Successful Surgical Treatment of Anuria Caused by Renal Artery Occlusion

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.     

Reno-vascular hypertension in childhood: a nationwide survey

Renovascular disease accounts for 8–10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu’s arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu’s arteritis, should not be underestimated in children with renovascular hypertension.     

Post-transplant renal artery stenosis: a cause of anuria. Report of 2 cases corrected by revascularization

We report 2 cases of severe hypertension and acute onset of anuria after renal transplantation in which angiography revealed renal artery stenosis. After renal artery reconstructive surgery renal function returned to normal and the hypertension improved. A high index of suspicion is needed to make the diagnosis. Only by heightened awareness of this important entity will patients with post-transplantation anuria secondary to renal artery stenosis be identified. Such patients may benefit from renal artery revascularization to reverse this type of renal failure.     

Plasma Exchange and Immunosuppression for Rapidly Progressive Glomerulonephritis: Prognosis and Complications

Rapidly progressive glomerulonephritis frequently leads to deathor dialysis. In 21 cases treated by plasma exchange and immunosuppressionwe observed seven deaths, with 12 others progressing to chronicrenal failure within 3 months. Patients who died were olderthan those who survived (57.5±17.7 vs 40.5±16.5years, mean ±SD, P=0.05), but had similar clinical symptoms(hypertension, haematuria, proteinuria, extrarenal signs) andbiochemical presentation (initial creatininaemia). They requiredthe same degree of haemodialysis, of plasma exchanges and ofbolus methylprednisolone. The causes of death were infection(three cases), cardiac arrhythmia (two cases) and gastrointestinalbleeding (two cases). Among the 14 remaining patients, onlytwo recovered normal renal function. Twelve had chronic renalfailure, six of them requiring chronic dialysis or transplantation.Severe renal failure at entry and anuria were more frequentlyobserved in patients whose renal function did not improve duringtreatment. Plasma exchange and steroid bolus infusions alsoseemed to have a beneficial effect on renal function.     

Short-term niflumic-acid-induced acute renal failure in children

Several reports emphasize the adverse effects of non-steroidalanti-inflammatory drugs (NSAIDs) on renal function. We haveobserved over the last 10 years seven cases of acute renal failure(ARF) due to immune interstitial nephritis in children. A recommendedoral or rectal dose of niflumic acid was prescribed for ear-nose-throatdisorders, Length of exposure was 1–5 days. Clinical symptoms (oedema, oliguria or anuria) appeared between3 and 6 days. Three patients had previously received the drug.Hypersensitivity signs (fever, skin rash, eosinophilia, and/orincreased IgE) were present in all cases, leukocyturia in fivecases, and haematuria in six cases. Renal biopsy showed interstitiallesions with lymphocyte, eosinophil, and plasma cell infiltrateswithout tubular cell necrosis. Glomeruli were normal on light-microscopy,except in one patient. Electron-microscopy showed extensivepodocyte fusion in two patients, who had clinical and laboratoryevidence of nephrotic syndrome (NS). ARF rapidly disappeared after NSAID withdrawal, except in twopatients whose renal failure was irreversible despite methylprednisolonebolus. ARF is very rare in children treated with niflumic acid.When ARF occurs, different pathophysiological mechanisms areinvolved but the most common is immunological.     

Atteinte rénale au cours de la maladie de Takayasu

Renal involvement in Takayasu's arteritis is frequent and worsens the progression of the disease. This is primarily a renal artery stenosis causing renovascular hypertension. The glomerular disease is exceptional. This study was undertaken to determine the clinical, radiological, biological features and therapeutic response in patients with kidney disease associated with Takayasu arteritis. A retrospective chart review was conducted on 11 patients (five men and six females), with a mean age of 31.1 years (19–40 years). The discovery of kidney disease preceded the diagnosis of Takayasu's arteritis in eight cases. Ten patients developed hypertension. Laboratory finding showed proteinuria in five cases of which one case was due to nephrotic syndrome. Renal failure was found in six cases including four cases in stage of terminal chronic renal failure. Impairment of the renal artery was present in nine patients, proximal in seven cases and distal in two cases, bilateral in five cases and unilateral in four cases. Narrowing renal artery was found in seven cases. The renal biopsy revealed membranoproliferative glomerulonephritis in one case and nephrosclerosis in another case. Eleven patients were followed for an average period of 155 months (3–335 months). Remission of nephrotic syndrome was concomitant with the remission of the disease. Seven patients developed outbreaks of Takayasu's arteritis of which six were in care. Relapse of nephrotic syndrome was concomitant with the outbreak of the disease followed by spontaneous remission of both diseases. Improved pressure was obtained in 5 cases and worsening renal function in seven cases. Death was observed in two cases.     

