Cases reported "Hypertension, Renal"

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1/418. Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis.

    Eleven patients with transient paralytic attacks of obscure nature are described. paralysis could involve face or leg alone, face and hand, or face, arm and leg. The duration varied from two minutes to one day. Four patients had brain tumors, six probably had brain infarcts, and one a degenerative process. The differential diagnosis included TIAs, migraine accompaniments, and seizures. In the absence of good evidence for the first two, the cases are discussed from the standpoint of possibly representing nonconvulsive seizure paralysis (ictal paralysis, inhibitory seizure paralysis or somatic inhibitory seizure). Because of the difficulty in defining seizures as well as TIAs and migraine in their atypical variations, a firm conclusion concerning the mechanisms of the spells was not attained. Two cases of the hypertensive amaurosis-seizure syndrome have been added as further examples of ictal deficits. ( info)

2/418. Solitary renal cyst, hypertension and renin.

    Solitary renal cysts may cause renin hypersecretion with associated hypertension by compressing surrounding tissue and by distortion of renal vessels. Selective measurements of plasma renin activity in the renal veins can predict the antihypertensive effect of decompression. An illustrative case is presented and its significance is discussed. ( info)

3/418. effect of kidney resection on blood pressure and plasma renin activity. Case report and clinical study.

    Acute transient hypertension following kidney trauma occurred in a 17-year-old youth due to increased activity of the renin/angiotensin system. The systemic blood pressure and plasma renin activity was also studied following elective kidney resection. In one group of patients the operation was performed with clamping of the renal vessels; in the other no clamping was performed. Only minimal changes in blood pressure and plasma renin activity was found in both groups. ( info)

4/418. Angioplasic surgery for renal artery aneurysm in pediatric hypertension.

    Aneurysmectomy and renal angioplasty were performed on a 14-year-old Japanese male and the blood pressure was within normal values 3 years after this surgery. Measurement of renal blood flow was facilitated by using 133Xe washout technique. This incidence is the eighth such case to be reported from japan. ( info)

5/418. Possible induction of renal dysfunction in patients with lecithin:cholesterol acyltransferase deficiency by oxidized phosphatidylcholine in glomeruli.

    To clarify the causes of renal dysfunction in familial lecithin:cholesterol acyltransferase (LCAT) deficiency, kidney samples from 4 patients with LCAT deficiency (3 homozygotes and 1 heterozygote) were examined immunohistochemically. All of the patients exhibited corneal opacities, anemia, renal dysfunction, deficiencies in plasma high density lipoprotein and LCAT activity and mass, and an increase in the ratio of plasma unesterified cholesterol to esterified cholesterol. Renal lesions began with the deposition of lipidlike structures in the glomerular basement membrane, and these structures accumulated in the mesangium and capillary subendothelium. By electron microscopy, 2 types of distinctive structure were found in glomerular lesions: vacuole structures and cross-striated, membranelike structures. The plasma oxidized phosphatidylcholine (oxPC) -modified low density lipoprotein (LDL) levels in LCAT-deficient subjects were significantly (P<0.01) higher than those in controls (1.30 /-0.82 versus 0.42 /-0.32 ng/5 microg LDL, respectively), and a significant (P<0.01) difference was observed even after adjustment for confounding factors by an analysis of covariance. The patient with the highest plasma oxPC-modified LDL had the most membranelike structures in the glomeruli and showed the greatest renal deterioration from a young age. In glomerular lesions, although there was an abundance of apoB and apoE, oil red O-positive lipids, macrophages, apoA1, and malondialdehyde were scarce. OxPC was found extracellularly in glomerular lesions, and although its distribution differed from that of apolipoproteins, it was quite similar to that of phospholipids. In conclusion, these results indicate that oxPC in plasma and glomeruli is distinctive for patients with LCAT deficiency. Therefore, oxPC may be a factor in the deterioration of kidneys in patients with familial LCAT deficiency. ( info)

6/418. The Ask-Upmark kidney: a form of ascending pyelonephritis?

    The case is presented of a young girl with recurrent urinary tract infection and vesico-ureteric reflux who developed a small scarred kidney and subsequently, hypertension. Pathologically, the renal changes were compatible with those of an Ask-Upmark kidney. The pathogenesis of the Ask-Upmark kidney is discussed. It is postulated that the lesion is not necessarily of congenital origin but may well be related to infection and intrarenal reflux, it is concluded that long-term follow-up of a young patient with a scarred kidney is indicated. ( info)

7/418. Ask-Upmark kidney associated with renal and extrarenal arterial aneurysms.

    Reports of Ask-Upmark kidney, initially described as a congenital defect in renal development, are uncommon. We report a case with the features of bilateral asymmetrical segmental atrophy in a patient with childhood-onset hypertension. As an adult, she developed cerebral, celiac, and renal artery aneurysms. She underwent successful clipping of the cerebral aneurysm and renal artery repair with preservation of renal function. Novel radiologic techniques make possible the noninvasive diagnosis of segmental atrophy and its complications. ( info)

8/418. Measurement of plasma renin concentration and angiotensin ii in peripheral and renal venous plasma in the management of renovascular hypertension.

    Athough in general, measurement of renal vein renin appears to give a good prediction as to the subsequent response to surgery, its main value lies in its ability to reflect changes in renal plasma flow; true changes in renin secretion rate being much more difficult to detect. Although it is a little early to say how much information can be derived from saralasin infusions, caution must be exercised in necessarily assuming that the test accurately reflects subsequent surgical response. ( info)

9/418. Interventions in renal scintirenography.

    Nuclear nephrourology continues to develop and expand on traditional provocative physiological maneuvers, such as diuretic and captopril renography. In addition, newer interventions are conceived, such as aspirin renography, which test new and fascinating aspects of renal functional reserve. Since the last review of this topic in 1991, nephrourologic nuclear medicine has made considerable progress in diverse ways. captopril and diuresis renography have made strides in establishing greater consensus of interpretation and procedure. Commonplace aspirin, the ubiquitous wonder drug, has revealed an unexpected role in renography by way of its inhibition of prostaglandin E2. Finally, further investigations of exercise renography in essential hypertension have deepened the plausibility of a renal role in the etiology of perhaps 50% of affected individuals. ( info)

10/418. angioedema due to losartan.

    OBJECTIVE: To report a case of angioedema associated with the angiotensin ii receptor antagonist losartan. CASE SUMMARY: A 62-year-old African-American woman was admitted to the hospital for acute renal failure and uncontrolled hypertension. After attempting blood pressure control with three different agents, captopril was combined with metoprolol. The patient noted swelling of the lips combined with shortness of breath after four days of captopril. losartan was substituted for captopril, which then produced similar swelling of the lips (without shortness of breath) after only one dose. These symptoms resolved after discontinuation of losartan and administration of antihistamines. DISCUSSION: losartan, like other angiotensin ii receptor antagonists, blocks the action of angiotensin ii at the receptor level. Five published case reports involved patients with a prior history of intolerance to the angiotensin-converting enzyme inhibitors. Two published case reports of similar reactions also occurred in patients with renal compromise. The mechanism for this reaction from losartan is not known, but may not be due to bradykinin excess. CONCLUSIONS: Clinicians should be aware that angiotensin receptor antagonists may not be safe alternatives in patients who have a history of angioedema secondary to the angiotensin-converting enzyme inhibitors. ( info)
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