1/15. pregnancy-induced hypertension complicated by postpartum renal failure and pancreatitis: a case report.Reported causes of pancreatitis in pregnancy include: gallstone disease, hyperlipidemia, alcohol ingestion, viral, and idiopathic. Few reports associate pancreatitis with pregnancy-induced hypertension. A 35-year-old women with pregnancy-induced hypertension and spontaneous rupture of membranes was admitted for induction of labor. Her postpartum course was complicated by acute renal failure that responded well to treatment with Lasix and Albumin. Subsequently, the patient developed acute pancreatitis and recovered following conservative treatment. It is possible that the pancreatic ischemia due to generalized vasoconstriction of preeclampsia and loop diuretics in the setting of oliguria with renal failure, had a synergistic effect on the pancreas. Therefore, we suggest that in postpartum women with pregnancy-induced hypertension and acute renal failure, diuretics should be cautiously used because they may increase the risk of pancreatitis.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/15. Oliguric acute renal failure in mycosis fungoides with lymphomatous infiltrates in the kidneys.OBJECTIVE: To present the clinical picture of acute renal failure in patients with mycosis fungoides (MF) and renal lymphomatous infiltrates. To analyze the pathogenesis of renal failure. methods: Correlation of clinical picture, urinary findings, imaging reports and autopsy findings in two patients with long-standing MF who died with renal failure. CASE SUMMARIES: Both subjects had sustained oliguria in the last 2 weeks. One patient had persistent hypotension, normal urinalysis, normal renal sonogram, and scarce interstitial lymphomatous infiltrates with preservation of renal parenchymal architecture. He was thought to have ischemic acute renal failure not directly linked to the lymphomatous infiltrates. The second patient developed hypertension one month prior to death, and had moderate proteinuria, hematuria, pyuria, grossly enlarged kidneys with hypoechoic masses, and extensive replacement of the renal parenchyma by lymphomatous infiltrates. This picture is typical of renal failure secondary to lymphomatous replacement of the kidneys. CONCLUSIONS: The development of oliguric renal failure in MF with renal lymphomatous infiltrates may have varying clinical and imaging manifestations and pathogeneses. Potentially reversible pathogenic mechanisms should be systematically investigated, particularly if the overall clinical picture is not characteristic of renal failure secondary to lymphomatous replacement of the parenchyma.- - - - - - - - - - ranking = 0.14285714285714keywords = hypertension (Clic here for more details about this article) |
3/15. Paradoxic activation of the renin-angiotensin system in twin-twin transfusion syndrome: an explanation for cardiovascular disturbances in the recipient.Despite advances in treatment, twin-to-twin transfusion syndrome (TTTS) still carries a high risk for perinatal mortality and morbidity. Simple blood transfer from the donor to the recipient twin cannot explain all of the features of this disease, in particular the recipient's hypertensive cardiomyopathy. We report a case in which TTTS resulted in preterm delivery with early neonatal death of both twins, allowing assessment of the renin angiotensin system (RAS) status of each fetus, both by cord blood renin and aldosterone assay and by renal immunohistochemistry. The donor had severe oliguria/oligohydramnios, whereas the recipient, in addition to severe polyuria/polyhydramnios, had cardiomyopathy, atrioventricular regurgitation, and ascites. Although immunohistochemistry demonstrated that renal secretion of renin was up-regulated in the donor and down-regulated in the recipient, cord blood levels of renin and aldosterone were similar, with high renin levels in both twins. This observation supports the hypothesis that despite renal RAS down-regulation, the recipient is exposed to RAS effectors elaborated in the donor and transferred via placental shunts. This may contribute to cardiomyopathy and hypertension in the recipient, which cannot be accounted for by hypervolemia alone. We thus hypothesized that in TTTS, the recipient's hypertensive cardiomyopathy could be due to a mechanism similar to the classical model of hypertension referred to as "2 kidneys-1 clip." Thus the hypovolemic donor twin, comparable to the clipped kidney, produces vasoactive hormones that compromise the recipient, comparable to the normal kidney, causing hypertension and cardiomyopathy.- - - - - - - - - - ranking = 0.42857142857143keywords = hypertension (Clic here for more details about this article) |