Late streptokinase therapy in thrombotic microangiopathy: a case study.

A 42 year woman presented with malignant hypertension, anuria and hemolytic anemia with schistocytosis. The diagnosis of thrombotic microangiopathy was confirmed by early renal biopsy. Purely symptomatic treatment (peritoneal dialysis and hypotensive drugs) was supplemented by administration of heparin and Dipyridamole. Gastro-intestinal bleeding prevented early thrombolytic therapy. Microangiopathic anemia rapidly disappeared but anuria persisted. Three months later a second renal biopsy showed persistence of active lesions and absence of irreversible parenchymal damage. Streptokinase treatment was then instituted and followed by a rapid return of urinary output. Hemodialysis was stopped and renal function continued to improve over the following months. Two years later the patient remains well despite persistence of hypertension difficult to control. Creatinine clearance is stable at 20 ml/min. This observation suggests that late thrombolytic therapy may be effective in patients with thrombotic microangiopathy when histological findings do not indicate extensive irreversible lesions.     

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Prior long-term retrospective studies have described renal sequelae in 25-50% of postdiarrheal hemolytic uremic syndrome (HUS) survivors, but the ability to predict the likelihood of chronic renal-related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who survived an acute episode of post diarrheal HUS (D+HUS) and were without end-stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least 1 year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least 1 day of oliguria, with 69 individuals having had at least 1 day of anuria. The incidences of renal-related sequelae [proteinuria, low glomerular filtration rate (GFR), and hypertension] were determined among experimental groups based on oliguria and anuria duration. One or more sequelae (e.g. proteinuria, low GFR, hypertension) was seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria, with anuria being a better predictor than oliguria of most related sequelae. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison with those with no anuria (8.9%) [odds ratio (OR) 12.8; 95% confidence interval (CI) 2.9-57.5]. Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR 35.2; 95% CI 5.1-240.5). These findings may help identify children who need periodic and extended follow-up after hospital discharge.     

Abdominal Aortic Surgery in the Presence of a Horseshoe Kidney

Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.     

Is incidental renal arteriography justified in a population of patients with symptomatic peripheral arterial disease?

Renal artery stenosis is a consequence of generalized atherosclerosis and many specialists perform routine selective renal angiography to detect and treat renal artery stenosis. The incidence of clinically important renal artery stenosis is not well defined in patients with symptomatic peripheral arterial disease. The purpose of this study was to better delineate the incidence of and the risk factors associated with renal artery stenosis, renovascular hypertension, and ischemic nephropathy incidentally discovered during angiography for symptomatic peripheral arterial disease. Two hundred consecutive patients undergoing angiographic evaluation of symptomatic lower extremity peripheral arterial disease were studied retrospectively. Angiograms were reviewed for the presence of renal artery stenosis (defined as >or= 25% diameter reduction in either renal artery) and findings were then correlated to the clinical diagnosis of renovascular hypertension (> 50% renal artery stenosis and >or= 3-drug resistive hypertension) and ischemic nephropathy (defined as > 50% bilateral renal artery stenosis, 3-drug hypertension, and creatinine >or= 1.5). Angiographic findings were also correlated with risk factors to determine if a relationship correlated to the presence of and degree of renal artery stenosis. Data were analyzed using the Student's t test, Chi-square model, and multiple logistic regression analysis. The overall incidence of any degree of renal artery stenosis in this study population was 26% (52 patients). Only 24 (12%) patients had an incidental finding of >or= 50% stenosis in either renal artery. Six (3%) of these patients were found to have associated renovascular hypertension. Additionally, 9 (4.5%) patients had coexistent renal insufficiency and significant renal artery stenosis; five with end-stage renal disease on chronic hemodialysis. Only one patient with end-stage renal disease had poorly controlled 3-drug hypertension. Thus definitive ischemic nephropathy was present in only one (0.5%) patient. Statistically significant risk factors associated with the presence of renal artery stenosis include hypertension (P < .001), coronary disease (P = .024), female gender (P = .010), diabetes (P = .039), aorto-iliac disease (P = .031), multiple levels of peripheral arterial disease (P < .001), and age over 60 ( P < .001). While the incidence of renal artery stenosis in patients being evaluated for symptomatic peripheral arterial disease is similar to that reported in the cardiology literature, the incidence of renovascular hypertension and ischemic nephropathy is exceedingly low (3% and 0.5%, respectively)-findings similar to data reported in the general hypertensive population. These data suggest that incidental selective renal angiography is not justified in patients with symptomatic peripheral arterial disease.     

