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PubMed1989

Mesangiolytic glomerulonephritis associated with Takatsuki's syndrome: an analysis of five renal biopsy specimens.

Renal biopsy specimens from five patients with Takatsuki's syndrome were studied. Proteinuria and hematuria were modestly positive in four cases and three cases, respectively. One case demonstrated early azotemia, while four cases revealed normal serum creatinine levels. All cases displayed glomerular enlargement and lobulation, mesangial cell proliferation, and double contour structure, simulating membranoproliferative glomerulonephritis. It is noteworthy that mesangial loosening was also detected in the renal biopsy specimens of this study. This change was present diffuse-globally in the well-developed cases and focal-globally or segmentally in the developing cases. In addition, various morphologic expressions were observed, ie, microaneurysms congested with RBCs, tentatively termed mesangial hyaline thrombi, nodule-like lesions, and tiny to small-sized mesangiolytic lesions. Since all these features could be explained by low-grade mesangiolysis, the renal alteration associated with this syndrome was termed mesangiolytic glomerulonephritis. Humoral factor(s) also toxic to the mesangium were implicated.

Adult↗
PubMed1995

Immunopathological characteristics of in situ T-cell subpopulations in human immunodeficiency virus-associated nephropathy.

Human immunodeficiency virus-associated nephropathy (HI-VAN) is a common form of nephropathy present in HIV-infected individuals that clinically presents with proteinuria that is frequently in the nephrotic range, less often with hematuria, and with a course that may evolve to irreversible azotemia ultimately resulting in renal failure. Pediatric and adult HIV-positive patients both experience HIVAN morphologically after displaying focal segmental glomerulosclerosis, diffuse mesangial hyperplasia, microcystic tubular dilatation, interstitial inflammation, edema, and fibrosis. There is minimal information regarding the interstitial inflammatory cell infiltrate, despite the possibility that these cells may play an important role in the etiology of HIVAN. This study was designed to characterize and compare several morphological and immunopathological features of clearly established HIVAN, particularly the hematopoietic cell markers present on the interstitial inflammatory cells and the state of T-lymphocyte activation (ie, class II expression). Quantitative grading of HIVAN kidneys showed that CD4-positive and CD8-positive T cells comprised the major cell populations in the interstitium, often with CD4-positive T cells exceeding or being equivalent in number to CD8-positive T cells. B cells and macrophages were negligible components of the infiltrate. Human leukocyte antigen-DR class II molecules were found to be increased on the interstitial T cells as well as on all glomerular cells and endothelial cells. There was no significant relationship established between the immunophenotype of the interstitial inflammatory cells and other morphological, ultrastructural, immunofluorescent, or clinical features. These data imply that the inflammatory infiltrate in HIVAN is largely composed of activated T cells. At this point the role of these interstitial T cells in HIVAN is undetermined, although it can be speculated that they may be participating as antiviral or autoreactive immune effector cells imparting renal injury in this entity.

AIDS-Associated Nephropathy↗
PubMed1983

Role of immunoglobulin class in mediation of experimental mesangial glomerulonephritis.

The contribution of immunoglobulin class to the histology and ultrastructure of renal lesions were examined in an experimental model of glomerulonephritis in which the glomerular deposits were selected to be predominantly IgM or IgG. The selection was accomplished by immunizing and then injecting rabbits with a carrier preparation plus heat-denatured (HD) DNA (n = 11) or ultraviolet-irradiated (uv) DNA [n = 11). It has been shown previously that HD DNA gives rise to an IgM antibody response and uv DNA to an IgG response. Groups of rabbits immunized with each preparation produced largely IgM (HD DNA) or IgG (uv DNA) anti-DNA antibody. After 10 and 20 weeks of injections, animals receiving both antigens developed diffuse mesangial hypercellularity with either IgM or IgG deposits accompanied by C3; by ultrastructural analysis all deposits were confined to the mesangium. By 28 weeks, heavy mesangial IgM and IgG deposits were noted but no quantitative or qualitative differences in the renal histology was observed. Individual animals developed sporadic hematuria and azotemia but proteinuria was not found. These results show that both IgM and IgG can mediate experimental mesangial proliferative glomerulonephritis and that the immunoglobulin class of the glomerular deposits does not influence the appearance of the renal lesion.

