[Two new cases of post-abortum anurias; certain considerations on anurias in pregnancy].
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Abortion, Induced↗
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About two new observations of post-abortion anurias; some considerations on pregnancy anurias.
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Abortion, Induced↗
[Survival from anuria and oliguria of 105 days in a case of acute kidney failure--analysis of 63 cases of prolonged anuria in the literature].
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Acute Kidney Injury↗
[Transitory postoperative anuria after transvesical prostatic adenomectomy: review of the literature, description of new clinical cases and physiopathological considerations].
Anuria is a rare complication after prostate adenomectomy. Three cases of complete bilateral anuria and one case of monolateral anuria are reported following transvesical prostate adenomectomy, characterized by immediate onset without any apparent cause and by spontaneous resolution within 48 hours. After a thorough review of the literature, the authors analyze the pathophysiological and clinical aspects of post-prostate-adenomectomy anuria and postulate an "obstructive" aetiology for the anuria cases observed in their series.
Aged↗
Noncontrast computed tomography in obstructive anuria: a prospective study.
OBJECTIVES: To evaluate the role of noncontrast computed tomography (NCCT) in the determination of the cause of obstructive anuria and to compare its accuracy with that of the traditional methods of combined plain abdominal x-ray (KUB) and gray-scale abdominal ultrasonography (US). METHODS: The study included 40 consecutive patients with obstructive anuria. In addition to the routine evaluation, which included history, clinical examination, biochemical profile, KUB, and US, all patients underwent NCCT. The study patients were tested against an age and sex-matched control group that included the normal contralateral kidneys of 57 consecutive patients who underwent KUB, US, and NCCT for acute flank pain during the same study period. The reference standard for the determination of the cause of obstruction was retrograde or antegrade ureterography with or without ureteroscopy or open surgery. The absence of obstruction in the control group was confirmed by nonequivocal normal intravenous urography of the side free of flank pain. Both NCCT and combined KUB and US were compared regarding the sensitivity, specificity, and overall accuracy. RESULTS: The study group had 48 renal units, because obstruction was bilateral in 8 patients and of a solitary kidney in 32. Of the 42 renal units with calculus obstruction, the site of stone impaction was identified in all renal units by NCCT (sensitivity 100%) and in only 25 by combined KUB and US (sensitivity 59.5%)-a significant difference (P = 0.0001). Of the 6 renal units with noncalcular obstruction, both NCCT and US diagnosed the cause of obstruction in 3. The overall sensitivity of NCCT in the determination of the cause of obstructive anuria was 94% and that of combined KUB and US was 58%-a significant difference (P = 0.0001). The specificity of NCCT was not significantly different from that of combined KUB and US (96.5% versus 93%, respectively). The overall accuracy of NCCT was 95% and that of combined KUB and US was 77%-a significant difference (P = 0.0003). CONCLUSIONS: In patients with obstructive anuria, conventional KUB and US could not identify the cause of ureteral obstruction in about 40% of the patients. Under such conditions, NCCT can accurately provide the diagnosis, obviating the need of invasive and expensive diagnostic procedures.
Anuria↗
Protracted anuria due to active vasoconstriction in primary or secondary malignant hypertension.
Anuria complicated the malignant phase of hypertension in twelve patients (ten males and two females). Five were black; five had primary hypertension; one had HBs virus angiitis; the six remaining cases suffered from previously documented renal disease, including two with Berger's disease. Renal angiography showed interruption of renal blood flow as far as the main branches of the renal artery and/or a false impression of 'cortical necrosis' and of 'renal infarcts'. In contrast, renal biopsy did not show irreversible vascular damage. Thus, anuria was mainly functional and due to active renal vasoconstriction. This was confirmed by the subsequent course; diuresis resumed after 1 week to 24 months of dialysis. Repeat angiography in six cases showed recovery of renal circulation and disappearance of 'cortical infarcts', even when plasma renin activity remained elevated and hypertension was not controlled. In one case captopril induced a new reversible episode of anuria. These observations suggest that active vasoconstriction with prolonged anuria might be due to some vasoconstrictive substance other than angiotensin II.
Adult↗
Successful surgical treatment of anuria caused by renal artery occlusion.
Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.
