[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↗
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[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↗
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↗
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↗
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↗
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↗
[Obstructive anuria in children. Apropos of 22 cases].
The authors report twenty two cases of obstructive anuria observed in children. Causes are diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases in the immediate postoperative period (including 8 after antireflux surgery). In the emergency situation, treatment of obstructive anuria is based on urinary diversion ideally by percutaneous nephrostomy under ultrasonic control. But prevention is the best treatment of anuria: treatment of urinary tract infections resulting in renal stones, in case of tumor, ultrasonographic survey of chronic upper tract dilatation: rigorous atraumatic operative technique avoiding any oedema.
Adolescent↗
[Obstructive anuria in children. Apropos of 22 cases].
The authors report twenty-two cases of obstructive anuria observed in children. Causes were diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases occurred immediately after an operation (including 8 after antireflux surgery). Emergency treatment of obstructive anuria is based on urinary diversion, ideally by percutaneous nephrostomy under ultrasonic control. However, prevention is the best treatment of anuria: treatment of urinary tract infections resulting in renal stones, ultrasonographic monitoring for chronic proximal urinary tract dilatation in tumors: rigorous atraumatic operative technique avoiding oedema.
Adolescent↗
Lethal anuria complicating high dose ifosfamide chemotherapy in a breast cancer patient with an impaired renal function.
A sixty-year-old woman with advanced breast cancer, previously treated with cisplatin, developed an irreversible lethal renal failure with anuria, the day after 5 g/m2 bolus ifosfamide. Postrenal failure was excluded by echography. A prerenal component could have contributed to renal failure because of a transient hypotension, due to an increasing ascitis, occurring just before anuria. However, correction of the hemodynamic parameters did not improve renal function. Ifosfamide is a known nephrotoxic drug with demonstrated tubulopathies. We strongly suspect that this lethal anuria was mainly due to ifosfamide, occurring in a patient having received previous cisplatin chemotherapy and with poor kidney perfusion due to transient hypotension. We recommend careful use of ifosfamide in patients pretreated with nephrotoxic chemotherapy and inadequate renal perfusion.
Antineoplastic Combined Chemotherapy Protocols↗
[Obstructive anuria with non-dilated cavities].
Four patients with no evidence of acute functional or organic renal failure suddenly developed anuria. Repeated ultrasonographic exploration failed to show any dilatation of the urinary tract. After 4, 5, 7 and 34 days of anuria respectively, an obstacle was detected, located and identified by ultrasonically guided antegrade pyelography, which led to immediate urine derivation by percutaneous nephrostomy. Three of these patients were cured by percutaneous techniques alone. These 4 cases represent a small but not negligible part of a series of 74 patients with obstructive anuria, 70 of whom had dilated renal cavities. They throw doubt not on the reliability of ultrasonography, but on the idea that all obstacles are associated with dilatation upstream. They also confirm that opacification of the urinary tract is the only way of making sure that an obstacle is present. Antegrade pyelography gives excellent contrast images and can be used as first stage of a percutaneous nephrostomy. The other diagnostic methods are fraught with a high proportion of inadequacy or failure.
Acute Kidney Injury↗
Reversal of postoperative anuria by decompressive celiotomy.
Postoperative oliguria or anuria can rarely be attributed to an increase in intra-abdominal pressure. In this documented case, postoperative anuria responded to reduction in abdominal pressure by celiotomy. Actual abdominal pressure measurements are not available but probably would not be useful. However, hemodynamic measurements that were not consistent with diminished renal blood flow in a middle-aged patient were nevertheless associated with anuria, which responded to release of the abdominal pressure. Because of the association of regional pressure and acute renal decompensation, release of abdominal tension should be considered as a therapeutic option when hemodynamic measurements cannot explain a rapid decline in urine production.
Abdominal Muscles↗
Calculus anuria in childhood.
The incidence of calculus anuria is relatively high in Iran. Eighteen children with this picture were studied in our departments between 1972 and 1984. The cause of anuria was bilateral obstruction by the calculi (14 cases), unilateral obstruction with a nonfunctioning kidney (3 cases) or aplasia on the other side (1 case). As demonstrated by our study, the cause of stone formation was a metabolic disorder in 50% of the children. This indicates that with anuria created by calculi formation, more consideration should be given to the possibility of metabolic disorders than has so far been the case. Further research should therefore be carried out in this respect, particularly in cases of the lower age range with indications of parental consanguinity, multiple and bilateral calculi, repeated calculi and repeated admissions, which were frequently observed by us.
Anuria↗
Morphologic evidence to support the role of tubular leakage as a cause of anuria induced by meercury poisoning.
The qualitative Hanssen technic was used to study the mechanism of anuria produced in rabbits by mercury poisoning. Twenty-four to 30 hours after intravenous injection of a low dose of HgCl(2), the animals were almost completely anuric. Sodium ferrocyanide injected intravenously was visualized as Prussian blue in essentially all glomeruli in anuric kidneys, and the amount of the dye in the glomerular tufts was almost the same as in control kidneys. Thus there was no evidence for a severe reduction in glomerular capillary blood flow. Besides, the distribution of Prussian blue in tubular lumina indicated that the anuria occurred in the presence of a significant glomerular filtration. Tubular walls of the anuric kidneys showed an abnormally increased permeability to sodium ferrocyanide. These findings suggested that the anuria during this stage was caused more by tubular leakage than by intrarenal vasoconstriction and subsequent cessation of glomerular filtration.
Animals↗
Increased intraabdominal pressure and anuria in the newborn.
Elevated intraabdominal pressure as a cause of anuria in the critically ill newborn with ascites should be considered after hypovolemia and other causes of intrinsic renal disease or obstruction have been excluded. In the rare patient with ascites who develops anuria, paracentesis should be considered if urine output cannot be established.
Anuria↗
Persistent clot anuria complicating renal transplant biopsy.
Serious morbidity from renal transplant biopsy is reported to be infrequent. However, 4 of 43 patients who had renal transplant biopsy between July, 1981, and March, 1984, experienced anuria from upper urinary tract obstruction by blood clots. Although these clots usually dissolve, 3 patients (7%) experienced persistent clot anuria and deterioration of renal function. Awareness of this complication is important. Retrograde pyelography and ureteral catheterization are preferred primarily for diagnosis and treatment. Percutaneous techniques are reserved for those cases in which the ureter cannot be catheterized cystoscopically.
Adult↗
Reflex anuria.
Reflex anuria is described, and various etiologic theories are presented. A case report of documented reflex anuria is presented. Both ureterorenal pain-induced reflex and neurovascular reflex may produce suppression of urine output from an otherwise normal kidney.
Adult↗
Post-transplant renal artery stenosis: a cause of anuria. Report of 2 cases corrected by revascularization.
We report 2 cases of severe hypertension and acute onset of anuria after renal transplantation in which angiography revealed renal artery stenosis. After renal artery reconstructive surgery renal function returned to normal and the hypertension improved. A high index of suspicion is needed to make the diagnosis. Only by heightened awareness of this important entity will patients with post-transplantation anuria secondary to renal artery stenosis be identified. Such patients may benefit from renal artery revascularization to reverse this type of renal failure.
Adult↗