A previously undescribed etiology for oliguria in a premature infant with a peripherally inserted central catheter.

Peripherally inserted central catheter use has become widespread in the management of premature infants as a means to provide long-term intravenous therapy and nutritional support until enteral feedings can be established. Peripherally inserted central catheters are not without complications. This article describes the case of a premature infant with oliguria with the suspected etiology of a malpositioned catheter tip at a location where it was either occluding/blocking the renal vein(s) or causing damage to the kidney(s) from administration of hypertonic total parenteral nutrition solution directly into the renal vein(s). Peripherally inserted central catheter position should be verified radiographically and evaluated serially in any infant, even more so in an infant with symptoms of oliguria and possible sepsis.

[Intraoperative diastolic dysfunction as a risk factor for hemodynamic instability]. / Evaluación de función diastólica intraoperatoria con ecocardiografía transesofágica: ¿es útil?

BACKGROUND: Diastolic function can be evaluated intraoperatively using transesoptiageal echocardiography. AIM: To study if intraoperative diastolic dysfunction is associated to a greater number of hemodynamic events during surgery and during the postoperative period. MATERIAL AND METHODS: Patients with indication of intraoperative transesophageal echocardiography due to cardiovascular diseases were included in the study. Diastolic function was assessed measuring transmitral intraventricular filling delay and pulmonary vein now. Patients were divided, according to diastolic dysfunction, in those with derangements in relaxation, pseudonormalization and restrictive patterns. Hypertension, hypotension, ST segment depression, alterations in myocardial contractility, pulmonary congestion and postoperative oliguria were recorded. RESULTS: Fifty eight patients aged 68+/- 12 years (39 males), were studied. Forty four had diastolic dysfunction. Intraoperative hypotension occurred in 82% of patients with diastolic dysfunction and 16% of patients without it. Likewise, hypotension and oliguria during the postoperative period were more common in patients with diastolic dysfunction. CONCLUSIONS: In this group of patients with cardiovascular disease, intraoperative diastolic dysfunction is a risk factor for hemodynamic instability.

A large renal pelvic diverticulum, presenting incomplete excretion during tc-99m MAG-3 scintigraphy and tracer accumulation on tc-99m DMSA scintigraphy; a case report.

This case report illustrates the dynamic and static renal scintigraphic images of a patient with an unusual large diverticulum of the renal pelvis. The initial diagnosis by intravenous pyelography (IVP) and ultrasonographic (US) examination was a renal pelvic diverticulum of the left kidney, and the patient was referred to the nuclear medicine department for exploration of the effect of the pelvic diverticulum on renal functions. We performed dynamic renal scintigraphy with technetium-99m (Tc-99m) labeled mercaptoacetyl triglycine (MAG-3) and static renal scintigraphy with Tc-99m labeled dimercaptosuccinic acid (DMSA). In dynamic renal scintigraphy, bilaterally normal concentration function was observed. While right kidney excretion function was normal, an incomplete excretion pattern was seen on the left side. Complete urinary flow obstruction occurred approximately at the 10th minute of the acquisition, which did not seem to respond to the i.v. furosemide application. However, when only the renal cortex was included in the region of interest, the obstructive pattern disappeared. In static renal scintigraphy, a large renal pelvic diverticulum localized antero-medially was clearly visualized in the left-anterior oblique projection, most probably due to accumulation of radiopharmaceutical inside it. This case showed that a renal pelvic diverticulum should be thought of when an incomplete excretion pattern is seen on dynamic renal scintigraphy. Using only a cortical region of interest may also help to distinguish other types of obstructive pattern from diverticulum. Additionally, Tc-99m DMSA scintigraphy may show diverticulum localization with antero-oblique projections in addition to routine projections.

Renal failure in the surviving monochorionic twin after death of the co-twin in utero.

Renal failure in the newborn infant is mainly determined by vascular causes. In this report we describe a patient with a particular vascular cause of renal failure. The patient was the product of a twin pregnancy in which the twin partner died in utero. In retrospect, the twins appeared to be monozygotic. As the pregnancy was studied carefully prenatally by ultrasound, we were able to observe the development of this condition, characterized by oliguria, oligohydramnios, and lung hypoplasia: the oligohydramnios sequence. After organ development had been normal initially, renal function was lost and the oligohydramnios sequence developed in the survivor after the co-twin had died in utero.

[The value of combined computer-aided perfusion scintigraphy and renography in renal transplant patients with oliguria/anuria]. / Zur Wertigkeit der kombinierten computerunterstützten Perfusionsszintigraphie und Renographie bei Oligurie/Anurie von nierentransplantierten Patienten.

Combined computer-aided perfusion scintigraphy and renography (computer renography) is used for the differential diagnosis of the etiology of transplant malfunctions in kidney-transplant patients. This article describes semiquantitative computer renography evaluation methods which have been used in 99 examinations of 58 oligo/anuric graft recipients. The accuracy of these methods was confirmed by patho-anatomical and roentgenological diagnosis. From the constellation of qualitative and semiquantitative scintigraphic perfusion, function and excretion parameters it was possible, by means of a flow chart, to draw conclusions regarding the location of the malfunctions (prerenal, renal or postrenal). Using the new methods, all patients could be correctly classified. With respect to more detailed differential diagnosis of renal malfunctions the accuracy was 82%. The comparison between perfusion measurements based on a perfusion index defined with the help of a planimeter on the one hand and an angiography graduation on the other hand, resulted in a correlation coefficient of 0.90 (p less than 0.001). As a non-invasive examination which can also be carried out in emergency cases, combined computer-aided perfusion scintigraphy and renography should become part of standard diagnostic procedures for oligo/anuric graft recipients.

Dynamic computed tomography in acute renal failure: analysis of time-density curve.

An analysis of dynamic CT curves in 12 patients with acute renal failure was performed. An oliguric patient who demonstrates corticomedullary differentiation on CT images will develop diuresis within 4 days. A corticoaortic junction time of more than 180 s associated with no differentiation between cortex and medulla is associated with prolonged oligoanuria. Impending diuresis is heralded by a corticoaortic junction time of less than 180 s. These preliminary results suggest that an analysis of dynamic CT curves in acute renal failure can predict the time of appearance of the diuretic stage.

Contrast-induced acute renal failure: persistent nephrogram as clue to early detection.

Renal failure from urographic contrast media is a serious potential hazard of excretory urography and is usually recognized by the clinician 24--48 hr after the procedure. The association of an abnormally increasing nephrogram with development of oliguric renal failure in children was described in 1969, but in 112 subsequent reported cases of contrast-induced renal failure, a persistent nephrographic pattern was described only once. With special attention to the abnormally persistent nephrogram, we were able to detect nine cases of contrast-induced renal failure after excretory urography. Two of these cases are discussed in detail and pertinent data on the other seven are presented.

Oliguria in the incubating neonate. Emergency aortography and urography in neonates using mobile X-ray equipment.

Neonates in incubators underwent umbilical aortography, excretory urography and suprapubic cysto-urethrography using a mobile X-ray machine in the Premature Baby Unit to define the cause of their oliguria. The techniques were easy to perform without endangering the infants by moving them. The radiological findings in the four neonates investigated contributed significantly to the management of their illnesses.