Postrenal Failure Research Articles

Percutaneous Transluminal Renal Angioplasty Remarkably Improved Severe Hypertension and Renal Function in a Patient with Renal Artery Stenosis and Postrenal Kidney Failure

A 69-year-old man was admitted to our hospital with severe hypertension and rapidly worsening renal function. He presented with a 10-year history of chronic renal failure caused by bilateral ureteral obstruction due to retroperitoneal fibrosis. Magnetic resonance angiography and Doppler ultrasonography suggested severe right renal artery stenosis (RAS). Renal angiography revealed 99% stenosis at the ostium of the right renal artery. We performed percutaneous transluminal renal angioplasty (PTRA) with the support of intravascular ultrasound to decrease the amount of contrast agent needed. In addition, to prevent distal atheroembolism, a distal protection device was used. The procedure was completed without any adverse effects. After PTRA, renal function and blood pressure improved remarkably and remained stable for one year. PTRA for RAS remains controversial, especially in patients with renal insufficiency. Use of new devices should be considered to decrease catheterization-related adverse effects.

Encrusted cystitis causing postrenal failure

Encrusted cystitis is characterized by chronic inflammation of the bladder with encrustation of the mucosa, induced by urea-splitting bacterial infection. However, encrusted cystitis in itself is not well known. We report a case of encrusted cystitis causing postrenal failure. An 81-year-old man with pneumonia complained of pollakisuria, micturition pain, and gross hematuria. Bladder calculi were found, and transurethral lithotripsy was performed. However, because his symptoms did not improve, he was referred to our hospital. His urine pH was 8.5, and urine culture grew Corynebacterium and Proteus. Computerized tomography and cystoscopy revealed bladder "encrustation," caused by bladder wall calcification, and bilateral hydronephrosis. Hence, he was diagnosed with postrenal failure resulting from encrusted cystitis. Immediate bilateral nephrostomy was constructed, with continuous bladder perfusion with an acid solution for acidification of his urine, followed by intravenous administration of ceftriaxone. After 2weeks of treatment, the calcification disappeared and his bladder mucosa was normalized. The postrenal failure also improved and thus the nephrostomy tubes were removed. Encrusted cystitis is curable by prompt treatment with acidification of urine. Therefore, precise diagnosis and therapy are critical.

Obstructive uropathy due to prolapsed lower ureters and bladder in patients with severe procidentia: A report of two cases

INTRODUCTIONPelvic organ prolape is not uncommon in multi-parous or elderly women. It is one of the rare but important causes of obstructive uropathy. Herein, we report two cases of severe procidentia that were referred with obstructive uropathy due to prolapsed bladder and ureters. PRESENTATION OF CASEThe first case was a 78-year-old woman, with severe pelvic organ prolape and secondary bilateral hydroureteronephrosis and post-renal failure. She was treated successfully by bilateral nephrostomy insertion and then pessary insertion. The second case was a 75-year-old woman who referred with the same presentation, but treated surgically with burch colposuspention and synchronous bilateral ureteral stent insertion. DISCUSSIONPelvic organ prolapse is not uncommon in old women. In addition to physical problems of procidentia, it may cause acute renal failure (ARF), chronic renal failure (CRF), and finally end stage renal disease (ESRD) if undiagnosed. CONCLUSIONIn every aged female case with obstructive uropathy and/or bilateral hydroureteronephrosis with unknown causes, gynecologic examination should be performed for early detection of possible pelvic organ prolapse. Appropriate management is necessary to prevent renal failure from uterine prolapse (UP).

A huge bladder calculus causing acute renal failure

A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7cm×6cm×6cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

A Novel mtDNA Large-Scale Mutation Clinically Exclusively Presenting With Refractory Anemia

We report a rare case of juvenile cobalamin deficiency who presented at the age of 17 years. He was underweight and had skin changes, normocytic anemia, and autonomic dysfunction, which led to adynamic ileus and acute postrenal failure. The expected macrocytosis was masked by an underlying alpha-thalassemia trait. The patient had an excellent response to parenteral cobalamin treatment.

Juvenile Cobalamin Deficiency in a 17-Year-Old Child With Autonomic Dysfunction and Skin Changes

We report a rare case of juvenile cobalamin deficiency who presented at the age of 17 years. He was underweight and had skin changes, normocytic anemia, and autonomic dysfunction, which led to adynamic ileus and acute postrenal failure. The expected macrocytosis was masked by an underlying alpha-thalassemia trait. The patient had an excellent response to parenteral cobalamin treatment.

