Cases reported "Polyuria"

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1/3. Persistent post-transplant polyuria managed by bilateral native-kidney laparoscopic nephrectomy.

    polyuria is not considered an absolute indication for pre-transplant nephrectomy; however, it may complicate post-transplantation fluid management. Bilateral native-kidney laparoscopic nephrectomy was performed at our centre in two patients (four kidneys) 1 month after they had received a living related-donor renal transplant. The indication for nephrectomy was severe post-transplant polyuria secondary to the patient's underlying disease: juvenile nephronophthisis. Both patients had a persistent post-transplant daily urine output of 7-8 l/day and continued to have a variable serum creatinine level, dependent on intravenous hydration, more then 3 weeks after transplantation. Bilateral laparoscopic native-kidney nephrectomy in children has previously been reported. However, to the best of our knowledge, laparoscopic nephrectomy has not been described after kidney transplantation and certainly not in the immediate post-transplantation period. The procedure was well tolerated and did not affect renal graft function. In fact, following the procedure, serum creatinine levels stabilized, while daily fluid requirements decreased to 2.5-3.5 l/day in both patients. We concluded that bilateral native-kidney nephrectomy can be safely performed in paediatric renal transplant recipients in the immediate post-transplantation period. This new approach may allow preemptive transplantation and avoid the need for a transition period on dialysis in patients for whom pre-transplant nephrectomy is not absolutely indicated.
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2/3. Improvement of polyuria, bladder sensation and bladder capacity following renal transplantation.

    Here, we report a patient with renal failure and bladder dysfunction whose symptoms improved following renal transplantation. A 23-year-old woman underwent renal transplantation for renal failure as a result of dysplastic kidneys. Urodynamic evaluation prior to transplantation showed decreased bladder sensation and increased bladder capacity, probably because of congenital polyuria. One week after surgery, dry mouth disappeared, and urine volume normalized gradually. Urodynamic studies performed 3 and 10 months after transplantation showed improvement of bladder function, and the frequency/volume charts of urination also showed normalization of urine volume. Renal and bladder functions were almost normal 45 months after transplantation. Bladder dysfunction involves numerous factors, but the primary cause was probably congenital polyuria in the present case. This case suggested that blood purification and correction of urine volume by renal transplantation might lead to restoration of normal bladder function.
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3/3. Obstructive polyuric renal failure following renal transplantation.

    In a previously nephrectomized patient with a well functioning renal allograft, acute renal failure with massive polyuria and hypertension developed. Relief of a periureteric obstruction resulted in rapid correction of all three. Pathogenesis of hypotonic polyuria is thought to be a defect in the collecting duct permeability to water, stimulating nephrogenic diabetes insipidus. Normal urinary dilution and acidification suggest intact function of the ascending loop of henle and distal convoluted tubules. The quick reversal of polyuria and renal failure after obtaining relief of the obstruction suggest that both the decrease in the glomerular filtration rate and tubular dysfunctions are due to functional changes in the nephron rather than to organic damage, a possibility also borne out by the findings in a renal biopsy specimen showing normal glomeruli and intact tubular epithelial cells. Ureteric obstruction should be considered in any patient with renal failure and polyuria; it may be a correctable cause of hypertension.
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