Acute renal failure in accidental hypothermia of cold water immersion

We report a 27-year-old Japanese man who developed acute renal failure associated with cold water immersion. The clinical course was consistent with that of acute renal failure attributable to acute tubular necrosis. A renal biopsy specimen showed patchy and focal loss of tubule cells, necrotic epithelium, interstitial edema, and arterial lumina obstructed by diffuse and severe intimal thickening. Endothelin increased more than five times in the early phase of the clinical course. Vasoconstriction and ischemia induced by cold exposure seem to lead to endothelin release. Endothelin may be related to the development of acute renal failure and intimal thickening.     

Acute renal failure in a patient with severe hemolysis

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder of bone marrow. It is characterized by blood cells lacking membrane proteins that are normally attached by the glycosylphosphatidylinositol (GPI) anchor. The cellular defect arises in a hematopoetic stem cell and is due to somatic mutation of the Phosphatidylinositol-glycan protein-A gene (PIG-A gene), encoding a protein needed for the biosynthesis of the anchor GPI. Paroxysmal nocturnal hemoglobinuria is presented by intravascular hemolysis, cytopenias, frequent infections, bone marrow hypoplasia, and a high incidence of life threatening venous thrombosis. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute renal failure may occur in association with a hemolytic crisis. Here we report a case of 40-year-old woman with hematuria, pancytopenia, and acute renal failure due to PNH.     

Acute renal failure due to severe Landry-Guillain-Barre syndrome

Background: Blood urea nitrogen (BUN) >60 mg/dl has been reported to occur commonly in patient's with severe Landry-Guillain-Barré syndrome. Aims: To find out the cause for this high BUN we compared the renal function tests of 30 consecutive cases with severe Landry-Guillain-Barré syndrome to those of 30 controls. Results: Acute renal failure occurred in seven patients with Landry-Guillain-Barré syndrome and one of the control group. Acute renal failure was found more in cases with Landry-Guillain-Barré syndrome compared to controls (P=0.0049). Six out of seven cases with Landry-Guillain-Barré syndrome and acute renal failure had dysautonomia and became oliguric while being in a hypotensive state. Of 30 patients with Landry-Guillain-Barré syndrome seven cases died. From eight patients with dysautonomia six cases who had acute renal failure died. The mortality rate was higher in cases with dysautonomia and acute renal failure (P=0.0001 and 0.00001, respectively). Interestingly no glomerular disease was found. Conclusion: In conclusion acute renal failure can occur commonly in cases with severe Landry-Guillain-Barré syndrome particularly in those with dysautonomia, causing high mortality.     

Acute renal failure in rhabdomyolysis.

Fifteen to 30% of patients develop acute renal failure (ARF) following rhabdomyolysis and rhabdomyolysis accounts for 5 to 9% of all ARF. Experimental studies revealed two critical factors that predispose to myoglobinuric ARF: hypovolemia/dehydration and aciduria. At the nephron level, three basic mechanisms underlie heme protein toxicity: renal vasoconstriction with decreased renal blood flow, intraluminal cast formation and direct heme protein-induced cytotoxicity. During the early phase of myoglobinuric ARF, hemodynamic process are mainly involved in glomerumar filtration rate decrease while tubular mechanisms occur in the late phase. Critical factors which predispose to myoglobinuric ARF in animal models--i.e. hypovolemia/dehydration and aciduria--are also encountered in human epidemiological studies. Prevention of myoglobinuric ARF rely on rapid and adequate correction of fluid deficits with saline, bicarbonates and mannitol. The choice of hemodialysis technique in the case of constituted ARF strongly depends on the site of intervention, especially in the case of rescue operation. The care of myoglobinuric ARF in intensive care unit do not differ from this of ARF from other causes.     

Acute renal failure in leishmaniasis.

Sir, Visceral leishmaniasis (VL) has become a frequent complicationof AIDS [1]. When Leishmania and HIV interact, a new broad spectrumof leishmaniasis occurs. Leishmanias can spread to unexpectedsites other than the reticulo-endothelial system, such as peripheralblood, normal skin, gastrointestinal tract and respiratory tract[2]. Acute renal failure (ARF) has rarely     

Dobutamine-induced myoclonia in severe renal failure.

