Transient Acute Renal Failure Research Articles

Rhabdomyolysis After Ingestion of “Foxy,” a Hallucinogenic Tryptamine Derivative

"Foxy methoxy" (chemical name, 5-methoxy-N,N-diisopropyltryptamine) is a hallucinogenic tryptamine that has been abused with increasing frequency since its appearance in the late 1990s. Like other drugs in this class, foxy frequently produces feelings of euphoria, disinhibition, and auditory as well as visual hallucinations. The drug has been linked to adverse effects, including restlessness, agitation, gastrointestinal distress, and muscle tension. In light of the relatively recent advent of foxy as a drug of abuse and given the inability of commercial toxicologic screening tests to detect the presence of hallucinogenic tryptamines, additional adverse effects seem probable. We report ingestion of foxy by a healthy 23-year-old man that resulted in rhabdomyolysis and transient acute renal failure.

Severe deficiency of the specific von Willebrand factor-cleaving protease (ADAMTS 13) activity in a subgroup of children with atypical hemolytic uremic syndrome

Objective The von Willebrand factor-cleaving protease (VWF-cp) activity has been reported to be deficient in adults with thrombotic thrombocytopenic purpura (TTP) and generally normal in adults with hemolytic uremic syndrome (HUS). The goal of this study was to determine VWF-cp activity in children with typical postdiarrheal (d+) HUS or atypical non-postdiarrheal (d-) HUS. Study design We measured VWF-cp activity in the plasma of 64 children with either (d+) HUS (n = 41) or (d-) HUS (n = 23). Results In the acute phase of HUS, VWF-cp activity was normal (>50%) in 54 children and undetectable (<5%) in one (d+) HUS and in 6 (d-) HUS children. After a 3-month remission, the (d+) HUS patient recovered a 100% VWF-cp activity, and the 6 (d-) HUS patients kept an undetectable level. In these 6 (d-) HUS patients, the disease was characterized by a neonatal onset and several relapses (hemolytic anemia, thrombocytopenia, transient acute renal failure, cerebral ischemia), and sometimes the development of arterial hypertension or end stage renal failure. Conclusion A subgroup of pediatric patients with atypical (d-) HUS, with hematologic symptoms starting at birth and a recurrent course progressively involving kidney and brain, is related to VWF-cp deficiency and actually corresponds to Upshaw-Schulman syndrome revisited as congenital TTP. (J Pediatr 2003;142:310-7)

Minimal Effective Dose of Indomethacin for the Treatment of Patent Ductus arteriosus in Preterm Infants

The aim of this study was to determine if it was possible to decrease the number of boluses of indomethacin for the treatment of patent ductus arteriosus. This retrospective study included 46 preterm neonates (<34 weeks’ GA) who had had an ultrasound diagnosis predictive of subsequent symptomatic patent ductus arteriosus. All patients had received a daily intravenous doses of indomethacin, 0.1 mg/kg. Mean age at initiation of treatment was 4.5 ± 3.1 days. Patency of the ductus arteriosus was controlled echocardiographically each day and treatment was discontinued as soon as the ductus arteriosus was closed. The initial success rate was 84.7%, of which 6.5% reopened. The mean cumulative dose of indomethacin was 0.35 mg/kg. There was no correlation between gestational age or birth weight and total cumulative dose. Overall tolerance was satisfactory with only one case of transient acute renal failure. A weak correlation between the cumulative dose of indomethacin and natremia (r = –0.43) or weight gain (r = 0.35) was noted, and none with serum creatinine or blood urea nitrogen levels. We confirm that lower indomethacin treatment of patent ductus arteriosus in premature neonates are as effective as standard protocols.

Résection segmentaire de la veine cave inférieure pour envahissement tumoral, sans rétablissement de la continuité

Study aim: Oncological complete surgery of retroperitoneal tumours may require segmental resection of part of the invaded inferior vena cava. The aim of this retrospective study was to assess whether reconstruction of the inferior vena cava is necessary and presents any advantage. Patients and methods: This study included four patients who underwent partial resection of the inferior vena cava invaded by a retroperitoneal tumour, without reconstruction. Tumours were one renal cancer, one malignant phaeochromocytoma, one malignant retroperitoneal histiofibroma and one undifferentiated retroperitoneal carcinoma. The resection was located at the level of the renal confluence, associated with right nephrectomy, in 3 patients, and above this confluence, at the level of the retrohepatic inferior vena cava in 1 patient. Results: Only one case of transient acute renal failure was observed during the postoperative course. One patient developed right deep vein thrombosis after three months and another one after 30 months. One patient died from cancer recurrence after 19 months. The other 3 patients were alive with anticoagulant therapy and without sequelae after 3, 6 and 15 years.

