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Obstructive polyuric renal failure following renal transplantation
B
0
Lung disease
lnterstltial pneumonltis
Nltrofurantoin PSUNJdopodla
Hydatid disease
Roux-en-Y
drainage
In
A 69 year old man with intrabiliary rupture of a calclfied echinococcal cyst mimicking acute cboleltthiils Is discussed. This case is of interest because the correct diagnosis was not recognized preoperatively despite the fact that certain aspects of the illness were classic features of this complication of hydatid disease. Atthough this Is a common complication of hydatid disease, which is well recognized in other countries, only seven cases have been reported in the American Ilterature. Treatment of our patient included successful use of a Roux-en-Y drainage procedure which, to the best of our knowledge, has not previously been employed in treating this disease.
Mackowlak PA, Lockwood TE, Jones SR, Thal ER, Smith JW: Pserxlocholelithiils an etderly man with calcified hydatid cysts. Am J Med 60: 707-710, 1976.
Echlnococcal cyst
Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales. roentgenographically by diffuse interstitial infiltrate, and physiologically by a restrictive lung defect. Light microscopy in two patients and electron microscopy in one patient revealed desquamative interstlttal pneumonia. Nitrofurantoin therapy was discontinued and corticosteroid therapy begun. Roth patients felt better and showed clinical improvement. Our flndings suggest that in some cases desquamative interstitial pneumonia may be drug related.
Bone RC, Wolfe J, Sobonya RE, Kerby DR. Stechschulte D, Ruth WE, Welch M: Desquamative interstitial pneumonia following long-term nitrotvantoin therapy. Am J Med 60: 897-701. 1976.
Mononuclear cells
Pneumonia
Foreign body granulomas
Pulmonary hypertension
Lung d&ease
Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; his talc granulomas were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures and his talc granulomas were located predominantly in the pulmonary interstitium. Df 19 previously described patients with pulmonary talc granutomas, 12 had morphologic evidence of pulmonary hypertension (In three of severe degree); in each talc @anulomas were located predominantly within the pulmonary arteries. In the seven without signs of pulmonary hypertension, granulomas were lacated predominantly in the pulmonary interstltlum. As demonstrated by one of our patients, severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.
Arnett EN, Battle WE, Russo JV, Roberts WC: Intravenous injection of talctontaining drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension. Am J Med 60: 711-716, 1976.
Arterial obstruction
Talc granulomas
Acute renal failure with massive polyuria and hypertension developed in a previously nephrectomized patient with a well functioning renal allograft. Relief of a periureteric obstruction resulted in rapid correction of all three. Pathogenesis of hypotonic polyuria is thought to be a defect In collecting duct permeability to water, simulating nephrogenic diabetes insipidus. Normal urinary dilution and acidification suggest intact function of the ascending loop of Henle and distal convoluted tubules. The quick reversal of polyuria and renal failure following relief of the obstruction suggest that both the decrease in glomerular filtration rate and tubular dysfunctions are due to functional changes in the nephron rather than to organic damage, a possibility also borne out by a renal biopsy specimen showing normal glomeruli and intact tubular epithelial cells. Ureterlc obstruction should be considered in any patient with renal failure and polyuria and may be a correctable cause of hypertension.
polyuric renal failure following renal
Nephrectomy
Renal transplantatlon
Ureterlc obstruction
Polyurla
Nagar D. Ferris FZ, Schacht RA: Obstructive transplantation. Am J Med 60: 702-706,1976.
Hypertension
Renal failure
0
Lung disease
lnterstltial pneumonltis
Nltrofurantoin PSUNJdopodla
Hydatid disease
Roux-en-Y
drainage
In
A 69 year old man with intrabiliary rupture of a calclfied echinococcal cyst mimicking acute cboleltthiils Is discussed. This case is of interest because the correct diagnosis was not recognized preoperatively despite the fact that certain aspects of the illness were classic features of this complication of hydatid disease. Atthough this Is a common complication of hydatid disease, which is well recognized in other countries, only seven cases have been reported in the American Ilterature. Treatment of our patient included successful use of a Roux-en-Y drainage procedure which, to the best of our knowledge, has not previously been employed in treating this disease.
Mackowlak PA, Lockwood TE, Jones SR, Thal ER, Smith JW: Pserxlocholelithiils an etderly man with calcified hydatid cysts. Am J Med 60: 707-710, 1976.
Echlnococcal cyst
Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales. roentgenographically by diffuse interstitial infiltrate, and physiologically by a restrictive lung defect. Light microscopy in two patients and electron microscopy in one patient revealed desquamative interstlttal pneumonia. Nitrofurantoin therapy was discontinued and corticosteroid therapy begun. Roth patients felt better and showed clinical improvement. Our flndings suggest that in some cases desquamative interstitial pneumonia may be drug related.
Bone RC, Wolfe J, Sobonya RE, Kerby DR. Stechschulte D, Ruth WE, Welch M: Desquamative interstitial pneumonia following long-term nitrotvantoin therapy. Am J Med 60: 897-701. 1976.
Mononuclear cells
Pneumonia
Foreign body granulomas
Pulmonary hypertension
Lung d&ease
Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; his talc granulomas were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures and his talc granulomas were located predominantly in the pulmonary interstitium. Df 19 previously described patients with pulmonary talc granutomas, 12 had morphologic evidence of pulmonary hypertension (In three of severe degree); in each talc @anulomas were located predominantly within the pulmonary arteries. In the seven without signs of pulmonary hypertension, granulomas were lacated predominantly in the pulmonary interstltlum. As demonstrated by one of our patients, severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.
Arnett EN, Battle WE, Russo JV, Roberts WC: Intravenous injection of talctontaining drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension. Am J Med 60: 711-716, 1976.
Arterial obstruction
Talc granulomas
Acute renal failure with massive polyuria and hypertension developed in a previously nephrectomized patient with a well functioning renal allograft. Relief of a periureteric obstruction resulted in rapid correction of all three. Pathogenesis of hypotonic polyuria is thought to be a defect In collecting duct permeability to water, simulating nephrogenic diabetes insipidus. Normal urinary dilution and acidification suggest intact function of the ascending loop of Henle and distal convoluted tubules. The quick reversal of polyuria and renal failure following relief of the obstruction suggest that both the decrease in glomerular filtration rate and tubular dysfunctions are due to functional changes in the nephron rather than to organic damage, a possibility also borne out by a renal biopsy specimen showing normal glomeruli and intact tubular epithelial cells. Ureterlc obstruction should be considered in any patient with renal failure and polyuria and may be a correctable cause of hypertension.
polyuric renal failure following renal
Nephrectomy
Renal transplantatlon
Ureterlc obstruction
Polyurla
Nagar D. Ferris FZ, Schacht RA: Obstructive transplantation. Am J Med 60: 702-706,1976.
Hypertension
Renal failure