregular, echogenic, circumferential urinary bladder base mass, bilateral hydroureter and hydronephrosis. Histopathology of percutaneous renal and urethrocystoscopic biopsy specimens, respectively, revealed focal segmental glomerulosclerosis (FSGS) and embryonal RMS. Tumour remission was induced with pulse doses of intravenous vincristine, cyclophosphamide, methotrexate and actinomycin D over a 15-month period. He has been followed-up for 28 months and has maintained a drug-free tumour and proteinuria remission for 1 year. While some malignancies have been reported in association with NS, its occurrence in association with RMS is quite exceptional. We conclude that RMS may be associated with FSGS and NS. Effective treatment of the RMS was associated with sustained remission of the nephrotic proteinuria.

ACUTE RENAL FAILURE:

Objective: To find out the various causes of acute renal failure (ARF) and its out come in our settingof tertiary Care Hospital in rural areas. Design: A retrospective Study. Setting: Nephro-urology department ChandkaMedical College teaching hospital Larkana. Period: From March 1998 to March 2005. Patients & Methods: Reviewof 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teachinghospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renalfailure were analyzed. Result: 294 patients were included in this study. Among them149 (51.7%) were in the youngerage group (less than 40 years) with dominance of males (1.61 to 1.00 male to female ratio). Major cause of ARF waspre renal, seen in 172 (66.6%) patients, 70 (23.8%) of all cases of acute renal failure had gynecological and obstetricalback ground. Other causes C.V.A in 24 (9.3%), HHD in 14(4.5%). Glomerulonephritis in 22(8.5%),and obstructiveuropathy in 16(6.2%). 92 Patients (31.3%) improved on conservative treatment,166(56.5%) needed dialysis and36(12.2%) left against medical advice. Conclusion: This data reveals that pre renal element is the single mostimportant cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD,glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good perinatal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patientsleft against medical advice due to heavy expenses on the treatment and needs NGOs and Government support fortreatment of poor patients.

Acute Renal Failure After Continuous Flow Irrigation in Patients Treated With Potassium-Titanyl-Phosphate Laser Vaporization of Prostate

Cases of acute renal failure after transurethral resection of the prostate have been reported since the late 1940s. The pathogenic mechanisms postulated were acute hemolysis, renal interstitial edema, ischemic tubular injury, and rhabdomyolysis, resulting from the absorption of irrigating fluid. Because of the excellent hemostasis of the new laser techniques, absorption of irrigation fluid is supposed to be minimal. Potassium-titanyl-phosphate laser vaporization is regarded as the most recent advance in the treatment of patients with benign prostate hyperplasia, with excellent hemostatic properties. We report 3 cases of acute renal failure after continuous flow irrigation in patients treated with potassium-titanyl-phosphate laser vaporization. Renal failure occurred on postoperative day 1, all patients became oligoanuric, 2 patients required hemodialysis therapy, and incomplete recovery of renal function was seen within 1 month. Biopsy findings were similar in all patients, consisting of widening of tubular lumens; partly containing Tamm-Horsfall protein casts, but neither hemoglobin nor myoglobin casts; flattened tubular epithelial cells with loss of brush borders; and variably edematous interstitium. During laser vaporization, irrigation pressure usually is higher than the physiological intravesical pressure and ranges from 60 to 100 mm Hg. High intravesical pressure may facilitate not only irrigating fluid absorption, but also transient urinary stasis or even vesicoureteral reflux. The latter may directly damage tubular epithelial cells and cause acute renal failure. Thus, intravesical pressure should be kept as low as possible, even during laser prostatectomy.

Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty

Antibiotic-impregnated cement is used frequently in revision procedures of infected total hip and knee arthroplasties. Local antibiotic treatment is as effective as the use of systemic antibiotics. The purpose of such treatment is to provide high tissue concentrations of antibiotics and minimize systemic toxicity, especially nephrotoxicity. Though antibiotic-impregnated cement is considered safe in terms of nephrotoxicity, two cases that have implicated aminoglycoside-impregnated cement in acute renal failure (ARF) after surgery for an infected total knee arthroplasty (TKA) have been reported [Curtis et al. 2005, Van Raaij et al. 2002]. Two more cases of postoperative ARF after use of combined tobramycin- plus vancomycin-impregnated cement, this time in total hip arthroplasty, have been recently reported [Patrick et al. 2006]. We report a case of ARF in a 61-year-old patient with a history of diabetes mellitus and hypertension after treatment of a febrile infection of a TKA with combined gentamicin- plus vancomycin-impregnated cement. The ARF could not sufficiently be attributed to other causes and though serum concentrations of antibiotics obtained from the 8th postoperative day and thereafter were far below the trough levels associated with nephrotoxicity, gentamicin and vancomycin seem to have contributed significantly to ARF in our case.

Acute Renal Failure Associated With Acute Epstein-Barr Virus Infection

Infectious mononucleosis is caused by the Epstein-Barr virus and most commonly causes a febrile illness with pharyngitis and lymphadenopathy. Complications involve the central nervous system, liver, heart, and blood. Hematuria and proteinuria have been reported in 10% to 15% of cases, but the development of acute renal failure during infectious mononucleosis is rare. In cases where renal biopsies have been performed, the most common pathology found is interstitial nephritis. There is some evidence linking Epstein-Barr virus to chronic interstitial nephritis. Steroid therapy and hemodialysis have been used, but some cases can resolve spontaneously. We wish to report a case of acute renal failure associated with an acute Epstein-Barr infection and discuss the possible pathogenesis.

Cardiovascular Risk Factors and Incident Acute Renal Failure in Older Adults

Although the elderly are at increased risk for acute renal failure, few prospective studies have identified risk factors for acute renal failure in the elderly. The associations of cardiovascular disease risk factors, subclinical cardiovascular disease, and clinical coronary heart disease with the risk for development of acute renal failure were examined in older adults in the Cardiovascular Health Study, a prospective cohort study of community-dwelling older adults. Incident hospitalized cases of acute renal failure were identified through hospital discharge International Classification of Diseases, Ninth Revision codes and confirmed through physician diagnoses of acute renal failure in discharge summaries. Acute renal failure developed in 225 (3.9%) of the 5731 patients during a median follow-up period of 10.2 yr. In multivariate analyses, diabetes, current smoking, hypertension, C-reactive protein, and fibrinogen were associated with acute renal failure. Prevalent coronary heart disease was associated with incident acute renal failure, and among patients without prevalent coronary heart disease, subclinical vascular disease measures were also associated with acute renal failure: Low ankle-arm index (< or =0.9), common carotid intima-media thickness, and internal carotid intima-media thickness. In this large, population-based, prospective cohort study, cardiovascular risk factors and both subclinical and clinical vascular disease were associated with incident acute renal failure in the elderly.

Partial Fanconi Syndrome Induced by Imatinib Therapy: A Novel Cause of Urinary Phosphate Loss

Imatinib mesylate (Gleevec, Glivec; Novartis, Basel, Switzerland) is a specific tyrosine kinase inhibitor that has become the gold-standard treatment for patients with chronic myeloid leukemia. Several tyrosine kinases inhibited by imatinib are expressed in the kidney, and although the drug is usually well tolerated, several cases of acute renal failure were reported. We describe for the first time a case of a patient treated by imatinib for chronic myeloid leukemia who developed partial Fanconi syndrome with mild renal failure, which leads to a discussion of the pathophysiological characteristics of imatinib-induced renal toxicity. Patients on long-term imatinib treatment should be monitored for renal failure, as well as proximal tubule dysfunction, including hypophosphatemia.

Case-control study of acute renal failure in patients with cystic fibrosis in the UK

Background:There has been a recent increase in the number of reported cases of acute renal failure (ARF) in cystic fibrosis (CF). A case-control study was conducted to determine the factors...

