Acute renal failure in pregnancy

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.     

Acute renal failure secondary to acute pyelonephritis

A six year-old girl presented with acute oliguric renal failure, secondary to acute, non-obstructive pyelonephritis. Evidence for pyelonephritis as the cause of renal failure included: the evolution of typical changes on serial intravenous pyelograms, an acute interstitial inflammatory exudate on percutaneous renal biopsy, and gram-positive cocci on gram stain of the biopsy tissue. Although a specific causative organism was not conclusively identified, enterococcus was isolated from the initial catheterized urine specimen. The patient recovered from the acute illness but was left with impaired renal function, hypertension, and cortical scarring. Acute, non-obstructive pyelonephritis can produce acute renal failure in children and must be considered in the differential diagnosis of this syndrome.     

Acute renal failure due to oxalate ingestion

Analysis of the infiltrant tumours of the bladder diagnosed in our service between 1986-1996 both inclusive, with associated tumour of the upper tract during its evolution. From a total of 262 infiltrant transitional tumours of the bladder and 52 transitional tumours of the upper urinary tract, 8 patients were found to have both types of tumours in association, which accounted for 3.05% of all infiltrant vesical tumours. Mean age of our patients, all male, was 65. The pathological anatomy of the upper tract tumours was: 4 pT1 and 4 pT3. 75% presented relapsing tumours of the bladder, 50% had a background of bladder Cys, 87.5% were multifocal vesical tumours and 100% were larger than 3 cm. In addition, 62% cases were ipsilateral to the tumours of the upper urinary tract. It can therefore be concluded that for tumours of the bladder, multifocality, relapse, presence of vesical Cys and tumour size, are all concurring features when association of these two types of tumours occurs.     

Hyperleptinemia in chronic renal failure

To investigate the mechanism(s) of degradation of leptin, the protein product of ob (obese) gene, we measured serum leptin levels in 70 patients with chronic renal failure (CRF). The median of serum leptin concentrations of 36 male and 34 female patients with CRF were 7.3 ng/ml ranging from 0.5 to 39.0 ng/ml and 34.9 ng/ml from 1.1 to 76.1 ng/ml, respectively, while those of 29 male and 29 female healthy subjects were 5.8 ng/ml ranging from 0.5 to 37.7 ng/ml and 12.0 ng/ml from 2.0 to 45.2 ng/ml, respectively. The difference in male and female serum leptin concentrations between CRF group and the normal counterpart was statistically significant (p<0.005 and p<0.05, respectively). However, there was no significant correlation, either between serum creatinine or BUN, and serum leptin concentrations. These findings suggest that leptin is degraded and/or filtered in renal tissue.     

Acute renal failure in theophylline poisoning

A 57-yr-old woman with an intentional theophylline overdose complicated by rhabdomyolysis, renal failure and microangiopathic haemolytic anaemia is reported. Severe renal vasoconstriction, myoglobinuria and antagonism of adenosine are considered to be the principal pathophysiological renal mechanisms involved.     

Acute effect of calcitonin on rat renal electrolyte transport

Renal clearance studies were performed on parathyroid-intact and acutely thyroparathyroidectomized (TPTX) rats to clarify calcitonin (CT) action on renal electrolyte transport. Although CT (0.15 U x 100 g body wt-1 x h-1) reduced fractional excretion of calcium and magnesium by 72 and 46%, respectively, in TPTX rats without altering sodium and phosphate excretion, a 10-fold increase in CT (1.5 U) caused a smaller reduction in calcium and magnesium excretion and significantly increased sodium and phosphate excretion. A higher CT dose (15 U) did not alter calcium excretion, increased magnesium excretion, and caused an even greater increase in sodium and phosphate excretion. Results in parathyroid-intact animals were similar. Despite the fall in plasma calcium following CT administration, the filtered calcium load was unaltered due to a concomitant increase in glomerular filtration rate. Calcium infusion prior to CT (0.15 U) prevented a detectable fall in plasma calcium concentration. However, a 45% fall in fractional calcium excretion occurred despite the significant increase in filtered calcium. These data suggest that the physiological role of calcitonin on the nephron is to conserve calcium. Reports of increased electrolyte excretion presumably reflect a depressant effect of pharmacological doses of CT on nephron function.     

The electroretinogram in chronic renal failure

Fifty-nine enterococci isolated from 18 patients in an intensive care unit (ICU) and 21 patients in general wards (GW) at Royal Perth Hospital (RPH) during a period of 14 months were examined for antibiotic resistance by susceptibility testing and DNA polymorphism by pulsed-field gel electrophoresis. The study showed that penicillin-resistant Enterococcus faecium is a common nosocomial isolate in ICU. The DNA patterns of various strains of E. faecium and E. faecalis were closely related in most consecutive isolates from the same patients but were generally different for isolates from different patients. Thirty two different DNA patterns were identified for 59 isolates from 39 patients. Identical or similar DNA patterns were also identified for some isolates from different patients, suggesting that cross-infection had occurred between patients in ICU and GW. These data suggest that cross-infection occurred more commonly in ICU than in GW and are consistent with the known higher risk of ICU patients for nosocomial infection.     

