Cases reported "Polycythemia"

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11/26. Polycythemia of end-stage renal failure: no inhibition of erythropoiesis by uremic serum and markedly increased serum erythropoietin level.

    This report describes the case of a 50-year-old male with end-stage renal failure accompanied with congenital heart disease and polycythemia. After he had received continuous ambulatory peritoneal dialysis for 1 year, he still remained polycythemic and his serum erythropoietin titer, assayed using fetal mouse liver cells, was markedly increased. An inhibitory effect on erythropoiesis was not detected by this method. bone marrow examination showed erythroid hyperplasia. These phenomena could be explained by an overproduction of erythropoietin by the remnant kidneys or extrarenal organs, such as the liver, in response to persisting hypoxia. The patient's bone marrow was still responsive to erythropoietin.
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12/26. Spurious polycythemia and renal malignancy.

    We have described a 19-year-old woman with polycythemia. Based on a normal red cell mass and decreased plasma volume, spurious polycythemia was diagnosed. CT scan of the abdomen revealed a 4 cm mass in the right kidney. Upon right nephrectomy, the mass was found to be an unusual neoplasm of the renal tubular epithelium. Four weeks postoperatively, both the hemoglobin and hematocrit values were normal.
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13/26. Cardial decompensation caused by hypertension and polyglobulia associated with multiple renal oncocytomas.

    A 43 year old man was referred to the Internal Department for the examination of cardial decompensation, hypertension, polyglobulia and atrophy blanche of the lower legs. Clinical and supersonic examination revealed two tumors in the left kidney (diameter 8 and 3.5 cm) and some small tumors in the right kidney. Laboratory studies disclosed erythropoietin levels up to 170 mU/ml (standard 14-61 mU/ml) and a red blood cell count of up to 8 X 10(6)/ml. After recompensation, a radical left nephrectomy and the removal of three small tumors of the right kidney four weeks later was initiated. Postoperative erythropoietin levels and red blood cell count sank to the normal range leading to the reduction of antihypertensive therapy. The clinical course indicates a strong etiological connection between hypertension as well as polyglobulia with the multiple bilateral oncocytomas. Polycythemia also led to the atrophy blanche which had resulted from disturbances of microcirculation.
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14/26. Focal glomerulosclerosis and erythrocytosis.

    A 22-year-old black male presented with erythrocytosis and proteinuria. The erythrocytosis was characterized by increased red cell mass, normal arterial oxygen saturation, and normal hemoglobin electrophoresis and oxygen affinity. There was no splenomegaly, and the white blood cell count, platelet count, serum uric acid concentration, serum B12 levels and leukocyte alkaline phosphatase activity were normal. Tumors of the liver, lung, kidney and cerebellum, which have been associated with erythrocytosis, were not found. The only associated disease was biopsy proven focal glomerulosclerosis. Renal vein thrombosis was excluded by renal venography and arteriography. This case illustrates the rarely reported association of the nephrotic syndrome and erythrocytosis. Other nephrogenic causes of erythrocytosis are mentioned, including renal cysts, tumors, renal artery stenosis and transplantation. The role of the kidney in erythropoietin production and possible mechanisms of nephrogenic erythrocytosis are discussed.
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15/26. hydronephrosis and polycythemia.

    Polycythemia is consistently produced in animals undergoing experimental hydronephrosis. This hematologic response is thought to be mediated by a microcirculatory insult and a more accelerated elaboration of erythropoietin by the hydronephrotic kidney. While an association between hydronephrosis and polycythemia has been reported in humans, it is a relatively rare event. Further studies are necessary to explain why this should be so, as well as to confirm that the polycythemia in humans is secondary to an increased production of erythropoietin.
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16/26. Erythrocytosis after renal allotransplantation: treatment by removal of the native kidneys.

    A patient with end-stage renal disease had erythrocytosis after kidney transplantation, with a hematocrit level that ranged between 52 and 60%. Selective catheterization of venous blood from his native kidneys and the transplanted kidney revealed a threefold increase of erythropoietin activity in blood from his own kidney over systemic blood and blood from the transplanted kidney. Bilateral nephrectomy cured the condition. Postoperative hematocrit and erythropoietin levels were within normal limits.
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17/26. Hyperreninemia, lysozymuria, and erythrocytosis in fanconi syndrome with medullary cystic kidney.

    adult onset fanconi syndrome with medullary cystic kidney was diagnosed in a 30-year-old male with muscular weakness, hypokalemia, normal BP, hyperreninemia, and secondary aldosteronism. He also had non-specific aminoaciduria, lysozymuria, and beta 2-microglobulinuria. Urinary concentrating and acidifying capacity was impaired, and both sodium and potassium were lost into the urine. I.v. pyelography revealed medullary cystic kidney. Renal biopsy showed juxtaglomerular hyperplasia, heavy subintimal deposits and C3 and IgG in preglomerular arteriolar walls, and degenerative changes in the tubules, including loss of brush border and "macula densa-like" lesions. Polycythemia with elevated serum erythropoietin levels, and raised blood ACTH values with features of cortisolism were also present. indomethacin therapy decreased plasma renin activity (PRA), plasma aldosterone, and urinary loss of potassium and sodium, while serum potassium approached normal levels. metoprolol, a beta-adrenergic blocking agent, caused similar effects. Insensitivity to the pressor effect of angiotensin ii was reversed by indomethacin treatment. somatostatin infusion lowered PRA and aldosterone without affecting BP. Several biochemical aberrations of this patient resemble Bartter's syndrome, including the effect of indomethacin.
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18/26. Erythrocytosis in patients on long-term hemodialysis.

    Erythrocytosis was seen in two men during maintenance hemodialysis therapy for end-stage renal disease secondary to apparent chronic glomerulonephritis. Nonrenal causes of erythrocytosis such as polycythemia vera, chronic hypoxemia, high-oxygen affinity hemoglobin, and hepatoma were excluded by appropriate clinical studies. A computed tomographic scan of the abdomen showed numerous renal cysts in each patient consistent with acquired cystic disease of end-stage kidneys. Peripheral serum erythropoietin levels were elevated as measured by sensitive radioimmunoassay. The findings suggest that the erythrocytosis is caused by an erythropoietic mechanism related to the diseased kidneys. A review of the literature failed to show previous reports of this clinical association.
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19/26. A case of intrarenal artery stenosis associated with erythrocytosis.

    A case of erythrocytosis with increased plasma erythropoietin level was reported. Peripheral leucocytes and thrombocytes were normal. No splenomegaly was detected. Studies to find underlying disorders causing increased plasma erythropoietin level and erythrocytosis revealed no abnormalities except for the thickened and tortuous interlobular and afferent arteries in the kidney. This change was suggested as the cause of erythrocytosis found in this case.
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20/26. Reversible erythrocytosis in a patient with a hydronephrotic horseshoe kidney.

    A 33-year-old man with dystrophia myotonica presented with erythrocytosis and an increased plasma erythropoietin concentration. Investigations showed a horseshoe kidney, one moiety of which was grossly hydronephrotic. Fluid aspirated from the latter had a similar erythropoietin concentration to that in plasma. Following partial nephrectomy, the hematocrit and plasma erythropoietin concentration returned to normal.
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