Charles P. Swainson

Sexual Acquisition of Urinary Tract Infection in a Man

A man was admitted with acute pyelonephritis due to Escherichia coli. Three days prior to the onset of his symptoms his wife presented with a 7-day history of cystitis due to E. coli. Before the wife developed her symptoms the couple were having vaginal intercourse every night, and this continued for the first 3 days of her symptoms. The organisms isolated from the urine of both patients were found to have the same biotype, an identical antibiogram, and the same serotype. The temporal sequence of events and the bacteriological findings strongly suggest the sexual transmission of this organism from the wife to her husband.

Spontaneous Hemorrhage of the Kidney

A young hypertensive man with hypertensive nephrosclerosis presented with an acute abdominal emergency due to a spontaneous renal hemorrhage. Investigations demonstrated a large left perinephric hematoma. This was managed conservatively. With control of his hypertension, renal function has remained stable.

Effects of cilazapril on renal function and hormones in hypertensive patients with renal disease

The effects of cilazapril 2.5 to 5.0 mg every 24 hours orally for one month on blood pressure, renal hemodynamics, and plasma and urinary hormones were investigated in 11 patients with renal disease and hypertension. Six patients had renal failure (pretreatment creatinine clearance of less than 1 ml/second). Both systolic and diastolic blood pressures were significantly decreased in all patients and seven of the 11 required 5.0 mg daily. There was no significant change in the effective renal plasma flow, glomerular filtration rate, or creatinine clearance, although the renal vascular resistance was significantly reduced. Albuminuria was reduced in most patients but the mean change was not significant. The mean plasma potassium concentration rose significantly, but no changes in electrolyte excretion or weight were noted. Mean ambulant plasma renin activity was normal before treatment and rose significantly. Mean ambulant angiotensin II concentrations did not change. Mean ambulant plasma aldosterone concentration and mean urinary aldosterone excretion decreased significantly. Plasma arginine vasopressin and cortisol concentrations did not change. No changes were noted in plasma glucose concentrations, liver function tests, hemoglobin concentrations, or white blood cell or platelet counts. A slight looseness of bowel motions occurred in two patients and was the only side effect recorded. Cilazapril appears to be an effective and safe antihypertensive drug in patients with hypertension and renal disease.

Malignant Hypertension in a Woman with Previous Chronic Lithium Nephrotoxicity

Ross R. Bailey, MD, Department of Nephrology, Christchurch Hospital, Private Bag, Christchurch (New Zealand) Dear Sir, Lithium carbonate causes a variety of renal disorders [1–3]. In 1979, we investigated a 31-yearold woman with a 10-year history of a manic-depressive psychosis. For 6 years she had been treated with lithium carbonate which had been stopped 10 weeks before presentation because of renal insufficiency. She had been troubled by polyuria and polydipsia for 4 years. Plasma lithium concentrations had been between 1.0 and 1.75 mmol/l. 1 month prior to presentation, she had suffered her third grand mal epileptic fit and had been commenced on phenytoin. The blood pressure was consistently about 136/86 mm Hg· Investigations: An MSU contained no cells or casts and was sterile on culture, the plasma creatinine was 0.16 mmol/l, creatinine clearance 0.78 ml/s, 5ICr-EDTA clearance 0.73 ml/s, 24hour urinary protein excretion less than 0.1 g and maximal urinary concentrating ability (following intranasal desmopressin) 304 mmol/kg. Renal biopsy showed a severe chronic interstitial nephritis with features closely resembling those reported by Hest-bech et al. [2]. 9 months later, the blood pressure was 138/98 mm Hg, the plasma creatinine 0.13 mmol/l, creatinine clearance 0.88 ml/s, 24-hour protein excretion 0.33 g and maximal urinary concentrating ability 301 mmol/kg. 4 years later, she presented with a 3-month deterioration in health including severe frontal headaches, chest pain and dyspnoea. She had been taking phenytoin, but no other medications. The blood pressure was 220/136 mm Hg and the fundi showed hemorrhages, exudates and papilledema. Left ventricular enlargement was present on chest X-ray and an electrocardiogram showed left ventricular hypertrophy and ischemic changes. The plasma creatinine was 0.14 mmol/l, creatinine clearance 0.6 ml/s, 51Cr-EDTA clearance 0.71 ml/s, mean 24-hour urinary protein excretion 0.7 g and maximal urinary concentrating ability 275 mmol/kg. A renal angiogram was normal. Plasma renin activity was 34.7 nmol/l/h (normal 0.15–1.55), plasma aldosterone 3,107 pmol/l (normal 140–550), plasma norepinephrine 946 pg/ml and plasma epinephrine 69 pg/ml (both within normal range). A renal biopsy again showed a chronic interstitial nephritis, but there were also severe hypertensive vascular changes. The patient’s blood pressure was controlled with frusemide and captopril.