Enalapril and prednisone in children with nephrotic-range proteinuria.

The effect of enalapril and low prednisone doses on the urinary protein electrophoretic pattern was studied in 13 pediatric patients with glomerular diseases and steroid-resistant nephrotic syndrome. Enalapril was administered at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was introduced 2 months later in 11 patients at doses of 30 mg/m2 on alternate days. The urine protein electrophoretic pattern showed a reduction of 80% and 70% in the total protein and albumin, respectively, after enalapril. Total urinary protein decreased from 5.46 to 1.1 g/m2 per day (P<0.001). A marked change from a pattern of non-selective urinary protein loss to an albumin-selective proteinuria was observed. Mean total plasma proteins increased from 4.7 to 5.43 g/dl (P<0.001). Four patients became free of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinuria at 48 months of follow-up. The other 11 patients had persistent albuminuria of between 0.5 and 2.6 g/m2 per day with a selective urinary electrophoretic pattern. No additional decrease was observed after steroids were introduced. A clinical improvement in edema was observed in all children. Three patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and 1 pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery of renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No episodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.

Transient acute renal failure (ARF) and anti-D intravascular hemolysis (IVH) following intravenous (IV) treatment of immune thrombocytopenia (ITP)

Transient acute renal failure (ARF) and anti-D intravascular hemolysis (IVH) following intravenous (IV) treatment of immune thrombocytopenia (ITP)

The role of percutaneous transluminal coronary angioplasty in heart transplant recipients

ObjectiveReview the acute and late results of percutaneous transluminal coronary angioplasty (PTCA) in heart transplant recipients and examine the factors predictive of restenosis. BackgroundCoronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retransplantation gives only suboptimal results in this regard. Therefore, PTCA has been attempted in this situation. MethodsMore than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are currently in charge of 450 patients. All the characteristics, procedure-related information, and clinical outcome of patients needing PTCA were assessed by review of each patient’s clinical records. All coronary angiograms were reviewed by an independent cardiologist. ResultsSince 1992, 53 coronary sites have been dilated in the course of 39 procedures in 29 patients. Indication for PTCA was asymptomatic angiographic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success (< 50% residual stenosis) was obtained in 50 (94.3%) of 53 lesions. No periprocedural death occurred. Procedural complications were 1 transient acute renal failure and 1 persistent bleeding at the puncture site. Six months restenosis rate (defined as percent stenosis > 50%) was 32.5% (14/43). Mean follow-up was 1.27 year ± 1.2 (SD). Five deaths (17.2%) occurred in follow-up and were all in relation to coronary graft disease. Mean time separating PTCA from death was 0.9 year ± 1.3 (SD). We also sought to look at factors predictive of restenosis. By multivariate analysis, a positive recipient’s serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). ConclusionsPTCA in heart transplant recipients allows a high level of primary success with a low periprocedural-complication rate. Restenosis rate seems equivalent to restenosis rate in native coronary arteries. Mortality during follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before the graft is associated with a protective effect from restenosis.

Hydroxyethylstarch-associated transient acute renal failure after epidural anaesthesia for labour analgesia and Caesarean section.

Hydroxyethylstarch-associated transient acute renal failure after epidural anaesthesia for labour analgesia and Caesarean section.

Interactions of ultrapure bovine hemoglobin with renal epithelial cells in vivo and in vitro.

Using an ultrapurified hemoglobin (Hb) solution, we investigated the physiological effects and cellular processing of Hb in rat kidneys and in cultured opossum kidney (OK) cells. Rats infused with < 5.0 g/kg Hb showed no change in baseline serum creatinine (SCr) values (0.58 +/- 0.05 mg/dl) over 48 h, whereas transient acute renal failure followed infusion of 7.5 g/kg Hb (SCr 3.4 +/- 1.02 mg/dl, P = 0.02). Histology of Hb-infused kidneys demonstrated tubular epithelial cell injury. Renal injury was not caused by volume or oncotic load, cardiovascular effect, or ATP depletion. After Hb infusion, heme oxygenase, the rate-limiting enzyme in Hb catabolism, was induced in an organ-specific fashion. Inhibiting heme oxygenase activity with cimetidine did not alter Hb renal injury. Using OK cells, we determined that renal epithelia process Hb by fluid-phase endocytosis. Proton permeability of fluorescein Hb endosomes was unaltered compared with fluorescein dextran controls, demonstrating that Hb does not alter endosomal membrane integrity. These data suggest that Hb renal injury in rats occurs following large doses of ultrapure Hb, does not alter early steps in Hb endosomal processing by renal epithelia, and involves a mechanism that is not heme oxygenase dependent.

