Postrenal Failure Research Articles

Promising Response of Paclitaxel in Metastatic Transitional Cell Carcinoma of Distal Ureter Complicated with Hydroureteronephrosis: A Case Report.

carcinoma; case reports; metastasis; paclitaxel.

PS-R07-4: EFFICACY OF DOPPLER ULTRASOUND FOR INVESTIGATING THE CAUSE OF WORSENING RENAL FUNCTION AND HYPERTENSION IN A CASE OF RENOVASCULAR HYPERTENSION

A 72-year-old man visited our hospital after his blood pressure increased from 130/80 to 170/95 mmHg and systemic edema appeared over the past two months. His renal function also deteriorated, with serum creatinine increasing from 2.0 to 4.7 mg/dL. He had developed hypertension aged 40 years and cerebral infarction aged 66 years, and had smoked from 16 to 55 years old. Upon admission, plasma renin activity was 14.8 ng/mL/h, serum aldosterone was 169.4 pg/mL, and he was under treatment with telmisartan 40 mg/day, bisoprolol 5 mg/day, cilnidipine 20 mg/day, and nifedipine 20 mg/day. Computed tomography showed a calcified lesion at the root of the right renal artery and atrophy of the left kidney. There was no postrenal renal failure. On Doppler ultrasound, the right intrarenal artery had no systolic peak wave and the blood flow waveform rose slowly, suggesting renal artery stenosis. Therefore, we suspected that the cause of worsening renal function and hypertension was the deterioration of his one remaining functional (right) kidney, treatment with angiotensin II receptor blocker, and progression of right renal artery stenosis. As this case met the indication criteria for percutaneous transluminal renal angioplasty (PTRA) (resistant to treatment, exacerbated hypertension, and renal artery stenosis in one kidney), we performed angiography and PTRA despite end-stage renal failure. Angiography revealed > 90% stenosis at the root of the right renal artery, and the patient was diagnosed with renovascular hypertension. Following renal artery stenting, the renal stenosis disappeared, blood pressure decreased to 135/75 mmHg, renal function improved to serum creatinine level 2.2 mg/dL, and the edema disappeared. On renal Doppler ultrasound, the waveform of intrarenal blood flow in the right kidney showed a normal pattern. In this case of renovascular hypertension, renal Doppler ultrasound was useful for investigating the cause of worsening renal function and hypertension that occurred over a period of several months.

MO362: Braunschweig Body Composition, Butterfly Sonography and Drug Dosing in AKI Study (B3 D2 AKI––Study)

Abstract BACKGROUND AND AIMS In-hospital AKI is associated with increased morbidity and mortality. AKI Alert systems are frequently used to allow time detection of AKI patients based on changes in creatinine. We aimed to examine the hydration status, medication errors and prior existing CKD in a series of AKI 3 patients in a tertiary care hospital. METHOD Prospective single centre cohort study. Study was approved by the local IRB. Hydration status was assessed by Bioimpedance using the body composition monitor (Fresenius Medical Care). Renal size and exclusion of postrenal failure were accomplished using a point of care ultrasound system (Butterfly Network Inc.). Pharmacotherapy was entered into the Federal Medication Plan of Germany (Bundesmedikationsplan). RESULTS A total of 101 patients with AKI 3 were identified based on changes in creatinine only. The median (IQR) age was 74.0 (64.7–82.0) years with a BMI of 27.8 (23.5–34.2) kg/m2. The baseline creatinine of the patients was 1.53 (0.92–2.85) mg/dL. At the time of AKI 3 diagnosis the median [IQR] 4.1 (1.9–5.9) L. Systolic blood pressure was 116 (100–140) mmHg (Fig. 1). Median (IQR) kidney length was 10.4 (9.2–11.7) cm. Polypharmacy (> 5 drugs) was seen in 89.7% of all patients. Almost half of the patients (48.3%) received 10 or more drugs. A total of 38% of patients receiving an antibiotic received an inadequately high dose, followed by 7.8% receiving an inadequate dosing of oral antidiabetic drugs. CONCLUSION Patients detected by an AKI alert in a tertiary care hospital did mostly neither exhibit low blood pressure nor volume depletion. Postrenal AKI was undetected in 1 out of 101 patients. Medication dosing errors were frequently seen, especially in the dosing of antibiotics. A joined nephron-pharmacological approach seems to be important in patients with hospital acquired AKI 3.

