Olmesartan associated with acute renal failure in a patient with bilateral renal artery stenosis

In patients with renal artery stenosis (RAS), the inhibition of renin-angiotensin-aldosterone system can cause deterioration of renal function. Here we present a 75-year-old man who developed acute renal failure after olmesartan treatment. Following discontinuation of olmesartan, his renal functions normalized. His renal Doppler ultrasonography and renal angiography showed findings consistent with bilateral RAS. In this case, unlike those previously reported, renal failure developed with olmesartan for the first time and after only a single dose, which is thought to be a new, safe, and tolerable antihypertensive agent. This is a well-defined effect of angiotensin-converting enzyme inhibitors, in patients with RAS. Also with the increasing use of angiotensin II receptor blockers (ARBs), renal failure associated with ARBs in patients with RAS is rising. The use of olmesartan also requires caution and close follow-up of renal functions for patients who have risk factors.     

The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure

BACKGROUND.: The pulsatility index (PI) and the resistive index (RI) areused as pulsed-wave Doppler measurement of downstream renalartery resistance. Little information is available on theirvalue in chronic renal failure and their correlation to parametersof renal function and haemodynamics. The aim was to comparePI and RI of renal arteries in healthy volunteers and in patientswith hypertension and chronic renal failure, and furthermoreto study the correlation of these indices to measurements ofrenal haemodynamics and function by standard methods in patientswith renal failure and hypertension. METHODS.: Twenty-five hypertensive patients (10 females, 15 males, meanage 52 years (24–74) with a glomerular filtration rate(GFR) less than 50 ml/min and an arterial blood pressure above140 mmHg systolic and 95 mmHg diastolic were included in thestudy. Ten healthy, normotensive volunteers (4 females and 6males, mean age 43 years (30–62)) served as controls inthe Doppler examinations. Doppler examinations were performedin segmental arteries by an Acuson 128. The PI and the RI wascalculated from the blood flow velocities. RESULTS.: Both the PI and the RI were significantly higher in the patientgroup (P) than in the control group (C) (PI, P 1.65 (1.31–1.86),C 1.19 (0.93–1.25), P=0.003; RI, P 0.76 (0.69–0.81),C 0.67 (0.64–0.70), P=0.003). Both PI and RI correlated significantly with effective renalplasma flow (PI: r= –0.5, P=0.02; RI: r=–0.5, P=0.006),renal vascular resistance (PI: r=0.4, P= 0.05; RI: r=0.5, P=0.02),filtration fraction (PI: r=0.6, P=0.005; RI: r=0.5, P=0.01)and clearance of creatinine (PI: r=–0.6, P=0.008; RI:r=–;0.6, P= 0.006). Only RI correlated significantly toGFR (r=–0.5, P=0.02). The indices did not correlate toserum creatinine, or mean arterial blood pressure. CONCLUSION.: PI and RI seems to be closely related to parameters of renalhaemodynamics and clearance of creatinine in patients with chronicrenal failure and hypertension.     

持续肾替代治疗在肝移植术后急性肾损伤的应用

目的 探讨持续肾替代治疗(CRRT)对肝移植术后急性肾损伤的治疗效果.方法 回顾性分析82例肝移植围手术期应用CRRT患者的肾功能情况,对其治疗前后的主要指标进行检测.结果 与治疗前比较,治疗后患者丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、血尿素氮(BUN)、肌酐(Cr)、肌酸磷酸激酶(CPK)、C反应蛋白(CPR)、肌酐下降,差异均有统计学意义(P＜0.05).与治疗前比较,CRRT治疗后患者血K+、Na+、Cl-、HCO3-、中心静脉压(CVP)显著好转,差异亦具有统计学意义(P＜0.05).其他生化指标与治疗前比较变化不大,差异无统计学意义(P＞0.05).对开始血滤治疗的时机进行研究显示,在急性肾损伤RIFLE分级Ⅰ级开始血滤治疗的患者肾功能恢复的比例明显高于在F级开始血滤治疗的患者(P＜0.05).结论 CRRT治疗能明显改善肝移植术后急性肾损伤患者的预后.     

零点活检对活体肾移植术后受体肾功能的预测价值

目的探讨活体肾移植供肾零点活检对受体术后1年内移植肾功能的预测价值。方法 149例活体肾移植受者,根据是否同意活检和活检是否发现异常分为3组：未活检组（63例）,活检正常组（58例）和活检异常组（28例）。受体术后平均随访8个月,比较3组间受体术后移植肾功能恢复情况。结果供肾零点活检异常率为33%,其中肾小管炎7例,肾小管萎缩5例,肾小球硬化8例,肾小球钙化3例,肾小球玻璃样变3例,肾间质炎7例,肾间质纤维化1例,系膜增生2例以及小动脉玻璃样变2例（部分病例有一种以上病理改变）。供者年龄与移植前零点活检异常相关（P〈0.05）。从术后1个月之后至术后1年内,活检异常组各时间点受体血清肌酐均高于未活检组和活检正常组（均为P〈0.05）;术后3个月,活检异常组各时间点受体肾小球滤过率均低于未活检组和活检正常组（P〈0.05）,但术后1年内3组各随访时间点的血尿素氮比较差异无统计学意义（P〉0.05）。术后6个月内重复测量趋势分析显示,与活检正常组比较,活检异常组的血清肌酐和肾小球滤过率的变化趋势差异有统计学意义（均为P〈0.05）,活检异常组的血清肌酐与未活检组比较差异亦有统计学意义（P〈0.05）。结论活体供肾零点活检结果对术后1年内特别是术后6个月内移植肾功能有预测价值,具有临床实用性。     