Acquired cystic disease of the kidneys and renal cell carcinoma in chronic renal insufficiency without dialysis treatment

We report 3 cases of acquired cystic disease of the kidneys with associated renal carcinoma in 2 of the cases. In all 3 cases, the patients had chronic renal insufficiency due to hypertension but had never required dialysis. Review of 176 reported cases of acquired cystic disease of the kidneys and renal tumors disclosed that 18 patients (including 1 previously reported by us) had never received dialysis treatment. These cases support the hypothesis that acquired cystic disease of the kidney is not restricted to patients treated with maintenance dialysis. Among the 18 patients, hypertension was the most common underlying cause of renal failure. Patients with chronic renal failure due to or associated with severe hypertension should be monitored carefully for the development of both renal cysts and tumors even though they have not started on chronic dialysis.     

Bilateral renal cortical necrosis: a report of 2 cases.

Two cases of renal cortical necrosis, one of which occurred after an obstetric complication (abruptio placentae) and the other after postpartum haemorrhage, are described. The diagnosis was made by percutaneous renal biopsy, intravenous pyelography and selective nephro-angiography. Immunofluorescence studies of the kidney showed no abnormality in one patient, but showed the presence of IgM in the glomerular basement membrane in the second patient. Hypotension was not observed when anuria occurred. Both patients survived. The importance of prolonged haemodialysis is stressed, since one patient was oliguric for 57 days and required intermittent haemodialysis for 5 months, while the second patient was oliguric for 17 days, required haemodialysis for 5 months and now has established hypertension.     

Complication during the period of anuria after cadaveric transplantation--with special reference to wound bleeding

Some period of anuria is usually expected after cadaveric renal transplantation, and hemodialysis is necessary during the period. Postoperative bleeding in the anuric period is not uncommon and usually can be easily controlled with adequate conservative treatment. However, it becomes uncontrollable in some cases and causes a series of serious complications. Out of 22 patients having undergone cadaveric renal transplantation in our hospital, six patients had postoperative bleeding. On investigation of these cases, we found that not only a hemorrhagic tendency due to uremia but also hemodialysis is a risk factor of bleeding in the wound.     

Endovascular treatment of splenic and renal aneurysms

Four cases (three women and one man) of embolization of visceral artery aneurysms are presented, of which two affected the splenic artery and two the renal artery. The two renal aneurysms were related to hypertension; one of the splenic aneurysms was diagnosed in the context of hypertension, and the other affected a woman of a fertile age. Microguides, microcatheters, and Guglielmi platinum coils, liberated by electrolysis, with different lengths and characteristics, were used. Also, one of the renal aneurysm cases was related to the placing of a stent due to the existence of a stenosis of the renal artery adjacent to the aneurysmatic neck. Immediate occlusion of the aneurysm was achieved in the four cases. Evaluation with nuclear magnetic resonance angiography carried out 3 months later confirmed the sealing of the aneurysm and the patency of the native artery. Currently available devices provide a good therapeutic option for the embolization of visceral aneurysms with low morbidity and mortality rates.     