The effects of surgical treatment on post-renal failure caused by the adenovirus hemorrhagic cystitis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation

The effects of surgical treatment on post-renal failure caused by the adenovirus hemorrhagic cystitis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation

A Rare Case of Acute Postrenal Failure after Prostate Surgery

In patients with acute ureteral obstruction, rapid increase in ureteral pressure results in dilatation of the ureter and intrarenal collecting system that usually may cause renal colic. Computed tomography and ultrasound are the gold standard to evaluate uretero-hydronephrosis. We report a case of a patient who underwent a robot-assisted radical prostatectomy for cancer and developed anuria in the immediate postoperative course without pain or hydronephrosis. Clinical and conventional imaging can be normal in case of acute post-renal failure.

Postrenal failure due to entrapment of the ureter in inguinal hernia: a case-report

Postrenal failure due to entrapment of the ureter in inguinal hernia: a case-report

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC.Methods: Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated.Results: A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%).Conclusions: In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Diagnosis and treatment of ceftriaxone sodium in the treatment of postrenal acute renal insufficiency(report of 17 cases)

Objective To investigate the clinical characteristics and ceftriaxone sodium in the treatment of postrenal acute renal insufficiency. Methods The clinical data of 17 patients with postrenal acute renal insufficiency who were treated with ceftriaxone sodium were retrospectively analyzed. 10 males and 7 females. The average age was 37.1 years. Scr was 423.6~1490.3 μmol / L, average 794.6 μmol / L, BUN was 9.8~38.1 mmol / L, average 18.5 mmol / L. All patients were treated by cystoscopy or ureteroscopy ureteral catheter or Double-J tube. Results Serum urea nitrogen, creatinine of patients returned to normal 2~9 d after operation and urine volume returned to normal. No obvious complications occured. Conclusions Use of ceftriaxone sodium may occur postrenal acute renal insufficiency, cystoscopy or ureteroscopy in the treatment of postrenal renal failure is effective and safety. Key words: Renal Insufficiency, Acute; Ceftriaxone

A case of post-renal failure accompanying pregnancy after augmentation cystoplasty in childhood

A case of post-renal failure accompanying pregnancy after augmentation cystoplasty in childhood

Holding Water: Congenital Anomalies of the Kidney and Urinary Tract, CKD, and the Ongoing Role of Excellence in Plumbing.

Congenital anomalies of the kidneys and urinary tracts can result in diminished natal kidney function, possibly through common embryologic pathway disruption or as a result of development taking place in the face of disordered 'post-renal' drainage. Impaired conduit and reservoir function present potential for an ongoing assault leading to further deterioration and progression of chronic kidney disease, a risk that extends to adults with these conditions, even after "correction". The drainage and storage aspects of the urinary system that can impact kidney function are reviewed with attention to correctable or manageable problems including: Bladder dysfunction wherein the low pressure storage of urine is compromised requiring the kidney to work against a pressure gradient, the classic post renal failure problem. The kidney in the aftermath of obstruction which may have lost concentrating capacity leading to a tendency to dehydration ('pre-renal' failure) and through polyuria which exacerbatesbladder pressure problems. Further there is an added challenge in evaluation for ongoing or reemergent obstruction in a significantly dilated system where the capacious system leads to slow turnover of urine often requiring a ureteral stent or nephrostomy to clearly establish clinical significance of delayed drainage. Stasis where slow urine flow leads to buildup of debris (stone) or potentiates infection. Vessicoureteral reflux which allows for introduction of lower urinary tract bacteria to the kidney and can lead to pyelonephritis. Conditions which combine problems such as posterior urethral valves where the bladder outlet obstruction compromises kidney function potentially impairing concentrating ability, creates bladder compromise often reducing emptying efficiency or elevating bladder storage pressures, as well as dilating the system potentially promoting stasis. Cognizance of the potential for plumbing problems to further kidney deterioration as patients with congenital urinary tract anomalies, even after they have been repaired is incumbent on those caring for these patients as they age. Thoughtful evaluation of those patients in whom kidney compromise maybe aggravated by drainage and storage disorder will optimize native renal function.

