Richard D. Wagoner

Acute Renal Failure After Excretory Urography in Diabetic Patients

Currently used contrast media for excretory urography are generally considered safe even in the presence of renal insufficiency. Isolated reports of acute oliguric renal failure in diabetic patients after excretory urography have been documented. We describe eight such patients who developed this complication. The approximate incidence of recognized acute oliguric renal failure in diabetics undergoing excretory urography was 2 in 1000 as compared with none in more than 100 000 procedures done in nondiabetic patients. Six of the diabetic patients with acute renal failure recovered; two required hemodialysis, never regaining self-sustaining renal function. If detected early, acute renal failure in this setting can often be managed conservatively. Attempts to induce diuresis have been discouraging.

Treatment of Lupus Nephritis with Prednisone and Combined Prednisone and Azathioprine

Abstract The relative effectiveness of high-dose prednisone (group A) was compared with the same regimen plus azathioprine (group B) for the treatment of lupus nephritis of mild or moderate severit...

Renal Complications of Lymphoma

Abstract In patients with lymphoma, impairment of renal function may occur as a direct consequence of the tumor either in the form of neoplastic infiltration of the kidney or as bilateral ureteral ...

Renal involvement in relapsing polychondritis.

Twenty-nine of the 129 patients with RP seen at the Mayo Clinic between 1943 and 1984 had renal involvement. These patients were older, had arthritis and extrarenal vasculitis more frequently, and had a significantly worse survival rate than those without renal involvement. Renal biopsies were obtained in 11 of these 29 patients. The predominant lesions were mild mesangial expansion and cell proliferation, and segmental necrotizing glomerulonephritis with crescents. Small amounts of electron-dense deposits, predominantly mesangial, were noted on electron microscopy. Immunofluorescence revealed faint deposition of C3 and/or IgG or IgM, predominantly in the mesangium. Autopsies were obtained in 13 of the 47 patients who had died. Information regarding the renal pathology was available in 10 of these 13 autopsies. At the time of the initial evaluation at the Mayo Clinic, 6 of these 10 patients had evidence of renal involvement. At autopsy, none of these 10 patients had evidence of active renal vasculitis or segmental necrotizing glomerulonephritis, but 8 of the 10 patients exhibited variable degrees of vascular and glomerular sclerosis, segmental mesangial proliferation, tubular loss, and interstitial lymphocytic infiltrates. These observations expand the limited information available in the literature, which is based on 11 previously published case reports of renal involvement in RP. In only a few of our patients and previously reported patients were the manifestations of the disease limited to the systems characteristically involved in pure RP. The frequent coexistence of other autoimmune and connective tissue diseases supports the role of immune mechanisms in the pathogenesis of this syndrome. Deposition of immune complexes is likely to play a role in the pathogenesis of the glomerular lesions associated with RP. Administration of corticosteroids alone is sufficient to induce a complete remission in some cases, while in others the addition of a cytotoxic agent is necessary to control the activity of the disease or to spare corticosteroid side effects and maintain a remission. Immunosuppression-related infectious complications and undetected relapses after discontinuation of immunosuppressive therapy are largely responsible for the morbidity and mortality observed in these patients.

Accelerated Nephrosclerosis and Postpartum Acute Renal Failure in Normotensive Patients

Abstract The cases of three patients in whom acute renal failure developed insidiously during the postpartum period are reported. Each patient was normotensive and historically exhibited no prior e...

Endoscopic Evaluation and Treatment of Patients with Idiopathic Gross Hematuria

We evaluated 4 patients with long-standing unilateral essential gross hematuria by newer endourological techniques. All 4 patients underwent ureterorenoscopy and 3 underwent percutaneous nephroscopy. Nephroscopy identified a bleeding site in 3 patients and ureteroscopy in 1. The bleeding sites were fulgurated and the hematuria has not recurred during followup. Percutaneous nephroscopy and/or ureterorenoscopy should be considered in selected patients with unilateral essential gross hematuria.

Hemolytic Uremic Syndrome after Bone Marrow Transplantation without Total Body Irradiation

The cause of hemolytic uremic syndrome after bone marrow transplantation is unknown. Investigators have implicated multiple causes, including cyclosporin A, graft versus host disease, cytomegalovirus infection, and total body irradiation. We report a case of biopsy-supported hemolytic uremic syndrome in a recipient of an autologous bone marrow transplant who did not receive total body irradiation or cyclosporin A and did not have clinical evidence of cytomegalovirus infection. This case casts doubt on the hypothesis that irradiation or any of these factors is the sole and universal cause of hemolytic uremic syndrome in patients receiving bone marrow transplants.

Treatment of Patients with Lupus Nephritis with Prednisone and Combined Prednisone-Azathioprine.

Excerpt It is unclear whether treatment of patients with lupus nephritis with combined corticoid and cytotoxic drugs is more effective than treatment with corticoids alone. Two treatment programs w...

Reversible Membranous Nephropathy Associated with the Use of Nonsteroidal Anti-Inflammatory Drugs

OBJECTIVE To investigate the frequency of membranous nephropathy associated with nonsteroidal anti-inflammatory drug (NSAID) use and identify associated clinical characteristics. DESIGN Retrospective chart review. SETTING A large group practice that staffs 2 large teaching hospitals. PATIENTS All patients diagnosed as having stage I or early stage II membranous nephropathy by renal biopsy between January 1975 and May 1995. MAIN OUTCOME MEASURES Nephrotic syndrome was said to be associated with NSAID use if patients developed nephrotic syndrome while taking an NSAID and if other causes of membranous nephropathy were excluded and a rapid remission of the nephrotic syndrome followed withdrawal of the drug. RESULTS Of 125 patients identified with early membranous nephropathy, 29 were taking NSAIDs at the time symptoms of nephrotic syndrome developed. Thirteen of these patients met the criteria for NSAID-associated membranous nephropathy. None of these patients had any evidence of renal insufficiency or significant proteinuria after follow-up periods ranging from 5 months to 13 years. In addition to diclofenac and fenoprofen, which have previously been implicated, ibuprofen, nabumetone, naproxen, and tolmetin were found to be associated. CONCLUSIONS Nephrotic syndrome due to membranous nephropathy should be recognized as an idiosyncratic drug reaction to many NSAIDS. Because withdrawal of the drug may result in prompt and complete recovery of normal renal function, a history of NSAID intake should be sought in patients with membranous nephropathy.

Analgesic nephropathy—a continuing problem

Analgesic-induced renal disease occurs more commonly than is recognized; unless specific inquiry is made, it is seldom diagnosed. Patients with chronic pain, especially those with hypertension, urinary tract infection, or renal insufficiency, should be suspect. The condition is preventable and even in the late stages is manageable if recognized. Analgesic abuse may result in end-stage renal disease; it accounts for a significant percentage of patients entering chronic hemodialysis or renal transplant programs.