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Biomedical subjects

W N Boyd

Publications and source records attributed to W N Boyd.

9 recordsLinked to original sources

Structural and functional changes in the renal circulation after complicated pregnancy.

Angiographic and histological studies of the intrarenal circulation have been undertaken in 20 patients following complicated pregnancies: 12 patients had had hypertension of pregnancy (group 1); 7 acute renal failure due to either ante- or post-partum haemorrhage and 1 patient post-partum renal failure (group 2). 3 months after delivery all patients had angiographic evidence of structural and functional abnormalities involving intrarenal blood vessels and cortical blood flow. The severity of the structural changes was related to the degree of microangiopathic haemolytic anaemia noted in the acute obstetric complication but not to the height of the blood pressure at this stage. Histological abnormalities of the cortical blood vessels were minimal. At the time of the renal angiogram and biopsy, 3 of the 12 group 1 patients were hypertensive and 3 had impaired renal function, compared with 5 and 1, respectively, in the 8 group 2 patients. Although during the follow-up period (mean 5 years) no further deterioration in renal function in either group has been observed, hypertension developed in 50% of the group 1 patients compared with only 1 of the patients in group 2. The relationship between the late onset of hypertension and the intrarenal vascular and haemodynamic abnormalities is discussed.

Acute Kidney Injury↗

Acute reversible renal failure in patients with acute cholecystitis and cholangitis.

Although acute renal failure is a well recognized complication of several extra-hepatic biliary tract diseases especially biliary tract surgery in the presence of obstructive jaundice, there is little information concerning renal failure in acute cholecystitis. Renal function was assessed in 14 patients with acute cholecystitis and two with acute cholangitis. Six patients had no evidence of renal impairment, four had modest elevations of plasma urea and creatinine concentrations and six had acute reversible renal failure of whom three required peritoneal dialysis. Only one patient was hypovolaemic and in the remainder there was evidence that intravasular coagulation was responsible for the renal failure. It is suggested that bacteraemia was the initiating factor. The therapeutic implications of these findings are discussed.

Acute Disease↗

Intrarenal vascular changes in patients receiving oestrogen-containing compounds--a clinical, histological and angiographic study.

Nine patients who developed reversible hypertension and/or evidence of impaired renal function whilst taking an oestrogen-progestogen-containing compound have been investigated. Serial haematological and biochemical studies have been carried out on each patient in association with selective renal angiography and renal biopsies. Abnormalities of the peripheral renal vessels have been demonstrated in all patients and a close correlation between the histological and angiographic appearances noted. The presence of microthrombi involving glomerular capillaries or intrarenal arterioles was invariably accompanied by evidence of micro-angiopathic haemolytic anaemia along with stasis of contrast medium in the intra-renal vascular circulation. Although the three different groups of patients studied tended to show their own particular intra-renal angiographic patterns, the definitive diagnosis depended on the haematological and histoligical findings. In the majority of patients, withdrawal of the oestrogen-progestogen-containing compound resulted in clinical improvement.

Acute Disease↗

Intrarenal vascular changes in adult patients with recurrent haematuria and loin pain--a clinical, histological and angiographic study.

Clinical features have been correlated with renal function, histology and selective renal angiography in 19 patients with recurrent painless haematuria, recurrent loin pain, or both haematuria and loin pain in whom urinary infection, calculi and anatomical abnormalities of the urinary tract had been excluded. No deterioration in renal function was observed in any patient over periods of up to nine years. Although all patients showed similar glomerular changes histologically, consisting of focal and segmental mesangial thickening and proliferation and periglomerular fibrosis, mild tubular damage was more common in those with loin pain. All patients with loin pain whether or not they had haematuria, had abnormal renal angiograms consisting of focal or generalized vascular lesions sometimes associated with cortical infarcts. The possible aetiological factors are discussed with particular reference to oestrogen-containing compounds.

Adolescent↗

Pregnancy, subarachnoid haemorrhage, and the intravascular coagulation syndrome.

Two patients are described who developed subarachnoid haemorrhage during pregnancy and the puerperium. In both patients there was clinical, haematological, histological, and renal angiographic evidence of the intravascular coagulation syndrome. No source of intracranial bleeding was demonstrated by bilateral carotid angiography in either patient. We suggest that the subarachnoid haemorrhage was a result of the intravascular coagulation syndrome in both patients.

Acute Kidney Injury↗