Clinical outcome and characteristics of patients with cervical cancer submitted to renal replacement therapy.

e21627 Background: Cervical cancer is the 2nd most prevalent and 4th cause of cancer-related death in Brazil among women. It may cause renal failure due to tumoral growth, the treatments, among other causes. Purpose: To evaluate the clinical outcome and the risk of death in patients with cervical cancer hospitalized submitted to hemodialysis, to describe the clinical characteristics of these patients. Methods: Retrospective observational study. Patients diagnosed with cervical cancer, hospitalized, submitted to renal replacement therapy were identified in a single institution (n = 92). Risk of death was estimated using Kaplan-Meier analysis. The Cox proportional hazards regression model was used to determine the risk of death on the basis of: cancer staging, disease activity, Performance status at admission, oncological surgery before hemodialysis subgroup. Results: 92 patients with cervical cancer hospitalized were submitted to intermittent hemodialysis between January 2007 and December 2008. Data was available for all the 92 patients. Median age at diagnosis 47.8 years (25.4-95.1), 73.9% was diagnosed stage III/IV, 95% had disease progression/ active disease before hemodialysis. 84 patients (91%) were dead at the moment of analysis (Cut-off date 30/03/2010), median interval between first hemodialysis and death 1.1 months (0-24.8). The main cause of death was postrenal kidney failure (82.6%). In multivariate analysis, stage II/III/IV (compared with stage I) and disease progression/active disease were the only independent prognostic factors associated with increased risk of death (HR = 3.149; 95% CI, 1.765 to 5.610; P = .001 and HR = 4.205; 95% CI, 1.002 to 17.65; P = .05). Conclusions: Women with advanced disease and active disease/ disease progression have a significant increased risk of death compared with those with stage I, stable disease/ disease in remission. Prospective studies are warranted to investigate the benefit hemodialysis in patients with cervical cancer.

Determining the optimum way to maintain quality of life for very elderly patients with advanced bladder cancer and poor performance status: A case report.

Locally advanced bladder cancer causes unpleasant symptoms such as irritative voiding symptoms, lower abdominal pain, gross hematuria and urinary retention, and lowers the quality of life. Treatment decisions in elderly patients may be difficult, as elderly patients are physically and psychologically different from younger patients. An 89-year-old male was referred to hospital for the treatment of an invasive bladder tumor with right hydronephrosis from tumor obstruction. The patient was elderly and did not have a good performance status; therefore curative radical cystectomy or chemotherapy was not indicated. Left retroperitoneoscopic ureterocutaneostomy was performed to alleviate gross hematuria and voiding difficulty. Intensity-modulated radiotherapy was administered 9 days after the surgery to control bleeding in the bladder tumor. After completing 8 days of radiotherapy, the patient was discharged from hospital. The patient exhibited no signs of either postrenal failure or gross hematuria for 7 months prior to mortality. Retroperitoneoscopic ureterocutaneostomy for very elderly patients with advanced bladder cancer with a poor performance status may be an important procedure for alleviating symptoms and improving quality of life.

Recovered Renal Function of Acute Post-Renal Failure with Crest-Variant Scleroderma Renal Crisis by Temporary Hemodialysis

Recovered Renal Function of Acute Post-Renal Failure with Crest-Variant Scleroderma Renal Crisis by Temporary Hemodialysis

Application of transparent film dressing in fistula nursing of patients with PCN

Objective To evaluate the clinical application effect of transparent film dressing in fistula nursing of patients with percutanueous nephrostomy (PCN). Methods By using before-after self control study method, 40 patients with pelvic tumor that caused by postrenal renal failure, and needed long-term fistula remained after PCN surgery were selected as the research object. Conventional sterile gauze and tape were used to nurse the fistula before intervention and transparent film dressing was used after intervention. Results Patents always worried about trachea cannula exodus and infection before intervention. After intervention, the comfort degree of their daily life (like showering, sleeping and daily activities) was obviously higher than that before intervention (P<0.01). The incidence of renal fistula local adverse effect after intervention is relatively low. And the difference was statistically significant (P<0.01). Before intervention, the tape was loosing in (5.47±1.48) days, there were three cases of accidental trachea cannula exodus; and after intervention, transparent film dressing hemmed in (14.22±1.99) days, and no accidental trachea cannula exodus occurred (P<0.01); and no hyper-sensitive cases happened with the transparent film dressing. Conclusions The transparent film dressing has the advantages of stable viscosity, waterproofing, fungi-proofing, breathability and hypoallergenic, etc. It can well protect and fix the fistula, and it is suitable for nursing care of patients with long-term renal fistula. Key words: Nephrostomy, percutaneous; Renal fistula; Transparent film dressing; Comfort degree

