• Journal of Veterinary Clinics
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• v.18 no.1
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• pp.35-43
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• 2001

Present study was undertaken in order to document early renal ultrasonographic changes of gentamicin nephrotoxicosis and to show the value of renal ultrasonography as a contributory means of early diagnosis of acute renal failure in dogs. The experimental design was a randomized complete block design with six treatments in two blocks (gentamicin-treated & saline-treated). Acute renal failure was induced by toxic dosage of gentamicin (30 mg/kg) and saline solution sham equivalent in volume to that of the toxic dosage of gentamicin (1.5-3ml). Subjective visualization of increased renal cortex was visible as homogenous echoes that were hypoechoic relative to the surrounding tissues, whereas the renal medulla was anechoic to slightly hypoechoic. After treatment, the renal cortex was hyperechoic relative to the surrounding tissue. Increased renal cortex echogenicity was associated with significant nephrotoxicosis and was superior to serum creatinine elevation in nephrotoxicosis detection. Urine GGT was superior to other clinicopathological data utilized in the diagnosis of nephrotoxicosis. Based on the above results, increased renal cortex echogenicity seemed to be of use in detecting of acute renal failure.

• Journal of Yeungnam Medical Science
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• v.1 no.1
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• pp.13-23
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• 1984

Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Post-renal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as $FENa^+$ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilyzing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.

• Clinical and Experimental Pediatrics
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• v.50 no.10
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• pp.948-953
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• 2007

Acute renal failure is the generic term for an abrupt and sustained decrease in renal function resulting in retention of nitrogenous and non nitrogenous waste product. This may results in life threatening consequences including volume overload, hyperkalemia, and metabolic acidosis. Acute renal failure is both common and carries high mortality rate, but as it is often preventable, identification of patients at risk and and appropriate management are crucial. This review summarized the most recent information on definition, epidemiology, clinical causes and management of acute renal failure in pediatric patients.

• Journal of Chest Surgery
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• v.14 no.4
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• pp.319-323
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• 1981

To clarify the clinical spectrum of non-oliguric acute renal failure, we undertook a retrospective study of 16 cases of acute renal failure following trauma and surgery, 6 of whom were non-oliguric throughout their periods of azotemia. With the clinical symptoms, BUN, creatinine and some urinary diagnostic indexes, we analyzed the differences between non-oliguric and oliguric renal failure. And the results were: 1. The nonoliguric form [10 cases] was more common than oliguric [6 cases], especially post-traumatic failure. 2. The both types belonged to parenchymal renal failure by the U/P UN ratio and urinary Na concentration [Vertal, 1967]. 3. The non-oliguric form was lesser severe in urinary diagnostic indexes and clinically. The non-oliguric renal failure has better clinical course and prognosis, the failure to diagnose it is as dangerous as the failure oliguric renal failure.

• Archives of Pharmacal Research
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• v.26 no.11
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• pp.979-983
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• 2003

The pharmacokinetic of tolbutamide was studied after the oral administration to normal rabbits or rabbits with mild to medium folate-induced renal failure. The plasma concentrations of tolbutamide were significantly elevated (p<0.05) during 9 to 24 h in rabbits with mild or medium folate-induced renal failure. Consequently, the area under the plasma concentration-time curves (AUC) was significantly higher in mild (p<0.05) and medium (p<0.01) folate-induced renal failure rabbits (i.e., 2906 $\mu$g/mL$.$h for mild renal failure and 4074 $\mu$g/mL$.$h for moderate renal failure) than that in normal rabbits (i.e., 2295 $\mu$g/mL$.$h). The cumulative urinary excretion of tolbutamide was significantly depressed (p<0.05) in medium folate-induced renal failure rabbits (i.e., 3.3 mg) compared with that in normal rabbits (i.e., 5.9 mg). The elimination rate constant (Kel) of tolbutamide was significantly decreased in medium renal failure rabbits (i.e., 0.027 $h^{-1}$) than that in normal rabbits (i.e., 0.044 $h^{-1}$ ); As a result, the terminal half-life of tolbutamide in medium folate-induced renal failure rabbits (i.e., 25.5 h) was significantly longer (p<0.01) than that in normal rabbits (i.e., 15.7 h). The change in pharmacokinetic parameters is consistent with the hypothesis that the alteration is mediated by the depressed metabolic elimination of the drug by the induction of renal failure. Therefore, these observations indicated that the dosage adjustment may be necessary for tolbutamide in patients with renal insufficiency.

• Journal of Sasang Constitutional Medicine
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• v.17 no.3
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• pp.103-112
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• 2005

1. Objective : The present author have examined the comparative effects of Hyeongbangjihwang-tang and Sibimikwanjung-tang in glycerol-induced acute renal failure, a model for myoglobinuric acute renal failure. 2. Methods : Above two prescriptions were applied to rat ad libitum and serum level of creatinine, glucose and blood urea nitrogen(BUN) were measured. And serum level of $Na^+$, $K^+$ and $Cl^-$, too. 50%(vol/vol) glycerol at a dose of 10 ml/kg of rat body weight intramuscularly and 1% concentration of prescriptions were applied to rats for 7 days ad libitum. 3. Results : Serum level of creatinine and $K^+$ significantly increased by glycerol injection, and these showed pre-renal and renal cause of acute renal failure. Hyeongbangjihwang-tang administered group showed decreasing tendency on serum level of creatinine when compared with control groups, but not significant. Sibimikwanjung-tang administered group showed significant increase of serum level of BUN when compared with control groups. 4. Conclusions : Above two prescriptions showed no significant changes on glycerol induced acute renal failure, but Hyeongbangjihwang-tang and Sibimikwanjung-tang showed a little different manner of response.