Acute kidney injury in children

Acute kidney injury (AKI) is defined as an abrupt or rapid decline in renal function.The condition often is transient and usually completely reversible. Pediatric retrospective studies have reported incidences of AKI in pediatric intensive care units (ICU) of between 8% and 30%. A new classification system, the risk injury failure loss end-stage renal disease (RIFLE) criteria (risk of renal dysfunction, injury to the kidney, failure or loss of kidney function, and end-stage kidney disease) has been introduced as standardized criteria for AKI in pediatric patients.The causes of AKI can be categorized as pre-renal, renal, or post-renal failure. A careful history and physical examination can frequently identify the likely processes that underlie AKI and suggest an underlying diagnosis. Urinalysis is the most important non-invasive test in the diagnostic evaluation. Renal ultrasonography should be performed in all children with AKI of unclear etiology. Biomarkers of the detection of AKI can also help differentiate between pre-renal, intrinsic renal or post-renal AKI and aid in identifying the etiology of AKI. They could also differentiate AKI from other forms of kidney disease such as urinary tract infection, interstitial nephritis, and glomerulonephritis. Besides the specific therapy for the underlying cause of AKI, specific attention should be focused on frequent assessment of fluid status and avoidance of any nephrotoxic insults. Children with AKI from any cause have a significant risk of kidney disease in later life, and should be on long-term follow-up so that interventions can be initiated at appropriate time.

FDG-PET/CTが診断の一助となった原発性精嚢癌の1例

We reported a case of primary seminal vesicle cancer, detected by FDG-PET/CT. A 65-year-old man with constipation and appetite loss was admitted to our hospital. An ultrasound examination revealed evidence of bilateral hydronephrosis. He was diagnosed as acute post renal failure, and nephrostomy was done. CT and MRI showed a solid mass in the area of seminal vesicle. He underwent transrectal core biopsy, which histologically showed poorly differentiated adenocarcinoma. Immunohistochemistry showed the tumor to be CA125 positive, CEA positive and CK7 positive but PSA negative. FDG-PET/CT revealed an increased uptake of FDG only in the area of seminal vesicle. Serum CA125 was elevated and PSA stayed within normal limit. Primaly rectal carcinoma was ruled out by colonoscopy. The result of transperineal prostate biopsy was negative. We diagnosed him as suffering from primary seminal vesicle carcinoma. Anti-androgen blockade and radiotherapy to whole pelvis were performed, and serum CA125 level was improved. But, 6 months later serum CA125 re-elevated and 19 months later multiple liver metastases were noted. The patient received two cycles of docetaxel and cisplatin chemotherapy, however he developed pulmonaly embolism and rectal bleeding by tumor invasion and he died of his disease 22 months after the diagnosis.

Acidosis with hyperuricemia and renal tubular damage in viral gastroenteritis

Acidosis with hyperuricemia and renal tubular damage in viral gastroenteritis

Re: Four cases of postrenal renal failure induced by renal stones associated with rotavirus infection

Re: Four cases of postrenal renal failure induced by renal stones associated with rotavirus infection

Akutes Transplantatnierenversagen - Prärenale, intrarenale und postrenale Ursachen

After renal transplantation, the main causes of kidney allograft dysfunction can be classified by time after transplantation and by the affected region of renal anatomy. Prerenal acute graft dysfunction induced by infection and hypovolemia is frequent. In particular, after kidney transplantation cytokine-release-syndrome caused by induction agents as well as vascular or anastomotic problems (from donor or recipient) play an important role. The main causes of intrarenal renal failure after transplantation are the different forms of acute rejection, calcineurin inhibitor nephrotoxicity and the acute interstitial nephritis. Lymphocele and ureteral obstruction often cause postrenal renal graft failure. Clinical symptoms and signs of failure must be carefully monitored. Ultrasound is the main component of diagnostic tools in all causes of dysfunction.

Silent onset of postmenopausal endometriosis in a woman with renal failure in hormone replacement therapy: a case report

IntroductionPostmenopausal endometriosis is a rare form of a common disease, since the absence of estrogenic hormone production should halt disease progression.Case presentationWe present the case of a 54-year-old Italian Caucasian woman in surgical menopause with a history of ovarian endometriosis, who underwent voluntary hormone replacement therapy for seven years. She developed postrenal renal failure due to bilateral compression of the pelvic ureteral tract caused by two large, deeply infiltrating endometriotic nodules with no pelvic pain. She underwent operative laparoscopy with adhesiolysis of enteroenteric adhesions and excision of the endometriotic nodules encompassing the juxtavesical tract of the ureters, without obtaining improvement of renal failure.ConclusionPostmenopausal endometriosis can manifest itself in an unpredictable and potentially very serious manner. It is therefore important to carefully evaluate the risks and benefits of administering hormone replacement therapy to patients with previous endometriosis.

