Cases reported "anuria"

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1/202. Unilateral renal agenesis presenting as anuria.

    The most common cause of sudden and total cessation of urine output is obstructive uropathy, usually at the bladder outlet. Bilateral ureteral obstruction is a much less common cause of anuria. In additioh, unilateral obstruction in the presence of a solitary kidney must be considered in the differential diagnosis. Primary renal parenchymal disorders and pre-renal azotemia occasionally may be anuric but more commonly are oliguric. A case of unilateral renal agenesis presenting as anuria and obstruction of the solitary kidney is described. ( info)

2/202. Renal aspergillosis giving rise to obstructive uropathy and recurrent anuric renal failure.

    A sixty-year-old previously healthy male patient presented with anuric renal failure of sudden onset. He was detected to have aspergillus fumigatus fungal balls in the renal pelvis, ureters and bladder which were removed and his renal function improved. He was treated with itraconazole and sent home. Three weeks later he again presented with anuria and renal failure. He had recurrence of the obstruction with the same fungus. The fungal ball was removed, a double 'J' stenting was performed and he was treated with amphotericin b and itraconazole. Hence we report a previously healthy patient with no evidence of immunosuppression presenting an obstructive anuric renal failure due to isolated renal aspergillosis. ( info)

3/202. Stenturia: An unusual manifestation of spontaneous ureteral stent fragmentation.

    Two patients presented with passage of worm-like stent fragments in the urine. The first had undergone attempted percutaneous removal of left renal calculus and ureteral stenting 4 months prior to presentation. The second had left-sided stent placement for obstructive anuria on account of bilateral renal calculi 3 months earlier. The stents had fragmented into multiple pieces over a mean indwelling time of only 3.5 months. Apart from calculus disease, both patients had documented urinary tract infection. Stent fragmentation is a relatively rare (0.3%) but major complication. However, spontaneous excretion of these fragments has not been hitherto reported. These cases of rapid stent disintegration highlight the need for closer monitoring of the indwelling stents, especially in patients with calculus disease and associated persistent infection. In such patients the stent should probably be changed within 3 months. ( info)

4/202. Moral and ethical dilemmas in critically ill newborns: a 20-year follow-up survey of massachusetts pediatricians.

    OBJECTIVE: To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates. STUDY DESIGN: A long-term follow-up survey of American Academy of pediatrics massachusetts membership, maintaining the 1987 instrument, was initiated. RESULTS: A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians' attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making. CONCLUSION: This study indicates stability and consensus in pediatricians' attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy. ( info)

5/202. Iliac arteriovenous fistula secondary to iliac aneurysm rupture associated with pulmonary embolism and anuria.

    We present a case of iliac aneurysm rupture that started with high-output cardiac failure and anuria and later presented as a pulmonary embolism that needed a preoperatory filter for the cava vein. ( info)

6/202. Bilateral percutaneous nephrolithotomy for multiple cystine stones in an infant presenting with anuria.

    We report the first case of simultaneous, bilateral percutaneous management of multiple urinary cystine stones in a 7.6-kg, 9-month-old infant who presented with anuria. A stone-free state was successfully achieved. ( info)

7/202. central nervous system involvement in a child with hemolytic uremic syndrome.

    We report a 20-month-old girl with postdiarrheal (shiga toxin) hemolytic uremic syndrome and severe encephalopathy. Magnetic resonance (MR) images were obtained in the acute phase of the disease and after 10 months. The first MR images showed widespread high signal intensity on T2-weighted and low signal intensity on T1-weighted images, in deep and subcortical white matter; the splenium of the corpus callosum was also involved, as well as cerebellar hemispheres. Neurological symptoms and signs gradually disappeared within 35 days. Follow-up MR imaging showed almost complete resolution of the previous findings, and the patient recovered without central nervous system impairment. The neurological lesions were probably due to hypoxia, although several other mechanisms could be involved, such as metabolic derangements and the action of shiga toxin. In spite of the dramatic clinical manifestations, we observed a good outcome, indicating that patients with similar lesions do not necessarily have a poor prognosis. ( info)

8/202. lesch-nyhan syndrome presenting as acute renal failure secondary to obstructive uropathy.

    lesch-nyhan syndrome is a rare genetic disorder characterized by mental retardation, self-mutilation, choreoathetosis, and hyperuricemia. The disease is caused by a mutation in the hypoxanthine-guanine phosphoribosyltransferase gene and is transmitted as a sex-linked recessive disorder. Since hyperuricemia is the primary metabolic problem caused by a hypoxanthine-guanine phosphoribosyltransferase mutation, urologic evaluation and treatment is often necessary for children with this disease. We report a 3-year-old boy who presented with anuric renal failure secondary to bilateral obstructing uric acid calculi. The evaluation of T lymphocytes revealed a hypoxanthine-guanine phosphoribosyltransferase mutation consistent with lesch-nyhan syndrome. The diagnosis and urologic management of this disorder is discussed. ( info)

9/202. 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. ( info)

10/202. Acute bilateral renal cortical necrosis as a cause of postoperative renal failure.

    Acute renal failure after a major intra-abdominal operation is, unfortunately, not an infrequent occurrence. Acute tubular necrosis, the most common cause of postoperative renal failure, usually follows a predictable clinical course, with most patients recovering full renal function. We describe a patient who developed acute renal failure after orthotopic liver transplantation. Subsequent workup revealed the patient to have acute bilateral renal cortical necrosis. Bilateral renal cortical necrosis is an extremely rare cause of renal failure and an even rarer cause of postoperative renal failure. We discuss the diagnosis and management of this uncommon disorder and review the salient literature. Of the approximately 15 known reported cases involving native kidneys after a major nonobstetric abdominal operation in the world literature, we believe this is the first to be related to an orthotopic organ transplant. ( info)
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