Transient acute renal failure in the neonate

We have observed a transient renal insufficiency in newborns associated with ultrasonographic finding of hyperechoic renal pyramids. This condition rapidly resolves, coinciding with both normalization of the renal ultrasound and the occurrence of significant proteinuria. Others have recognized a similar state of oliguria and cylindruria associated with a prolonged nephrogram on intravenous urography in newborns. There is evidence to suggest that hyaline cast deposition within the collecting tubules may account for these imaging abnormalities. The precise events surrounding the protein deposition are unknown, and it may be either the cause or the result from the transient renal dysfunction. Our 2 cases add to the evidence that there is a distinct entity of acute renal dysfunction, with identifying characteristics, in neonates associated with a good prognosis and rapid resolution.

Acute reversible renal failure with macroscopic haematuria in IgA nephropathy

Macroscopic haematuria is common in IgA nephropathy, but its significance and influence on prognosis remains uncertain. We compared the clinical and pathological features of 11 adult patients with primary IgA nephropathy who had had a renal biopsy during or shortly after a bleeding episode. Six patients developed transient acute renal failure (ARF) (group 1) and five did not (group 2). Patients of group 1 had a higher percentage of tubular red-blood-cell (RBC) casts (P < 0.05) and of glomerular crescents (P < 0.001). However, crescents were focal and involved less than 50% of glomeruli. Acute tubular necrosis was only present in patients of group 1, and ARF was attributed to the acute tubular changes rather than to the glomerular lesions. Despite a prolonged duration of ARF (mean: 38 days), further outcome did not differ in patients of both groups. We suggest that acute tubular damage and/or tubular obstruction by RBC casts should be considered in any patient who develops ARF soon after a haematuric episode.

Two outbreaks of Yersinia pseudotuberculosis 5a infection in Japan.

In the summer of 1984 there occurred 2 outbreaks of infection with Yersinia pseudotuberculosis 5a. 58 persons ate meat products, vegetables and rice at a Japanese barbecue restaurant. 39/58 (67%) developed symptoms. In 19/39 persons an infection with Y. pseudotuberculosis could be diagnosed by stool cultures and/or serological techniques. Fever occurred in all patients, exanthema in 68% and abdominal pain in 68%. Thus, human yersiniosis due to Y. pseudotuberculosis 5a could be a febrile disease with exanthema and gastrointestinal disturbances. A transient acute renal failure developed around the 10th day of illness in 4 children. The source and mode of spread of this infection could not be clarified.

Renal involvement following near-drowning in the sea

1. 1. The metabolic changes in rats following introduction of sea water directly into the stomach were studied. The results were compared with those of a human case report of acute renal failure following swallowing of sea water. 2. 2. In both rats and man, acute renal failure appeared within the first 24 hr. A slight improvement was found five days later. 3. 3. There was an acute hypocalcemia. This was supposedly due to the large magnesium content of the sea water. 4. 4. It is probable that water entering the alimentary canal, dry drowning, affects the kidneys by the initial flow of water to the intestines. This results in hemo-concentration and reduced kidney function. The abnormality is a transient one and could be due to a partial anoxia due to shrinking of the erythrocytes. 5. 5. It is concluded that an apparently uneventful swallowing of sea water can turn into secondary drowning with transient acute renal failure.

Isopropyl Alcohol Intoxication

Transient acute renal failure, hemolysis, and myopathy occurred during an episode of isopropyl alcohol intoxication. Whether these three phenomena represent a direct toxic effect of isopropyl alcohol ingestion remains a matter of conjecture. Only further observations of other cases of isopropyl alcohol poisoning will establish the significance of the features described. Despite the similarities of intoxication with isopropyl alcohol to that with ethyl alcohol, there are certain clinical features which may be of value in differentiating the two.

Isopropyl alcohol intoxication. Report of a case associated with myopathy renal failure, and hemolytic anemia.

Transient acute renal failure, hemolysis, and myopathy occurred during an episode of isopropyl alcohol intoxication. Whether these three phenomena represent a direct toxic effect of isopropyl alcohol ingestion remains a matter of conjecture. Only further observations of other cases of isopropyl alcohol poisoning will establish the significance of the features described. Despite the similarities of intoxication with isopropyl alcohol to that with ethyl alcohol, there are certain clinical features which may be of value in differentiating the two.