A vanishing right ventricular mass

Vanishing intracardiac masses can emerge as a diagnostic and therapeutic dilemma. The most common causes of intracardiac masses are thrombi, vegetations and primary or metastatic tumors. A 73-year-old male patient was admitted to internal medicine clinic with the diagnosis of acute postrenal failure superimposed on chronic renal failure. He also had fever and urinary tract infection. Eosinophil count was 1975/mm³ (22.7%). Transthoracic echocardiography (TTE) revealed a 12x10 mm mobile mass attached to right ventricular (RV) lateral wall. The patient was on bicarbonate, sulbactam+cefoperazone 2x1 g, enoxaparine 1x4000 IU and silodosin 1x8 mg, when the patient discharged. One month after discharge, the patient came back for control examination. Surprisingly, control TTE revealed complete disappearance of the RV mass. Eosinophil count was 500/mm³ (4.9%). Intracardiac masses may emerge as a feature of hypereosinophilic state and may resolve in due course by recovery of hypereosinophilia and adjunct anticoagulation.

Postrenal Failure due to Urinary Stones Associated with Acute Viral Gastroenteritis: Three Case Reports.

Acute gastroenteritis with viral infection in infants causes severe diarrhea and often results in acute renal failure due to severe dehydration. However, a viral infection, particularly rotavirus, rarely induces postrenal failure due to bilateral stones in infants. Herein, we report three cases of postrenal failure in infants due to bilateral ureteral stones induced by acute gastroenteritis with rotavirus. Following immediately nephrostomy, chemical dissolution therapy succeeded to treat postrenal failure. Immediate nephrostomy for the release of upper urinary tract obstruction combined with urinary alkalization as a chemical dissolution therapy should be considered in such cases.

Factors Those Up Regulate &lt;i&gt;Klotho&lt;/i&gt; and Glutathione Peroxidase-1 Gene Expression Improve Renal Function in Rats with Acute Renal Failure

Acute Renal Failure (ARF) has traditionally been defined as the abrupt and progressive loss of kidney functions resulting in the retention of urea and other nitrogenous waste products associated with interstitial inflammation, tubular injury and increasing Tumor Necrosis Factor (TNF). Mortality in patients with ARF remains high >50% in severely ill patients. Klotho gene is a new anti-aging gene. Genetic mutation of klotho gene causes multiple premature aging-like phenotypes and shortens lifespan. Klotho gene is highly expressed in the kidney and a soluble form of klotho functions as an endocrine substance that exerts multiple actions including the modulation of renal solute transport and the protection of the kidney. This study aimed to clarify the pre treatment and/or post treatment effect of vitamin E as an antioxidant on kidney functions, klotho gene expression and glutathione peroxidase-1 gene expression among rats with acute renal failure. Using glycerol as oxidative stress factor to cause acute renal failure and Real time PCR for assessment of gene expression of target gene in the control and treated groups. Our results demonstrated that the vitamin E (I± tocopherol) as antioxidant factor decreased the kidney injuries as pre renal failure administer and improve kidney function as post renal failure administer. Those effects were through up regulating the Klotho as anti aging gene and the Glutathione Peroxidase (GPx-1) as antioxidant gene expression in the kidney tissue. We concluded that factors those up regulate the klotho gene expression can use as protective factors against kidney injuries and to improve kidney function in renal failure.

A case of acute kidney injury due to secondary retroperitoneal fibrosis caused by direct invasion of esophageal squamous cell carcinoma.