A case of acute renal failure associated with diffuse infiltrative lymphocytosis syndrome

A 58-year-old African American man with an uncontrolled HIV infection presented to hospital with nephrotic syndrome and diffuse lymphadenopathy. The patient had been taking highly active antiretroviral therapy (HAART; lamivudine, abacavir, fosamprenavir and ritonavir) for 10 years. A renal biopsy showed acute granulomatous interstitial nephritis. Despite a negative tuberculin skin test, he was treated with antituberculosis drugs for 12 months without improvement of his renal profile. Two months after antituberculosis treatment was discontinued, the patient was readmitted to hospital because of acute renal failure. Corticosteroid therapy (prednisone) was started and resulted in a marked improvement in renal function. However, 18 months after steroids were discontinued, renal function declined dramatically. Furthermore, the patient had CD8+ lymphocytosis as well as interstitial tissue infiltration by CD8+ T lymphocytes. Physical examination, plasma HIV viral load, lymphocyte counts, urinalysis, tuberculin skin test, liver function tests, renal ultrasonography, human leukocyte antigen (HLA) typing, renal and minor salivary gland biopsies, ophthalmological examination, chest radiography and culture of bronchoalveolar lavage fluid. Acute granulomatous interstitial nephritis secondary to diffuse infiltrative lymphocytosis syndrome. HAART and prednisone.

Methylglyoxal increase in uremia with special reference to snakebite-mediated acute renal failure

BackgroundAdvanced glycation and lipoxidation endproducts (AGEs and ALEs) due to oxidative and carbonyl stress are involved in pathogenesis of several diseases including uremia. Methylglyoxal, a dicarbonyl compound is a metabolic hazard and potent glycating agent in the body, which is an important precursor of AGE and ALE. Methylglyoxal has been reported to be increased in uremia, but there is no report of MG status in snake venom mediated acute renal failure cases (SARF). We investigated the carbonyl and oxidative stress as well as the methylglyoxal concentration in SARF where renal clearance is rapidly shut down. MethodsWe studied serum carbonyl compounds, methylglyoxal, total antioxidant status, GSH and cellular damage marker thiobarbituric acid reacting substances (TBARS) and intracellular erythrocytic GSH concentration following standard methods of 45 SARF and 56 normoglycemic chronic renal failure cases (CRF) and compared with 81 normal controls. ResultMethylglyoxal concentration has been found to be significantly increased in SARF associated with decreased concentration of serum as well as erythrocytic GSH and other antioxidant markers , in comparison with CRF and normal control. The cellular damage (TBARS concentration), is also found increased in SARF. ConclusionMG increase as well as accumulation due to GSH depletion may play a pivotal role in their rapid pathophysiological complicacies in SARF.

The McKittrick-Wheelock Syndrome: A Case of Acute Renal Failure Due to Neoplastic Cholera

The McKittrick Wheelock syndrome is characterized by severe electrolyte and fluid depletion as a result of rectal tumor hypersecretion. Typically, a metabolic acidosis ensues. We report the case of a 58-year-old man who presented with a mixed metabolic acidosis and alkalosis. He was hyponatremic, hypokalemic, and hypochloremic, with acute renal failure on blood testing. Following fluid resuscitation, a predominant alkalemia was observed. The patient was found to be passing 1.5 L of mucous per rectum per day, containing high concentrations of sodium and potassium, similar to that observed in cholera stool. A large rectal villous adenoma was discovered on sigmoidoscopy, and definitive management was achieved by removal of the tumor. This case provides a demonstration of the ranging metabolic disturbance associated with secretory diarrhea. Other endogenous and infective causes are discussed, and mechanisms compared with the case described.

