Chien-Hsing Meng

Renal Blood Flow and Renin Activity in Renal Venous Blood in Essential Hypertension

The intrarenal distribution of blood flow measured by the133xenon washout method and the renin activity of renal venous blood were determined in 16 patients with early essential hypertension. None of the patients had evidence of systemic disease except for the elevation in blood pressure (> 150/100 mm Hg). Fifteen of the subjects received a controlled sodium diet during 7 to 9 days before study, at the time of renal angiography. An inverse relationship was noted between the cortical component of the renal blood flow and renin activity of renal venous blood (r = 0.64, P < 0.02). Renin secretion rates were also calculated in 12 patients confirming the inverse relationship between cortical distribution of blood flow and renin secretion (r = 0.763, P < 0.01). The cortical renal blood flow in 10 patients on a low salt intake was 79.6% ± 2.6 (SE) of the total renal blood flow. The cortical blood flow in five patients on a high salt diet was 87.6% ± 1.9 (SE); the statistical difference between the two groups is significant (P < 0.05). A direct relationship was noted between cortical blood flow and the logarithm of the 24-hour urinary sodium excretion from the day preceding the study (r = 0.54, P < 0.05). Renin secretion rate and renin in renal venous blood were directly correlated (r = 0.813, P < 0.01). Changes in corticomedullary distribution of flow were inversely related to the changes in cortical distribution. The degree of reduction of cortical renal blood flow correlated with the degree of increase in renin secretion and in renin activity in renal venous blood. Our data are compatible with reduced cortical renal blood flow mediating renin release or vice versa. Either mechanism would result in more efficient conservation of salt and water by the kidney.

Immediate Angiographic Manifestations of Iatrogenic Renal Injury Due to Percutaneous Needle Biopsy

Immediate postbiopsy selective renal angiography was performed on 18 patients. The most common finding was filling of the needle track with opacified blood. Minimal to extensive perirenal puddling of contrast material was seen in 6 patients. Minimal arteriovenous communication, arterial occlusion, and nephrographic defects were also noted. Accurate placement of the biopsy needle in the cortical region is important in preventing major complications.

False positive liver scans caused by disease processes in adjacent organs and structures

Abstract As a result of its great pliability, the liver can change its shape and form when impinged upon by disease processes in neighbouring organs and structures. The resultant hepatic scan is quite confusing, since the picture portrayed is frequently indistinguishable from that of intrinsic space-occupying disease of the liver. Enlarged gall-bladders, kidney cysts and tumours, pancreatic lesions, dilated bile ducts and subdiaphragmatic fluid are examples of extrahepatic disease processes that can simulate intrahepatic defects. It is quite essential that the physician interpreting hepatic scans has an appreciation that such a situation can exist. In this manner, one may hopefully reduce the incidence of his “false positive” interpretations. When doubt exists on the hepatic scan, a careful consideration of the clinical and laboratory findings, as well as the employment of complementary radiographic techniques such as selective angiography, can help elucidate the problem.

Correlation of Intravenous Urography and Renal Angiography in Kidney Injury

Hematuria following trauma raises the suspicion of injury to the kidney. Radiologic evaluation of the extent of renal injury is based chiefly on the results of intravenous urography. Normal renal and psoas outlines in association with a normal-appearing urogram suggest only minor injury. The intravenous urogram, however, may be abnormal in minor renal injury, demonstrating such findings as delayed excretion of the contrast medium, diminished excretory nephrogram, diminished concentration of the contrast medium, filling defects (clots) in the renal pelvis, and minimal distortion of calyces resulting from intrarenal hematoma or edema. Extravasation of the contrast medium or evidence of perirenal hematoma suggests major kidney injury. However, signs of retroperitoneal hemorrhage—obliteration or diminution in clarity of the psoas or renal outline, displacement of the kidney or upper ureter—may result from bleeding in other retroperitoneal structures. In catastrophic injury as with the shattered kidney there i...