Adolescent↗
Renal distribution volumes of indocyanine green, ( 51 Cr)EDTA, and 24 Na in man during acute renal failure after shock. Implications for the pathogenesis of anuria.
The mechanism responsible for the anuria in acute renal failure after shock is still controversial. Suppressed glomerular filtration and/or tubular back-diffusion of the filtrate are major possible causes. In the present investigation, seven patients with acute anuria, three of these seven again in the polyuric phase, six patients with moderate renal impairment, four patients with chronic renal failure, and eight subjects with normal renal function were studied by a multiple indicator-dilution method in which the total renal blood flow and renal distribution volumes of indocyanine green, [(51)Cr]EDTA, and (24)Na were determined. In normal subjects the average values for one kidney were 582 ml/min, 42 ml, 92 ml, and 139 ml, respectively. The measurements in the patients with moderate renal impairment were similar to those in the normal subjects, but were decreased in chronic renal failure. In acute anuria, the average values were 269 ml/min, 40 ml, 101 ml, and 114 ml and the kidney volume, estimated radiographically, was increased by 40%. When expressed as milliliters per milliliters kidney, the average distribution volume of (24)Na was decreased from 0.64 to 0.38. This decrease is consistent with the hypothesis that suppressed filtration is largely responsible for the anuria and that back-diffusion is, at most, a contributory factor. The apparent contradiction between the relatively well-preserved total blood flow and the suppressed filtration may be due to a combination of afferent vasoconstriction and efferent vasodilatation. This view is supported by the observation that low filtration fractions were found in clearance measurements performed during the polyuric phase.
Anuria↗
[Obstructive anuria in patients with tumors of the pelvic organs].
The paper discusses the data on 57 cases of pelvic tumor--induced obstructive anuria. As a rule, obstructive anuria is easy to diagnose ultrasonography being most instrumental. Duration of anuria was found to be the main factor determining outcome in the early postoperative period. Early detection of ureteral obstruction and timely treatment prevented excretory anuria in some cases.
Anuria↗
An incompletely identified combined urogynecological malformation presenting as anuria.
We report on an 18-year-old woman with a combined urogynecological malformation who presented with anuria. At the age of 8 years she presented elsewhere with urometrocolpos secondary to a left hypoplastic kidney and an ectopic ureter that inserted into the vagina. A retroiliac right ureter also was identified. She underwent surgical treatment and was reported in the urological literature. At menarche she began to have severe dysmenorrhea. After multiple hospitalizations elsewhere without diagnosis she presented to our emergency room with anuria. The anuria was the direct result of additional, previously unidentified malformations, consisting of uterus duplex bicollis and vaginal hypoplasia. We emphasize the importance of identifying all components of the genital and urological systems whenever anomalies are present in either system.
Abnormalities, Multiple↗
Anuria in infants and children.
The urologist may be involved in the initial evaluation of a child with anuria. In our experience the most common cause of anuria in neonates was perinatal hypoxia and in older children it was the hemolytic uremic syndrome. Obstructive uropathy as a cause of anuria in infants and children appears to be uncommon.
Anuria↗
[Obstructive anuria secondary to uterine prolapse].
The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.
Aged↗
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.
Aged↗
Reflex anuria from unilateral ureteral obstruction.
Renal function is usually normal or only marginally affected in patients with unilateral ureteral obstruction due to the vicarious function of the contralateral kidney. Few reports exist in which unilateral renal obstruction is associated with anuria (reflex anuria, RA) and acute renal failure. We report the clinical case of a female patient who was referred to the emergency department due to anuria of 72 h duration and acute renal failure (serum creatinine 9 mg/dl) associated with several episodes of violent right flank pain with hematuria following extracorporeal shock wave lithotripsy (ESWL). A few weeks before ESWL, urography showed a 2-cm stone located in the right pelvis whilst the left kidney was functionally normal. On admission, renal ultrasound documented a normal left kidney, whilst the right pelvis was hydronephrotic and there were two indwelling stones at the right pyeloureteral junction. After the patient passed a urinary stone, diuresis restarted and acute renal failure was resolved. Thereafter, urography confirmed that the left kidney, the left ureter and bladder were functionally and morphologically normal. RA with acute renal failure has been so scarcely documented that it is considered to be legend by many clinicians. Major textbooks do not discuss RA with acute renal failure. Vascular or ureteral spasm related in part to a peculiar hyperexcitability of the autonomic nervous system may explain RA. We suggest that nephrologists should always consider RA when evaluating acute renal failure. On the other hand, RA might be relatively common and we cannot rule out that only the most severe and/or better-documented cases have been reported in the medical literature.