• Childhood Kidney Diseases
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• v.1 no.2
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• pp.189-194
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• 1997

Oligomeganephronia is a rare congenital form of bilateral renal hypoplasia histologically characterized by reduction in number and hypertrophy of nephrons. Clinically, this condition is presented in early infancy with vomiting, polyuria, polydipsia and dehydration. The problems are readily corrected, but slowly progressive renal failure follows accompanied by failure to thrive, short stature, and renal osteodystrophy. We experienced three cases of oligomeganephronia. Case 1. : A 3 2/12 years old female child was incidentally diagnosed as renal failure at age of 2 months when she was hospitalized due to pneumonia. She had open renal biopsy and was diagnosed as bilateral dysplastic kidney. On OPD follow-up, she progressed to end-stage renal failure (BUN/Cr 114/4.6 mg/dl) and had renal transplantation. The specimen was shrunk remarkably and light microscopy showed oligomeganephronia. Case 2. : A 14 8/12 years old female child with proteinuria was detected in an annual urine screening program for school children, she was diagnosed as renal failure (BUN/Cr 33.9/4.1 mg/dl), and had $5{\times}4{\times}3\;cm$ sized mass on abdominal CT scan. She had renal biopsy, and the specimen showed oligomeganephronia. She had hemodialysis for six months, and renal transplantation along with bilateral nephrectomy was performed. Case 3. : A 14 8/12 years old male child was diagnosed having chronic nephritis and chronic renal failure at 3 years old, progressed to end-stage renal failure (BUN/Cr 87/9.6 mg/dl) on OPD follow-up, and had a rephrectomy and renal transplantation. The biopsy specimen showed oligomeganephronic hypoplasia, secondary focal segmental glomerolosclerosis, and chronic interstitial nephritis. We report 3 cases of oligomeganephronia that progressed to end-stage renal failure and had successful renal transplantation with a brief review of related literatures.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.347-350
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• 1988

Recent advances in the managements of chronic renal failure have increased the number of the candidates for cardiac operation in patients with chronic renal disease. There have been reports that the operative mortality of the open cardiac surgery in patients with end stage renal diseases was equal to that of the patients with normal renal function. Aortic valve replacement and mitral annuloplasty was successfully performed in a patient with chronic renal failure, and the pre-and postoperative managements are presented.

• Archives of Pharmacal Research
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• v.24 no.4
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• pp.333-337
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• 2001

The pharmacokinetic changes of diltiazem (DTZ) and its main metabolite, deacetyldiltiazem (DAD) were studied after oral administration of DTZ to normal rabbits and mild and medium folate-induced renal failure rabbits. DTZ 10 mg/kg was given to the rabbits either orally (n=6). Plasma concentrations of DTZ and DAD were determined by a high performance liquid chromatography assay. The area under the plasma concentration-time curves (AUC) and maximum plasma concentration ($C_{max}$) of DTZ were significantly increased in mild and medium folate-induced renal failure rabbits. The metabolite ratio of the DTZ to DAD were significantly decreased in mild and medium folate-induced renal failure rabbits. The volume of distribution ($V_{d}$) and total body clearance ($CL_{t}$) of DTZ were significantly decreased in mild and medium folate-induced renal failure rabbits. The elimination rate constant ($\beta$) of DTZ was significantly decreased in folate-induced renal failure rabbits, but that of DAD was significantly increased. These findings suggest that the hepatic metabolism of DTZ was inhibited and the $V_{d}$, $CL_{t}$ and $\beta$ of DTZ were significantly decreased in mild and medium folate-induced renal failure rabbits.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.122-127
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• 1994

A retrospective study of 737 consecutive patients surviving the first 24 hours who underwent valve replacement surgery from July 1980 to June 1993 was undertaken to determine the prevalence, variables that could be used to predict outcome and results of therapy for postoperative acute renal failure[ARF]. Twenty-one patients[2.8 %] developed acute renal failure. Positive risk factors noted in the development of postoperative renal failure included age, New York Heart Association class III & IV, endocarditis and elevated preoperative concentration of serum creatinine. The duration of cardiopulmonary bypass, aortic cross-clamping and the total duration of the operation also closely correlated with the incidence of ARF. The mortality rate for established ARF was 38.1% and ARF was associated with a significant increase in the length of hospitalization, ventilator support and intensive care unit stay. The incidence and mortality rate of oliguric renal failure was 38.1% and 85.7%. The highest mortality rate was associated with two or more postoperative complications and serum creatinine value exceeded 5 mg/dl. We concluded that therapy should be aimed at prevention of oliguric renal failure, or at least its conversion to nonoliguric renal failure, and early institution of renal replacement therapy with intensive support probably gives the best chance for survival.