Sir, Dobutamine is a catecholamine with ß₁-, ß₂-and ₁-adrenergic properties. This drug is marketed as a racemicmixture containing two stereoisomers having different distributionand elimination properties. Pharmacological activity also differs:the L-enantiomer is a potent ₁-agonist whereas the D-enantiomeris a potent ß₁-agonist [1]. Dobutamine is widely usedin the treatment of     

Acute renal failure in natural disasters.

Sudden-impact natural disasters such as earthquakes present a serious challenge to medical personnel in both developed and less developed countries. Crush syndrome with acute renal failure has been identified as a major medical complication that occurs among people whose limbs are trapped by heavy objects during natural disasters such as earthquakes or volcanic eruptions. Rescue and field medical teams should be trained to recognize and promptly treat the problems associated with prolonged limb compression and should carry the appropriate fluids and medications to treat the complications of traumatic rhabdomyolysis. Early, aggressive volume replacement followed by forced solute-alkaline diuresis therapy may protect the kidney against acute renal failure. Better epidemiologic knowledge of the specific disaster conditions that predispose traumatic rhabdomyolysis to develop is clearly essential for those who must determine when emergency dialysis services are required in response to injuries sustained during natural disasters. Disaster health care personnel involved with providing emergency acute renal care should have a basic familiarity with disaster epidemiology in order to determine whether a given event requires their intervention. This paper includes recommendations for improving medical planning, preparedness, and response to natural disasters that cause acute renal failure.     

Acute renal failure in visceral leishmaniasis.

We describe the case of a 33-year-old male patient with an acute visceral leishmaniasis (Leishmania donovani) associated with an acute renal failure. The clinical manifestations were dominated by fever, oliguric renal failure and hepatic alterations. Serum C3 and C4 fractions of complement were decreased, and a renal biopsy demonstrated an interstitial nephritis with no glomerular involvement. The clinical course was favorable with recuperation of renal function without sequels.     

Acute renal failure in Central Anatolia.

BACKGROUND: The aetiological spectrum of acute renal failure (ARF) has changed in developed countries. It was the purpose of the study to evaluate whether similar changes have occurred in this part of the world as well. METHODS: In a prospective study a total of 439 patients with ARF were evaluated. They had been admitted to one hospital during two successive periods, i.e. 1983-1990 and 1991-1997. RESULTS: Of 439 patients with ARF, 116 were admitted in 1983-1990 (first period) and 323 in 1991-1997 (second period). The age of presentation increased from 49.8+/-6.2 years in the first period to 58.8+/-16.4 years in the second. Medical causes were present in 259 cases (59%), surgical causes in 110 cases (25%), and obstetric causes in 70 cases (16%). The frequency of surgical cases decreased from 28.4% in the first period to 23.8% in the second period. The respective figures for obstetric cases were 18.9% and 14.8%. Mortality did not change with time (33.6% in the first and 31.0% in the second period); the overall mortality was 31.7%. The mortality was higher for surgical (45.5%) than for obstetric (27.8%) and medical ARF (24.3%). CONCLUSION: In the mid-1970s, the most common causes of ARF in Turkey were obstetric complications and septic abortion. The aetiological spectrum of ARF has changed and today medical causes predominate. ARF resulting from septic abortion has become rare, possibly because of liberalization of abortion in 1983 in Turkey.     

Acute renal failure following trauma.

Acute renal failure is often fatal, but usually this complication following trauma is avoidable. Of fifteen patients with acute tubular necrosis associated with severe trauma, thirteen survived. This is a marked improvement in survival rate compared with the rates previously published. We credit the improvement to aggressive medical and surgical treatment by a team of orthopaedic surgeons, nephrologists, and surgeons.     

Acute renal failure in newborn. Case presentation

Acute renal failure in newborn occurs in 6-8%. Using a systematic approach, physicians can determine the cause of acute renal failure in most patients. Renal cortical necrosis is an uncommon cause of acute renal failure, secondary to perinatal asphyxia or severe anemia. We report our first experience in peritoneal dialysis for a newborn with renal injury due to severe bleeding through the umbilical cord.