Chronic renal vein thrombosis in a renal allograft

Acute renal vein thrombosis in a renal allograft is uncommon and usually occurs in the post-transplant period. Chronic renal vein thrombosis can occur insidiously many years after transplant without significant deterioration in renal allograft function or symptoms.     

Long-term consequence of renal function following nephrectomy for renal cell cancer

AIM: A retrospective analysis was performed involving patients who had undergone radical nephrectomy for renal cell cancer to determine the long-term outcome of this surgery on renal status. MATERIALS AND METHODS: Between 1977 and 2001, 172 patients having undergone radical nephrectomy for renal cell cancer were followed for a period of more than one year at the Department of Urology Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan. The preoperative and postoperative serum creatinine values of these individuals were reviewed. Long-term effects of radical nephrectomy on renal function and factors influencing postoperative renal dysfunction were analyzed. RESULTS: Six (3.5%) of the 172 individuals progressed to hemodialysis. Eleven (6.4%) patients displayed serum creatinine values of > or =1.6 mg/dL. The remaining 155 patients (90.1%) demonstrated postoperative serum creatinine values of <1.6 mg/dL. The present study suggests that aging, a high degree of proteinuria, hypertension and diabetes mellitus were the predominant risk factors for renal deterioration following nephrectomy. CONCLUSIONS: We have primarily selected radical nephrectomy for cases exhibiting smaller renal tumors with a normal contralateral kidney. We encourage nephron-sparing surgery where possible in patients displaying risk factors, including a high degree of proteinuria, hypertension, or diabetes mellitus.     

Successful ex vivo renal artery reconstruction and renal autotransplantation

Background : The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery. Methods : A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital. Results : Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years. Conclusion : The present review confirms the long‐term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.     

Pathogenesis and management of hyperparathyroidism in end-stage renal disease and after renal transplantation

SUMMARY: Secondary hyperparathyroidism is an adaptive response to progressive loss of renal function so as to maintain calcium and phosphate homeostasis, 1,25-dihydroxyvitamin D₃ levels and normal bone turnover, despite skeletal resistance to parathyroid hormone. As feedback regulation fails, complications of parathyroid overactivity develop, and by the commencement of dialysis abnormal bone histology is present in almost all patients, with hyperparathyroid changes most commonly found. Post transplantation, persisting hyperparathyroidism predisposes to osteoporosis. The risk of bone disease is reduced by early, carefully targeted dietary measures and suppressive therapy with calcitriol and calcium-based phosphate binders, while newer therapies include bisphosphonates and calcimimetics. Timely surgical intervention is necessary in some patients.     

肾肿瘤剜除术治疗肾细胞癌、肾血管平滑肌脂肪瘤

目的探讨肾肿瘤剜除术治疗肾细胞癌及肾血管平滑肌脂肪瘤的疗效。方法回顾分析15例在我院进行肾肿瘤剜除术的肾细胞癌及肾血管平滑肌脂肪瘤患者的临床及病理资料。结果全部肾肿瘤均成功剜除，平均热缺血时间为15min，术中肿瘤剜除面平均出血25ml，术后无继发出血，无急性肾小管坏死、慢性肾功能不全及尿瘘等并发症发生。术后平均随访时间为2．5年，均未见肿瘤复发或转移。依据2003AJCC肾癌分期方法，所有肾癌患者均为Tla期，组织学形态为透明细胞癌。病理分级按Fuhrman标准为G1。结论肾肿瘤剜除术对有假性包膜的Tla肾细胞癌和肾血管平滑肌脂肪瘤是有效和安全的，术后并发症少，可以最大程度地保留肾脏功能。     

Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease.

BACKGROUND: Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. METHODS: In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. RESULTS: Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. CONCLUSION: ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.     

Tacrolimus vs Neoral in renal and renal/pancreas transplantation

In a retrospective analysis we compared the outcome of a group of 63 kidney or kidney/pancreas transplant recipients who were transplanted between June 1994 and February 1997 and received either tacrolimus (FK, n=22) or Neoral (NEO, n=41) as part of a triple immunosuppressive protocol. Ten patients in the NEO group had recurrent rejection episodes between 1 and 8 months post-transplant and were converted to FK. CellCept was the secondary immunosuppressive agent in about half the FK, three-quarters of the NEO, and in all but one in the conversion (CON) groups. Patients in all groups were on prednisone in equal amounts. Mean duration of follow-up for FK, NEO and CON groups was 32, 19 and 13 months, respectively. One-yr patient and graft survival was 100% in all groups. At 2 yr, graft survival was 95, 96 and 100% in FK, NEO and CON groups, respectively. Acute rejection at 1 yr was twice as high in the NEO group as the FK group. There were no rejection episodes among the FK patients who also received CellCept. The mean current serum creatinines (mg%) were: FK=1.6, NEO=1.8, CON=1.9. Recurrent infection was more common with FK (8/22) than NEO (1/31) (p=0.023). Our experience suggests there is less rejection but more infection in recipients treated with FK compared to NEO. In patients with recurrent rejection, conversion from NEO to FK stabilizes renal function and minimizes subsequent rejection episodes.     

