Asunto(s)
Síndrome Nefrótico/complicaciones , Obstrucción de la Arteria Renal/complicaciones , Venas Renales , Trombosis/complicaciones , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Humanos , Infusiones Intraarteriales , Masculino , Persona de Mediana Edad , Obstrucción de la Arteria Renal/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificaciónRESUMEN
Strenuous exercise leading to heat stroke is known to cause rhabdomyolysis and acute renal failure in men, but there are no reports of this environmental illness in otherwise healthy women. We report the first case of heat and exercise induced acute renal failure in a young nonacclimated adult female following intense exertion in the Grand Canyon. This individual displayed the typical clinical features of exertional heat stroke including hyperpyrexia, CNS disturbance, rhabdomyolysis, oligoanuric acute renal failure, and disseminated intravascular coagulopathy. The pathophysiology is discussed as well as sexual differences in response to heat and exercise. The specific factors that may have predisposed this young woman to heat stroke from exertion are identified.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Agotamiento por Calor/diagnóstico , Esfuerzo Físico , Aclimatación , Lesión Renal Aguda/etiología , Lesión Renal Aguda/fisiopatología , Adulto , Anuria/diagnóstico , Anuria/etiología , Anuria/fisiopatología , Arizona , Coagulación Intravascular Diseminada/diagnóstico , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/fisiopatología , Femenino , Agotamiento por Calor/complicaciones , Agotamiento por Calor/fisiopatología , Humanos , Rabdomiólisis/diagnóstico , Rabdomiólisis/etiología , Rabdomiólisis/fisiopatología , VirginiaRESUMEN
Continuous arteriovenous hemodiafiltration (CAVHD) offers a modified therapeutic approach to the patient with acute renal failure. The system employs a hollow-fiber dialyzer, whose perfusion is dependent on the patient's BP. Peritoneal dialysis solution is infused through the dialysate ports in a direction countercurrent to blood flow at a rate of 500 to 1,500 mL/h. Five complex patients with acute renal failure were treated with CAVHD for periods ranging from two to 40 days. Urea clearances approached 37 L/d, and in stable patients, the BUN was maintained at 40 to 60 mg/dL and serum creatinine 1.4 to 4.0 mg/dL. Ultrafiltration up to 1 L/h could be obtained without difficulty. CAVHD is a safe and technically simple procedure that is particularly suitable for hemodynamically unstable patients with ongoing needs for fluid removal.
Asunto(s)
Lesión Renal Aguda/terapia , Hemofiltración , Presión Sanguínea , Nitrógeno de la Urea Sanguínea , Heparina/uso terapéutico , Humanos , Factores de TiempoRESUMEN
Aminoglycoside nephrotoxicity is a common clinical problem among hospitalized patients despite close attention to pharmacokinetics and dosing schedules. The present study was designed to evaluate the potential protective effect of nitrendipine, a calcium channel blocker, on the natural history of gentamicin renal injury in the rat. Gentamicin was administered intramuscularly in a dose of 40 mg/kg/day for 12 days to adult Fischer rats. Nitrendipine was given by gavage on a b.i.d. schedule in a dose of 30 mg/kg/day or 10 mg/kg/day. Gentamicin alone caused a significant decrease in glomerular filtration rate (GFR) and renal plasma flow (RPF). Concurrent administration of nitrendipine did not influence RPF, but promoted a significant increase in GFR. Nitrendipine also prevented the increase in urinary excretion of N-acetyl-glucosaminidase and beta-glucosidase, enzymatic markers of renal tubular injury in the gentamicin-treated animals. Gentamicin-induced pathologic injury was significantly ameliorated by nitrendipine. Renal cortical gentamicin content was diminished, but not significantly, by nitrendipine. The exact mechanism of action of nitrendipine in aminoglycoside-induced renal injury remains unknown. These observations suggest a potential pharmacologic approach to preventing a common problem with substantial morbidity.