Angiographic Evaluation of Traumatic Intrahepatic Pseudoaneurysm and Hemobilia

The authors discuss complications of liver trauma—infection and hemorrhage—and review 2 cases of traumatic intrahepatic pseudoaneurysms with hemobilia. Since major hepatic resection is the treatment of choice, the value of preoperative angiography is emphasized.

The contribution of renal scanning in the evaluation of renal trauma.

The problem of assessing the degree of parenchymal injury following renal trauma has caused a great deal of difficulty and controversy in the past several years. In the majority of cases, plain abdominal roentgenograms as well as intravenous urograms prove inadequate (2, 7), and the fact that only a small percentage of these patients undergo laparotomy further compounds the difficulty in clinical evaluation. In the past three years, direct visualization of the intrarenal vasculature with aortography and selective renal angiography has contributed greatly to the better understanding of the nature of renal injuries (7), but renal angiography may not be necessary in all cases of renal trauma. In attempts to understand further the nature of these injuries and to find a simple and fully innocuous method of studying kidney trauma, the mercury-197 chlormerodrin renal scan was utilized. The simplicity of the procedure makes it easily adaptable for use in smaller centers where angiographic technics may not be read...

Ureteral Obstruction in Patients with Uterine Prolapse

Nineteen cases of procidentia with upper urinary tract dilatation of varying degrees are presented. These cases demonstrate the importance of this entity as a cause of urinary tract obstruction. A significant incidence of urinary tract infections (74%) without an increased frequency of hypertension was found. Intravenous urography should be an integral part of the work-up of patients with uterine prolapse and should include views in the prone and erect positions. The caudal displacement of the trigone which can occur in patients with procidentia may be the cause of ureteral obstruction in these patients by increasing the resistance to drainage at the ureteral meati.

Venous impression on the calyceal system.

Arterial impressions on the pelvi-calyceal system are commonly seen on the intravenous urogram and have been well documented (4, 6). In general, this type of pressure defect is sufficiently characteristic to be recognized easily. By correlating Supported in part by Public Health Service Research Grant No. NIH FR-66 OG5IRISI the findings on “angio-pyelograms,” Kreel and Pyle (4) were able to classify and illustrate six groups of arterial impressions on the calyces and pelvis. Other investigators have reported indentation of the pelvis and ureter by varices (1–3). Angio-graphically documented cases, however, with impression on the calyceal system by the renal vein have not, to our knowledge, been reported. In a large series of patients undergoing urography and renal angiography in this institution (Albert Einstein College of Medicine, Bronx, N. Y.) during the past few years, ten cases showed striking filling defects of a superior infundibulum, caused apparently by pressure from an adjacent renal vein. Three...

Rapid, sequential renal blood flow scintiphotography.

With use of the Anger scintillation camera, the injection of a small bolus containing a large amount of radioactive tracer makes possible visualization of major vascular pathways (11), as well as of the blood supply to certain critical organs (4, 10). We have had the opportunity of applying rapid sequential scintiphotographic technics to the study of renal blood flow in a wide variety of cases. In this report an attempt will be made to indicate the potential usefulness of the procedure in several different clinical situations. Method The Pho Gamma III scintillation camera2 was employed in this study. The patient is placed in the prone position with the cameras detector head situated over the renal area. One hundred microcuries of 197Hg-chlormerodrin is given intravenously, and ten to twenty minutes later sufficient activity is present in the renal cortex to collect 50,000 counts in five to seven minutes. Specific abnormalities are identified on the conventional chlormerodrin study, particularly in cases ...

Intrarenal Arterial Collateral

Three cases of intrarenal arterial collateral circulation are presented. Significant intrarenal stenotic pathology associated with previous renal injury and dual blood supply to the kidney favors the utilization and demonstration of such collateral pathways. Differential diagnosis includes vascular malformation and tumor vasculature.