鹿角形肾结石合并肾盂癌的诊治

目的:提高鹿角形肾结石合并肾盂癌的诊治水平。方法:回顾性分析16例鹿角形肾结石合并肾盂癌患者的临床资料。结果:16例患者中,13例行CT检查,确诊4例;2例行MRI检查,确诊1例。术前确诊的5例患者行根治性肾输尿管切除加膀胱袖状切除。5例分别于开放手术或PCNL术中发现新生物,活检证实后行根治性肾切除加输尿管部分切除。1例行经皮肾镜取石术(PCNL)者后2个月再次手术时发现转移而被迫放弃手术。5例无功能肾者于肾切除术后常规病检发现合并肾盂癌。病理检查证实为鳞状细胞癌12例,移行细胞癌3例,腺癌1例。获随访10例,随访时间1~35个月,死亡7例,术后生存时间1~27个月。结论:鹿角形肾结石合并肾盂癌诊断困难,预后差。对结石病史长、合并感染或肉眼血尿者,术前应考虑合并肾盂癌的可能。CT与MRI检查对诊断鹿角形肾结石合并肾盂癌有重要价值;对术前未确诊而又怀疑结石合并肾盂癌患者,建议行开放手术,勿选PCNL。     

结石肾并肾癌的诊断和治疗

目的 探讨结石肾合并肾癌的诊断与治疗策略.方法 回顾分析9例结石肾合并肾癌患者的病例资料及诊治经过.结果 9例患者中2例术前检查已发现结石肾合并肾占位病变行根治性肾切除;另7例中4例因结石手术术中发现可疑病灶行快速冰冻切片病检证实为肾细胞癌而行根治性肾切除,3例因结石肾积水合并感染形成脓肾行患肾切除,术后病理证实为肾癌...     

Indirect computed tomography sign of renal artery injury: Retrograde filling of the renal vein

Computed tomography is a very useful diagnostic tool in children's trauma. In the present case report, retrograde filling of the renal vein during computerized tomographic examination of a patient with renal trauma is presented. This is an indirect sign of traumatic renal artery injury. This finding might assist in the early diagnosis of severe renovascular trauma.     

Postpartum renal cortical necrosis

Case report Two young females presented with postpartum acute renal failure. A 24-year-old unsupervised primigravida developed severe lowerabdominal pain and vaginal bleeding at 38 weeks gestation. Shewas     

Angiographic visualization for percutaneous renal biopsy

Fifteen patients underwent visualization of the kidney for percutaneous biopsy by selective renal angiography. Biopsies were performed in 11 patients, and adequate renal tissue was obtained in all instances. Postbiopsy angiogram revealed pinpoint bleeding in ten patients and significant extravasation in one case, which was controlled with a selective epinephrine infusion. In four cases, biopsy was not performed when the cortex was found to be less than 5 mm thick.     

Incidental neoplasms in renal biopsies.

BACKGROUND: Incidental neoplastic lesions are occasionally found in renal biopsy specimens, but there is no evidence to indicate how they should be managed. METHODS: A retrospective review was made of the management and clinical course of patients in whom an unsuspected neoplasm had been found in a renal biopsy. RESULTS: In 11 880 biopsies taken over 22 years, there were incidental neoplasms in 25 (0.2%). Twenty-three of the 25 patients were men, and the median age was 59 years (range, 42-83 years). All had chronic renal damage, with a median index of chronic damage of 37% (range, 10-83%; normal=0%). Twenty-two neoplasms were papillary, two were clear cell renal carcinomas and one was in situ carcinoma in a collecting duct. The two clear cell carcinomas, three papillary neoplasms with residual masses after biopsy and the two papillary neoplasms in renal allografts were resected by nephrectomy or partial nephrectomy. Seven patients without resection were imaged with computerized tomography, six with magnetic resonance imaging and three with ultrasound scanning. Two were not imaged. None of the 11 patients who died, nor any of the other 14, had evidence of renal cell carcinoma at death or last follow-up respectively, at median 3.6 years after biopsy (range, 1 month-18.2 years). CONCLUSIONS: When an incidental neoplasm is found, the pathological type should be defined, and imaging should be performed. Surgery should be considered in patients in whom there is a neoplasm of any type detectable by imaging, and limited resection may be possible. Neoplasms that are undetectable with imaging cannot be resected as the site of the lesion is unknown. We suggest surveillance of these, but whether this is necessary is undetermined. There is no evidence whether neoplasms undetectable with imaging in renal allografts require aggressive treatment.