Malignant hypertension in children in India

BACKGROUND: Malignant hypertension is now an uncommon entity in the westernworld but still remains a significant problem in India. Thereforewe studied the aetiological spectrum, management, and outcomeof these patients. METHODS: Forty consecutive children (<16 years) with malignant hypertensionwere admitted and investigated to exclude or confirm the secondarycauses of hypertension. For acute control of blood pressuresublingual nifedipine was used in dosage of 0.3–0.6 mg/kg,failing which intravenous nitroglycerin was used. In patientswith aortoarteritis with active disease, steroids were used.Angioplasty was carried out for renal artery stenosis wheneverpossible. RESULTS: Renoparenchymal disease was the commonest cause of malignanthypertension, and was seen in 25 cases, renovascular hypertensionin 13 cases (11 aortoarteritis and two fibromuscular dysplasia),and two had essential hypertension. For acute control of severehypertension, sublingual nifedipine was effective in 92.5% ofpatients. Of the patients with renoparenchymal disease fivebecame normotensive with treatment of the underlying disease,four received renal allograft, seven died, and nine are stableon antihypertensive drugs. Renal angioplasty was carried outin seven patients with renovascular hypertension (4 cured, 3improved) and six are controlled on drugs. CONCLUSIONS: We conclude that apart from renoparen-chymal disease, aortoarteritisis a common cause of malignant hypertension in children. Sublingualnifedipine is effective for the rapid control of severe hypertension,and angioplasty is effective in aortoarteritis for short-termpreservation of renal function and control of hypertension.     

Hospital outcomes of obstetrical-related acute renal failure in a tertiary care teaching hospital

Management of obstetrical acute renal failure remains a challenging task. We present data of 100 cases of obstetrical -related acute renal failure of 3-year duration (2007-2009) from Department of Nephrology & Hypertension, Lady Reading Hospital, Peshawar, Pakistan. The study is aimed to look at overall mortality and relationship of oliguria/anuria at presentation to dialysis dependency and renal cortical necrosis (RCN). Evaluation of comorbidity to dialysis dependency and RCN was also considered. While 91 patients required hemodialysis, 9 were managed conservatively; 57 were dialysis dependent whereas 43 remained dialysis independent on discharge; 47 patients had oliguria, 30 had anuria, and 23 had an output of >800 mL per 24 h on admission. RCN was seen in 30 cases, all biopsy confirmed; among these, 26 cases (86.67%) were associated with oliguria/anuria and dialysis dependency right from the beginning (p < 0.0001). However, four (13.33%) with RCN had output >800 mL per 24 h but remained dialysis dependent. Our data showed that out of 30 patients who presented with anuria, only 10 patients (33.33%) were dialysis independent on discharge, whereas out of 47 oliguric patients, 21 patients (44.6%) were dialysis independent upon discharge. Thus dialysis dependency does not correlate with anuria or oliguria at presentation (p?=?0.133). Mortality of 7% was recorded; 23% were discharged with normal renal function. Septicemia, operative interventions, retained product of conception, post-partum hemorrhage, and RCN remained important comorbid conditions with regard to survival and dialysis dependency.     

Simultaneous reconstruction of infrarenal abdominal aorta and renal arteries

From 1980 to 1990, 48 (4.7%) of 1,002 patients underwent elective aortic reconstruction and simultaneous renal artery reconstruction. Forty-five men and three women (mean age: 66.5 years) had 59 renal artery lesions (51 stenoses, six occlusions, one dysplasia, and one aneurysm) associated with 20 infrarenal aortic aneurysms and 28 aortoiliac occlusive lesions. One nephrectomy and 58 renal artery reconstructions were performed (35 prosthetic bypasses, 11 vein bypasses, six direct reimplantations, five transaortic endarterectomies, and one resection of an intrahilar aneurysm followed by autotransplantation). Operation was always indicated for the aortic lesions. Indication for renal artery repair was hypertension in 33 cases (17 associated with renal insufficiency) and one with isolated renal insufficiency. In the remaining 14 cases, surgery was deemed preventive. One patient died (2%). There were 12 nonfatal complications two of which were kidney failures requiring chronic extrarenal epuration. Routine follow-up arteriograms showed four postoperative renal artery occlusions. Mean follow-up was 35.8 months. Four patients were lost to follow-up; 10 died secondarily. Five year survival was 72.1±19.1%. Secondary patency of renal artery reconstruction was 89.5±9.4% at five years. Late results were favorable in 45% of patients with hypertension and in 39% of patients with renal insufficiency. Mortality in simultaneous aortic and renal artery reconstruction is not superior to that of isolated infrarenal aortic surgery.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, June 21–22, 1991, Marseille, France.     

