11/14. Reversible renal failure in malignant hypertension.Acute renal failure requiring dialysis to sustain life may be due to malignant hypertension. If the blood pressure is controlled during a period of dialysis, then it is possible that the renal lesions may heal, with some recovery of renal function. This report describes eight patients with acute renal failure due to malignant hypertension who required temporary dialysis. In all eight cases adequate control of blood pressure was achieved and all recovered renal function such that dialysis could be discontinued. The longest period of follow-up was five years, and one patient achieved a creatinine clearance of 23 ml/min. Renal histology, available in five cases, showed changes of malignant hypertension only, with no evidence of other renal lesions. A review of the literature is presented and the potentially reversible nature of acute oliguric renal failure due to malignant hypertension is emphasized.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
12/14. Postresuscitative hypertension: a reappraisal.New concepts of cause and therapy for postresuscitative hypertension (PRH) were evaluated in four patients with PRH. Each patient had severe injury and shock, and received an average of 28.3 transfusions, 15.4 L of electrolyte solution, and 1.4 L of plasma by the end of surgery for control of bleeding. Near the end of the sequestration phase, PRH developed. In two patients, PRH (190/100 mm Hg and 180/90 mm Hg) responded to previously recommended therapy; blood pressure fell to about 135/90 mm Hg. Shortly thereafter, bradycardia developed and both patients died. In the latter two patients, PRH (205/115 mm Hg and 150/120 mmHg) was treated less aggressively, maintaining intravenous fluids to keep urine output at a minimum of 50 mL/hr. Postresuscitative hypertension persisted for five and six days as both patients improved, continued to mobilize sequestered fluid, and maintained good organ perfusion. Postresuscitative hypertension may be a cell-mediated protective response to a need for increased capillary hydrostatic pressure to facilitate mitochondrial oxygenation. Fluid replacement should be guided by careful monitoring of cardiac, pulmonary, and renal function.- - - - - - - - - - ranking = 0.875keywords = hypertension (Clic here for more details about this article) |
13/14. Successful renal autotransplantation for renal failure with prolonged oliguria in a Jehovah's Witness with fibromuscular dysplasia of the renal arteries.A young female presented with hypertension and oliguric renal insufficiency caused by fibromuscular dysplasia of the renal arteries. There was a left kidney remnant and a normal-sized right kidney with a retrograde blood supply through capsular arteries. Reconstruction of the occluded right renal artery with autotransplantation of the kidney after 60 days of oliguric renal insufficiency was followed by complete functional repair. erythropoietin treatment was a great help in the management of this patient who refused blood transfusions because she was a Jehovah's Witness.- - - - - - - - - - ranking = 0.125keywords = hypertension (Clic here for more details about this article) |
14/14. Bilateral renal artery stenosis causing acute oliguric renal failure. Report of a case corrected by renovascular surgery.A 70-year-old woman with chronic hypertension and previously normal renal function had acute oliguric renal failure requiring hemodialysis. Renal arteriograms revealed the presence of bilateral renal artery stenosis and normal-sized kidneys. Nineteen days after admission to hospital, after undergoing nine hemodialysis procedures, surgical revascularization of renal artery stenosis was performed utilizing a single bypass graft of the left renal artery. Postoperatively, an immediate diuresis ensued, with resolution of acute renal failure. It is critically important in the evaluation of patients with anuria, acute renal failure without obvious cause, or impending uremia in patients with chronic stable renal insufficiency, to consider the possibility of renal artery stenosis or thrombosis. Recognition and then surgical correction of significant renal arterial hypoperfusion allows the reasonable potential for reversibility of this important form of acute or progressive renal failure.- - - - - - - - - - ranking = 0.125keywords = hypertension (Clic here for more details about this article) |
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