Animals↗
PubMed1985

Defective autologous mixed lymphocyte reactions in patients with renal insufficiency--evidence for cellular and serum factors.

The autologous mixed lymphocyte reaction (AMLR) was studied in 10 patients who were azotemic from renal diseases not considered to be immunologically mediated. These patients were not on chronic dialysis. The AMLR was significantly depressed in patients with azotemia when compared to the AMLR in normals. When the AMLR was performed utilizing lymphocytes from normals, the proliferative response was markedly decreased if azotemic serum was substituted for normal serum. However, when the AMLR was performed utilizing lymphocytes from azotemic patients, the proliferative response did not significantly improve if normal serum was substituted for azotemic serum. In addition, the proliferative responses of T cells to concanavalin A (Con A) and phytohemagglutinin (PHA) were not significantly depressed in azotemic patients when compared to normal controls. These data suggest that the AMLR is abnormal in azotemic patients because of an intrinsic defect in the mononuclear cells, possibly in the stimulating non-T cells, and an inhibitory factor in the serum.

Humans↗
PubMed1976

Hypertension as complication of vesicoureteral reflux in children.

Eight cases are reported of female children presenting with hypertension and found to have primary vesicoureteral reflux with chronic pyelonephritis. In 6 patients renal function was essentially normal while 2 had azotemia and progessive renal deterioration. As a result of early surgical intervention in the form of antireflux procedures, occasionally combined with unilateral nephrectomy for renin-dependent lesions, 5 of the 8 had complete disappearance or amelioration of hypertension with stabilization of renal function. The interactions of each member of the triad--vesicoureteral reflux, pyelonephritis, and hypertension--are reviewed with emphasis on pertinent pathophysiologic concepts regarding their roles in the production of progressive renal deterioration.

Adolescent↗
PubMed1976

Nonoliguric renal failure after transurethral prostatic resection.

Six cases of acute nonoliguric renal failure following transurethral prostatectomy were studied. This condition usually has a milder clinical course than the oliguric type; but some patients will need dialysis and fatalities can occur. Although it is relatively rare, every urologist shoud be aware of the entity. The first clue is usually increasing azotemia despite a normal or increased urine output.

Acute Kidney Injury↗
PubMed1976

Renal complications of drug addiction.

The kidney is one of the target organs involved as a consequence of the systemic complications seen in drug abusers. This may manifest itself in one of the following forms: acute hepatitis with modest proteinuria (less than 2 Gm. per day); bacterial endocarditis with hematuria, azotemia, and a focal or diffuse glomerulonephritis; the nephrotic syndrome with focal mesangial sclerosis and diffuse interstitial nephritis often pursuing a fulminant course terminating in uremia; acute renal failure secondary to rhabdomyolysis and myoglobinuria; polyarteritis nodosa with renal involvement; and obstructive uropathy secondary to fungus ball in the urinary tract.

Acute Kidney Injury↗
PubMed1976

Parasitic lumbar arterial blood supply in renal angiomyolipoma.

A young woman with azotemia was found to have an angiomyolipoma which had parasitic blood supply from a lumbar artery. Parasitic lumbar arterial blood supply from a lumbar artery. Parasitic lumbar arterial blood supply has previously been considered a strong indication of malignancy. Since this benign lesion had not invaded the adjacent retroperitoneal structures, the phenomenon tends to confirm the postulate that parasitic blood supply to a lesion may occur through hypertrophy of small anastomotic channels normally present between adjacent vessels but not normally seen in angiography.

Adult↗
PubMed1977

Tapered ileum as ureter substitute in severe renal damage: antireflux technique for bladder implantation.

Three cases are reported in which ileum has been used to replace irreparably damaged ureters despite preexisting moderate to severe pyelocaliectasis. Two cases have had satisfactory results while one had increasing pyelocaliectasis and azotemia requiring subsequent cutaneous diversion. The rationale for using ileum to replace ureter is presented with a discussion of objectives to be achieved surgically to assure the success of the procedure.

Adolescent↗
PubMed1978

Urethral valves: management of upper urinary tract changes.

A conservative approach to upper urinary tract changes in urethral valves is suggested. The bladder is initially decompressed by insertion of a feeding tube via the urethra if the patient has azotemia, acidosis, or serious urinary infection. After correction of fluid and electrolyte deficits and control of infection, the valve is destroyed transurethrally despite the presence of severe upper tract dilatation.

