1/18. Repeated transient anuria following losartan administration in a patient with a solitary kidney.We report the case of a 70-year-old hypertensive man with a solitary kidney and chronic renal insufficiency who developed two episodes of transient anuria after losartan administration. He was hospitalized for a myocardial infarction with pulmonary edema, treated with high-dose diuretics. Due to severe systolic dysfunction losartan was prescribed. Surprisingly, the first dose of 50 mg of losartan resulted in a sudden anuria, which lasted eight hours despite high-dose furosemide and amine infusion. One week later, by mistake, losartan was prescribed again and after the second dose of 50 mg, the patient developed a second episode of transient anuria lasting 10 hours. During these two episodes, his blood pressure diminished but no severe hypotension was noted. Ultimately, an arteriography showed a 70-80% renal artery stenosis. In this patient, renal artery stenosis combined with heart failure and diuretic therapy certainly resulted in a strong activation of the renin-angiotensin system (RAS). Under such conditions, angiotensin ii receptor blockade by losartan probably induced a critical fall in glomerular filtration pressure. This case report highlights the fact that the angiotensin ii receptor antagonist losartan can cause serious unexpected complications in patients with renovascular disease and should be used with extreme caution in this setting.- - - - - - - - - - ranking = 1keywords = renovascular (Clic here for more details about this article) |
2/18. Two episodes of anuria and acute pulmonary edema in a losartan-treated patient with solitary kidney.Atherosclerotic renal artery stenosis (RAS) is an increasingly important cause of end-stage kidney disease, and may cause hypertension, progressive renal failure, and recurrent pulmonary edema. Herein, we report two episodes of anuria and acute pulmonary edema associated with losartan treatment in a hypertensive patient with preexisting severe renal artery stenosis in a solitary kidney. After successful percutaneous renal balloon angioplasty procedure, urine flow was started immediately, despite 10 days of anuria. blood pressure measurements were still at acceptable levels with a low dose Beta blocker, and serum creatinine levels were normal even after eight months. PTRA should be done in such patients, even with prolonged anuria. physicians who recommend angiotensin receptor blockers in patients with RAS, especially in patients wih hypovolemia or a solitary kidney, should be careful about this complication.- - - - - - - - - - ranking = 0.066097973536766keywords = hypertension (Clic here for more details about this article) |
3/18. pseudomonas aeruginosa infection: an uncommon cause of post-renal obstruction following induction therapy for acute lymphoblastic leukemia.A 14-month-old infant presented with gastroenteritis with febrile pancytopenia and was diagnosed with acute lymphocytic leukemia (ALL). Ten days post induction therapy, the patient developed hypertension that was ascribed to steroid therapy and treated with metoprolol and amlodipine. As leukocyte numbers began to recover the asymptomatic patient became anuric. Ultrasound showed echoic floating structures in the bladder. Following cystoscopy and retrograde pyelography examination, purulent debris was irrigated from the bladder and grew Pseudomonas aeruginosa. ciprofloxacin therapy was initiated and renal function was restored within 2 days. The case highlights the potential for renal obstruction after neutropenia recovery in children undergoing induction therapy for ALL.- - - - - - - - - - ranking = 0.066097973536766keywords = hypertension (Clic here for more details about this article) |
4/18. Acute renal failure of renovascular origin: cure by aortorenal reconstruction after 25 days of anuria.A case of dialysis-dependent acute renal failure due to bilateral renal artery occlusion is described. Renal function was improved dramatically by revascularization after 25 days of anuria and no further dialysis was required.- - - - - - - - - - ranking = 4keywords = renovascular (Clic here for more details about this article) |
5/18. Intrathecal morphine analgesia and low-dose dopamine for oliguria in severe maternal pulmonary hypertension. A case report.Maternal pulmonary hypertension can be life threatening, and many problems and complications can occur during labor and delivery as well as postpartum. A case of severe maternal pulmonary hypertension was monitored with a pulmonary artery catheter. Intrathecal morphine was administered for labor analgesia, and low-dose dopamine was utilized for maternal oliguria. Neither the morphine nor the dopamine resulted in adverse maternal hemodynamic effects. Both analgesia and resolution of the oliguria were accomplished.- - - - - - - - - - ranking = 0.3965878412206keywords = hypertension (Clic here for more details about this article) |
6/18. Neonatal renal failure: a complication of maternal antihypertensive therapy.Persistent anuria was diagnosed in a neonate born to a mother whose pregnancy was complicated by severe hypertension and systemic lupus erythematosus. Severe maternal hypertension necessitated the use of a battery of antihypertensive medications that included enalapril, an angiotensin converting enzyme inhibitor. The role of enalapril in neonatal renal failure is discussed.- - - - - - - - - - ranking = 0.13219594707353keywords = hypertension (Clic here for more details about this article) |
7/18. Successful revascularization of an occluded renal artery after prolonged anuria.Renal atherosclerosis and fibromuscular dysplasia are the most common causes of curable human renovascular hypertension and renal failure. Vascular reconstruction often preserves renal function, but renal failure is rarely reversed, especially after days of anuria. We report a case of a 23-year-old woman who as a child underwent a nephrectomy for congenital hydroureter and renal hypoplasia. She later experienced fibromuscular dysplasia of the remaining renal artery, which ultimately progressed to a complete occlusion and 31 days of total anuria. The patient was revascularized, and within 2 months renal function returned with a blood urea nitrogen and creatinine of 9.0 and 1.0 mg/dl, respectively. After a follow-up of 6 months the patient's blood pressure remained 120/80 to 130/80 mm Hg without administration of hypertension medication. In this report we emphasize that under selected circumstances a kidney can survive prolonged ischemia and that delayed revascularization may reestablish renal function.- - - - - - - - - - ranking = 1.1321959470735keywords = renovascular, hypertension (Clic here for more details about this article) |
8/18. polyarteritis nodosa involving only the main renal arteries.A unique case of accelerated hypertension and acute anuria in a 24-year-old man is presented. Clinically, the patient was found to have obstruction of both main renal arteries caused by extensive bilateral thrombosis. Microscopically, a healing panarteritis involving only the main renal arteries was found. This was associated with acute renal infarction and tubular atrophy in the left kidney. This appears to be an unusual variant of polyarteritis nodosa limited to both main renal arteries.- - - - - - - - - - ranking = 0.066097973536766keywords = hypertension (Clic here for more details about this article) |
9/18. 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.- - - - - - - - - - ranking = 0.13219594707353keywords = hypertension (Clic here for more details about this article) |
10/18. Dopexamine hydrochloride, a novel drug with renal vasodilator properties: two case studies.Two patients who received an infusion of dopexamine hydrochloride are presented. The dopexamine infusion was associated with a useful increase in urine output. The mechanisms for these effects are discussed and the renovascular dilatation associated with dopexamine highlighted.- - - - - - - - - - ranking = 1keywords = renovascular (Clic here for more details about this article) |
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