4/15. methyldopa, intravascular haemolysis and renal disease. A case report.A 74-year-old man, who was receiving methyldopa to control systemic hypertension, presented to hospital in biventricular cardiac failure. He was found to be severely anaemic and jaundiced as a result of acute intravascular haemolysis with prominent haemoglobinuria. The cardiac failure and anaemia were initially refractory to fluid restriction and diuretics, but responded to red cell transfusion. Renal failure supervened, probably on the basis of hypoperfusion as a consequence of diuresis and hypotension. The patient died suddenly, possibly from myocardial infarction. Acute intravascular destruction of red cells in association with methyldopa appears not to have been previously reported.- - - - - - - - - - ranking = 0.14285714285714keywords = hypertension (Clic here for more details about this article) |
5/15. 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 = 0.85714285714286keywords = hypertension (Clic here for more details about this article) |
6/15. Neurologic complications of captopril treatment of neonatal hypertension.The occurrence of neurologic abnormalities is described in a series of nine infants with chronic hypertension, in whom antihypertensive therapy decreased BP markedly and for a prolonged period, although to levels often within the normal range. All infants had mean systolic BPs greater than 113 mm Hg and elevated renin values to a mean of 134 /- 128 ng/mL/h. Antihypertensive therapy, such as captopril, an inhibitor of angiotensin i-converting enzyme, consistently lowered the systolic BP by 20% from baseline per dose. However, the nine infants exhibited a total of 17 episodes of striking decreases in systolic BP of greater than 40% from baseline; the markedly decreased systolic BP values were usually within the normal range for corrected age. Seven of the 17 episodes were characterized by marked decrease in systolic BP, ie, decreased by 57% /- 10%, and were prolonged, ie, remained at the lower values for 17 /- 6 hours despite therapeutic interventions. These seven episodes were accompanied by oliguria (urine output less than 1 mL/kg/h) and neurologic abnormalities (ie, seizures). In the remaining ten episodes, the systolic BP decreased by 50% /- 8%, but the decreases were relatively brief, ie, remained at the lower values for 2.8 /- 2 hours. These briefer episodes were not accompanied by renal or neurologic signs. These data indicate a particular vulnerability of the cerebral and renal circulation in premature infants with chronic hypertension to decreases in systolic BP to levels that would otherwise be considered in the normal range. The findings suggest that adaptive responses in both cerebral and renal blood flow are altered by chronic hypertension in such infants.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
7/15. 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 = 0.29633980806073keywords = renovascular (Clic here for more details about this article) |
8/15. The use of urinary diagnostic indices in pre-eclampsia-associated oliguria.A case is presented of severe pregnancy-induced hypertension that was complicated by oliguria and managed with the aid of a pulmonary artery catheter. This case illustrates that urinary diagnostic indices may be unreliable in predicting the etiology of oliguria. Although urinary diagnostic tests are advocated routinely as reliable in the nonobstetric literature, possible misinterpretation of these values in severe pre-eclampsia with oliguria may require confirmation with hemodynamic data obtained from a pulmonary artery catheter.- - - - - - - - - - ranking = 0.14285714285714keywords = hypertension (Clic here for more details about this article) |
9/15. Nonoliguric acute renal failure after captopril therapy.In a patient with severe renovascular hypertension, nonoliguric acute renal failure developed after she received captopril treatment. We believe this to be a previously unreported complication. urine volume ranged from 1,640 to 2,260 mL/24 hr, and serum creatinine level rose from 2.3 to 8.3 mg/dL. There was no evidence of renal hypoperfusion or interstitial nephritis. Acute renal failure most likely was secondary to the nephrotoxic effect of captopril on chronically hypoperfused kidneys. Renal function improved rapidly after withdrawal of the drug therapy.- - - - - - - - - - ranking = 0.43919695091788keywords = renovascular, hypertension (Clic here for more details about this article) |
10/15. minoxidil treatment of malignant hypertension. Recovery of renal function.We treated eight severely hypertensive, long-term hemodialysis patients who failed to respond to ultrafiltration or conventional medication with minoxidil rather than with bilateral nephrectomy. Control of blood pressure and relief of symptoms was achieved in all eight. In addition, three of the patients, who were all severely oliguric, recovered sufficient renal function to allow the discontinuation of dialysis. Two are presently doing well, while one died of causes unrelated to uremia or minoxidil therapy. We presently reserve bilateral nephrectomy for those hypertensive dialysis patients who are awaiting transplantation.- - - - - - - - - - ranking = 0.57142857142857keywords = hypertension (Clic here for more details about this article) |
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