Estrogen-stimulated neurophysin in chronic renal failure

Estrogen-stimulated neurophysin (ESN) was determined by radioimmunoassay in three groups of patients with chronic renal failure: predialysis patients, patients on hemodialysis and patients on continuous ambulatory peritoneal dialysis. ESN levels were significantly elevated in all patients. ESN of these patients is undistinguishable from highly purified pituitary ESN. Immunological and physicochemical analyses of ESN in patients with renal failure suggest that the elevated plasma level is due to a failure of renal clearance. In addition, heterogeneity of urinary ESN, revealed by multiple immunoreactive peaks after gel filtration, indicates altered renal metabolism.     

Glucose intolerance in chronic renal failure

It has been recognized that glucose intolerance is a common finding in patients with chronic renal failure (CRF). Insulin resistance and impaired insulin secretion contribute to the pathogenesis of glucose intolerance. The resistance to insulin action is commonly observed in chronic renal failure and mainly due to impaired glucose uptake by muscle. In contrast, insulin secretion in response to hyperglycemia is variable: increased, decreased and normal. Recent studies reported that high PTH levels impaired insulin secretion from pancreatic islets. In this review, we mention the mechanism of glucose intolerance in chronic renal failure.     

Acute renal failure in open heart surgery

A case-control study was performed to establish possible risk factors for acute renal failure (ARF) and mortality in patients undergoing cardiac surgery. A consecutive series of 704 patients were included in the study. A randomized sample of 255 patients was taken to analyze risk factors for ARF and mortality. Incidence of acute renal failure was 3.8% (27/704). Low cardiac output (LCO) was observed in all patients who developed ARF and in 72/255 without ARF (p < 0.0005). When LCO was isolated, no difference was found between groups. Association to prolonged perfusion time and sepsis increased the probability of developing ARF: 5/27 versus 0/255, p < 0.001; and 9/27 versus 0/255, p < 0.001, respectively. Overall mortality was 7.2% (51/704). Significant difference was found between ARF (55.6%, 15/27) and non-ARF patients (5.4%, 36/704), p < 0.005. Neither age nor sex was associated to outcome. Nonsurvivor patients were more oliguric (11/15 vs. 0/12, p < 0.005), required dialysis more frequently (7/15 vs. 0/12, p < 0.005), and were complicated with sepsis more often (9/15 vs. 0/12, p < 0.005), compared to survivors. We concluded that ARF was an uncommon complication in this group of patients, but mortality rate was dramatically high. This study identified LCO associated to prolonged perfusion time and sepsis as risk factors for ARF. Severity of ARF (oliguric forms and dialysis requirement) and postoperative events (sepsis) were associated with mortality.     

Acute renal failure in Kuwait--a prospective study

This prospective study was conducted over a period of 18 months (February 1989 to July 1990) in the State of Kuwait. It covered a population of 1,024,211 and eight multidisciplinary hospitals with an in-patient admission of 118,079 per year. Two hundred and twenty-six adult patients with acute renal failure (ARF) were seen and followed up by nephrologists. This made the calculated annual incidence of ARF 14.7 per 100,000 population, nearly five times that reported by the EDTA registry (Biesenbach et al. 1991). Drugs, sepsis and volume depletion were the most frequent causes, with sepsis resulting in 36% cause specific mortality compared to zero mortality with the other two. The overall mortality rate was only 14% which clearly indicated a markedly improved prognosis in cases of ARF. The prognosis in ARF depended on two major factors, viz. the type of aetiological insult and the presence of predisposing associated medical illnesses. Multiple insults, though common, do not affect the mortality rate. Secondary sepsis or gastrointestinal bleeding as a cause of death in ARF was rarely seen in our study. Those who required dialytic support for renal failure had a 45% patient mortality rate in general. Over 40% of our patients were 60 years or older compared with only 3.5% in the local population. This indicated old age as a major risk factor in the development of ARF. The overall mortality in the elderly did not differ from that in the young, but sepsis in the elderly carried a mortality rate of 60% compared to only 14.8% in the younger age group.     

Serum lipids in chronic renal failure

The serum lipids and lipoprotein patterns in 100 adult patients with nonnephrotic chronic renal failure were analyzed retrospectively. Hypertriglyceridemia was found in 43% of these patients. Forty-nine of the 100 had a normal lipoprotein pattern, whereas 42 had type IV hyperlipoproteinemia. This abnormal lipoprotein pattern could not be correlated with the degree of renal impairment, the type of renal disease, or with the patient's age, sex, weight, or diet.     

Acute renal failure due to severe Landry-Guillain-Barré syndrome

BACKGROUND: Blood urea nitrogen (BUN) >60 mg/dl has been reported to occur commonly in patient's with severe Landry-Guillain-Barré syndrome. AIMS: To find out the cause for this high BUN we compared the renal function tests of 30 consecutive cases with severe Landry-Guillain-Barré syndrome to those of 30 controls. RESULTS: Acute renal failure occurred in seven patients with Landry-Guillain-Barré syndrome and none of the control group. Acute renal failure was found more in cases with Landry-Guillain-Barré syndrome compared to controls (P=0.0049). Six out of seven cases with Landry-Guillain-Barré syndrome and acute renal failure had dysautonomia and became oliguric while being in a hypotensive state. Of 30 patients with Landry-Guillain-Barré syndrome seven cases died. From eight patients with dysautonomia six cases who had acute renal failure died. The mortality rate was higher in cases with dysautonomia and acute renal failure (P = 0.0001 and 0.00001, respectively). Interestingly no glomerular disease was found. CONCLUSION: In conclusion acute renal failure can occur commonly in cases with severe Landry-Guillain-Barré syndrome particularly in those with dysautonomia, causing high mortality.