Four cases of postrenal renal failure induced by renal stone associated with rotavirus infection

Rotavirus (RV) is a common pathogen that causes acute gastroenteritis in childhood. Some cases with RV infection also have prerenal renal failure induced by dehydration associated with vomiting and diarrhea. Here, we report 4 patients with RV infection who developed postrenal renal failure induced by urinary tract obstruction with uroammoniac calculi or crystals. The patients did not have metabolic disorders or abnormalities of the urinary tract, and increased urinary excretion of uric acid was not recognized at discharge. In addition, no abnormalities in the uric acid transporter (URAT1) were found in any of the patients. Uric acid stone formation was considered to have originated from the low pH caused by dehydration and the increase of urinary uric acid excretion from damaged cells.

The role of the nurse in the management of acute kidney injury

Acute kidney injury can occur with patients within the hospital and within the community setting. The term acute kidney injury replaces the previous recognized term acute renal failure in the literature and uses two internationally recognized classification systems. The causes of acute kidney injury remain the same, pre renal failure, intra renal (intrinsic), or post renal failure. The nursing care of acute kidney injury is challenging and multifaceted as the patient can be critically ill and requires constant monitoring. It is therefore vital that nurses understand what acute kidney injury is, and the management of it in order to deliver holistic care to the patient concerned.

重度雄性化を伴う褐毛和種フリーマーチン肥育牛にみられた腎後性腎不全の1例

排尿異常を認める21カ月齢の褐毛和種フリーマーチン肥育牛が，臨床的に水腎症および腎不全と診断された． 病理学的検査において，泌尿生殖器の重度雄性化，腎膿瘍および尿路結石が明らかとなった． 本症例は異常な尿道形態から尿路感染症と尿石症を継発し，最終的に腎後性腎不全に陥ったまれなフリーマーチン症例である．

日本住血吸虫症による後腹膜線維症の１例

We report a case of retroperitoneal fibrosis due to Schistosoma Japonicum in patient with urothelial carcinoma. Retroperitoneal fibrosis was observed in a-83-year-old man during examinations for postrenal renal failure. The symptoms were improved by percutaneous nephrostomy and pulse therapy using corticosteroids, however, urothelial carcinoma was detected during follow-up examinations. The biopsy of retroperitoneal tissue was performed during the surgery for urothelial carcinoma. The histopathological examination revealed scattered calcified eggs of Schistosoma Japonicum in retroperitoneal fibrosis tissue. Therefore, in this case, we assumed Schistosoma Japonicum was the cause of retroperitoneal fibrosis. In our knowledge, there is no report about retroperitoneal fibrosis due to Schistosoma Japonicum. We hypothesize the pathway that the eggs penetrate into retroperitoneal space is extravasation from intestinal wall and peritoneal cavity, although the detail of this mechanism is not obvious. It is well known about the relationship between Schistosomasis and malignant tumors. However, it seemed no evidence regarding the relationship between Schistosoma Japonicum and urothelial carcinoma, since there is no report about it and the eggs were not found in specimen of urothelial carcinoma.

ロタウィルス腸炎後に両側尿管結石による急性腎不全を呈した２幼児例

We report on 2 infants with acute renal failure caused by bilateral obstructive ureteral stones associated with rotavirus gastroenteritis. A 28-month boy and a 13-month boy with several days history of watery diarrhea and vomiting were referred to our hospital because of anuria. They were diagnosed acute post-renal failure due to obstructive bilateral ureteral stones based on the findings of ultrasound scan and computed tomography. Immediately, percutaneous nephrostomy tubes were inserted for urinary drainage, serum levels of creatinine and uric acid returned to normal within several days. Sandy stones were excreted through the nephrostomy tubes with urine after urinary alkalization, which were proved to be mainly ammonium acid urate. Ammonium acid urate is rare in developed countries, but some cases of bilateral urolithiasis causing acute renal failure in infants with rotavirus gastroenteritis were reported in recent years. It has been known that the cause of acute renal failure is renal azotemia resulting from sustained hypovolemia, but post-renal causes due to ammonium acid urate stones should be taken into consideration.