Child↗
PubMed1978

Megalourethra.

Two cases of megalourethra are presented, the ninth and tenth cases to be documented in the literature. Both patients exhibited mesodermal abnormalities which justify categorization among the minor forms of prune belly syndrome. One patient, the youngest to have undergone surgical correction, presented with azotemia, dilated posterior urethra, megacystis, and megaureters. The second patient with incomplete or scaphoid form of megalourethra also exhibited undescended testis, corrected by orchiopexy at the time of urethoplasty. In all instances the goal of treatment is preservation of renal function with subsequent functional and anatomic reconstruction of the urinary tract.

Child, Preschool↗
PubMed1978

Urinary tract reconstruction in prune belly syndrome.

Fifteen boys with prune belly syndrome cared for over a ten-year period required surgical treatment because of uncontrolled infection and/or progressive azotemia. Five died of renal dysplasia. Primary or staged reconstruction resulted in significant improvement when ureteral reimplantation was combined with tailoring of ureteral caliber.

Abdominal Muscles↗
PubMed1979

Primary massive reflux in children.

Over a ten-year period, of more than 1,000 children whose primary vesicoureteral reflux was treated surgically, there were 54 children with 80 single ureters which were massively dilated. Primary reconstruction with ureteral tailoring was done in 25 ureters with a success rate of 92 per cent. Forty-five ureters were temporarily diverted because of uncontrolled infection and/or azotemia. In almost half of these instances, temporary diversion resulted in improvement in ureteral caliber to such an extent that nontailored reimplantation could be performed with a success rate of 87 per cent. Six kidneys were removed and four have been maintained in the diverted state with severe renal dysplasia. Eighty-eight per cent of the refluxing megaureters were reconstructed with a success rate of 89 per cent.

Child↗
PubMed1980

Idiopathic rupture of bladder.

Idiopathic bladder rupture is uncommon but not rare. It should be considered in patients with depressed sensorium who present with mild azotemia, acidosis, and inability to void. A cystogram is diagnostic, and recovery is usually uneventful after primary bladder closure.

Alcoholism↗
PubMed1980

Renal failure in diabetes after intravenous urography.

A review of the literature reveals that patients with juvenile onset diabetes with azotemia, associated vascular disease, and proteinuria, are at great risk of sustaining acute renal failure following intravenous pyelography. Predisposing factors are identified, but the exact mechanism of acute renal failure remains obscure. Since no prophylactic measures or effective treatment exist, the benefits and risk must be weighed prior to the procedure.

Acute Kidney Injury↗
PubMed1987

Urinary ascites: complication of umbilical artery catheterization.

In the newborn, intraperitoneal extravasation of urine from a urachal laceration may follow an attempt at umbilical artery catheterization. Clinical results of this injury are neonatal ascites, anuria, and azotemia. Herein, we describe a case of iatrogenic bladder injury with successful management following late detection. The anatomy of the urachus and bladder in the newborn are reviewed as well as clues to the diagnosis of neonatal urinary ascites.

Anuria↗
PubMed1989

Posterior urethral valves. Role of temporary and permanent urinary diversion.

Between 1960 and 1983, 67 boys were treated for posterior urethral valves. Despite adequate valve ablation, azotemia eventually developed in 19, and they underwent permanent urinary diversion. Normal renal function was not achieved in any of these children. Diversion does not appear to have changed the natural course of their renal insufficiency, which is most likely secondary to damage incurred prior to their initial presentation. Prognostic factors useful to identify this select population are examined.

Blood Urea Nitrogen↗
PubMed1990

Percutaneous nephrostomy in infants.

We reviewed our experience with percutaneous nephrostomy placement in children less than one year of age during a five-year period. Placement was successful in 8 of 9 cases. There were no complications. The procedure favorably altered the outcome for each patient and was useful for reversing azotemia prior to surgical intervention for repair of an obstructed system (2 renal units), for providing drainage of pyonephrotic kidneys (3 renal units), for demonstrating inadequate recovery of renal function after relief of obstruction (2 renal units), and for replacing a surgically placed nephrostomy that was dislodged (1 renal unit). Our experience has encouraged us to accept the technique, and we believe that it is a valuable nonsurgical alternative that should be available to urologists managing infants with urinary tract pathology.

Drainage↗