A 71-year-old man who developed renal failure was admitted to our hospital. Computed tomography without contrast enhancement showed bilateral hydronephrosis together with a soft tissue mass around the abdominal aorta, leading to the diagnosis of retroperitoneal fibrosis. Serum levels of immunoglobulin G4 were within the normal range. The patient was then evaluated for the presence of undiagnosed malignancy as a possible cause of secondary retroperitoneal fibrosis. Upper gastrointestinal tract endoscopy demonstrated esophageal cancer. Histology of the esophageal lesion and the retroperitoneal mass showed squamous cell carcinoma (SCC). Therefore, the retroperitoneal fibrosis was considered to be due to the invasion of SCC of the esophagus, and chemotherapy was chosen as the treatment. This is the first case report of postrenal failure due to secondary retroperitoneal fibrosis caused by the direct invasion of esophageal SCC. Physicians should be aware of occult malignancy as the cause of unexplained retroperitoneal fibrosis, even clinically silent, to avoid inappropriate management or delay in the treatment of potentially life-threatening co-morbidities.

INJÚRIA RENAL AGUDA: ESTUDO DE 179 CASOS INTERNADOS NO HOSPITAL DE CLÍNICAS DA UNIVERSIDADE FEDERAL DO PARANÁ (UFPR)

Introdução: a injúria renal aguda (IRA) é caracterizada por um declínio súbito da filtração glomerular e é uma complicação frequente em pacientes internados em hospitais terciários. Objetivo: este estudo teve como objetivo avaliar a epidemiologia, as principais etiologias e a evolução dos pacientes com IRA atendidos no Hospital de Clínicas da UFPR (HC/UFPR). Métodos: Realizou-se um estudo retrospectivo por meio de análise de prontuários dos casos de IRA definidos conforme a classificação AKIN, atendidos no HC/UFPR entre janeiro e dezembro de 2010. Resultados: foram avaliados 179 pacientes com média de idade de 57.3 anos. Entre estes, 98 (55%) tiveram diagnóstico presumido de IRA intrínseca, 72 (40%) lesão pré-renal e 9 (5%) causa pós-renal. De acordo com a classificação AKIN, 36 doentes atingiram o estágio 1 (20.1%), 38 o estágio 2 (21.3%) e 105 o estágio 3 (58.6%) no momento do diagnóstico sendo que 45% dos pacientes foram submetidos à terapia de substituição renal (TSR). A duração média da TSR foi de 10,9 dias e mortalidade atingiu 38,5% e cerca de 15 % deles permaneceram em TSR após a alta. A mortalidade foi significativamente maior entre os pacientes dialíticos comparada aos não dialíticos (26% vs 12%, p&lt;0.0001). Conclusões: a IRA intrínseca foi a principal causa de IRA entre esses pacientes. Observou-se uma maior mortalidade em indivíduos que necessitaram de TSR, principalmente os classificados como AKIN 2 e 3. Dessa forma, o diagnóstico e o tratamento precoce, da IRA, parece ser uma estratégia importante no manejo de pacientes com IRA em um hospital terciário.

Same-Session Bilateral Retrograde Intrarenal Surgery for Upper Urinary System Stones: Safety and Efficacy

We present our experience with same-session retrograde intrarenal surgery (RIRS) for the management of bilateral upper urinary system stones (UUSS) in terms of clearance of stones, operative times, duration of hospital stay, and complications. Between November 2007 and January 2013, a total of 44 simultaneous bilateral RIRS were performed at our hospital. Initially, symptomatic sides of the patients were operated on, and, when asymptomatic, the greater stone burden was treated first. Having completed stone fragmentation with a holmium:YAG laser, larger fragments were extracted with a nitinol basket. All patients underwent noncontrast CT scanning or urinary ultrasonography 2 months after the removal of the stent to detect any residual fragments. The stone-free status was defined as no fragments and/or the presence of asymptomatic fragments <4 mm in the urinary system. The total stone number was 201 with a mean stone burden per patient of 30.0±15.4 mm (range 10-85 mm). The overall stone-free rate (SFR) was 88.6% after all procedures. The patients in this study were divided into two groups according to stone burden: Although the overall SFR was 100% for a stone burden <25 mm, the SFR was 80% for a stone burden ≥25 mm (P=0.006). A Double-J stent was not placed in two patients, and they developed postoperative anuria; both cases were treated with Double-J stent placement. Bilateral same-session RIRS is a safe and effective procedure that can be considered a first-line treatment for bilateral UUSS in select patients. The SFR is satisfactory, especially in patients with a stone burden <25 mm. At minimum a unilateral Double-J stent should be placed in patients undergoing bilateral RIRS to avoid postrenal failure.