Andrei N. Lupu

Plasma Renin Activity and Blood Pressure in Terminal Renal Failure

Abstract The predictive value of renin determinations in selection of patients with terminal renal failure and hypertension for bilateral nephrectomy was evaluated in 51 patients maintained on chronic hemodialysis. Nine patients were normotensive before dialysis (Group 1); of the 42 hypertensive subjects, blood pressure was controlled by sodium restriction and Ultrafiltration in 24 (Group 2), but was resistant to these modalities and antihypertensive drugs in 18 (Group 3). Moderately to markedly increased plasma renin activity (PRA) levels clearly distinguished the 17 patients of Group 3 whose hypertension was improved by nephrectomy from patients with sodium-volume-dependent hypertension treatable by dietary restrictions and hemodialysis (Group 2). One patient of Group 3 had a normal PRA and did not benefit from nephrectomy. alpha-methyldopa consistently decreased PRA and should be withdrawn before diagnostic studies. In 16 of our 17 cases of hypertensive hyper-reninemic terminal renal failure the underl...

Treatment of ureteral calculi by extracorporeal shock-wave lithotripsy UCLA experience

One hundred sixteen patients underwent extracorporeal shock-wave lithotripsy (ESWL) for ureteral stones. In 108 patients, the stones were manipulated pre-ESWL whereas 8 patients underwent ESWL without prior stone manipulation. Ureteral lubrication using a 2% Xylocaine jelly solution greatly facilitated the retrograde advancement of the calculus or the passage of ureteral catheters alongside the stone. ESWL disintegrated all but 4 stones for an overall success rate of 96.6 per cent. It is considered that the combination of retrograde ureteral stone repositioning and ESWL is a highly successful alternative in the management of ureteral calculi.

Plasma Aldosterone in Terminal Renal Failure

Abstract Plasma aldosterone concentrations in 27 patients with terminal renal failure ranged from subnormal to excessively elevated values and correlated significantly with plasma renin activity an...

Calcification of Ureteral Stent Treated by extracorporeal Shock Wave Lithotripsy

A patient with stones presented with large calcifications of the J ends of a Double-J stent that had been placed in the ureter for an obstructing ureteral stone 1 month previously. The J end located in the renal pelvis was treated with extracorporeal shock wave lithotripsy and the calcification was disintegrated completely. This noninvasive procedure appears to be the method of choice in the treatment of such complications.

Carcinoma of deep male urethra.

Carcinoma of the deep male urethra is a rare disease. Conservative measures yielding dismal outcomes were standard until 1957, with the report of an 80 per cent five-year survival rate after radical surgery. To assess the value of this surgery, we reviewed all cases of carcinoma of the deep male urethra managed at UCLA Medical Center and its affiliated hospitals between 1952 and 1980. Of the patients managed with radical surgery, 1 died of a myocardial infarction between staged surgical procedures, and 5 died of their disease between twelve and fifty-two months postoperatively (mean survival, 26 months). There were 2 long-term disease-free survivors, yielding a survival rate of 25 per cent. We have also compiled the results of all major series dealing with deep urethral carcinoma published subsequent to the 1957 report. This review of the literature supports the concept that radical extirpative surgery is mandatory in the management of carcinoma of the deep male urethra.

Experimental Unilateral Renal Artery Constriction in the Dog

Chronic hypertension caused by unilateral constriction of the renal artery in the presence of the opposite untouched kidney can be produced in the dog by progressive plication of the renal artery over a period of several hours. Twenty-three female dogs were studied. Mean arterial blood pressure was measured in the unanesthetized recumbent dog by direct puncture of the femoral artery. Reproducible control blood pressure readings were obtained only after daily training of the animals for at least 2 months. Mean arterial blood pressure for the whole group of animals was 98.25 ± 7.45 (SD) mm Hg prior to constriction. Three months after constriction, the mean arterial blood pressure of the group of dogs with a 50−63% reduction in renal blood flow was 132.4 ± 5.51 (SD) mm Hg (P < 0.001); for the group with a 78−86% reduction in renal blood flow it was 144.68 ± 10.68 (SD) mm Hg (P < 0.001). Six dogs from these two groups underwent ipsilateral nephrectomies 4−16 months after constriction, and their elevated arterial blood pressures returned to preconstriction normal values. It was concluded that this type of experimental hypertension in the dog is renal dependent in both the acute and the chronic stages.

Alum Irrigation for Severe Bladder Hemorrhage

We report 5 cases of severe bladder hemorrhage treated with alum irrigation. The severe hemorrhage stopped in all patients after 12 to 48 hours of irrigation. No toxic side effects were noted in all 5 patients, including 1 in whom intra-abdominal spillage of the solution occurred after spontaneous rupture of the bladder.

The Value of the Renal Biopsy in Unilateral Renovascular Hypertension

Renal biopsies from fifteen patients with unilateral renal arterial hypertension have been evaluated. In all cases, biopsies of the ipsilateral (‘ischemic’) kidney were obtained. In ten cases, biopsie

High Grade Invasive Ureteral Transitional Cell Carcinoma with a Congenital Solitary Kidney: Long-term Survival after Ureterectomy and Radiation Therapy

The circumstances surrounding the treatment of a primary high grade invasive transitional cell carcinoma occurring in the ureter of a solitary kidney indicate that the combination of surgery and radiation therapy occasionally may be markedly effective for controlling this generally lethal disease.

Further Experiences in the Diagnosis and Treatment of Renovascular Hypertension

The history of operations to correct renal artery stenosis is reviewed and the results of surgical treatment in 125 cases are described. Nephrectomy is indicated for severe degrees of renal atrophy, m