Anuria↗
Relationship of the recovery in the glomerular filtration rate to the duration of anuria in diarrhea-associated hemolytic uremic syndrome.
The relationship of the duration of anuria to the recovery in glomerular filtration rate (GFR) was studied in 71 children with diarrhea-associated hemolytic uremic syndrome. A significant relationship was found, and regression analysis revealed that y = 114.61 - 5.68 x, where y is predicted GFR (ml/min/1.73 m2) and x is the square root of the duration of anuria in days. The presence of hypertension or proteinuria on follow-up was significantly related to the duration of anuria (p = 0.005 and p = 0.002, respectively).
Anuria↗
Acute renal failure due to acute bilateral renal artery thrombosis: successful surgical revascularization after prolonged anuria.
Acute bilateral renal artery thrombosis is a rare but surgically correctable cause of acute renal failure. A middle-aged woman with acute renal failure and anuria due to atherosclerotic occlusion of the abdominal aorta and both renal arteries was surgically treated 42 days after the onset of anuria. Revascularization resulted in the reversal of renal failure and complete recovery of renal function in spite of prolonged anuria. An aggressive diagnostic and therapeutic approach is important whenever this condition is suspected.
Acute Kidney Injury↗
The role of "leakage" of tubular fluid in anuria due to mercury poisoning.
The role of "leakage" of tubular fluid in anuria produced by mercury poisoning was studied in rats by micropuncture techniques. After an initial brisk diuresis, almost all animals were completely anuric 24 hours after HgCl(2) injection. Lissamine green injected intravenously in the early stage of anuria appeared in the beginning of the proximal tubule, but the color became progressively lighter as the dye traversed the proximal convolutions. The dye was barely visible in the terminal segments of the proximal tubule; it did not appear at all in the distal tubules. These observations suggest that the proximal epithelium had become abnormally permeable to Lissamine green. Tubular fluid to plasma inulin (TF/P(In)) ratios and inulin clearance were measured in individual nephrons at three sites: early proximal tubule, late proximal tubule, and distal tubule. It was found that TF/P(In) ratios were abnormally low in the late proximal and distal tubules. Inulin clearance was normal at the beginning of the proximal tubule but fell by more than 60% by the late proximal convolutions. Thus, the proximal tubule had also become permeable to inulin. We conclude from these observations that anuria in mercury poisoning can occur in the presence of a normal glomerular filtration rate. The absence of urine flow appears to be due to complete absorption of the filtrate through an excessively permeable tubular epithelium. The driving force affecting this fluid absorption is probably the colloid oncotic pressure of the peritubular capillary blood.
Animals↗
[Anuria due to bilateral renal artery spasm during hysterectomy and oophorectomy].
A decrease in urinary volume during surgery is often encountered. Usually it can be treated with intravenous fluid or diuretics. We here report a rare case of intraoperative anuria in which renal blood flow ceased totally. The patient was 36 year old female (166 cm 50 kg), who was admitted for a investigations of long-term severe hypertension of unknown origin. Radiographic examination showed no adrenal tumor but a right ovarian cyst was found and suspected to be malignant, for which oophorectomy was indicated. After epidural catheterization, general anesthesia was induced by intravenous propofol and vecuronium, and maintained with epidural lidocaine and the inhalation of isoflurane and nitrous oxide mixed with oxygen. During surgery, urinary outflow decreased gradually leading to total anuria, which was resistant to intravenous fluid and furosemide. Intraoperative pyelography was performed and both kidneys and urinary tracts were not visualized. After the surgery, when the patient returned to the ward, urine began to flow. Postoperative pathological examination of the removed ovary showed a presence of renin excreting tumor cells. The anuria was considered to be the result of transient spastic obstruction of bilateral renal arteries, presumably in response to a high level of plasma renin.
Adult↗