Haemolytic-Uraemic Syndrome: A 10-Year Follow-Up Study of 73 Patients

Long-term follow-up is presented of 73 patients suffering fromthe haemolytic-uraemic syndrome 10 years after the acute initialillness. The patients were subdivided into three groups, accordingto the criteria proposed by Gianantonio and based on the durationof oliguria and/or anuria. Four out of 38 patients belongingto the first group (oliguria for less than 7 days) had a slightlyincreased blood pressure as the only sequela. Two patients outof group two (n=29, oliguria for 7–14 days or anuria forless than 7 days) had a diminished GFR and a reduced concentratingcapacity, some protein uria, and mild hypertension. Five otherpatients had slight proteinuria (<500 mg/24 h) and one ofthem a mild hypertension. All six patients belonging to thethird group (oliguria for more than 14 days or anuria for morethan 7 days) had late sequelae: two started haemodialysis morethan 10 years after the initial phase; three have a decreasedGFR and concentrating capacity. The unique remaining patientwith a normal GFR without hypertension has a decreased concentratingcapacity. The importance of careful treatment in children with a decreasedGFR 2 years after the initial phase is stressed.     

Assessment of lupus nephritis activity using urinary retinol-binding protein

We evaluated the presence of proximal renal tubular dysfunctionas measured by urinary retinolbinding protein (RBP) in 70 patientswith systemic lupus erythematosus. Renal disease activity wasassessed using the British Isles Lupus Assessment Group (BILAG)index. This is a clinical-laboratory score based on the principleof the physician's intention to treat. Increased urinary RBP(>400 jig/I) was detected in 17 of 22 (77%) patients withactive nephntis, six of 18 (33%) patients with probably activenephritis, one of nine (12%) cases with stable renal disease,and one of 21 (5%) cases without apparent renal disease (P<0.01).Compared to initial values, mean urinary RBP decreased significantlyin six patients evaluated after improvement of the exacerbationof renal disease. There was a positive correlation between urinaryRBP and 24-h proteinuria (r=0.40, P <0.01), and an inversecorrelation between urinary RBP and creatinine clearance (r=–0.60,P<0.0l). In a multivariate analysis adjusting for durationof disease, blood pressure, 24-h proteinuria, and creatinineclearance, mean urinary RBP continued to be significantly andprogressively greater for patients with no renal disease, stablerenal disease, probably active and active nephritis. Proximaltubular dysfunction is frequent in patients with active lupusnephritis. This association cannot be completely explained bythe effects of increased total proteinuria, reduced glomerularfiltration rate, and systemic hypertension. Urinary RBP seemsto be a marker of renal disease activity. This test may be clinicallyuseful to differentiate patients with active lupus nephritisfrom those with stable or absent renal disease.     

Exercise-induced acute renal failure associated with renal vasoconstriction]

Exercise-induced acute renal failure without rhabdomyolysis is not a rare condition. We experienced 6 cases (5 men and a woman) during last the 8 years. All cases complained of severe loin pain and nausea after mild to moderate exercises (for example, a track race in an athletic meeting). The elevation of serum and urinary myoglobin was undetected. In 4 of 5 patients with abdominal CT, renal patchy vasoconstriction (wedge-shaped low-density lesion) was observed. This was diagnosed as exercise-induced acute renal failure with loin pain (serum creatinine levels: 1.7-8.6 mg/dl). The renal function in 5 of the 6 cases normalized in about three weeks by fluid replacement therapy and hemodialysis support, which one patient received for 3 days. One patient required a long time for improvement of renal function and renal insufficiency persisted (serum creatinine 1.8 mg/dl). In 2 patients, the concentration of serum uric acid became very low after the recovery of renal function. These two patients were diagnosed as an isolated hyperuricosuric hypouricemia. More than half of the 6 patients had previously experienced the same episodes (loin pain and nausea) after exercise. Exercise-induced acute renal failure, probably due to renal patchy vasoconstriction, seems to be not a rare disease. The etiology of renal patchy vasoconstriction after exercises remains to be elucidated. The occurrence of acute renal failure must be taken into consideration when the youngster, especially with renal hypouricemia, complains of severe loin pain and nausea after exercise such as a track race.