Lesch-Nyhan syndrome presenting with acute renal failure in a 3-day-old newborn

Acute renal failure developed during the first 3 days after birth in a newborn subsequently diagnosed with hypoxanthine-guanine-phosphoribosyl-transferase (HPRT) deficiency. Fluid infusion and allopurinol therapy normalised renal function and serum uric acid levels. Only a few cases of acute renal failure due to acute hyperuricemic nephropathy related to HPRT deficiency have previously been reported in infants, and there are no reported cases in newborns as young as 3 days old.

Acute Renal Failure in Four HIV-Infected Patients: Potential Association with Tenofovir and Nonsteroidal Anti-Inflammatory Drugs

Acute Renal Failure in Four HIV-Infected Patients: Potential Association with Tenofovir and Nonsteroidal Anti-Inflammatory Drugs

Two Cases of Acute Renal Failure Complicating Paroxysmal Nocturnal Hemoglobinuria in Children

Two Cases of Acute Renal Failure Complicating Paroxysmal Nocturnal Hemoglobinuria in Children

Crataegus Orientalis Associated Multiorgan Hypersensitivity Reaction and Acute Renal Failure

Patients, especially those with chronic disease and disorders are increasingly relying on complementary and alternative medical therapies (CAMT). Because the use of CAMT is escalating worldwide, it is essential to be aware of the clinical and adverse effects, doses and potential drug-herb interactions. Crataegus orientalis or hawthorn is a small tree with red fruits. A number of studies appear to demonstrate that Crataegus spp. have a clinically detectable positive cardiac inotropic action. The ingredients, characteristics of metabolism and elimination, and adverse effects of hawthorn remain largely unknown. We report a case of multisystem hypersensitivity reaction and progressive acute renal failure associated with the consumption of Crataegus orientalis.

A case of fever and unexplained acute renal failure

A 45-year-old male was admitted with history of fever for 3 weeks and abdominal pain and dysuria for the last 20 days, generalized swelling of the body for 15 days, and increasing breathlessness and decreasing urine output for the last 4 days. No h/o hematuria, pyuria, graveluria; h/o nausea, vomiting, altered sensorium;and h/o orthopnea, paroxysmal nocturnal dyspnea or seizures. Past history: Hypertensive - 11 years, pulmonary tuberculosis since 1992, received ATT for 3 years. Smoker (two pack beedies/day × 25 years) and h/o cough with mucoid expectoration since 1995. On examination: Patient conscious, PR - 92/min, regular; BP - 140/90 mmHg; RR - 30/min. There was pallor and pedal edema. No icterus, cyanosis, clubbing or lymphadenopathy. JVP was normal. Abdomen - No organomegaly, flank and renal angle tenderness + Nervous system - Flaps +, No meningeal signs or focal neurologic deficit; Respiratory system - Barrel chest, expiratory polyphonic wheeze; CVS - Normal. Investigations Urinalysis Ascitic fluid Complete blood count Microbiology

Rx Report

Rx Report

Linezolid-induced interstitial nephritis in a kidney-transplant patient

Linezolid is a recent oral antibiotic used in drug-resistant Gram-positive cocci infections. Herein, we report on the first case of linezolid-related acute renal failure in a kidney-transplant patient. A 60-year-old male having autosomic polycystic kidney disease with liver involvement, on cyclosporin A, mycophenolate mofetil and very low dose prednisolone, presented with an Enterococcus faecium abscess of a huge liver cyst, which was treated by percutaneous drainage and linezolid therapy. Eight days after starting linezolid, he presented with acute renal failure, i.e. serum creatinine increased from 136- 221 micromol/l, associated with mild hypereosinophilia, anemia and thrombocytopenia. There was no skin rash, arthralgia, eosinophiluria or proteinuria. The transplant kidney biopsy, performed 15 days after the beginning of linezolid therapy, showed interstitial nephritis and focal tubular atrophy. After linezolid withdrawal and increasing prednisolone daily dose to 20 mg/d, within a few days, serum creatinine had decreased; after 2 and 4 weeks post linezolid withdrawal, his serum creatinine was 166 and 159 micromol/l, respectively. Because of the potential side effects of linezolid, i.e. myelosuppression and possibly nephrotoxicity, we recommend close monitoring of these parameters when linezolid therapy is attempted in kidney transplant patients.