Acute renal failure due to obstructive uric acid stones associated with acute gastroenteritis

Sirs, The development of acute renal failure (ARF) in young children with acute gastroenteritis can lead to a presumptive diagnosis of pre-renal azotemia resulting from diarrheal dehydration. Recently, however, several cases of children with acute post-renal failure due to bilateral obstructive uric acid stones associated with acute gastroenteritis have been reported in Japan [1]. We have also encountered three similar cases in which the serum uric acid concentration was in the lower end of the normal range and fractional excretion of uric acid (FEUA) increased after the patients had recovered. Case 1 was a 3-year-old boy with a 1-week history of rotavirus gastroenteritis and a 2-day history of oligouria. He was referred to our hospital for further examination of the oligouria. He had been healthy prior to the presentation of the gastroenteritis and had no familial history of urolithiasis. On admission, physical examination showed peripheral oxygen saturation (SpO2) of between 80 and 90% for a maximum of 2 l/min supplemental O2. Clinical and laboratory data are summarized in Table 1. Ultrasound scan of the kidney disclosed bilateral dilated pelvises containing debris. Despite adequate fluid control and diuretic therapy, his condition worsened rapidly, desaturating to SpO2 60% for a maximum of 10 l/min supplemental O2, so that he required mechanical ventilation. Emergent computed tomography (CT) disclosed pulmonary edema and bilateral urolithiasis located at the pelviureteric junction (PUJ). Based on these findings, he was diagnosed with severe overhydration resulting from post-renal ARF due to bilateral urolithiasis. Since the anuria continued after 15 h of emergent continuous venovenous hemodiafiltration, percutaneous nephrostomy tubes were inserted bilaterally under ultrasound guidance. Sandy stones excreted through the nephrostomy tubes together with the urine consisted mainly of ammonium acid urate (AAU) (>98%). An antegrade nephrostogram performed on postoperative day (POD) 6 showed residual stones in the left PUJ. The patient therefore underwent left-sided extracorporeal shockwave lithotripsy (ESWL). He was discharged on POD 17. Follow-up ultrasound performed 6 months postoperatively indicated bilateral mild hydronephrosis, but no evidence of stones. Case 2 was a 16-month-old boy with a 3-day history of vomiting and diarrhea. He was initially admitted to a local hospital because of dehydration but was referred to our hospital the following day as he demonstrated prolonged oligouria despite sufficient fluid replacement therapy. He had been previously healthy and had no familial history of urolithiasis. On admission, physical examination revealed mild dehydration. Ultrasound scan of the kidney disclosed bilateral dilated pelvises containing debris, and the abdominal CT scan revealed bilateral urolithiasis at the PUJ. Percutaneous nephrostomy tubes were inserted bilaterally on his second day of hospitalization, and after 48 h of Pediatr Nephrol (2009) 24:2467–2469 DOI 10.1007/s00467-009-1222-x

Acute Renal Failure and Mechanical Ventilation: Reality or Myth?

Acute Renal Failure and Mechanical Ventilation: Reality or Myth?

Acute Renal Failure in Children

1. Dilys A. Whyte, MD* 2. Richard N. Fine, MD* 1. *State University of New York at Stony Brook, NY After completing this article, readers should be able to: 1. Define acute renal failure (ARF). 2. Differentiate the three forms of ARF. 3. Initiate treatment, including stabilization, of a patient who has ARF. 4. Discuss the various medications necessary for treating a patient who has ARF. Acute renal failure (ARF) is defined as an acute decline in renal function characterized by an increase in blood urea nitrogen (BUN) and serum creatinine values, often accompanied by hyperkalemia, metabolic acidosis, and hypertension. Significant morbidity and mortality can accompany ARF. Patients who have ARF recover their renal function either partially or completely or they develop end-stage renal disease. They also may develop associated multiorgan disease. ARF is divided into three forms: prerenal failure (most common), intrinsic renal failure, and postrenal failure. Treatment ranges from conservative medical management to dialysis or renal transplantation, depending on the severity of kidney disease and degree of renal function recovery. Worldwide, most cases of ARF in children are due to hemolytic-uremic syndrome or volume depletion. ### Causes Prerenal failure refers to hypoperfusion of the kidneys. There are a variety of causes for such hypoperfusion, the most common of which is hypovolemia due to gastrointestinal (GI) diseases, congenital heart disease, and sepsis (Table 1). | Extracellular Fluid Volume Deficits | || | | | Cardiac Dysfunction | | | Table 1. Causes of Prerenal Acute Renal Failure ### Pathophysiology Prerenal ARF …