Trends in acute renal failure associated with coronary artery bypass graft surgery in the United States

Acute renal failure remains a major complication of coronary artery bypass graft surgery that is strongly associated with in-hospital mortality. Based on similar observations in other clinical settings, we tested the hypothesis that the diagnosis of acute renal failure associated with coronary artery bypass graft surgery is increasing in the United States. Observational cohort study. The Nationwide Inpatient Sample database was used to test the hypothesis. This database contains discharge information from 20% of U.S. hospitals. Hospital discharges coded for coronary artery bypass graft surgery from 1988 to 2003 comprised the study population; those also coded for acute renal failure formed the subset of interest. None. Multivariable regression models were constructed, including adjustment for risk factors and comorbidities, to identify the relationship between year of surgery and diagnosis of acute renal failure and mortality. The incidence of acute renal failure diagnosis increased significantly during the study period from 1.1% to 4.1% (p < .0001). The proportion of acute renal failure cases that required dialysis decreased from 15.8% to 8.7% (p < .0001). Despite an increase in comorbid disease burden, mortality in the acute renal failure subgroup declined from 39.5% to 17.9% (p < .0001). The percentage of acute renal failure survivors with postdischarge special-care requirements increased from 35.5% to 64.5% (p < .0001). Our findings suggest that the observed increase in acute renal failure diagnosis rates may be partly attributable to less restrictive criteria for acute renal failure diagnosis, consistent with acute renal failure patterns observed in other clinical settings. Although the need for dialysis is a relatively clear benchmark for diagnosing acute renal failure, use of alternate criteria to define this disorder has become more common, perhaps contributing to higher diagnosis rates. We conclude that the nationwide trend of acute renal failure associated with coronary artery bypass graft surgery has significantly increased from 1988 to 2003. Despite declining mortality, acute renal failure remains a burden on healthcare resources.

Aprotinin May Decrease Blood Loss in Complex Adult Spinal Deformity Surgery, But It May Also Increase the Risk of Acute Renal Failure

Matched cohort comparison. This study examines the potential for aprotinin to conserve blood in adults undergoing long thoracolumbar deformity procedures and characterizes patients at risk for acute renal failure. Aprotinin has been shown to reduce intraoperative blood loss and reduce transfusion requirement in pediatric spine and cardiac surgery populations. Previous literature (before 2006) has not reported acute renal failure as a potential complication. This study was designed to examine the efficacy of aprotinin in reducing operative blood loss following long spinal arthrodesis in adult spinal deformity patients and to analyze complications. Adult spinal deformity patients undergoing long spinal arthrodesis at 1 institution between 2001 and 2005 were analyzed. Patients were matched according to age and type of procedure performed. Forty patients received high-dose aprotinin (Group A) intraoperatively, and 41 patients matched as controls (Group NA) received no aprotinin. Outcome variables included intraoperative blood loss, intraoperative transfusion requirement, early postoperative blood loss and transfusion requirement, and postoperative complications. Average blood loss for Group A was 906 mL and 1.3 L for Group NA. The difference was statistically significant with a P < 0.05. Complications seen in Group A included 4 cases of acute renal failure requiring dialysis and 1 deep venous thrombosis. In Group NA, there was only 1 case of acute renal failure (presumed to be secondary to inadvertent gentamycin overdose) and 1 case of pulmonary embolus. The 4 Group A patients with acute renal failure were female, 61 to 73 years of age, with various comorbidities. All required inpatient hemodialysis. Three averaged 2 months of continued outpatient dialysis before resolution of renal compromise while 1 patient is on chronic dialysis. In long spinal arthrodesis for complex adult spinal deformity surgery, aprotinin does reduce intraoperative blood loss, but may increase the risk of acute renal failure, especially in women over the age of 60.